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Mr. Drew: To ask the Secretary of State for Health (1) what rehabilitation help is available for blind and partially sighted people; how many trained staff there are who can provide that help in health trusts and local authorities; and what advice is she seeking to increase appropriate training and numbers; 
(2) what action she plans to take to ensure that each health trust and local authority has an adequate number of trained people to deliver rehabilitation help to blind and partially sighted people in accordance with the Government's Fair Access to Care Services and if she will estimate the additional funding required in order to meet that target. 
Mr. Byrne: Rehabilitation services for blind and partially sighted people are predominantly provided by local authorities and to some extent NHS trusts. It is for those organisations to commission appropriate services based on local need. This would include the number, training and composition of teams available to provide rehabilitation for blind and partially sighted people, based on local need.
Fair Access to Care Services (FACS) is a system to help local authorities to set eligibility criteria for provision of services. It is up to local authorities and health trusts to ensure they have an adequate number of trained people to deliver rehabilitation services to the blind and partially sighted people in their area.
Mr. Lansley: To ask the Secretary of State for Health what assessment she has made of the cost of extending the routine NHS breast screening programme to (a) women aged between 70 and 75 years of age, (b) all women above 70 years of age, (c) women aged between 45 and 49 and (d) women aged between 40 and 49. 
Ms Rosie Winterton:
Expanding the national health service breast-screening programme to include women aged 65 to 70 was supported by investment of £11.5 million, with an additional £11.4 million for new equipment. No assessment has been made on the cost of expanding the service to include women aged 70 to 75;
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however, we would expect it to be in a similar range. No assessment has been made on the cost of expanding the programme to include all women aged 70 or over. All women over 70 can request free three yearly breast screening.
Research is ongoing into screening women aged 4049, entitled "UKCCCR randomised controlled trial of the effect of breast cancer mortality of annual mammographic screening of women starting at age 40". This study is due to report in late 2005, at the earliest, and will address the issues of cost and cost effectiveness.
Mr. Lansley: To ask the Secretary of State for Health what assessment she has made of the rate of implementation of the National Institute for Health and Clinical Excellence's clinical guideline published on 23 June 2004 on The Classification and Care of Women at risk of Familial Breast Cancer in Primary, Secondary and Tertiary Care, with particular reference to screening for women aged between 40 and 49; and what plans she has to extend the NHS breast screening programme to all women aged between 40 and 49. 
Ms Rosie Winterton: Clinical guidelines from the National Institute for Health and Clinical Excellence (NICE) are reflected in the standards published by the Department, which provide a framework for continuous improvement in the overall quality of care people receive. Clinical guidelines are covered by the developmental standards, standards which the national health service is expected to achieve over time. The Healthcare Commission has responsibility for assessing progress towards achieving these standards.
Clinicians are expected to take full account of NICE guidelines because they are based on the best available evidence and have been put together after wide consultation, drawing on the views of patients and carers as well as the experts in the field.
Research is currently ongoing into extending the NHS breast screening programme to include women aged 4049, entitled "UKCCR randomised controlled trial of the effect of breast cancer mortality of annual mammographic screening of women starting at age 40".
The main aim of this study is to evaluate the effect of annual mammographic screening of women starting at ages 40 to 41 on mortality from breast cancer, thus giving a definitive answer to the outstanding question of whether population screening below 50 is beneficial or not. Full results are expected in late 2005 at the earliest.
Mr. Baron: To ask the Secretary of State for Health what steps the Government are taking to encourage greater choice on (a) when, (b) where and (c) how women can access the NHS breast screening programme. 
Ms Rosie Winterton
[holding answer 20 June 2005]: Choice is already an important part of the national health service breast screening programme. All invitations to be screened for breast cancer include leaflets on the benefits and limits of screening, allowing the woman to make an informed choice about whether to be screened or not. The invitation letter also includes details on how the screening appointment can be
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changed to a more convenient date and time. On average 30 per cent. of women rearrange their appointments each year.
It is important to note that the amount of choice that the programme can offer is limited by the logistics involved in a screening programme that sees, on average, 1.4 million women each year. However, we are looking at how greater choice can be given. We are exploring, in London, the use of a central call centre, which will be closely followed and evaluated for implementation elsewhere in the country.
Jane Kennedy: The only routinely available mortality statistics on Clostridium difficile are those associated with enterocolitis, the most common illness caused by Clostridium difficile infection. The figures for 2003 are shown in table 1.
Complete information on the number of patients with Clostridium difficile infections in the last five years are not available but reports made under the Health Protection Agency's voluntary reporting scheme are shown in table 2.
Mr. Byrne: Standard seven of the national service framework for older people, launched in March 2001, describes the services that we expect local health and social services organisations to provide for those with dementia, and their carers.
The Government introduced the carers grant in 1999 for councils to provide support to carers in England through breaks and other services. The grant has increased each year and has provided an extra £450 million over the past six years. It is worth £185 million in 200506. In the last local Government finance settlement, we confirmed our commitment to continue the carers grant until at least the end of the 200708 financial year.
Guidance called "Developing Services for Carers and Families of People with Mental Illness", for the development of services for supporting carers of people with mental health problems, was launched by the then Minister for Community, Ms Jacqui Smith, in November 2002.
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