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Mr. Lansley: To ask the Secretary of State for Health (1) what guidance his Department gave to strategic health authorities to help them decide how much they should allocate for deep cleaning in 2007-08; 
Ann Keen: I refer the hon. Member to the written ministerial statement by the Secretary of State for Health on 21 November 2007, Official Report, columns 134-35WS. In addition, copies of letters of 1 and 29 November 2007 from the Department to strategic health authorities giving further details on plans for deep cleaning have been placed in the Library.
Ann Keen: Within the Department, different teams within the Chief Nursing Officer's Directorate and the NHS Finance, Performance and Operations Directorate are involved in different aspects of the deep clean programme, for instance in policy development or performance management. As it is a front line delivery issue, the programme will be delivered by trusts and monitored by primary care trusts and strategic health authorities (SHAs). SHAs will ensure that all trusts have plans in place to deliver deep cleans before 31 March 2008.
Ann Keen: Information is not collected in the precise format requested. However, in 2006-07 the average amount spent per patient meal was £2.83. This amount includes the cost of provisions and staff costs. Patients are expected to receive three main meals a day and the average total daily cost of providing food for hospital patients can therefore be estimated to be £8.49.
Mr. Lansley: To ask the Secretary of State for Health how much his Department plans to spend in each year between 2007-08 and 2010-11 on (a) MRSA and (b) clostridium difficile screening for (i) elective patients and (ii) emergency admissions. 
Funding to support implementation of screening of all patients for meticillin resistant Staphylococcus aureus will be reflected in future primary care trust allocations. Our central assessment of the cost of screening all admitted patients for
MRSA is £124 million per annum, but it is for local organisations to determine how to implement improvements to patient care, so actual spend will be based on local implementation decisions.
Prompt testing of patients who develop diarrhoea is crucial but we have not made any commitments to introduce screening for clostridium difficile because there is no evidence that it is clinically effective.
Ms Abbott: To ask the Secretary of State for Health what change there has been in the level of hospital-acquired infections since the introduction of subcontracting in hospital cleaning; and if he will make a statement. 
Ann Keen: Mandatory surveillance of health care associated infections was not introduced until 2001 but prevalence surveys of health care associated infections were undertaken in 1980, 1993 and 2006. There has been little change in the prevalence of hospital acquired infections overall over the last twenty years.
The Conservative Government introduced compulsory competitive tendering in 1983, requiring the national health service to market test domestic cleaning, catering, and linen and laundry services on a regular basis. This Government lifted that requirement in 2000 and trusts must now benchmark their services before deciding whether to market test.
Current guidance on contracting for cleaning makes it clear that quality must be considered alongside cost when deciding how to provide cleaning services. Recent information suggests that there is currently no difference between in-house and out-sourced cleaning in terms of standards and outcomes.
Mr. Lansley: To ask the Secretary of State for Health which NHS trusts (a) were and (b) were not auditing compliance with policies on invasive procedures, as stated in his Department's chief nursing officer's Dear Colleague letter of 8 November 2007, on the national confidential study of deaths following MRSA infection. 
Mr. Lansley: To ask the Secretary of State for Health if he will provide a breakdown of the £140 million his Department was allocated in the comprehensive spending review to reduce clostridium difficile infections by (a) financial year and (b) anti-infection measure on which this money will be spent. 
Ann Keen: This funding will be included within primary care trust (PCT) allocations to support PCTs to reduce health care associated infections. PCTs are responsible for delivering improvements to patient care, so actual spend will be based on local decisions. Information on the action we expect from the national health service will be included in the Healthcare Associated Infections and Cleanliness Strategy which we will be publishing in early 2008.
To ask the Secretary of State for Health if he will provide a breakdown of the £130 million his
Department was allocated in the comprehensive spending review for the introduction of MRSA screening for all patients, increased powers for matrons and tougher regulation on infection control by (a) financial year and (b) anti-infection measure on which this money will be spent. 
Ann Keen: The £130 million announced in the comprehensive spending review 2007 was for the introduction of Meticillin resistant Staphylococcus aureus screening for all patients. Primary care trusts are responsible for delivering improvements to patient care, so actual spend will be based on local decisions. Further details on implementation of this commitment will be included in the Healthcare Associated Infections and Cleanliness Strategy which we will be publishing in early 2008.
Mr. Lansley: To ask the Secretary of State for Health for what reason his Department has (a) made a commitment to screen patients for MRSA on admission to hospital, and (b) not made a commitment to screen patients for health care associated infections other than MRSA. 
Ann Keen: This commitment is based on evidence that screening admitted patients for meticillin resistant Staphylococcus aureus can reduce infection rates. Equivalent data are not available for other infections. In relation to clostridium difficile infection specifically, expert advice is that screening of asymptomatic patients is unnecessary.
Mr. Amess: To ask the Secretary of State for Health which (a) diseases and (b) conditions were treated using materials created by research on (i) embryonic stem cells and (ii) adult stem cells in each year since 1997. 
Dawn Primarolo: Stem cell research offers exciting opportunities to develop new therapies for a broad range of debilitating conditions, some of which are currently incurable (e.g. neurodegenerative disease). However, at this time, the only clinical use of stem cells remains bone marrow transplants for cancer therapy, though a number of other adult stem cell therapies have entered early phase clinical trials.
The MRC spent £17.4 million on stem cell research in 2005-06, split 55 per cent. and 45 per cent. between embryonic and adult stem cell research. Much of this is directed at improving the understanding of stem cell biology to ensure effective and safe therapies can be delivered. In terms of clinical therapy, the MRC is funding work in Cardiff to look at transplanting foetal stem cells (and in the longer term human embryonic stem cells) for the neurodegenerative diseases Huntingtons and Parkinsons (approximately £2 million), while two experimental medicine awards were funded in 2006 to move towards human trials in stroke and multiple sclerosis (both using autologous adult stem cells).
Dawn Primarolo: The routine programme could cost up to £100 million a year and the catch-up programme could cost up to £200 million in 2009-10 and 2010-11. Exact figures will not be known until the procurement process for human papilloma virus vaccine has been completed.
Adam Afriyie: To ask the Secretary of State for Health what assessment he has made of the contribution which will be made by medical research to achieving the Government's public service agreement 2010 target to reduce infant mortality. 
Dawn Primarolo: Strengthening the research and evidence base to help meet the 2010 health inequalities and infant mortality target was a recommendation of the Review of the Health Inequalities Infant Mortality PSA Target published in February. As part of this developing work, the Department has commissioned a programme of systematic reviews of the research evidence to identify and promote the key interventions most likely to contribute to meeting the 2010 target.
Dr. Murrison: To ask the Secretary of State for Health if he will place in the Library copies of all representations received in response to his Department's national framework for responding to an influenza pandemic; and if he will make a statement. 
Dawn Primarolo: The draft version of Pandemic flu: A national framework for responding to an influenza pandemic was issued for public discussion and comments were reflected in the final version issued in November. We are not planning to place the representations in the Library.
Dr. Murrison: To ask the Secretary of State for Health (1) what information is being made available on the use of (a) anti-viral drugs, (b) facemasks and (c) stocking of home supplies in consequence of Exercise Winter Willow; and if he will make a statement; 
(3) what steps are being taken to consider the prioritisation of (a) anti-viral drugs, (b) vaccines and (c) antibiotics in the event of a shortage of supply caused by any future influenza pandemic; and if he will make a statement; 
(4) what assessment he has made of the (a) costs and (b) benefits of a national stockpile of (i) masks
and (ii) antibiotics for health professionals in preparation for any future influenza pandemic; and if he will make a statement; 
(5) what steps are being taken to ensure that the continuity of supply of (a) anti-viral stocks, (b) masks and (c) antibiotics in the event of any future influenza pandemic; and if he will make a statement; 
(6) what assessment he has made of the impact of increased demand for countermeasures against an influenza pandemic on the supply of (a) masks and (b) antibiotics; what steps he is taking to ensure that supply meets demand in the event of an outbreak; and if he will make a statement. 
Dawn Primarolo: Vaccines, antivirals, antibiotics and facemasks are a key part of the Government response to pandemic influenza. The Government approach to the stockpiling and distribution of these countermeasures is covered in the national framework for responding to an influenza pandemic, published on 22 November 2007. The lessons learned from Exercise Winter Willow have been published on the Cabinet Office website.
Stockpiling of clinical countermeasures is essential to ensure the continuity of supply and that demand can be met. For example, there is already a stockpile of antivirals sufficient to treat the United Kingdoms population up to a clinical attack rate of 25 per cent. The Government are planning to double the stock of antivirals, to cover at least half the population. We will continue to keep the level of stock under review in light of the scientific evidence, as we develop our business case. The Government also has a stockpile of 3.3 million doses of H5N1 pre-pandemic vaccine for health care workers. The science underpinning the further development and potential use of pre-pandemic vaccine is cutting-edge and has just been reviewed by UK and international experts. We are actively considering their findings and the implications for our policy to inform future decisions.
The antivirals stockpile should be adequate to treat all those who fall ill in a pandemic of similar proportions to previous ones in the 20th century but we recognise that some prioritisation will be necessary if the attack or consumption rates are higher than anticipated. Antiviral prioritisation has been considered with the Committee on Ethical Aspects of Pandemic Influenza, but final decisions can only be made when the pandemic emerges.
To be effective, antiviral medicines need to be taken within 48 hours of the onset of symptom. A National Flu Line Service is being developed to enable timely distribution. On contacting the National Flu Line Service, a clinical algorithm will be used to assess a callers symptoms and determine whether or not they are eligible for antiviral treatment and/or need further care or treatment by a clinician. We are making use of and building upon normal delivery systems by asking NHS Direct, who already provide contact-centre based assessment and triage to callers, to lead on the development of the National Flu Line Service. We are engaging with other stakeholders on its development, including the NHS, independent contractors, and other existing contact centre services. Consultation on legal changes necessary to facilitate this system went out alongside the national framework. The national
framework and its supporting guidance, will help trusts create effective local systems for coordinating the operational aspects of antiviral allocation with local partners prior to a pandemic occurring.
The Government are already making progress with work on the business case for facemasks to be made available to healthcare and social care workers during a pandemic and plan to purchase 34 million disposable respirators and 350 million surgical face masks for the use of health and social care workers in the event of a pandemic. The national framework, advises other employers to seek information on their obligations under health and safety legislation and to carry out local risk assessments to determine whether employees should be provided with facemasks. Stockpiling facemasks for use by the general public is not currently planned. Although the available medical evidence does not support the use of facemasks in all settings, we recognise that the public may want to have access to facemasks for their personal use. The Government will explore the approach that retailers are planning to adopt when stocking facemasks for sale to the public.
Exercise Winter Willow identified that there may be problems with managing the surge in demand for antibiotics. The range of antibiotics needed to treat bacterial complications arising from pandemic influenza has been identified and published in the form of Clinical Management Guidelines. Building on this, the Government plan to procure 14.7 million treatment courses of antibiotics to treat and prevent the complications arising from pandemic flu. That stockpile will enable us to give antibiotics to vulnerable symptomatic flu patients, such as those with chronic conditions and the elderly, in advance of the development of secondary complications, and to treat others in the community if they develop complications. The antibiotics will also be used in hospitals to treat the sickest patients and may reduce the length of hospitalisation. The procurement of both antivirals and antibiotics will be subject to emerging scientific evidence and to normal commercial procurement procedures to ensure that we purchase those products at the best price, and achieve value for money for the taxpayer.
This summer, Advance Purchase Agreements for pandemic specific vaccine were signed with GlaxoSmithKline and Baxter. These guarantee a supply of vaccine for the UK population as soon as the vaccine becomes available after the onset of the pandemic; decisions about vaccination strategies will only be made once the clinical impact of the disease becomes known. All decisions on prioritisation will take scientific and ethical issues fully into account.
Public consultation and information is at the heart of the Governments planning. The Government will be testing the public's reactions to many issues in pandemic planning and decision-making and gauge the level of information on specific issues, including the use of clinical countermeasures. Work continues on the design of a public engagement programme to facilitate this process, with the active participation of the public.
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