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The scenarios discussed in the modelling summary paper include stockpiles of antibiotics of 0.4 per cent. and 14 per cent., pre-pandemic vaccines of 2 per cent., 40 per cent. and 100 per cent., and antivirals of 25 per cent., 75 per cent. and 100 per cent. population coverage. The outcomes of simulations of these scenarios are
taken into account, as well as a variety of important but non-scientific considerations, when deciding on the stockpile levels to be purchased.
Mr. Lansley: To ask the Secretary of State for Health what the evidential basis is for his statement that pandemic influenza plans are in place in most key sectors, as stated in paragraph 4.11.2 of his Departments National Framework for responding to an influenza pandemic. 
Dawn Primarolo: All Government Departments are directly or indirectly involved in preparing for an influenza pandemic and play an active role in informing and supporting contingency planning in their areas of responsibility, including public and private sector organisations. Departments work closely with these sectors to promote business continuity management and facilitate robust and resilient planning to deal with a wide range of emergencies, including an influenza pandemic. To facilitate sectoral planning central Government Departments have issued guidance specific to pandemic planning, and regularly meet stakeholders to update them on the emerging situation and to provide advice.
The National Capabilities Survey (NCS). The confidential survey goes out to organisations providing essential services; as well as local emergency responders, regional government offices and central Government Departments. This includes the private sector. The results of the last NCS survey in 2006, showed that, in the main, the essential services had well established business continuity plans, which were designed to prepare for, respond to, and recover from, a whole range of risks including an influenza pandemic. The NCS 2008 will give us a more detailed picture, by evaluating recent progress and exploring these issues in greater depth;
Exercise Winter WillowOver 5,000 people from government, industry and the voluntary sector participated in Exercise Winter Willow, with a common aim to review and validate our preparations and plans for the major challenges that an influenza pandemic would bring. This was supported by a number of sector specific exercises; and
Stakeholder engagementThe Cabinet Office and other Government Departments meet regularly with representatives from public and private sector bodies (through the business forum and other ad hoc meetings) to review the development of plans and to disseminate good practice.
Mr. Lansley: To ask the Secretary of State for Health what the evidential basis is for his statement on page 32 of his Department's National Framework for responding to an influenza pandemic, that fuel supplies are expected to be maintained in the event of an influenza pandemic. 
Dawn Primarolo: The Department for Business, Enterprise and Regulatory Reform (DBERR) continues to work closely with all its stakeholders in the fuel, energy, telecommunications and postal services sectors to ensure that they recognise the impact a pandemic would have on the United Kingdom and factor this into their business continuity plans so that any disruption to consumers is minimised.
We have continued to keep them up to date with Government policy and planning as set out in the National Framework. Should it become necessary, DBERR and industry, in consultation with other stakeholders, would introduce a range of measures to ensure that
essential supplies and services will be maintained. Planning by fuel suppliers is aimed at maintaining near-normal levels.
The results from the last National Capabilities Survey (NCSa confidential survey which goes out to organisations providing essential services, including the private sector, as well as local emergency responders, regional Government offices and central Government Departments) in 2006, also showed that, in the main, the essential services had well-established business continuity plans, which were designed to prepare for, respond to, and recover from a whole range of risks including an influenza pandemic.
Mr. Lansley: To ask the Secretary of State for Health what the evidential basis is for the statement that a high efficacy vaccine given to 75 per cent. of the population will eliminate further pandemic waves, as stated in paragraph 7.41 of the Cabinet Offices document Overarching Government strategy to respond to pandemic influenza: analysis of the scientific evidence base. 
Dawn Primarolo: The statement follows from epidemiological theory for a disease in which one infected person generally infects fewer than two or so others. This is understood to be likely for a future pandemic influenza based on previous pandemics and seasonal influenza, although the exact properties of such a virus cannot be known in advance.
Mr. Lansley: To ask the Secretary of State for Health what plans the Government have to procure a central stockpile of (a) aprons and (b) gloves for use by health and social care staff in the event of an influenza pandemic. 
Dawn Primarolo: Used correctly, disposable gloves and aprons will increase protection and support good hygiene practice in primary and secondary health care. The quantities and type of products needed and the options for procuring them are currently under consideration.
The Government do not purchase flu vaccine on behalf of individual general practitioners (GPs) or hospitals. GPs order their own supplies of flu vaccine from the supplier(s) of their choice based on the number of eligible patients on their register.
Mr. Spellar: To ask the Secretary of State for Health what steps his Department is taking to ensure that the purchase of disposable respirators and face masks for a possible flu pandemic will be sourced in the UK. 
Dawn Primarolo: The purchase of disposable face masks and respirators will be done in accordance with European Union procurement legislation and will also take full account of the ability of manufacturers to supply the numbers of products needed, wherever they are located.
Mr. Lansley: To ask the Secretary of State for Health what research has been commissioned by his Department since 1997 on the effectiveness of the seasonal influenza immunisation programme; and if he will place copies of this research in the Library. 
Dawn Primarolo: Two research projects(1) have been commissioned by the Department to study the effectiveness of the influenza immunisation programme for health care workers. The first studied the effectiveness of vaccinating care staff in preventing illness among residents of care homes. The second study looked at how well the health care worker vaccination policy was being implemented and the attitudes of health care workers to flu vaccination. The papers have been published in the scientific literature, and a copy has been placed in the Library.
(1)( )Hayward A.C., Harling R., Wetten S., Johnson A.M., Munro S., Smedley J., Murad S., Watson J.M.
Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial.
BMJ. 2006 Dec 16;333(7581):1241. Epub 2006 Dec 1.
Smedley J., Poole J., Waclawski E., Stevens A., Harrison J., Watson J., Hayward A., Coggon D.
Influenza immunisation: attitudes and beliefs of UK healthcare workers.
Occup Environ Med. 2007 Apr;64(4):223-7. Epub 2006 Dec 20
Mr. Stephen O'Brien: To ask the Secretary of State for Health on what dates since January 2007 the Information Centre for Health and Social Care has had discussions with the Prescription Pricing Division of the NHS Business Services Authority; and what the content was of such discussions. 
Mr. Swire: To ask the Secretary of State for Health what estimate he has made of the number of people likely to have undiagnosed active Lyme disease; and what steps his Department will take to (a) identify these people and (b) raise awareness of Lyme disease and its symptoms among GPs. 
The Department is not proposing to take steps to identify people with undiagnosed active Lyme disease. Those in whom infection is asymptomatic or has caused only mild or self-limiting symptoms and who do not consult a general practitioner (GP) are not identifiable. Those with active disease whose symptoms require them to seek a GP consultation will be diagnosed.
The Health Protection Agency (HPA) has published guidance for GPs and other clinicians on the diagnosis and treatment of Lyme Disease on its website and has also run various campaigns to promote awareness of Lyme disease among clinicians and the public.
The HPAs Lyme Disease Reference Laboratory provides an expert and freely available diagnostic service to GPs and other clinicians and has nationwide links to experts in infectious diseases, neurology, rheumatology and other specialties that have a particular interest in Lyme disease.
Mr. Swire: To ask the Secretary of State for Health what assessment he has made of the adequacy of blood tests as a tool for diagnosis of late-stage Lyme disease; and what other tools for diagnosis he is considering. 
Blood testing to confirm late stage Lyme disease is undertaken for the national health service by the Health Protection Agencys (HPA) Lyme disease Reference Laboratory. This laboratory is fully accredited and the tests conform to the internationally agreed testing criteria for Borrelia burgdorferi, the causative agent of Lyme disease, based upon stringent interpretation of serological test results. The testing is a two stage process: testing for the presence of antibodies to B. burgdorferi followed by specific immunoblot (Western blot) tests on all specimens that react in preliminary tests. The significance of the results are then carefully
assessed in the light of the patient's clinical signs and exposure history to ticks. This two stage testing procedure is carried out by world-renowned experts at the HPA's Lyme disease reference unit and supports the clinical assessment to provide the most accurate diagnosis. These tests are freely available to clinicians in the NHS. A small group led by the Inspector of Microbiology reviewed the testing methodology in 2006 and we are satisfied that the tests available to the NHS are adequate for the diagnosis of late-stage Lyme disease.
Molecular diagnostic tests have been developed for detection of B. burgdorferi and can be a useful in particular circumstances such as a diagnostic test on joint fluids in patients with suspected chronic Lyme arthritis. Such tests are not yet considered useful as a routine diagnostic tool. Direct detection by culture of B. burgdorferi is not useful for the diagnosis of late-stage Lyme disease.
The Chief Medical Officer's Inspector of Microbiology undertook a thorough investigation in 2006 of unorthodox and unvalidated blood tests offered by some non-NHS practitioners to make a diagnosis of Lyme disease in patients with medically unexplained symptoms similar to those of late stage Lyme disease. He found such unvalidated tests wholly unsuitable for the diagnosis of late-stage Lyme disease. His report is available at:
Norman Lamb: To ask the Secretary of State for Health whether medical students from non-European Economic Area countries undertaking postgraduate training will be able to complete their entire training in the UK; and if he will make a statement. 
Ann Keen: Medical students from non-European Economic Area countries undertaking post graduate training will be able to complete their training subject to satisfactory progress and meeting all competition and eligibility requirements.
Mr. Harper: To ask the Secretary of State for Health pursuant to the answer of 5 December 2007, Official Report, column 1318W, on mental health and employment: meeting the challenge, what the average cost is of treating an individual for depression and anxiety disorders. 
Mr. Ivan Lewis: Depression and anxiety disorders are treated in two main ways: by medication and through evidence-based psychological therapies such as cognitive behavioural therapies (CBT). No estimate has been made of the average cost per head of anti-depressants or other medication.
The London School of Economies Centre for Economic Performance calculates that the average cost per head to deliver a course of CBT for depression or an anxiety disorder is £750. Additionally, the National Institute for Health and Clinical Excellence has calculated that the average cost of delivering a course of CBT to patients with post-traumatic stress disorder at 12 weeks after the traumatic event (the most cost-effective option) is £825.
The cost calculation for delivering CBT and other evidence-based psychological therapies used in implementing the Improving Access to Psychological Therapies (IAPT) programme is lower than the above figures because the IAPT model of care includes a wider range of evidence-based therapeutic approaches and delivery methods.
Lynne Featherstone: To ask the Secretary of State for Health (1) what the rate of occupancy of psychiatric beds was in each London mental health trust in each of the last five years; and if he will make a statement; 
Not everybody who needs care for a mental health related problem needs a psychiatric bedeven in an emergency. We have developed a range of alternatives to in-patient acute beds. These include new models of practice, robust care pathways and supported accommodation or respite care in ordinary settings.
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