Part of the increase in cases of A. baumannii reflects the increase in the proportion of cases of acinetobacter bloodstream infections in which the organism has been fully identified to species level (51 per cent. in 2001, 62 per cent. in 2005). A. baumannii is one of the less difficult species to identify and both this and clinical concern have probably contributed to increased reporting.
Two multi-resistant clones of A. baumannii (Southeast clone, OXA-23 Clone 1) have affected hospitals in the United Kingdom in the past few years. Both clones have been identified in about 40 hospitals, predominantly in the London area and in south-east England(2,3).
The HPA has advised hospitals to implement urgently robust infection control measures to prevent spread of these clones, and is currently undertaking an analysis of outcomes, in order to identify optimum treatment for those patients who become infected(4).
A multi-resistant strain of A. baumannii, known as the T strain, has been isolated from casualties returning to the United Kingdom from Iraq(5 )but the exact source has not been identified. The T strain has also been isolated from US casualties from Iraq and it is very similar to the Southeast clone.
(1) Acinetobacter spp bacteraemia in England, Wales, and Northern Ireland: 2001 to 2005 Communicable Disease Report (CDR) Weekly 2006; 16 (42) 19 October 2006.
(2) JF Turton, ME Kaufmann, M Warner et al. A prevalent, multiresistant clone of Acinetobacter baumanii in Southeast England. Journal of Hospital Infection 2004; 58: 170-179.
(3) JM Coelho, JF Turton, ME Kaufman et al. Occurrence of carbapenem-resistant Acinetobacter baumanii clones at multiple hospitals in London and Southeast England. Journal of Clinical Microbiology 2006; 44: 3623-3627.
(4) Working Party Guidance on the Control of multi-resistant Acinetobacter Outbreaks. www.hpa.org.uk/infections/topics_az/acinetobacter_b/guidance.htm.
(5) JF Turton, ME Kaufmann, MJ Gill et al. Comparison of Acinetobacter baumanii isolates from the United Kingdom and the United States that were associated with repatriated casualties of the Iraq conflict. Journal of Clinical Microbiology 2006; 44: 2630-2634.
To ask the Secretary of State for Health if she will investigate whether the University Hospitals of Morecambe Bay NHS trust followed appropriate codes of practice in considering complaints presented
by local people on the recent consultation process on acute medical services provision. 
Ms Rosie Winterton: A final decision on proposed changes to the provision of health services provided by University Hospitals of Morecambe Bay NHS Trust will be made shortly by the boards of the hospital trust and of the Cumbria and North Lancashire primary care trusts. This decision will then be considered by the overview and scrutiny committees of Cumbria and Lancashire county councils. The OSC has the power to refer the matter to the Secretary of State for Health if it believes that consultation has been inadequate or that it is not in the interests of the health service.
Tim Farron: To ask the Secretary of State for Health if she will urge the University Hospitals of Morecambe Bay NHS Trust to reverse its decision to reduce staff by 90 posts until the conclusion of its acute medical services review. 
Ms Rosie Winterton: The decision to reduce the number of posts at the University Hospitals of Morecambe Bay NHS Trust has been taken in order to return the trust to financial balance and is not connected to the review of acute medical services. The trust board is responsible for taking these matters forward working in conjunction with its primary care trust partners and NHS North West.
Miss McIntosh: To ask the Secretary of State for Health what representations she has received on the decision by the National Institute for Health and Clinical Excellence that from 22 November people with Alzheimers disease should no longer be prescribed Alzheimers drugs on the NHS in the early and late stages of the disease. 
Mr. Ivan Lewis: Between 11 to 26 October 2006, the Department received 115 letters regarding the National Institute for Health and Clinical Excellences appraisal of drugs for the treatment of people with Alzheimers disease.
Miss McIntosh: To ask the Secretary of State for Health what assessment she has made of the clinical benefits of Alzheimers drugs at each stage of the disease; and what estimate she has made of the cost of such drugs at each stage. 
Mr. Ivan Lewis: The National Institute for Health and Clinical Excellence has not yet published its final revised guidance to the national health service on drugs for the treatment of Alzheimers disease. I understand that this guidance will be published on 22 November 2006.
Mr. Evans: To ask the Secretary of State for Health how much was spent on medicines for people affected by asbestos-related cancer in the last period for which figures are available, broken down by type of drug. 
Mr. Amess: To ask the Secretary of State for Health (1) what representations she has received since July 2006 from (a) doctors, (b) nurses and (c) other health care professions in (i) support of and (ii) opposition to (A) assisted suicide and (B) voluntary euthanasia; and if she will make a statement; 
(2) how many times her Department has consulted (a) formally and (b) informally on end-of-life decision making since June 2006; if she will list the stakeholders who have made representations to her Department on end-of-life issues during this period; and if she will make a statement. 
Ms Rosie Winterton: We have had 72 letters and e-mails from professionals, the public and organisations since July 2006 on end-of-life issues expressing a wide range of views and opinions. Ministers have held recent meetings with the Archbishop of Westminster and with Dignity in Dying during which issues including end-of-life issues were discussed.
In 2005-06, funding for digital hearing aids was given to individual primary care trusts that had the authority to make decisions about the allocation of resources for audiology services according to the needs of the populations they serve.
In 2006-07, the Department allocated NHS central revenue budgets on 25 July 2006. This amounted to a total allocation of £5.5 billion across all the strategic health authorities and is the aggregate value of all the individual allocations from many different budgets, including audiology. It is the responsibility of SHAs to reach agreement with their local NHS trusts and PCTs over the allocation of these resources to best meet local need. In addition, capital allocations for audiology services in 2006-07 amounted to £26 million.
A partnership between the Department of Health, The Royal National Institute for the Deaf and the audiology professional bodies has developed a new four-year BSc (Hons) in audiology. This will help to
address the national shortage of audiologists; currently there are 348 audiology students on eight BSc audiology courses.
The public-private partnership (PPP) is proving to be very successful and has recently been extended to March 2007. The latest data for October 2006 shows that about 50,000 patients have completed pathways through PPP. NHS trusts benefit from the increased capacity, competitive pricing and quality of service provision available through the PPP.
In order to provide digital hearing aids at an affordable cost to the NHS, contracts have been negotiated by the NHS Procurement and Supply Agency with certain manufacturers. NHS audiologists can choose from a range of aids on contract for different types and levels of hearing loss. This enables the NHS to treat more patients from the funds available.
The bowel cancer screening programme is an ambitious project, and one of the first of its kind in Europe. When fully implemented, it will detect around 3,000 bowel cancers every year. We are committed to implementing this important programme.
Ms Rosie Winterton: There is currently insufficient evidence for inviting women aged over 70 for screening, but research is underway for the advisory committee on breast cancer screening. A final report is due in the next few weeks, and the committee will advise us on a way forward.
We have collaborated with Age Concern to produce the leaflet, Over 70? You are still entitled to breast screening. The leaflet is widely available in general practitioner surgeries, health centres, breast screening units and Age Concern outlets.
Mr. Morley: To ask the Secretary of State for Health what steps are taken (a) to identify women at genetic risk from breast cancer and (b) to raise awareness of the genetic risk of that cancer. 
Ms Rosie Winterton:
The National Institute for Health and Clinical Excellence (NICE) published clinical guidance in May 2004 (updated October 2006
to reflect new evidence) on The classification and care of women at risk of familial breast cancer in primary, secondary and tertiary care. This provides clear guidance to health professionals on how to identify and manage patients who are, or are concerned that they may be, at increased risk of developing breast cancer because of their family history. The guidance has raised awareness among health professionals of the need to consider the possibility of genetic risk in women with a family history of the disease.
The Department is also currently jointly funding, with Macmillan Cancer Support, pilot services in seven sites, for people at risk of, or concerned about, familial cancer. The model offers a continuum of advice and care involving primary care, local cancer services and specialised genetic and cancer services to provide consistent management of individuals in the appropriate setting according to their level of risk. These aim to provide better, more patient-focused services for those concerned about their inherited risk of developing cancer by ensuring health care professionals along the patient pathway have relevant information to support and inform patients.
Paul Rowen: To ask the Secretary of State for Health what guidance she has issued to the National Institute for Health and Clinical Excellence on the use of (a) quality adjusted life year measures and (b) cost per life year gained when assessing cancer medicines. 
Andy Burnham [holding answer 1 November 2006]: No such guidance has been issued to the National Institute for Health and Clinical Excellence (NICE). NICEs appraisal methods are set out in its methods guide published in April 2004 and available on NICEs website at www.nice.org.uk/page.aspx?o=201973.
As part of NICEs normal business, its technology appraisal process and methodology is subject to periodic review which includes a public consultation. NICEs appraisal process was last subject to such a review in 2003-04, and I understand that NICE will be undertaking a further scheduled review next year including a public consultation stage.
To ask the Secretary of State forHealth what representations she has received from (a) patients and (b) other interested parties on the availability of intravenous immunoglobulin for the treatment of chronic inflammatory demyelinating polyradioculoneuropathy (CIDP); whether she intends to ask the National Institute for Health and Clinical Excellence to undertake a technology appraisal of intravenous immunoglobulin for the treatment of
CIDP; what steps she is taking to ensure patientshave access to intravenous immunoglobulin for the treatment of CIDP; and if she will make a statement. 
Mr. Ivan Lewis: We have received one recent email from a Guillain-Barre syndrome support group regarding access to intravenous immunoglobulin treatment for those living with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).
The National Institute for Health and Clinical Excellence can undertake technology appraisals only for treatments licensed in the United Kingdom. Currently there are no intravenous immunoglobulin drugs licensed for the treatment of CIDP.
It is the responsibility of primary care trusts, working with local health professionals, to ensure all patients have access to the most suitable drugs and treatments for their disease. This may include the use of medications off-licence if considered appropriate.
Mr. Amess: To ask the Secretary of State for Health what action her Department is taking to prevent the spread of clostridium difficile in (a) hospitals and (b) the community; what representations she has received from (i) members of the public and (ii) hon. Members on this issue; and if she will make a statement. 
In December 2005, the Chief Medical Officer and Chief Nursing Officer reminded the NHS of the importance of this infection, listed the key actions for its control and highlighted the guidance available. The current guidance is on the Health Protection Agency website at www.hp.org.uk and we have commissioned the HPA to review and update this national guidance. A new high impact intervention protocol on clostridium difficile disease was added to Saving lives: a delivery programme to reduce healthcare associated infections including MRSA in June 2006, and this tool will help the NHS reduce the number of infections. In addition, we will be introducing quarterly publication of mandatory clostridium difficile surveillance data as more rapid feedback of results will help performance.
However, controlling this infection requires appropriate management and clinical governance systems. This will be addressed by the code of practice for the prevention and control of health care associated infection developed under the Health Act 2006 which was published on 1 October 2006.
To ask the Secretary of State for Health pursuant to her oral statement of 5 July 2006, Official Report, column 819, on community hospitals, how
many community hospitals in the Thames Valley strategic health authority area are based in Victorian workhouse facilities.