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Hospital Infections

Mr. Andrew Turner: To ask the Secretary of State for Health how many cases of MRSA were recorded in each year since 1997; and how many resulted in death (a) in and (b) not in hospital. [193550]

Miss Melanie Johnson [holding answer 25 October 2004]: Available data on methicillin resistant Staphylococcus aureus (MRSA) blood stream infections from the voluntary and mandatory surveillance systems are shown in the tables. One of the reasons that the Government introduced mandatory surveillance in April 2001 was that the previous voluntary system produced incomplete data. Neither of these systems provides information on patient outcomes, including death, but an in-depth study of deaths possibly related to health care acquired infections (including MRSA) is being commissioned by the Chief Medical Officer.
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Methicillin resistant Staphylococcus aureus bacteraemia (blood stream) laboratory reports (voluntary reporting scheme), England and Wales, 1997–2003


Health Protection Agency.

Reports under the mandatory MRSA bacteraemia surveillance system (acute NHS trusts, England)

April 2001 to March 20027,250
April 2002 to March 20037,384
April 2003 to March 20047,647

Health Protection Agency.

Simon Hughes: To ask the Secretary of State for Health which strains of MRSA primary care trusts are required to report; and if he will make a statement. [194233]

Miss Melanie Johnson: Primary care trusts are not required to report methicillin resistant Staphylococcus aureus (MRSA). The mandatory reporting of MRSA blood stream infections applies to acute trusts.


Mr. Edwards: To ask the Secretary of State for Health what information is provided by the NHS to women on treatment options for (a) menorrhagia and (b) uterine fibroids; and what alternatives to hysterectomy are available through the NHS for the treatment of each condition. [195029]

Dr. Ladyman: The National Institute for Clinical Excellence (NICE) guidance is provided in formats written for patients, carers and the public. NICE issued guidance on endometrial ablation for menorrhagia on 28 April 2004. It has issued guidelines on alternative surgical treatments for menorrhagia, including balloon thermal endometrial ablation (August 2003), uterine artery embolisation for fibroids (August 2003), free and fluid thermal endometrial ablation March 2003.

NICE is developing a clinical guideline on hysterectomy, which is likely to include guidance on menorrhagia, as part of its eighth wave work programme. The anticipated publication date of this guideline is February 2006.

The Royal College of Obstetricians and Gynaecologists (RCOG) also produces information for patients, developed from guidelines. The RCOG leaflet on hysterectomy advises that alternative treatments may be appropriate for patients and that their doctors will be able to fully advise on these. The national electronic library for health programme is working with national health service libraries to develop a digital library for NHS staff, patients and the public and has recently developed a specialist library covering women's health.
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Jeremy Corbyn: To ask the Secretary of State for Health what arrangements are available for Iraqi nationals who are victims of violence in the war and who cannot be treated in Iraq due to medical deficiencies to be treated in hospitals in England; and if he will make a statement. [194014]

Mr. Hutton: Iraqi nationals are treated in civilian health care facilities in Iraq wherever possible. Some requiring care may be treated by military field hospitals and, exceptionally for specialist care, may be brought back to United Kingdom hospitals where additional capacity has been made available.

IT Systems

Mr. Burstow: To ask the Secretary of State for Health pursuant to the answer of 14 June 2004, Official Report, column 685W to the hon. Member for Westbury (Dr. Murrison) on IT systems, if he will break down the estimated costs by (a) procurement, (b) implementation and (c) running cost; and on what assumptions the estimates were based. [194363]

Mr. Hutton: The procurement phase of the national programme for information technology (NPfIT) is now complete and contracts awarded are shown in the following table.
£ million
Local service providers4,988
National health service care records service/spine620
New national network (N3)530

These figures relate to contractual commitments. They cover ongoing funding of core deliverables and the connection of existing systems to national applications from central budgets.

The £2.3 billion, earmarked in the 2002 spending review to fund the IT development and NPfIT central programme costs over the three years 2003–04 to 2005–06, was based on individual project business case assumptions about the speed and scope of deployment in the period concerned. This figure does not include the cost of training NHS staff or local change management costs.

Funding for the local NHS service implementation and running costs of NPfIT will come from normal NHS allocations, which are being increased year on year and will reach £90 billion by 2008. This will involve prioritising normal expenditure, including training budgets to include NPfIT in local training programmes.

Future funding to the NHS determined by the SR2004 expenditure settlement will enable trusts to achieve the target of 4 per cent. for total NHS spending on IT, set by the 2002 Wanless Report, "Securing our Future Health". This total includes spending on IT provision outside the NPfIT remit, such as human resources and finance IT systems.
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Junior Doctors

Dr. Murrison: To ask the Secretary of State for Health what assessment he has made of unemployment levels among non-UK trained junior doctors living in England. [195580]

Mr. Hutton: In September 2003, the national health service employed almost 36,000 doctors who had obtained their medical qualification outside of the United Kingdom. The Department does not collect information about the unemployment levels of junior doctors.

Junior doctors who have trained outside of the UK have to pass the Professional and Linguistic Assessment Board (PLAB) examination before being accepted onto the General Medical Council (GMC) register. The GMC has surveyed doctors who have taken the PLAB examination in the last year to find out how quickly they obtain posts. The survey has shown that 93 per cent. have obtained a post within a year.

Mental Health

Lynne Jones: To ask the Secretary of State for Health what steps he is taking to ensure that the patient choice agenda extends to mental health patients. [195783]

Ms Rosie Winterton: A mental health choice steering group has been established under the auspices of the National Institute for Mental Health England (NIMHE). The group aims to inform the development of choice policy in mental health and has produced a discussion document which will be presented to the mental health taskforce in December.

In 2002–03, NIMHE's Access, Booking and Choice in Mental Health programme was rolled out across each of its eight development centres in order to provide stakeholders from across local mental health communities with proven tools and techniques of service redesign. Detailed outcomes of this NIMHE programme are described in "Improving Access and Choice: Service Improvement Guide, 2003" which is available on the NIMHE website at 03.pdf

Lynne Jones: To ask the Secretary of State for Health what steps he is taking to ensure that patients with severe mental health problems have access to (a) useful information and (b) the highest quality treatments. [195784]

Ms Rosie Winterton: The national service framework for mental health (1999) set national standards and identified key interventions for working age adults with mental health problems.

Clinical guidelines published by the National Institute for Clinical Excellence (NICE) provide guidance on the appropriate treatment and care of people with specific mental health problems within the national health service.

Technology appraisals published by NICE provide guidance on the use of new and existing medicines and treatments within the NHS.
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NICE runs a web-based online environment, the knowledge community (, to help improve the delivery of mental health services. The knowledge community represents the diversity of approaches and perspectives that exist within the mental health field, and provides a practical means by which these can be brought together to improve services.

Lynne Jones: To ask the Secretary of State for Health whether the proposed five-yearly review of the national service framework for mental health will examine issues relating to patient choice, with particular reference to (a) the availability of cognitive behaviour therapy and (b) implementation of guidance from the National Institute for Clinical Excellence for atypical antipsychotics where choice is central to that guidance. [195787]

Ms Rosie Winterton: The national director for mental health's review of the national service framework for mental health (1999) looks at the implementation of its seven standards and the supporting programmes. The review will also take a forward look outlining future priorities for mental health including how these will align with broader national health service initiatives such as choice.

Lynne Jones: To ask the Secretary of State for Health what objectives he has set the National Director for Mental Health in relation to patient choice. [195788]

Ms Rosie Winterton: No specific objectives in relation to patient choice have been set for the national director for mental health. However, he is actively involved in the mental health choice steering group, which has been established under the auspices of the National Institute for Mental Health England to inform the development of choice policy in mental heath.

Lynne Jones: To ask the Secretary of State for Health (1) what assessment he has made of the implementation of current guidance from the National Institute for Clinical Excellence in relation to atypical antipsychotics; [195785]

(2) what monitoring he undertakes of the extent to which patients with newly diagnosed schizophrenia are being offered a clear choice of treatment, in line with guidance from the National Institute for Clinical Excellence; and what assessment he has made of the barriers to implement that guidance. [195786]

Ms Rosie Winterton: Responsibility to implement guidance published by National Institute for Clinical Excellence (NICE) is devolved within the National Health Services to local trusts, supported and performance managed by strategic health authorities. The Department has made no assessments of the kind outlined by my hon. Friend.

However, the Department routinely monitors prescribing trends of all antipsychotics. For the year ending June 2004, atypical antipsychotics accounted for 60 per cent. of all prescription items of antipsychotics dispensed in the community in England, compared to 48 per cent. of all antipsychotics for the year ending June 2002, when the relevant NICE appraisal guidance was published.
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Since January 2002, the National Health Service has had three months from the date of publication of each technology appraisal guidance to provide funding so that clinical decisions made by doctors involving NICE recommended treatments or drugs can be funded.

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