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Prosthetic Services

Mr. Sheerman: To ask the Secretary of State for Health what steps he is taking to ensure that national prosthetic services attracts the appropriate calibre of qualified personnel. [5330]

Jacqui Smith: All professional staff in prosthetic services are highly skilled graduates. The team is made up of multi-professional members including doctors, physiotherapists, occupational therapists and, importantly, prosthetists. All the staff are graduates and have to be state registered.

Qualification for prosthetists are B.Sc. Honours; entry onto the courses is at Strathclyde and Salford Universities. Once students qualify, they are state registered by the Council of Professions Supplementary to Medicine (CPSM). Prosthetic service contracts negotiated by the National Health Service Purchasing and Supply Agency generally stipulate the minimum number of days a prosthetist will be allocated to continuing professional development. This is normally around one day per month.

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Other staff groups including physiotherapists and occupational therapists are provided by the NHS for these services. All staff have a professional obligation to keep themselves up to date and maintain and develop their skills.

Mr. Sheerman: To ask the Secretary of State for Health what steps he is taking to ensure that the national prosthetic service is adequately funded. [5328]

Jacqui Smith: Prosthetic services are currently commissioned and funded by health authorities who base their resource allocation on local need.

The National Health Service Purchasing and Supply Agency, supported by the Department, has commenced work on the development of a commissioning guide for prosthetic services. This will provide a tool for commissioners to ensure that funding is utilised in the most effective way and highlight to them the most important factors required for a user focused service.

Mr. Sheerman: To ask the Secretary of State for Health what steps he is taking to ensure that patients requiring modern prosthetic limbs have access to a high quality, well fitting and comfortable choice. [5329]

Jacqui Smith: Patients who require artificial limb components have available to them through their national health service limb centre the widest possible range of limb componentry. The NHS Purchasing and Supply Agency who negotiate the contract on behalf of the NHS source these products from manufacturers across Europe and North America. The NHS PASA contract has some 18,000 lines available to NHS rehabilitation centres. If any new products become available from contracted suppliers, the NHS PASA contract has the flexibility to add these throughout the contract term. There is an emphasis in contracts on continuing professional development to ensure that prosthetic staff are able to deliver the highest quality service to their patients.

New products such as gel liners/silicone liners, and techniques such as computer aided design and computer aided manufacture for fitting limbs are already being used by some trusts across the country to maximise comfort and fitting. Modernisation of this sort will be evaluated and where appropriate will expand to all centres.

Mr. Sheerman: To ask the Secretary of State for Health what steps he is taking to ensure that the quality of prosthetic services available to patients in the UK are of at least an equal standard to those available in (a) the rest of Europe and (b) in North America. [5364]

Jacqui Smith: Prosthetic services have moved from providing a "limb fitting service" to an "amputee rehabilitation service". Disablement service centres (DSCs) now treat users in a more holistic manner. This has resulted in the development of a whole package of care and has given more involvement to occupational therapists, physiotherapists and counsellors in the service. The United Kingdom is at the forefront of this multi-professional approach.

Many DSCs prescribe state of the art components. The UK was the first country in the world to develop and

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adopt an intelligent prosthesis. Another important feature of the UK service is that product prescription is impartial, based on clinical need, whereas in some countries commercial considerations are taken into account.

The delivery of prosthetic services around the world is far more fragmented than in the UK. For example England delivers prosthetic services from 33 DSCs which means that the service benefits from the concentration of expertise and economies of scale.

The UK prosthetic service is well structured, provides good value for money and delivers a coherent service.

A recent Government development is the introduction of silicon cosmesis, as outlined in HSC2001/01 and LAC (2001)1. We have made available £0.5 million in 2001–02 and £1.5 million and £2.0 million in 2002–03 and 2003–04 respectively to be invested in silicone cosmesis. The National Health Service Purchasing and Supply Agency have undertaken a tendering exercise to

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make these products available on the NHS during August 2001. This was announced by my predecessor, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), in March 2001.

Private Finance Initiative

Mrs. Curtis-Thomas: To ask the Secretary of State for Health if he will list the PFI contracts entered into since 1997, indicating (a) the value of the PFI, (b) the name of the successful contractor, (c) those PFIs which have benefited from refinancing arrangements, (d) the value of the benefit accrued to the company concerned and (e) the extent of the clawback. [4534]

Mr. Hutton: There follows a list of major private finance initiatives contracts which have been signed since May 1997; the capital value of the contract; and the names of the leading contractors and facilities management firms who make up the successful consortia. To date none of the PFI schemes listed have been refinanced.

Scheme Capital value (£ million) Consortia
Dartford and Gravesham NHS Trust94Carillion Construction(24)
Carillion Services Ltd.(25)
Carlisle Hospitals NHS Trust65AMEC(24)
Building and Property Group(25)
South Buckinghamshire NHS Trust45Taylor Woodrow(24)
Healthcare Group(25)
Greenwich Healthcare NHS Trust93Kvaerner Construction(24)
ISS Mediclean/Kvaerner Rashleigh/Weatherfoil(25)
Calderdale and Huddersfield NHS Trust65Bovis(24)
RCO/Bovis Building Management(25)
North Durham Health Care NHS Trust61Balfour Haden JV(24)
Norfolk and Norwich NHS Trust158Laing(24)
South Manchester University Hospitals NHS Trust66Alfred McAlpine(24)
WS Atkins/Sodexho(24)
Bromley Healthcare NHS Trust118Taylor Woodrow(24)
Taylor Woodrow/ISS Mediclean(25)
Barnet and Chase Farm Hospitals NHS Trust54Bouygues(24)
Ecovert South(25)
Worcestershire Acute Hospitals NHS Trust87Bovis(24)
Hereford Hospitals NHS Trust64Alfred McAlpine/(24)
Sodexho/WS Atkins(25)
South Durham Healthcare NHS Trust41Shepherds(24)
Jarvis/ISS Mediclean(25)
South Tees Acute Hospitals NHS Trust122Mowlem(24)
Aqumen FM(25)
Swindon and Marlborough NHS Trust96Carillion Construction(24)
Carillion Services Ltd.(25)
King's Healthcare NHS Trust64Costain/Skanska(24)
Leeds Community NHS Trust47Carillion/Weaver Construction(24)
Bradford and Northern Housing Association(25)
St. George's Hospital NHS Trust49Gleeson(24)
University College London Hospitals NHS Trust404AMEC/Balfour Beatty(24)
Building and Property Group(25)
Hull and East Yorkshire Hospitals NHS Trust22Bilfinger and Berger/Haden Young(24)
MandW Zander(25)
West Middlesex University Hospitals NHS Trust60Bouygues(24)
Dudley Group of Hospitals NHS Trust137Sir Robert McAlpine(24)
Building and Property(25)
West Berkshire Priority Care NHS Trust30Kier(24)

(24) Constructor

(25) FM provider

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Matthew Taylor: To ask the Secretary of State for Health what central monitoring his Department undertakes of value for money obtained in Private Finance Initiative projects; and if he will make a statement. [4460]

Mr. Hutton: The Department reviews all private finance initiative projects over £1 million in value through the Business Case approval system. To be approved, the Business Case must clearly demonstrate that, overall, the private finance option is better value for money when compared to the publicly funded alternative, the Public Sector Comparator, and that it provides improved facilities for the national health service. NHS trusts are required to monitor performance throughout the lifetime of the PFI contract.

As a result of PFI, six major new hospitals have opened and another 17 are under construction, representing capital investment in the NHS of over £2 billion.

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