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(2) what proposals he has to amend hospital cleanliness inspections to reflect the disparity between inspection outcomes and patient experience noted in the Healthcare Commission State of Healthcare Report 2004. 
Mr. Hutton: The patient environment action team (PEAT) process for measuring hospital cleanliness was redesigned for the 2004 inspection round, following discussions with a number of representative bodies. The number of areas assessed this year was increased from 18 to 24.
This has significantly extended the information available to hospitals about their performance. A new rating system was designed around a five-point scale and introduced an "excellent" category. The scoring process continues to be weighted in relation to cleanliness issues in wards and accident and emergency departments.
The new national healthcare standards, published on 21 July, include cleanliness and performance against them will be rated in the Healthcare Commission's annual assessments of national health service bodies in England. The Commission will undertake a review of hospital cleanliness and infection control shortly.
Mr. Norman: To ask the Secretary of State for Health what evidence he has collected on whether the results of hospital cleanliness inspections differ depending on whether they are pre-announced. 
Mr. Hutton: Information concerning the specific cleanliness and hygiene of operating theatres is not collected centrally. Guidance was issued in the form of a standard measure of cleanliness for hospitals in the national standards of cleanliness 2002 (further revised in 2003). In this guidance, operating theatres are classified as very high risk and it is stressed that constant cleaning is deemed critical.
Mr. Norman: To ask the Secretary of State for Health what (a) research he has commissioned and (b) evidence he has collected on the influence of the control of laundering of nurse and medical staff uniforms on hospital-acquired infection rates. 
Mr. Hutton: The Department published evidence-based guidelines for the prevention and control of healthcare acquired infection in 2001, which included the standard principles covering the use of personal protective clothing and equipment.
It is for the chief executives of national health service trusts to ensure that nurses have enough suitable clothing and equipment to carry out their work effectively. The decision as to whether nurses' uniforms are laundered through the hospital laundry services or whether nurses clean the uniforms themselves is made locally.
Norman Baker: To ask the Secretary of State for Health what estimate he has made of the volume of material arising from NHS hospitals which was incinerated (a) on site and (b) elsewhere in each year since 1997. 
Ms Rosie Winterton: National Health Service trusts are legally autonomous bodies and they will tender for waste disposal services taking into account local requirements. Data is not collected centrally in relation to the precise method of disposal.
Mr. Sanders: To ask the Secretary of State for Health pursuant to the answer of 23 June 2004, Official Report, column 1434W, on insulin, if he will place in the Library details of contacts between his Department and companies that supply insulin. 
Ms Rosie Winterton: The information requested cannot be provided without incurring disproportionate cost, or without breaching commercial confidentiality (exemption 13 of the open government code applies).
My noble Friend, the Parliamentary Under-Secretary of State (The Lord Warner), who has responsibility for pharmaceutical industry matters will write to the hon. Member with an overview of the current situation regarding the supply of insulin shortly. A copy of this letter will be placed in the Library.
Mr. Amess: To ask the Secretary of State for Health pursuant to his answer of 28 June 2004, Official Report, column 106W, whether the licensing process compared mortality rates, the development of diabetic complications and the quality of life of those using animal and synthetic insulin; and if he will make a statement. 
Ms Rosie Winterton:
All authorised insulins, whether human (synthetic) insulin or animal insulin, have been demonstrated to be efficacious in people with diabetes mellitus. As part of the licensing approval process for
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any medicinal product, including insulins, the applicant has to provide evidence that the product meets appropriate standards of quality, safety and efficacy. These standards are set out in European Guidance documents, including, for example, "Notes for Guidance on Clinical Investigation of Medicinal Products in the Treatment of Diabetes Mellitus" (CPMP/EWP/1080/00). This will include clinical trial data of appropriate duration in patients with diabetes as set out in the guidance document. The primary purpose of the confirmatory studies involving the assessed insulin is to demonstrate a favourable effect on blood glucose control (this is considered clinically relevant in terms of risk reduction of diabetic complications).
Data on mortality rates, development of diabetic complications and quality of life are not necessarily required for the licensing process. Additionally, there are no requirements for comparative studies between animal and synthetic insulins as part of the licensing process. Therefore, the licensing process has not compared mortality rates, development of diabetic complications or the quality of life of patients using animal and synthetic insulins. After licensing, all drugs, including insulins, are continually monitored for safety. The decision to use one or other of the insulins rests with the physician in consultation with the patient.
The committee on safety of medicines and its sub-committee on pharmacovigilance (SCOP) have kept the safety of synthetic (human) insulins under close review and have considered the available data on a number of occasions. Most recently in 2002, the SCOP considered the findings of an independent review of controlled clinical trial data by the Cochrane collaboration. The conclusions of the Cochrane review were that there is no difference in blood glucose control or the incidence of adverse events between patients on synthetic insulin compared with patients on animal insulins. The SCOP confirmed its previous advice that there is no clear evidence of a safety problem specific to human insulin.
Sandra Gidley: To ask the Secretary of State for Health pursuant to the answer of 7 June 2004, Official Report, column 158W, on intermediate care, when the validation process of data regarding intermediate care beds and places will be completed. 
Sandra Gidley: To ask the Secretary of State for Health how many people aged (a) 25, (b) between 26 and 50, (c) between 51 and 60, (d) between 61 and 70 and (e) 71 years have received kidney dialysis in each of the last three years; and if he will make a statement. 
Ms Rosie Winterton:
The table shows the latest information from the 2002 renal survey for people who were receiving haemodialysis or peritoneal dialysis at 31 December 2002. Figures exclude patients who dialysed during 2002 but were either transplanted or died prior to 31 December 2002.
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|Age||Number of dialysis patients at 31 December 2002|
|Under 26 years||554|
|71 years plus||4,894|
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