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Here, the Healthcare Commission (HCC) inspects against the duties set out in the Code, which require them to have appropriate management and clinical governance systems in place to deliver effective infection control. In April this year, specialist HCC inspections began against the Code, thus ensuring that acute trusts will be inspected every year on the cleanliness of the environment.
the HCC's annual 'healthcheck' assessing against three national core standards which relate to cleanliness,
a national Cleanliness Summit held in February 2008, hosted by the NHS Chief Executive,
Patient environment action teams (PEAT), assessing the quality of the environment, (including cleanliness),
HCC's annual inpatient survey includes questions about cleanliness of the wards and of toilets,
at the end of May 2008, there were 5000 matrons in hospitals with more powers over cleaning,
the Department worked with the National Patient Safety Agency to issue a revised national specifications for Cleanliness in the NHS for hospitals in 2007,
an annual NHS spend on cleaning that has increased year on year since data collection began in 2000, the 2007-08 total spend being £720 million.
the development of a new national standard for monitoring cleanliness in healthcare environments. This work, which will be carried out under the auspices of the British Standards Institute, will focus in the first instance on hospitals in England, and will be developed by leading experts in the field of healthcare cleaning. A draft standard is anticipated by April 2009, in time for the establishment of the Care Quality Commission and its new regulation assessment.
compiling a compendium of good practice case studies arising from the Deep Clean initiative, (to be published this autumn),
issuing a national specification for cleanliness relating to GP surgeries and ambulances, (to be published this autumn),
reviewing the comprehensive NHS Healthcare Cleaning Manual (April 2004), to publish a revised version in summer 2009,
joint working between with the NHS Purchasing and Supplies Agency that will continue to look at new technologies for cleaning.
Steps taken in Southend-on-Sea, Essex and the Greater London area to improve hospital cleanliness, reflect the national initiatives set out above. More detail of cleanliness-related action in these particular areas is available from the relevant strategic health authority.
As set out in the Clean, Safe Care strategy, one element of the contract is the requirement for providers to achieve the target reduction in the rate of C. difficile agreed with PCTs. The contract provides for measures
to remedy any failure to achieve the required improvements and ultimately for a financial sanction if the failure continues.
Dawn Primarolo: All national health service bodies are subject to the Health Act 2006: Code of Practice for the Prevention and Control of Healthcare Associated Infections (commonly known as the Hygiene Code), which came into force on 1 October 2006. The Healthcare Commission (HCC) inspects hospital cleanliness against the duties set out in the code and has the power to issue an improvement notice, when it considers an NHS body is failing to observe the code. In addition to its scrutiny of trusts' annual declarations of their own assessments of the measures they have in place to meet the code, last year, the HCC made 120 unannounced visits to assess compliance independently. To strengthen this process, since April 2008, specialist teams from the HCC have been carrying out an annual infection control inspections programme of all acute trusts in the context of the code's requirements. The HCC plans to publish a summary report of some key emerging findings from these inspections shortly.
Additionally, the HCC's annual healthcheck procedure includes three national core standards set by the Department, (C4a, C4c and C21) which relate to cleanliness. The HCC assesses against these standards and it publishes the results.
Also, under the auspices of the National Patient Safety Agency, patient environment action teams, assess the quality of the environment, (including cleanliness), of every inpatient health care facility in England with more than 10 beds. The assessment takes place on a voluntary basis and leads to ratings of; excellent, good, acceptable, poor or unacceptable.
Mr. Amess: To ask the Secretary of State for Health what representations he has received since June 2007 on the use of ward sisters in relation to cleanliness on hospital wards; from whom those representations have been received; what response he gave; if he will place in the Library copies of (a) the representations received and (b) the replies given; and if he will make a statement. 
Fiona Mactaggart: To ask the Secretary of State for Health how many cases of (a) MRSA and (b) c. difficile infection there were in (i) Wexham Park Hospital and (ii) Upton Hospital in each year since 1997. 
The best source of data is the mandatory surveillance system for acute trusts. Surveillance of meticillin-resistant Staphylococcus aureus (MRSA) blood
stream infections (bacteraemia) started in April 2001 and surveillance for Clostridium difficile infection began in January 2004. Data are therefore not available before these times. Wexham Park hospital is part of Heatherwood and Wexham Park Hospitals NHS Foundation Trust and the data for the trust are shown in the following tables. Data are not available for Upton hospital as it is not an acute trust.
|MRSA bacteraemia reports: Heatherwood and Wexham Park Hospitals|
|April to March each year||Number|
|Number of C. difficile reports for patients >65 years: Heatherwood and Wexham Park Hospitals|
|January to December each year||Number|
All data are provisional.
Health Protection Agency.
Mr. Hancock: To ask the Secretary of State for Health what estimate his Department has made of the average length of time spent on waiting lists by patients who were transferred from one NHS hospital to another NHS hospital when the first hospital was unable to perform an operation in the latest period for which figures are available; what steps his Department is taking to reduce such waiting lists; and if he will make a statement. 
By the end of December 2008, no one should wait more than 18 weeks from the time they are referred by their general practitioner to the start of their treatment unless it is clinically appropriate to do so or they choose to wait longer. The 18-week target applies equally to those patients who need to transfer between hospitals while they are on their 18-week pathway.
Dawn Primarolo: The information requested on the unit cost, number of units and value of the contract for Cervarix is commercially confidential. The contract will allow the Department to purchase sufficient vaccine to vaccinate all the identified cohorts of girls eligible for the Human Papilloma virus vaccine under the national programmes in the United Kingdom.
Mike Penning: To ask the Secretary of State for Health (1) what the basis is for the efficiency assumption described on page 16 of his Departments impact assessment of proposals relating to Part IX of the Drug Tariff; 
(2) with reference to the impact assessment of his Departments proposals on Part IX of the Drug Tariff, what assessment he has made of the likely effect of a cap on reimbursement payments on contractor efficiency; and what factors were taken into account in deciding on 50,000 items as the cap on reimbursement; 
(3) what assessment he has made of the likely effect on patient choice of his Departments proposals to impose a capped payment structure for the reimbursement of stoma and incontinence items; 
(4) whether he plans to extend the imposition of a three per cent., reduction in remuneration as referred to in his Departments proposals relating to Part IX of the Drug tariff to other NHS suppliers. 
Dawn Primarolo: No explicit assumption on contractors ability to secure greater efficiency has been made by the Department. What has been suggested is that the national health service annual efficiency targets should be shared by dispensing contractors as well.
The 50,000 items cap has been raised significantly from previous proposals. For instance, in September 2007 the cap was set at 30,000 items. The cap does not apply to payment for specific services but to the infrastructure payment that has been proposed. The infrastructure payment is intended to contribute towards the cost of elements of essential service provision which are not directly linked to dispensing a prescription item; for instance, operating within a clinical governance framework.
In the consultation entitled Proposed new arrangements under Part IX of the Drug Tariff for the provision of stoma and urology appliancesand related services in Primary Care June 2008 there are no proposals relating to a capped payment structure for the reimbursement of stoma and incontinence items.
However, subject to the outcome of the consultation, patient choice could be increased as proposals regarding remuneration for service relate not only to the 100-plus dispensing appliance contractors but also to the 10,000 plus pharmacy contractors.
No reduction in remuneration for services has been proposed. In fact, the Department has estimated that if these proposals had been implemented in 2007 they would have increased overall expenditure by primary care in this area by £5 million. If the proposals are implemented, the level of expenditure will continue to rise in line with any increase in the number of Part IXA, B and C prescription items dispensed in the future.
To ask the Secretary of State for Health what assessment his Department has made of the possibility of extending the prescription fee to dispensing appliance
contractors in the proposed new arrangements under Part IX of the Drug Tariff for the provision of stoma and urology appliances and related services in Primary Care: A Consultation in June 2008; and if he will make a statement. 
Dawn Primarolo: In the consultation entitled Proposed new arrangements under Part IX of the Drug Tariff for the provision of stoma and urology appliancesand related servicesin Primary Care. June 2008 it has been proposed that dispensing appliance contractors should be required to provide a dispensing service for items that they supply in the normal course of their business and that they should receive a 90p professional dispensing fee for each part IX prescription item dispensed for providing this service.
This reflects one of the Departments stated aims of the review of the arrangements under part IX of the drug tariff for the provision of stoma and incontinence appliancesand related servicesin primary care, which is to ensure equitable payment to dispensing appliance contractors and pharmacy contractors for equivalent services.
Dr. Naysmith: To ask the Secretary of State for Health with reference to his Department's consultation of June 2008 on the proposed new arrangements for the provision of stoma and urology services and related services in primary care, what steps his Department is taking to ensure that the provision of associated services supplied with single line items is maintained. 
Dawn Primarolo: One of the stated aims of the review of the arrangements under Part IX of the Drug Tariff for the provision of stoma and incontinence appliancesand related servicesin primary care is the maintenance and, where applicable, improvement of the current quality of care to patientsand provision of a consistent level of care.
Although many dispensing appliance contractors and pharmacy contractors provide additional services such as home delivery, these services are not required under their National Health Service service provision. Therefore, we want to make sure that key services are included in the arrangements for the provision of pharmaceutical services made by primary care trusts under Part 7 of the NHS Act 2006 and incorporated in to the terms of service set out in the NHS (Pharmaceutical Services) Regulations 2005and that such services are provided to the same standard.
Consequently, the proposals relating to services set out in the consultation document entitled Proposed new arrangements under Part IX of the Drug Tariff for the provision of stoma and urology appliancesand related servicesin Primary Care. June 2008 apply to single line items.
Anne Milton: To ask the Secretary of State for Health (1) what assessment he has made of the likely effect on patient choice of his Department's proposals to impose a cap on remuneration for providers of stoma and incontinence services; 
(2) what assessment he has made of the likely effect on disabled people of his Department's proposals to impose a cap on the payment for stoma and incontinence services provided by contractors; 
(3) whether patients will continue to be able to choose any dispensing appliance contractor under the proposals in his Departments June 2007 consultation document on stoma and urology appliances; 
Dawn Primarolo: In reviewing arrangements under Part IX of the Drug Tariff for the provision of stoma and incontinence appliancesand related servicesone of the Department's key aims has been to maintain, and where applicable improve, the current quality of care to patientsand provide a consistent level of care. The Department recognises that a number of dispensing appliance contractors provide a number of services which many users value. However, these services are not required under the terms of their national health service service provision. Therefore, the Department wants to make sure that key services are included in the arrangements for the provision of pharmaceutical services made by primary care trusts under Part 7 of the NHS Act 2006, and incorporated in to the terms of service set out in the NHS (Pharmaceutical Services) Regulations 2005and that such services are provided to the same standard.
The latest consultation entitled Proposed new arrangements under Part IX of the Drug Tariff for the provision of stoma and urology appliancesand related servicesin Primary Care. June 2008, which has just closed, set out a number of proposals relating to remuneration for service provision directly linked to dispensing a prescription item. It was proposed that remuneration for only one such service should be capped. This service is appliance use reviews, which are intended to improve the patient's knowledge and use of the appliance they are using.
It was proposed that the number of total reviews that a dispensing appliance contractor or pharmacy contractor may claim for should be limited to one for every 35 Part IXA (catheter excluding any catheter accessory and maintenance solution), Part IXB and Part IXC prescription items dispensed in a year (April to March). However, the cap that was proposed in the latest consultation was lower than that proposed in earlier consultation published in September 2007; this was one for every 70 Part IXA (catheter excluding any catheter accessory and maintenance solution), Part IXB and Part IXC prescription items dispensed in a year (April to March). The new proposals reflected discussions with Industry and with representatives from the NHS and seeks to address concerns expressed about the previous cap.
The proposals set out in the consultation relate to the reimbursement for stoma and incontinence items dispensed and remuneration for related services. Consequently, patients will continue to be able to choose any dispensing appliance contractoror pharmacy contractorsubject to the fact that they provide the requisite appliance and related service in the normal course of their business.
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