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The World Health Organisation (WHO) makes recommendations, in the International Classification of Diseases, currently in its tenth revision (ICD-10), on certification of cause of death by doctors, coding and classification of diseases, and selection of a single cause for each death for statistical purposes. The General Register Office and ONS follow ICD-10 recommendations and go further, as explained below.
Doctors have a statutory duty, under the Births and Deaths Registration Act 1953, to certify the cause of death to the best of their knowledge and belief. GRO produces books of Medical Certificates of Cause of Death (MCCDs), in the format recommended by WHO, and supplies these to doctors through local registrars of births and deaths. The books include notes to doctors, based on ICD-10, on how to complete the MCCD. These ask the doctor to describe the sequence of illnesses or events that led directly to death in part I of the MCCD, ending on the last used line with the underlying cause of death. The underlying cause is defined by WHO as the disease or (external cause of) injury that initiated the morbid train of events leading directly to death. Certifiers are also asked to write in part II of the certificate any other conditions which contributed to the death but were not part of the direct sequence. WHO makes clear that the certifying doctor must use his/her clinical judgement to decide which of the conditions present at or before death contributed to the death and so should be included on the certificate.
In addition to the notes in the front of every book of MCCDs, the ONS Death Certification Advisory Group (DCAG) published updated guidance to certifiers in ACP News and on the GRO website (www.gro.gov.uk/medcert/) in June 2005. This guidance, which is also supplied to doctors with every new book of MCCDs, includes specific advice about certifying deaths involving health care associated infections (HCAI). The Department of healths Chief Medical Officer, Sir Liam Donaldson, in his CMO Update no 42 of July 2005, which is sent to all registered doctors, drew attention to the DCAG guidance in a short article entitled Certifying deaths involving MRSA http://www.dh.gov.uk/en/PublicationsAndStatistics/LettersAndCirculars/CMOUpdate/DH__4115663). These publications, from ONS/GRO and the Department of Health, make absolutely clear that doctors should include MRSA and other HCAI on the death certificate in the appropriate place if they believe that the infection was part of the direct causal sequence or contributed to the death.
WHO recommends that the underlying cause of death is tabulated for routine mortality statistics because preventing it would prevent not just the death, but the whole period of illness leading up to death and so result in the greatest health gain. MRSA infection is often associated with health care, and so it will not usually be the underlying cause of death, which may be the disease or injury necessitating the care during which the MRSA infection was acquired. Because of the public, policy, professional and media interest in the subject of MRSA infection, ONS provides more than just routine underlying cause statistics. Using ICD-10 codes and the full text from MCCDs, ONS publishes annual figures on the number of deaths in which MRSA was mentioned anywhere on the death certificate, in addition to those where it was selected as the underlying cause of death. Figures for 2001 to 2005 were published in Health Statistics Quarterly no 33, which is available in the House of Commons library, in February 2007. Statistics based on death certificates which cited MRSA have also been quoted in answer to a number of previous Parliamentary questions and published in Hansard. In 2005 there were 1,629 death certificates that cited MRSA in England and Wales and in 29% of these (467 deaths) MRSA was the underlying cause of death.
Dawn Primarolo: Information on the number of people employed by the National Institute for Health and Clinical Excellence (NICE) is not held by the Department. NICE is an independent body and should be contacted direct for this information. In 2007-08, NICE'S total budget is £35.05 million, of which £33,349 million was funding direct from the Department.
Graham Stringer: To ask the Secretary of State for Health what estimate he has made of the number of foundation hospitals whose boards met wholly in private; and what percentage this figure represents of the total number of foundation hospitals. 
The Department does not hold this information. Legislation governing national health service foundation trusts allows them to open board of governors meetings to the public. There is no equivalent provision for meetings of the board of directors. The way in which these meetings are conducted is a matter for individual trusts. Directors would need to justify decisions on the conduct of their
meetings with governors, who can hold directors to account for the performance of the trust and are responsible for communicating with the membership community information relating to the performance of the organisation.
Mr. Keith Simpson: To ask the Secretary of State for Health what the cost to the public purse has been of (a) early retirement and (b) redundancy agreements for (i) chief executives and (ii) executive directors who were not reappointed following reorganisation of the primary care trusts and NHS trusts in the eastern region. 
Dr. Gibson: To ask the Secretary of State for Health (1) whether the National Institute for Health and Clinical Excellence appraises the cost-effectiveness of the price paid for treatments by the NHS; 
Dawn Primarolo: The National Institute for Health and Clinical Excellence (NICE) Guide to the methods of technology appraisal, describes all aspects of appraisal methodology, including the principles and methods of health technology assessment. The Guide states that estimates of...prices for particular resources should be used consistently across appraisals, and that the Institute uses the public list price of a treatment when conducting its appraisals.
NICE is currently undertaking a review of its Guide to the methods of technology appraisal, which underpins the technology appraisal programme. NICE expects to commence a three-month public consultation on its findings in November 2007.
NICEs technology appraisal guidance on the use of erythropoietin analogues in the management of cancer treatment induced anaemia is due to be published in November 2007. The appraisal is being conducted in line with NICEs published methodology.
Dr. Pugh: To ask the Secretary of State for Health what the expected cost is of converting the NHS e-mail system to Microsoft Exchange; and what added functions will be provided by the new system. 
Mr. Bradshaw: NHSmail first went live October 2004. There are over 260,000 NHSmail users registered for the national health service e-mail and directory service which is increasing every week with an average of one million messages sent or received across the NHSmail platform daily.
Since 2004 the technological and market environment has changed significantly. A number of opportunities for technology refresh were built into the original NHSmail contract. The move to Microsoft Exchange is the first of those. The cost of the transition will not exceed the existing programme budget. Costs have been controlled partly by the licences gained through the renewal of the enterprise agreement with Microsoft and partly through the reuse of existing infrastructure.
The move to Exchange will deliver new functionality and improved usability to NHSmail users. These include full mobile access via an extensive range of wireless devices, facilitating access to the many peripatetic workers in the NHS, full support for shared calendar use between doctors and managers, easier navigation between screens and functions, and the ability to share contacts between users. Exchange will also enable much faster recovery should any event impact one of the two data centres.
Other additional features are currently under consideration, such as instant messaging, which we believe will further increase the service appeal to NHS staff. As a result of this and the features described above, early contact with NHS trusts and NHS staff indicates that the transition to Exchange is likely to increase NHSmail user take-up above the current rate of 5,000 new users per month.
Mr. Bradshaw: Revenue allocations to primary care trusts are informed by a fair funding formula. The formula is overseen by an independent body, the Advisory Committee on Resource Allocation (ACRA). ACRAs role is to ensure equity in resource allocation. In order to achieve this objective, ACRA ensures that the most up-to-date, accurate and robust data available at the time of making allocations are used in the formula.
Mr. Bradshaw: Cerner is the chosen subcontractor of two of the local service providers (LSPs) under the national programme for information technology in the national health service, Fujitsu in the South and BT in London, for the provision of secondary care systems.
In the South, six health communities have to date gone live with the Cerner Millennium system provided through the national programme. Each health community typically comprises an acute NHS trust and the associated primary care trust sites in its area. Details are provided in the following table.
|Trust name||Total users||Peak users||Average users||Go live date|
Five further systems are planned to go live in the South during 2007, 24 in 2008, and 19 in 2009. In London, three Millennium deployments are planned in 2007, the first, at Barnet and Chase Farm Hospitals Trust, due to go live before the end of July, and a further four in 2008. Go live dates in each strategic health authority (SHA) area are determined by agreement with the NHS bodies concerned.
The Millennium system is a robust product built on modern architecture, with greater patient data security and stability than older systems. It is used in many other countries and currently has a worldwide patient base of some 100 million patients. The version of Millennium being deployed through the national programme is based on that purchased in 2005 by two London NHS hospital trusts, the Homerton, and Newham University Hospitals Trusts. This version, release 0, contains the patient administration service functionality, is compliant with Choose and Book, and has the ability to order pathology tests and radiological diagnoses, and receive the reports. Subsequent releases will include ever greater functionality, particularly clinical functionality, bringing increasing benefits to patients and those who treat them.
Current users of the Homerton and Newham systems, who have had two years to become familiar with the system and to make local improvements, have expressed their satisfaction with the system. Further positive feedback has been received from a number of users, especially nurses.
Though the current Millennium release version has less functionality than that of certain advanced alternative systems in some trusts, this limitation is a necessary step in building up a fully integrated secondary care system through subsequent releases. Meanwhile, NHS Connecting for Health and SHAs are working closely with the LSPs and Cerner to further develop and improve the product, its functionality, and its ease of use.
Mr. Spring: To ask the Secretary of State for Health how many people are employed in the NHS in (a) England and (b) Suffolk; and what percentage of each is employed in (i) management, (ii) administrative, (iii) scientific, (iv) research, (v) clinical medical, nursing and midwifery and (vi) other roles. 
Qualified ambulance staff have been excluded as the East of England Ambulance Service Trust falls within the Suffolk region, but serves a much wider area. Consequently the number of ambulance staff in Suffolk is much higher than would be expected, which also distorts the percentages in the other staff group areas.
|National health service staff in England and Suffolk by specified staff group, as at 30 September 2006|
|England||Percentage||Of which : Suffolk||Percentage|
|(1 )The figures for Suffolk are based on 2006 Primary Care Trust and trust boundaries and consists of Ipswich Hospital NHS Trust, Suffolk Mental Health Partnership Trust, Suffolk PCT, West Suffolk Hospitals NHS Trust and East of England Ambulance Service NHS Trust.|
(2 )Front line medical staff includes HCHS doctors, general medical practitioners, qualified nurses (including GP practice nurses), qualified scientific, therapeutic & technical staff and Qualified ambulance staff.
(3 )Excludes medical hospital practitioners and medical clinical assistants, most of whom are general practitioners (GPs) working part time in hospitals.
(4 )General Medical practitioners includes GP providers, GP others, GP retainers and GP registrars.
Annual Workforce Census
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