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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.
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. 
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. 
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.
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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.
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 200102 and £1.5 million and £2.0 million in 200203 and 200304 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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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. 
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 Trust||94||Carillion Construction(24)|
|Carillion Services Ltd.(25)|
|Carlisle Hospitals NHS Trust||65||AMEC(24)|
|Building and Property Group(25)|
|South Buckinghamshire NHS Trust||45||Taylor Woodrow(24)|
|Greenwich Healthcare NHS Trust||93||Kvaerner Construction(24)|
|ISS Mediclean/Kvaerner Rashleigh/Weatherfoil(25)|
|Calderdale and Huddersfield NHS Trust||65||Bovis(24)|
|RCO/Bovis Building Management(25)|
|North Durham Health Care NHS Trust||61||Balfour Haden JV(24)|
|Norfolk and Norwich NHS Trust||158||Laing(24)|
|South Manchester University Hospitals NHS Trust||66||Alfred McAlpine(24)|
|Bromley Healthcare NHS Trust||118||Taylor Woodrow(24)|
|Taylor Woodrow/ISS Mediclean(25)|
|Barnet and Chase Farm Hospitals NHS Trust||54||Bouygues(24)|
|Worcestershire Acute Hospitals NHS Trust||87||Bovis(24)|
|Hereford Hospitals NHS Trust||64||Alfred McAlpine/(24)|
|South Durham Healthcare NHS Trust||41||Shepherds(24)|
|South Tees Acute Hospitals NHS Trust||122||Mowlem(24)|
|Swindon and Marlborough NHS Trust||96||Carillion Construction(24)|
|Carillion Services Ltd.(25)|
|King's Healthcare NHS Trust||64||Costain/Skanska(24)|
|Leeds Community NHS Trust||47||Carillion/Weaver Construction(24)|
|Bradford and Northern Housing Association(25)|
|St. George's Hospital NHS Trust||49||Gleeson(24)|
|University College London Hospitals NHS Trust||404||AMEC/Balfour Beatty(24)|
|Building and Property Group(25)|
|Hull and East Yorkshire Hospitals NHS Trust||22||Bilfinger and Berger/Haden Young(24)|
|West Middlesex University Hospitals NHS Trust||60||Bouygues(24)|
|Dudley Group of Hospitals NHS Trust||137||Sir Robert McAlpine(24)|
|Building and Property(25)|
|West Berkshire Priority Care NHS Trust||30||Kier(24)|
(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. 
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.
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