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Mr. Jamie Reed: To ask the Secretary of State for Health (1) whether any (a) services and (b) clinical procedures have been removed from the West Cumberland hospital, Whitehaven, to be undertaken at the Cumberland Infirmary, Carlisle, since the opening of the Cumberland Infirmary; 
In addition to the development of the action plan, the Department has also announced the procurement
of up to 300,000 audiology pathways to provide assessment, fitting and follow up.
Jon Trickett: To ask the Secretary of State for Health (1) how many people are waiting for hearing tests in (a) England, (b) West Yorkshire, (c) Hemsworth constituency and (d) Mid Yorkshire hospitals NHS trust; what steps are being taken to decrease these waiting lists; and if she will make a statement; 
(2) how many patients have been waiting (a) more than six months, (b) more than 12 months and (c) more than 24 months for a hearing aid to be issued after an initial hearing test and diagnosis in (i) England, (ii) West Yorkshire, (iii) Hemsworth constituency and (iv) Mid Yorkshire hospitals NHS trust; and what steps are being taken to decrease these waiting times. 
Mr. Ivan Lewis: The table contains information about the number of people waiting for audiological assessments, including hearing tests. A breakdown of data is not available for specific kinds of audiological tests. It includes details of the number of people waiting for audiological assessments within all primary care trusts (PCTs) in West Yorkshire. Figures on Hemsworth constituency are not available but figures for Wakefield PCT are shown in the table. We do not collect data about how long patients are waiting for a hearing aid fitting or issue following diagnosis.
|Commissioner based waiting information for audiological assessments (end of December 2006)|
|Total waiting||Total waiting over 26 weeks||Total waiting over 52 weeks|
Department of Health, DM01
Mr. Ivan Lewis: National health service data show that since the cancelled operations guarantee was introduced in April 2002, the number of last minute (on the day of admission) cancellations has fallen by 20 per cent. to 0.8 per cent. of elective operations, its lowest level for five years.
The guarantee covers heart operations for children although separate data on them are not collected centrally. Cancellations are sometimes unavoidable, due to emergency admissions, for example, but can be reduced through good planning and waiting list management. Clinical priority has to be the main determinant of when patients are seen. It is recognised that any cancellation is likely to cause anxiety, but this can be reduced by good communication between hospitals and patients.
The Department has taken a number of steps to reduce the number of late cancellations. The rate of cancelled operations is one of the key pieces of information given to patients to help them choose a hospital. Additional funding of £25 million a year has been provided to increase and improve access to paediatric intensive care, a significant part of which relates to scheduled heart operations for children.
Other steps include increasing the number of critical care beds by 36 per cent. between January 2002 and January 2006, and increasing the use of day surgery and treatment centres which minimize the disruption of emergency admissions. The number of cancellations is also addressed by the Healthcare Commission in its annual health checks on providers.
Mr. Lansley: To ask the Secretary of State for Health what the evidential basis is for her statement of 23 January 2007, Official Report, column 1305, that local variation in the incidence of Clostridium difficile is greater than local variation in the incidence of meticillin resistant Staphylococcus auerus. 
Mr. Ivan Lewis:
The statement was made in the context of considering a target for Clostridium difficile and how this differed from the meticillin resistant Staphylococcus aureus (MRSA) target. The MRSA national target was set when mandatory surveillance for this infection was well established. In contrast the
position for C difficile is different as mandatory surveillance was only introduced in 2004 and a reliable baseline from which to measure trends is not available yet. In addition, interpretation of C. difficile data is not straightforward as some trusts report cases that occur in the community and other trusts as well as their own cases. After considering these factors and the variation in C. difficile reports in 2006, when rates ranged from over five to less than one per 1,000 bed days we concluded that local targets were the best option as trusts and primary care trusts would be aware of local issues.
Norman Lamb: To ask the Secretary of State for Health what method the (a) Health Protection Agency and (b) Office of National Statistics use to collect statistics on hospital acquired infections; why the incidence of hospital acquired infections varies between the statistics published by each agency; and if she will make a statement. 
Mr. Ivan Lewis [holding answer 2 March 2007]: Statistics from the Health Protection agency (HPA) and Office for National Statistics (ONS) do not measure the same thing. HPA figures refer to incidence, that is the number of new cases, of infection. Figures from the ONS refer to deaths.
The HPA does not measure the incidence of all healthcare associated infections but collects data on selected healthcare associated infections of significance. All acute NHS trusts in England are obliged to report to the HPA cases in four categories are listed as follows.
Staphylococcus aureus (including meticillin resistant Staphylococcus aureus (MRSA) bacteraemias Clostridium difficile (age 65 and over)
Orthopaedic surgical site infections (SSI)
Glycopeptide resistant enterococci
The MRSA and SSI data are collected via web based systems but most of the other data are provided from routine laboratory reporting. This electronic reporting system also covers infections caused by other micro-organisms and hospital laboratories voluntarily supply these data.
The ONS does not collect information or publish statistics on the incidence (number of new cases) of hospital acquired infection. The ONS produces annual reports on deaths involving MRSA, and on deaths involving Clostridium difficile. The methods ONS uses in preparing these reports is explained fully in the reports themselves. ONS statistics are based on the cause of death information given by doctors and coroners on certificates used to register death and include all deaths that are registered in England and Wales. The cause of death statements from coroners and doctors are coded to the Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD-10), following internationally agreed rules and guidelines. From these data, ONS tabulates the numbers of deaths for which MRSA and/or Clostridium difficile infections were mentioned anywhere on the death certificate, and the numbers for which they were the underlying cause of death. It is not possible to say how many of these infections were acquired in hospital, because this information is not recorded on death certificates. ONS
figures therefore represent the actual number of deaths in England and Wales each year with MRSA or Clostridium difficile on the death certificate.
Doctors and coroners should only include on the death certificate conditions which they believe contributed to the death, not all of the conditions present at or immediately before death. Increased concern about health care associated infections, recent outbreaks of a virulent strain of Clostridium difficile and an article in CMOs update of July 2005 on certifying deaths involving MRSA may have led to increased reporting of these infections on death certificates. It is very difficult to obtain the evidence needed to measure how much of the apparent increase in deaths involving these infections is real and how much may be due to increased reporting
1. The third annual report on MRSA, and the second annual report on C. difficile were published in February 2007.
2. Report: Deaths involving MRSA, England and Wales, 2001-2005. Health Statistics Quarterly33, 76-81.
3 Report: Deaths involving Clostridium difficile, England and Wales, 2001-2005. Health Statistics Quarterly33, 71-75.
Jon Trickett: To ask the Secretary of State for Health what recent changes have been made to the provision of urinary and faecal (a) appliances and (b) services on the NHS; for what purpose in each case; what assessment she has made of the potential impact on users; and if she will make a statement. 
Mr. Ivan Lewis: We are not aware of any recent changes made to the provision of urinary and faecal appliances and services on the national health service. All health bodies are expected to follow the guidelines contained in Good Practice on Continence Services. These guidelines set out a model of good practice to help achieve more responsive, equitable and effective continence services.
Mr. Lansley: To ask the Secretary of State for Health what the evidential basis is for the statement that 2,500 live births a year at the Calderdale and Huddersfield maternity units were insufficient births to keep consultant staff at each unit fully occupied and up-to-date as specialists as referred to in her Departments publication Making it Better: For Mother and Baby. 
Mr. Ivan Lewis: The reconfiguration of maternity services in Calderdale and Huddersfield, to focus consultant-led services at Calderdale Royal Hospital, with a high quality midwife-led unit at Huddersfield Royal Infirmary, will enable viable local 24-hour consultant cover which provides sufficient practice for consultants to meet the standards set for education and training by the Royal College of Obstetricians and Gynaecologists, and meets the European Working-Time Directive for junior doctors. The proposals were scrutinised by the Independent Reconfiguration Panel, which found them to be the most appropriate way to deliver safe, effective and accessible maternity services for the 21(st) century.
Mr. Lansley: To ask the Secretary of State for Health pursuant to the statement on page 3 of Making it better: For mother and baby regarding the number of consultants needed in a maternity unit to work within the safety margins, what estimate she has made of the number of live births in a unit required to make it sustainable. 
Mr. Ivan Lewis: Local managers need to take account of a range of issues. These include how their services are organised within a maternity network, the provision of safe, responsive care for women with complex and straightforward pregnancies at all times, and arrangements for transfers across the network that take into account emergencies and geographical factors.
Philip Davies: To ask the Secretary of State for Health how much was spent on mental health in each primary care trust area in the last year for which figures are available; and how many mental health patients there were in each area. 
Ms Rosie Winterton: Information about the expenditure by each primary care trust (PCT) on commissioning secondary care mental health services in 2005-06 has been placed in the Library. The Department does not collect information about expenditure by PCTs on commissioning primary care mental health services.
Mr. Carswell: To ask the Secretary of State for Health how much funding from the public purse for treatment in the private mental health sector for patients referred via the national health service was provided in each of the last five years. 
Ms Rosie Winterton: Information is not available in the requested format. Data are available for the reported cash investment in the independent sector by the national health service in mental health services for working age adults in 2002-03, but accurate date is not available prior to this. From 2003-04 onwards, data are available only for the combined voluntary and independent sector reported cash investment by the NHS in mental health services. Available data are shown in the table.
|Non-statutory sector (independent and voluntary providers) reported cash investment in NHS mental health services for working age adults in England (£000)|
Mental Health Strategies February 2007
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