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Caroline Leonard, director of surgery and specialist services at the Belfast Health and Social Care Trust, highlighted that delivering palliative care well is not necessarily easy.

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James Sanderson, director of Community Health and Personalised Care at NHS England, explained palliative and end of life care is delivered by, and across a range of, local and national statutory and voluntary organisations.

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Work was ongoing to review the funding of palliative and end of life care services across Wales.

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The first recombinant factor product was Factor 8. The recombinant Factor 8 within the product, which was the only active ingredient, constituted less than 1% by volume.

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Professors Edward Tuddenham and Mike Laffan wrote in the British Medical Journal that: "Recombinant factor VIII is therefore the treatment of choice, given its freedom from viruses derived from plasma..."

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Dr Christine Lee and Dr Brian Colvin wrote to the Secretary of State for Health, Stephen Dorrell, to argue the case for payment of the costs of treatment with recombinant Factor 8 concentrate.

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Dr Geoffrey Savidge, wrote to the Secretary of State for Health, Stephen Dorrell, stating that recombinant Factor 8 "represents the safest product available to patients" and sought reassurances that it would remain affordable.

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The Haemophilia Society wrote to the Chancellor of the Exchequer, Kenneth Clarke, and asked him to reverse the VAT decision regarding recombinant product in the forthcoming budget. It described it as "vital" that this "new, safer product should be available, at least to young children."

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A report in the Daily Telegraph quoted Dr Winter stating that in respect of the VAT increase that "No one doubts that recombinant Factor VIII is the best treatment. It is the safest and it is the future."

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Dr Savidge sent a letter to Kenneth Clarke regarding Recombinant Factor VIII and VAT.

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Fax from HM Customs and Excise to Dr Rejman regarding Recombinant VAT and Factor VIII.

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Kenneth Clarke stated the treatment of patients with recombinant Factor VIII, which contains human serum albumin as a stabiliser, was not without risk.

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Dr Metters made the point that recombinant had a risk, namely, that of being combined with albumin.

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Dr Rejman wrote: "there is no evidence that recombinant Factor VIII is any safer than plasma derived Factor VIII at the present time. You will be aware that recombinant Factor VIII contains plasma derived albumin as a carrier."

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Dr Savidge did not agree with Kenneth Clarke's comments concerning the comparative safety of the recombinant product.

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Dr Savidge's view on behalf of the Recombinant Factor VIII Users' Group was that the cheaper high purity plasma-derived Factor 8 was substantially contaminated by parvovirus B19. Recombinant Factor 8 was not.

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Dr Savidge stated that market trends in Europe, and North America showed that plasma derived Factor 8 was rapidly being phased out from clinical use in favour of recombinant.

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Draft briefing for an answer to a parliamentary question which arose in relation to the imposition of VAT on recombinant.

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Dr Rejman observed that "You will recall that in summary the Department feels that there is no justification for routine use of recombinant Factor VIII in patients with haemophilia".

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John Horam replied to Baxter Healthcare Limited regarding the imposition of VAT on recombinant.

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