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Mr. Hancock: To ask the Secretary of State for Health (1) what and how many reports her Department has received on the side effects of Efexor XL capsules (venlafaxine); and if she will make a statement; 
Andy Burnham: Venlafaxine (brand names Efexor, Efexor XL) is a selective serotonin and noradrenaline reuptake inhibitor (SNRI) antidepressant. The Efexor brand is authorised for the treatment of major depressive disorder at a recommended dose of75 milligrams (mg) daily and a maximum dose of375 mg daily. The Efexor XL brand is a modified release product additionally authorised for the treatment of generalised anxiety disorder (GAD) at a recommended dose of 75 mg daily.
Since venlafaxine was first authorised in 1994 its safety has been closely monitored by the Medicines and Healthcare products Regulatory Agency (MHRA). Up to 26 October 2006, a total of 4,739 reports of suspected adverse drug reactions (ADRs) have been received through the yellow card scheme in association with the use of venlafaxine. The most commonly reported suspected ADRs include withdrawal reactions on stopping treatment, nausea, dizziness, headache, vomiting, increased sweating and tremor. All of these are recognised side effects and are listed in the product information provided for prescribers.
In May 2003, an expert working group of the Committee on Safety of Medicines (CSM) was set up to consider further the safety of selective serotonin reuptake inhibitors (SSRIs) and related antidepressants such as venlafaxine, with a particular focus on withdrawal reactions and a possible link with suicidal behaviour.
The conclusions and key findings of the expert group were communicated to health professionals on6 December 2004 to coincide with the publication of guidelines on the treatment of depression by the National Institute for Health and Clinical Excellence (NICE). The CSM and its expert working group concluded that SSRIs and venlafaxine are effective medicines in the treatment of depression and anxiety conditions, and that the balance of risks and benefits of all SSRIs and venlafaxine in adults remains positive in their licensed indications.
During the expert groups review, concerns were raised about the potential for cardiotoxicity and toxicity in overdose associated with venlafaxine. A review of the available data led to restrictions of venlafaxine to specialist, for example hospital
consultant, initiation and addition of contra-indications in patients with heart disease. A comprehensive report of the expert groups findings and the evidence base for these conclusions has been published and is available on the MHRAs website.
The safety of venlafaxine remains under close constant scrutiny by the MHRA. As new data emerges this is carefully evaluated and if necessary new prescribing advice to maximise its safe use is issued. In May 2006, health care professionals and patients were informed of updated prescribing advice for venlafaxine following further MHRA review of these restrictions and evaluation of new evidence, in particular relating to toxicity in overdose.
the need for specialist, for example hospital consultant, supervision in those severely depressed or hospitalised patients who need doses of 300 mg daily or more;
cardiac contra-indications are more targeted towards high risk groups;
a reminder that patients with uncontrolled hypertension should not take venlafaxine and that for all patients blood pressure should be monitored; and
updated advice on possible drug interactions.
In December 2004, NICE issued two separate guidelines for the management of depression and anxiety disorders both of which include recommendations relating to the use of venlafaxine. An independent working group of representatives from the anxiety and depression guideline development groups have been asked to determine what changes need to be made to recommendations about venlafaxine in light of the data underpinning the changes in the venlafaxine product information for prescribers. It is expected that NICE will publish the updated recommendations early in 2007.
Andy Burnham: United Kingdom law on embryo research has evolved over 20 years through public and parliamentary debate. Throughout this time there have been many influencing factors that have helped shape Government policy, including the Warnock Report in 1984. Following the discovery of human embryonic stem cells and cloning mammalian cells, the Human Fertilisation and Embryology Authority and the Human Genetics Advisory Committee consulted extensively. Their report was considered by the Chief Medical Officers Expert Group on Cloning in 2000. All were subject to extensive public and parliamentary debates.
Mr. Stewart Jackson: To ask the Secretary of State for Health how many emergency admissions for (a) angina and (b) asthma there were in hospitals in Peterborough and Stamford NHS foundation trust area in each year since 2001; and if she will make a statement. 
Mr. Ivan Lewis: The latest available information on the number of emergency admissions for angina and asthma in hospitals under Peterborough and Stamford NHS foundation trust in each year since 2001 is shown in the following table.
|Count of finished admission episodes for angina and asthma at Peterborough and Stamford NHS Foundation Trust. Admission method (Emergency)|
Finished admission episodes:
A finished admission episode is the first period of in-patient care under one consultant within one health care provider. Admissions do not represent the number of in-patients, as a person may have more than one admission within the year.
Diagnosis (primary diagnosis):
The primary diagnosis is the first of up to 14 (seven prior to 2002-03) diagnosis fields in the hospital episode statistics (HES) data set and provides the main reason why the patient was in hospital.
Angina defined as the following ICD-10 code in primary diagnosis:
120 Angina Pectoris
Asthma defined as the following ICD-10 codes in primary diagnosis:
J46 Status asthmaticus
Emergency Admission is defined as the following admission methods:
21 = Emergency: via accident and emergency (A&E) services, including the casualty department of the provider
22 = Emergency: via general practitioner (GP)
23 = Emergency: via Bed Bureau, including the Central Bureau
24 = Emergency: via consultant outpatient clinic
28 = Emergency: other means, including patients who arrive via the A&E department of another health care provider.
Figures have not been adjusted for shortfalls in data; that is the data is ungrossed.
HES are compiled from data sent by over 300 NHS trusts and primary care trusts (PCTs) in England. The Information Centre for health and social care liaises closely with these organisations to encourage submission of complete and valid data and seeks to minimise inaccuracies and the effect of missing and invalid data via HES processes. While this brings about improvement over time, some shortcomings remain.
Ms Hewitt: It is recognised good practice for employers to support the development of their staff. Many permanent secretaries and senior officials in Government Departments, like chief executives and directors of major public and private sector organisations, have benefited from tailored support both as individuals and in teams. Such support has been made available to Ministers and senior civil servants in the Department on this basis. All costs are met from within the existing administration budgets.
To ask the Secretary of State for Health pursuant to the answer of 1 March 2006, Official Report, column 759W, on fiscal incentives, what her Department's most recent assessment is of the merits
of the use of fiscal incentives in order to promote public health; what assessment she has made of the ways fiscal incentives could form part of the social marketing approach to incentivise people to change their behaviour; and if she will make a statement. 
Caroline Flint: All matters relating to tax are, of course, a matter for my right hon. Friend the Chancellor of the Exchequer. He will take all relevant factors into consideration when making decisions at the Budget.
Ms Rosie Winterton: The Government have made no representations to the Nuffield Council on Bioethics working party on public health with respect to issues relating to water fluoridation during its consultation period nor has it been invited to. The Governments policy with respect to water fluoridation is in the public domain and is therefore available to the working party should they wish to see it.
Mr. Stephen O'Brien: To ask the Secretary of State for Health how many single-handed practitioners there are in England; and how many of them have not received the full amount of seniority pay appropriate to their years of experience within the NHS in the financial years 2005-06 and 2006-07. 
Mr. Lancaster: To ask the Secretary of State for Health when the tender for the new contract for general practitioner services for the Middleton area of Milton Keynes is expected to be issued. 
Ms Rosie Winterton: It is the responsibility of primary care trusts (PCTs) and strategic health authorities to analyse their local situation and develop plans, in liaison with their local national health service trusts and primary care providers, to deliver high quality NHS services.
However, I understand that Milton Keynes PCT has yet to formalise the precise timetable for the process to select a provider for primary medical services for residents in the eastern expansion area of Milton Keynes.
|In cash terms||In real terms at 2004-05 prices|
Expenditure on general dental services and pharmaceutical services accounted for by the Dental Practice Board and prescription pricing division (formerly the Prescription Pricing Authority) of the NHS business services authority, respectively, are excluded. This expenditure cannot be included within the figures for the individual health bodies as they are not included in commissioner accounts
Audited accounts of relevant health authorities 1997-98
Audited summarisation forms of Surrey and Sussex strategic health authority 2004-05
Audited summarisation schedules of relevant primary care trusts 2004-05
Office of National Statistics un-weighted population figures
Andrew George: To ask the Secretary of State for Health pursuant to the answer of 23 August to question 13422, what weight of resources expressed as a proportion of the whole capitation target is accounted for in respect of (a) age, (b) additional need and (c) unavoidable geographical difference in the cost of providing health care. 
Andy Burnham: The adjustments in the weighted capitation formula for age, need and unavoidable geographical difference in the cost of providing health care generate a separate index comparing the primary care trust (PCT) score on the index to the national average. The indices are simultaneously applied to the PCT population to produce a weighted population. Therefore, it is not possible to provide their relative weighting.
However, the indices for the Hospital and Community Health Services component of the formula which accounts for 77 per cent. of the overall allocation for PCTs that fall within the St. Ives constituency, along with the national maximum and minimum are shown in the table. Different indices are used to calculate the prescribing, primary medical services and HIV/AIDs components of the formula.
|Age index||Need index||Market forces factor index|
The full indices are published in the PCT revenue resource limits exposition book for each allocation round. Exposition books are available in the Library and on the Departments website at www.dh.gov.uk/allocations.
Andrew George: To ask the Secretary of State for Health pursuant to the answer of 23 August to question 13422, for each of the three elements of the national weighted capitation formula, what level of capita capitation targets have been set for each of the primary care trusts for the financial year (a) 2004-05, (b) 2005-06 and (c) 2006-07. 
Andy Burnham: A single weighted capitation target is calculated for each primary care trust (PCT) at each allocation round. Weighted capitation targets are not set separately for the age, need and unavoidable geographical difference in cost adjustments.
PCT targets are in section 4 of the 2003-04 to 2005-06 PCT revenue resource limits exposition book and in section 3 of the 2006-07 and 2007-08 PCT revenue resource limits exposition book. Both are available in the Library and at www.dh.gov.uk/allocations.
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