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30 Oct 2006 : Column 172Wcontinued
Bob Russell: To ask the Secretary of State for Health what assessment she has made of how the move to practice-based commissioning will affect the commissioning and provision of specialised services for those who have suffered brain injuries. 
Andy Burnham: The move to practice-based commissioning (PBC) should not affect the commissioning and provision of specialised services for brain injury, including specialised rehabilitation services, as specialised services are not covered by PBC.
Chris Ruane: To ask the Secretary of State for Health how many (a) consultants, (b) GPs, (c) all doctors, (d) nurses, (e) ancillary staff and (f) NHS staff in each (i) trust and (ii) county there were in each of the last 20 years. 
Ms Rosie Winterton: This information is not available in the format requested.
Mr. Drew: To ask the Secretary of State for Health how many deaths attributable to hospital acquired infections were recorded by each NHS trust in the 2005-06 financial year. 
Andy Burnham: It is not possible to give reliable figures on the number of deaths involving hospital-acquired infections from routinely collected mortality data, as information on where the infection was acquired may not be available to the doctor certifying the death.
Tim Loughton: To ask the Secretary of State for Health what the cost is of pension contributions for staff at (a) Southlands Hospital in West Sussex, (b) Worthing Hospital and (c) the Royal Sussex County Hospital. 
Ms Rosie Winterton: The information requested is not held centrally.
Mr. Drew: To ask the Secretary of State for Health if she will place a moratorium on closure of independent birth units until the conclusion of the National Perinatal Epidemiological Unit's study into midwifery services and the role of such units. 
Mr. Ivan Lewis: The Government's vision is that women should have easy access to supportive, high quality maternity services, designed around their individual needs and those of their babies. Any decisions about reconfiguration of services should be made at local level as local commissioners and managers are in the best position to determine the needs of their local population. Reconfiguration does not necessarily mean reducing service capacity, but rather affords local managers the opportunity to build local services that are fit to deliver 21st century maternity care, recognising the fact that services may need to be delivered differently, and in different locationsfor example in community based settings. By 2009, all women will have choice over where and how they have their baby, from a range of settings, including hospitals, midwifery-led units and at home. A home birth or a birth in a midwifery-led unit, should be a realistic option for all women with uncomplicated pregnancies. The choices offered to women should fall within the safety net of an emergency network that is readily available, should the need arise.
Dr. Richard Taylor: To ask the Secretary of State for Health what measures are being put in place to avoid in 2007 the shortages of influenza vaccine which have been experienced in 2006. 
As part of the routine planning process for the seasonal flu programme, departmental officials meet with the United Kingdom vaccine industry group (UVIG) to discuss the UKs flu vaccine requirement for the forthcoming winter. Initial production problems
were encountered by manufacturers this year that have lead to delays to some deliveries of vaccine rather than an overall shortage.
The latest information from industry indicates that more seasonal flu vaccine will be available this year than in previous years.
Tim Loughton: To ask the Secretary of State for Health what the cost has been of installing updated information technology systems in the last five years at (a) Southlands Hospital in West Sussex and (b) Worthing Hospital. 
Caroline Flint: The information requested is not collected centrally.
Mr. Iain Wright: To ask the Secretary of State for Health (1) what information and advice was provided by the local NHS to inform her decision to refer maternity and paediatric services in Teesside to the Independent Reconfiguration Panel; 
(2) To ask the Secretary of State for Health what the basis was for her decision to refer maternity and paediatric services in Teesside to the Independent Reconfiguration Panel; 
(3) whether the contents of the letter of 31 July to her from the chairman of Hartlepool borough councils adult and community services and health scrutiny forum formed part of the basis of her decision to refer maternity and paediatric services in Teesside to the Independent Reconfiguration Panel. 
Mr. Ivan Lewis: The Secretary of State received referrals affecting maternity and paediatric services in Teesside from the joint overview scrutiny committee (JOSC) chaired by the Middlesbrough borough council covering the local authorities of Middlesbrough, Redcar and Cleveland, Stockton, Hartlepool, North Yorkshire and Durham on 7 July 2006 and the Stockton overview and scrutiny committee (OSC) on 3 July 2006. In addition, Hartlepool borough councils adult and community services and health scrutiny forum also wrote to her on the same subject on 31 July.
Both the OSCs and the JOSC respectively stated that they felt that the proposals to reconfigure maternity services were not in the best interests of the local population.
The views expressed in each of the referrals were fully taken into consideration in the Secretary of States request to the Independent Reconfiguration Panel (IRP) to undertake a review of maternity and paediatric services in Teesside.
For the JOSC, the rationale is to retain a consultant-led maternity and paediatric service on both the North Tees and Hartlepool hospital sites. For the Stockton OSC, the principle of centralisation of these services on to one site was accepted, with a view that this could only be based at North Tees (Stockton). The Hartlepool borough council supported centralisation of these services on one site with a view that these could only be based at Hartlepool.
The advice from the local NHS (the North East Strategic Health Authority) was that the two issues of centralisation and location of services needed recognition and resolution. The strategic health authority's view is that centralisation of consultant-led services to form one service within the trust is essential, and two separate consultant-led services as advocated by the JOSC are unsustainable. The issue is therefore one of where to locate these services.
In light of the differing views expressed by the local OSCs to her, the Secretary of State wrote to the IRP asking them for their advice on 22 September 2006. A copy of this letter has been placed in the Library.
The IRP will submit its report to the Secretary of State no later than 18 December 2006.
Mr. Iain Wright: To ask the Secretary of State for Health what her Departments policy is on midwife-led maternity units. 
Mr. Ivan Lewis: The Governments vision for woman-focused, family-centred care as well as choice in maternity services is pivotal to the maternity standard of the national service framework for children, young people and maternity services. The standard requires national health service maternity care providers and primary care trusts to ensure that the range of ante-natal, birth and post-birth care services available locally provides real choice for women (including home births) and that local options for midwife-led care will include midwife-led units in the community or on a hospital site to all women who have been appropriately assessed.
In their manifesto, the Government made a commitment that, by 2009, all women will have choice over where and how they have their baby and this should include offering services in a range of settings, including hospitals, midwife-led units and at home. The choices offered to women should ensure access to an emergency network that is readily available, should the need arise. The Government have further demonstrated their commitment to choice in maternity in the White Paper Our Health, Our Care, Our Say, published on 30 January this year, which pledges to raise the profile of maternity services and encourages doctors to support birth choices.
Ultimately, decisions about the patterns of maternity service delivery are matters for local NHS trusts to determine, taking into account local population needs, priorities and resources.
Mr. Burstow: To ask the Secretary of State for Health (1) what proportion of the total NHS mental health budget was allocated to (a) services dedicated to addressing the mental health problems of children and adolescents and (b) services dedicated to addressing the mental health problems of adults in each of the last 10 years; 
(2) what the total financial investment in (a) children and adolescent mental health services and (b) adult mental health services was in each of the last 10 years. 
Mr. Ivan Lewis: Information is not available in the requested format. Information about gross expenditure on mental illness elements of the national health service hospital and community health services budget in each of the last 10 years for which data are available has been placed in the Library. The data exclude social care spend on people with mental health problems, and expenditure concerning people treated in primary care for whom a specific diagnosis has not been reached. The figures therefore underestimate the total mental health expenditure. From 2003-04, the national programme budget project began mapping all NHS expenditure, including primary care services, to programmes of care based on medical conditions such as mental health problems. This information is published on the Departments website at www.dh.gov.uk/assetRoot/04/13/74/68/04137468.xls.
The child and adolescent mental health services (CAMHS) mapping exercise for 2005 found that in 2004-05 the total spend on specialist CAMHS by the NHS and local authorities was £431 million. Further information on expenditure on CAMHS can be found at www.camhsmapping.org.uk/2005.
Tim Loughton: To ask the Secretary of State for Health (1) what discussions she had with Tony Maden before she produced the Review of Homicides by Patients with Severe Mental Illness; 
(2) what method she used to decide who would produce the Review of Homicides by Patients with Severe Mental Illness; what factors she took into account when deciding to commission Tony Maden; and if she will make a statement; 
(3) when she commissioned the Review of Homicides by Patients with Severe Mental Illness; 
(4) what consultations were held to discuss the criteria which Tony Maden used to carry out her assessment of mental health patients for the Review of Homicides by Patients with Severe Mental Illness; and who decided the criteria for (a) the assessment and (b) the case selection; 
(5) whom she consulted before commissioning the Review of Homicides by Patients with Severe Mental Illness. 
Ms Rosie Winterton: Following a number of high profile homicides by people with a mental illness the Home Secretary and the Secretary of State for Health asked for an assessment of what actions could be taken to prevent such tragedies.
In October 2005, as part of a broader programme of work, the Department of Health Risk Management Programme commissioned Professor Anthony Maden, as an acknowledged international expert on risk in mental health, to review independent homicide inquiry reports relating to patients with severe mental illness and a history of violence and report on the lessons services could learn to help avoid such tragedies.
The terms of reference of the work, case selection criteria and outputs were agreed between Professor Maden, the national director for mental health Professor Louis Appleby and departmental officials. Departmental Ministers have not met Professor Maden to discuss the work.
Cases were selected from the database of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness using the following criteria:
a current patient of the NHS mental health services in England and Wales committing a homicide during the last 10 years;
a diagnosis of schizophrenia or other delusional disorder or of bipolar affective disorder as recorded on the homicide form for the Confidential Inquiry;
availability of Confidential Inquiry forms and at least one psychiatric court report relating to the homicide; and
a history of previous violence known to the mental health team before the homicide occurred.
The data were used to complete the HCR20, a structured clinical assessment of violence risk, for each case. The findings were then used to draw practical conclusions as to how clinical services can better manage violence risk in patients with major mental illness and a previous risk of violence.
David Howarth: To ask the Secretary of State for Health (1) what proportion of the budget each strategic health authority was spent on mental health in each of the last five years; 
(2) what the budget was for each mental health trust in each of the last five years; 
(3) what proportion of the budget of each primary care trust was spent on mental health in each of the last five years. 
Ms Rosie Winterton: Information is not available in the requested format.
The Department makes revenue allocations to primary care trusts (PCTs), but not to mental health trusts. Allocations were first made to PCTs in 2003-04, but prior to this funding was allocated to health authorities. Information has been placed in the Library.
Information on expenditure by each PCT on commissioning of mental illness services in each of the last five years for which data are available has been placed in the Library.
The data exclude social care spend on people with mental health problems, and expenditure concerning people treated in primary care. It should be noted that some commissioning expenditure would also have been undertaken by health authorities, particularly in 2000-01 and 2001-02. The figures therefore underestimate the total mental health expenditure.
Some primary care trusts may have local arrangements in respect of commissioning. For example, North and South Peterborough PCTs have an arrangement whereby the commissioning of health care expenditure in the area is by North Peterborough only. This produces a degree of variance year on year.
In order to gain a more comprehensive picture of mental health spend, the Department commissioned national surveys of investment in mental health services in each year since 2001. The reports of five surveys covering the period from 2000-01 to 2005-06 are available from the Department's website at www.dh.gov.uk.
Mr. Kidney: To ask the Secretary of State for Health what the current level of provision is of mental health advocates for NHS patients; and what level of provision she plans to put in place in 2007-08. 
Ms Rosie Winterton: This information is not collected centrally. It is for local statutory commissioning bodies to determine the level and scope of advocacy services in their areas in the light of their knowledge of local needs and priorities.
The Government support mental health patients' access to advocacy. We have commissioned a programme with the University of Durham to develop training and standards for mental health advocates and systems to support the commissioning of services. The initial research findings indicate that some form of advocacy is available to mental health patients in over 80 per cent. of local implementation team areas in England.
Mr. Binley: To ask the Secretary of State for Health how many midwives were enrolled in training between 2003 and 2006 due to the need to retrain because of absences from the profession. 
Ms Rosie Winterton: Between 1 January 2003 and 31 December 2005, 563 midwives successfully completed Nursing and Midwifery Council return to practice programmes.
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