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Mr. Ian Taylor: To ask the Secretary of State for Health what strategy is in place to meet an epidemic of smallpox caused by terrorist action. 
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Mr. Hutton: The Department has contingency planning in place to mitigate the effects of a bioterrorist act and to ensure response and recovery in conjunction with other Government Departments, the national health service and key public health agencies.
Guidance has been issued to senior managers in the NHS on procedures to be followed in the event of a release of a biological agent, including smallpox.
There are strategic stocks of vaccine which would be rapidly deployed for use as appropriate to the incident to contain any outbreak.
Ann Keen: To ask the Secretary of State for Health what steps he is taking to improve the level of health care administered by local health authorities to sufferers of lymphoedema. 
Mr. Boris Johnson: To ask the Secretary of State for Health what system is used in the funding of lymphoedema clinics; if he will take steps to encourage a uniform service; and if he will make a statement. 
Jacqui Smith: It is the role of health authorities, in partnership with primary care groups and trusts, to decide what services to provide for their populations including those with lymphoedema. They are best placed to understand local health needs and commission services to meet them.
We are currently developing a National Service Framework (NSF) for long-term conditions. The precise scope of the NSF has not yet been decided. Although it may not address lymphoedema directly, the NSF is likely to set general standards which will improve the quality of treatment and care for all people living with long-term conditions. It will help overcome problems of patchy provision of services. The Department is consulting the Long Term Medical Conditions Alliance, of which the Lymphoedema Support Network is a member, on the development of the NSF.
Mr. Bercow: To ask the Secretary of State for Health if he will make a statement on the measures of cost efficiency developed by his Department as part of the performance assessment system. 
Mr. Hutton: The performance indicators were published in July 2000 on the Department's website: www.doh.gov.uk/nhsperformanceindicators. This includes a number of efficiency indicators:
average length of stay;
maternity unit costs;
mental health unit costs; and
percentage of prescribing on generic drugs.
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In addition, a new public service agreement target for value for money was agreed as part of spending review 2000:
Mr. Bercow: To ask the Secretary of State for Health if he will make a statement on the costs in (a) 200001 and (b) 200102 of the Medical Devices Agency. 
Mr. Hutton: The information requested is shown in the table.
Mr. Luff: To ask the Secretary of State for Health what assessment he has made of the advice available to diabetics on the safe disposal of their used needles; and if he will make a statement. 
Jacqui Smith: We would expect a person with diabetes who injects insulin to be advised by their doctor or pharmacist about the safe disposal of their used syringes and needles. Because of the potential hazards to refuse collectors, used syringes and needles should not be disposed of in the domestic waste. Local authorities have a duty to collect clinical waste on request, although they may levy a reasonable charge for doing so. Some general practitioner practices, hospitals and pharmacists also provide a collection service for clinical waste. GPs may prescribe the 1 litre "Sharpsbin" for the disposal of needles and contaminated waste.
Mr. Sanders: To ask the Secretary of State for Health if he will publish the Diabetes National Framework Standards by the end of November. [19552R]
Jacqui Smith: We will be publishing the Diabetes National Service Framework Standards this year.
Dr. Kumar: To ask the Secretary of State for Health what expenditure on diabetes was in each year since 1997 in the Tees health authority. 
Jacqui Smith [holding answer 6 December 2001]: Information is not collected on disease based costs in the format requested. It is not possible, therefore, to identify total health authority diabetes related costs.
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In the particular instance of diabetes a whole range of services are involved in the treatment of patients where the condition is a result of diabetes, for example ophthalmic services, renal services, general surgical services, primary care treatment and prescribing costs.
The table shows the general medical services non-discretionary expenditure on the chronic disease management programme for diabetes, that was incurred by Tees health authority in each financial year since 199798.
200001 data are provisional
Annual financial returns for health authorities
Mr. Soley: To ask the Secretary of State for Health what account was taken of the complexity of cases referred to Hammersmith hospital for cardiac surgery in producing the performance tables. 
Mr. Hutton: The Department recently produced comparative data on mortality following a coronary artery bypass graft which were published by Dr. Foster alongside their own version of the same indicator. The Department's data are adjusted to take account of variation between trusts in the age and sex of patients treated and whether the patient is admitted to hospital as an emergency case or for a planned operation.
Mr. Nicholas Winterton: To ask the Secretary of State for Health what plans he has to (a) alter the remit and (b) review the framework of the National Institute for Clinical Excellence; and if NICE includes the therapeutic requirements of specific diseases in its assessments of the efficacy of individual drugs. 
Mr. Hutton: I refer the hon. Member to the reply given to the hon. Member for Sutton and Cheam (Mr. Burstow) on 22 November 2001, Official Report, column 416W.
The precise methodology used in appraisals of individual therapies is for the National Institute for Clinical Excellence itself, but the institute's recommendations always take account of the specific features of the conditions in which the therapies are to be applied.
Mr. Flight: To ask the Secretary of State for Health how many people have been diagnosed with tuberculosis in Arundel and South Downs in each year since 1990. 
Ms Blears: Information on statutory notifications of tuberculosis (excluding chemoprophylaxis) is available from the Public Health Laboratory Service.
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The Department collects information on tuberculosis as part of the hospital episodes statistics (HES) system, which contains details of patients admitted to and treated in national health service hospitals in England.
The nearest available data for Arundel and South Downs are for local authority district, Arun. The numbers of patients treated in Arun is shown in the table.
(53) An FCE is defined as a period of patient care under one consultant in one health care provider. The figures do not represent the number of patients, as one person may have several episodes within a year.
(54) Means a figure between 1 and 5.
The main diagnosis is the first of seven diagnosis fields in the HES data set, and provides the main reason why the patient was in hospital.
The table uses ICD9 codes: O10-O18 (199091 to 199495) and ICD10 codes A15-A19 (199596 to 200001).
Hospital Episodes Statistics (HES) Department of Health
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