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Domiciliary Oxygen Services

Lord Clement-Jones asked Her Majesty's Government:

Baroness Andrews: The review of the domiciliary oxygen service is at an advanced stage. It has considered the provision of ambulatory oxygen for domiciliary use and the use of technologies such as conserving devices. We expect to announce our conclusions shortly.

NHS: Management Costs Exclusions

Baroness Noakes asked Her Majesty's Government:

Baroness Andrews: Details of the costs that are excluded from management costs definitions and the number of staff whose salaries fell below the "salary threshold" are not collected centrally.

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Beta Interferon Risk-sharing Scheme for Multiple Sclerosis

Earl Howe asked Her Majesty's Government:

    Of the 9,000 patients who may be eligible to participate in the beta interferon risk-sharing scheme for multiple sclerosis:


    (a) how many were on waiting lists for treatment when the scheme started on 6 May 2002; and


    (b) how many are now receiving treatment; and[HL3073]

    To whom, figures for the number of patients currently:


    (a) on the waiting list for the beta interferon risk-sharing scheme for multiple sclerosis; and


    (b) receiving treatment on the beta interferon risk-sharing scheme for multiple sclerosis, are being reported by primary care trusts; and[HL3074]

    What action they are taking to encourage primary care trusts to implement the beta interferon risk-sharing scheme for multiple sclerosis; and[HL3075]

    What specific activities the steering group set up to oversee the implementation of the beta interferon risk-sharing scheme for multiple sclerosis is undertaking, and how its work will be passed down to Primary Care Trust for implementation; and[HL3076]

    Why there are no plans to publish a progress report on the implementation of the beta interferon risk-sharing scheme for multiple sclerosis, and how they will ensure that an update on progress is made available.[HL3077]

Baroness Andrews: We estimate there are around 5,000 patients now receiving treatment with a disease-modifying drug for their multiple sclerosis. About 300 new patients each month are being initiated on treatment. We do not have information about numbers waiting to be assessed.

The project is administered by the scheme steering group which is composed of representatives from all participating companies, the MS Society and the MS Trust, the Association of British Neurologists, the Royal College of Nurses/Association of MS Nurses, and the four UK health departments. In broad terms, the steering group's role is to oversee implementation of the scheme and to advise the scheme co-ordinator and participants on any actions which could help to ensure the smooth and effective entry of patients into the scheme. For day-to-day purposes the scheme steering group has delegated its authority to a project monitoring group which works closely with the Sheffield School of Health and Related Research (ScHARR). ScHARR is co-ordinating the initiation of the project and the collection, capture and analysis of data relating to the scheme. ScHARR manages the consortium which is responsible for monitoring the health outcomes of patients entered into the scheme. To do so, they need to establish and maintain links with all the specialist centres which are assessing and

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prescribing treatment for MS patients. It is envisaged that the formal patient monitoring process for assessing cost effectiveness and pricing adjustments will continue for up to 10 years. Within this period there will be two yearly reviews of the reimbursement arrangements. It is intended that valid findings arising out of the data monitoring and analysis of the scheme will be published, if possible in peer-reviewed journals.

We do not hold precise details about the way in which primary care trusts (PCTs) are implementing the scheme but following earlier reports of slow progress we asked strategic health authorities (SHAs) to adopt a proactive role with their PCTs to meet their statutory responsibilities. SHAs and PCTs have previously been reminded of their responsibilities to implement the scheme in the chief executive's bulletin dated 17 July 2002.

Non-invasive Positive Pressure Ventilation: Indemnity Insurance for Nurses

Baroness Finlay of Llandaff asked Her Majesty's Government:

    Whether National Health Service community nursing staff, including district nurses, have indemnity cover to manage non-invasive positive pressure ventilation devices for patients, such as those with motor neurone disease, who are ventilated at home.[HL3111]

Baroness Andrews: Registered nurses are required to work within the nurses' and midwives' Code of professional conduct, as set out by the Nursing and Midwifery Council, and are personally accountable to the NMC for their practice. The code states that, "you have a duty of care to your patients and clients, who are entitled to receive safe and competent care".

Nurses usually have their own indemnity insurance through membership of a professional organisation, which if they are trained in non-invasive positive pressure ventilation, would provide cover. Employers, such as National Health Service trusts, primary care trusts or general practitioners, also have vicarious liability for the actions of nurses as their employees, and their indemnity scheme would provide cover, providing that the nurse was working within the role agreed with their employer.

Technetium-99: Discharge into Irish Sea

Lord Faulkner of Worcester asked Her Majesty's Government:

    When was the most recent discharge of technetium-99 into the Irish Sea from Sellafield.[HL2758]

The Parliamentary Under-Secretary of State, Department for Environment, Food and Rural Affairs (Lord Whitty): Technetium-99 is discharged into the

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Irish Sea from Sellafield primarily as the result of treating Medium Active Concentrate (MAC), a liquid waste arising from the reprocessing of spent Magnox fuel. Batches of MAC are treated in "campaigns" at the Enhanced Actinide Removal Plant (EARP) which removes the most radiotoxic components of the MAC mixture. The latest treatment campaign, and hence the most recent discharges, were in February and March of this year.

Lord Faulkner of Worcester asked Her Majesty's Government:

    How they intend to respond to the letter of 1 April from the Norwegian Minister of the Environment regarding the discharge of technetium-99 into the Irish Sea from Sellafield.[HL2760]

Lord Whitty: My right honourable friend the Minister of State for the Environment (Mr Michael Meacher) met the Norwegian Environment Minister, Borge Brende, on 15 May. A discussion took place for two hours during which expert advisers from both countries were able to address the complex technical issues that surround technetium-99 discharges. My right honourable friend emphasised that even though technetium-99 at the levels currently discharged does not pose a risk to human health or the environment, we do take very seriously Norwegian concerns about its presence in their coastal waters. Norway is concerned that the fact that technetium may be detected in seaweed and crustaceans in their coastal waters might lead to a perception of contamination for their fishing industry. The Government are sympathetic to these concerns, but when making decisions on how best to manage the backlog of liquid waste that contains a mixture of radiotoxic components along with the technetium-99, they must judge that against the possibility of increasing the radiation dose to workers at Sellafield and the safety hazards on the site. We have already taken action to reduce the technetium-99 discharge limit to 45 per cent of its 1999 level, and further action, currently being implemented, will reduce the discharge limit to 50 per cent of this level by 2006. There is no simple way forward that would allow us to manage the waste effectively and safely and reduce the discharges more quickly, but further scientific analysis is being carried out, and we are working hard to address Norwegian concerns as fully as we can.


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