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Mr. Truswell: To ask the Secretary of State for Health which districts in the Yorkshire and Humberside strategic health authority area (a) have and (b) have not achieved the Healthcare Commission's recommended ratio of midwives to deliveries. 
Ann Keen: Strategic health authority maternity workforce plans are based on delivering safe care and their commitment to Maternity Matters (published on 3 April 2007), a copy of which has already been placed in the Library. Safe levels of midwives to births will vary according to variations such as case mix, local models of service delivery and staffing skill mix.
Mr. Truswell: To ask the Secretary of State for Health (1) how many full-time equivalent midwife agency staff have been employed at (a) Leeds General Infirmary and (b) St. James's Hospital in each month of the last two years; 
The information is not available in the format requested. The following table shows the number
of qualified midwives and bank staff in the Leeds Teaching Hospitals NHS Trust as at 30 September each specified year.
|Leeds Teaching Hospitals NHS trust|
|Midwives||Of which: bank|
| Notes: 1. The figures above reflect data as published each year. However, 2006 data needs to be treated with caution. During the validation process for the 2007 NHS workforce census, Leeds Teaching Hospitals reported that its registered midwives for 2006 should have been 267 and not 215 (excluding bank) as submitted at the time. 2. Full time equivalent figures are rounded to the nearest whole number. 3. Data Quality: Workforce statistics are compiled from data sent by more than 300 NHS trusts and primary care trusts (PCTs) in England. The NHS Information Centre for health and social care liaises closely with these organisations to encourage submission of complete and valid data and seeks to minimise inaccuracies and the effect of missing and invalid data. Processing methods and procedures are continually being updated to improve data quality. Where this happens, any impact on figures already published will be assessed but unless this is significant at national level they will not be changed. Where there is impact only at detailed or local level this will be footnoted in relevant analyses. Source: The Information Centre for health and social care.|
Mr. Lansley: To ask the Secretary of State for Health what progress his Department has made on the process for appointing the new Strategic Health Authority Medical Directors as announced in the NHS Next Stage Review, High Quality Care for All, published on 30 June 2008. 
Ann Keen: The strategic health authorities are making good progress in providing the medical leadership described in High quality care for all and we expect that all will have a medical director in post by April 2009.
Mr. Lansley: To ask the Secretary of State for Health what steps he (a) has taken and (b) plans to take to ensure that incomplete or unvalidated data returns for NHS bodies made available to Government departments are not used publicly by those departments. 
Mr. Stephen O'Brien: To ask the Secretary of State for Health with reference to the answer of 26 June 2008, Official Report, columns 519-22W, on NHS: personal records, how many nutrition-related adverse incidents were recorded in each month between January 2005 and December 2007 in each NHS trust. 
For the period between January 2005 and December 2007, it is estimated that there have been around 68,148 nutrition-related adverse incidents recorded
on the reporting and learning system (RLS) at strategic health authority (SHA) level.
Detailed information on the type and size of incidents is not held or analysed centrally by the Department or the National Patient Safety Agency and could be obtained only at disproportionate cost due to the complexity associated with processing 36 months of data by each trust.
Mike Penning: To ask the Secretary of State for Health how many people were employed as (a) managers and senior managers, (b) nurses and midwives and (c) administrative and clerical staff in each primary care trust in (i) 2006-07 and (ii) 2007-08. 
Ann Keen: A table showing the number of people that were employed as: managers and senior managers; nurses and midwives; and administrative and clerical staff in each primary care trust as at 30 September 2006 and 2007 has been placed in the Library. The data for 2008 will be published during March 2009.
Dr. Naysmith: To ask the Secretary of State for Health what recent consideration his Department has given to the variability of rates of exception reporting on quality and outcomes framework (QOF) indicator CHD 08; what his assessment is of the reasons for the range in rates of exception reporting for QOF indicator CHD 08 in each year since the introduction of the framework; and if he will make a statement. 
Ann Keen: Practices with extremely low or high rates, generally have small numbers of patients. For example, if there is only one patient and that patient is exception reported, then the rate will be 100 per cent. If that patient is not exception reported the rate will be 0 per cent. The highest exception rate for practices with substantial numbers of patients are almost always substantially below 100 per cent.
The exception rate for coronary heart disease (CHD) 8 for England in 2007-08 was 8.96 per cent. (compared with a rate of 5.26 per cent. across all indicators). The interquartile range of practice level exception rates for CHD 08 was 5.21 per cent. to 11.28 per cent.
There is evidence that some practices, whether in deprived or more affluent areas, are using exception reporting inappropriately. Manipulating quality and outcomes framework (QOF) data in order to increase rewards without delivering the required level of quality for patients is clearly unacceptableand also unfair on the majority of practices who comply with QOF requirements. Primary care trusts are responsible for verifying evidence of achievement. They should analyse exception rates and recorded prevalence, investigating any outliers, correcting payments where necessary and taking action if they uncover any actual fraud.
The Government are committed to ensuring in consultation with the profession, that QOF continually develops and supports leading edge quality of care for patients based on best available evidence. We will look at exception reporting and prevalence recording patterns as part of that process.
Dawn Primarolo: Shingles is not a notifiable disease and the Health Protection Agency does not undertake national surveillance of shingles. Data are available from some sentinel surveillance systems such as the General Practice Research Database (GPRD). A recently published study (Epidemiology and cost of herpes zoster and post-herpetic neuralgia in the United Kingdom) using data from the GPRD between January 2000 and the end of March 2006 reported an estimated 88,667 shingles cases in England per year in the population aged 50 and above.
Dawn Primarolo: The Consultation on the future of tobacco control included a consultation-stage impact assessment that calculated the costs and benefits of removing tobacco displays. This document can be viewed in the consultation document, which has been placed in the Library and is available online at:
Mr. Stephen O'Brien: To ask the Secretary of State for Health (1) in which NHS trusts have transplant operations been performed on foreign nationals in the last 12 months; which organs or tissues were transplanted in each case; and how the (a) trust and (b) NHS were remunerated for the procedure; 
Departmental Directions, issued in September 2005 by authority of the Secretary of State for Health under section 17 of the National Health Service Act 1977 to NHS Blood and Transplant (NHSBT), specify that priority for transplants should be given to group 1 patients (mainly people ordinarily resident in the United
Kingdom or in countries with which the UK has reciprocal health arrangements) rather than group 2 (those not in group 1). Group 1 includes European Union residents. Group 2 patients are only entitled to an organ if there is no one in group 1 who is clinically suitable. It is the responsibility of the consultant registering each patient for transplant to confirm eligibility, and NHSBT and/or transplant centres are then responsible for ensuring organs are correctly allocated based on eligibility information supplied.
The transplantation of donated organs into non-UK EU residents who qualify for NHS treatment is guided by European law, which effectively regards such patients as having equal access to the NHS. Decisions over accepting a patient on to the transplant waiting list rests with the individual transplant centre. Article 3 of Regulation 1408/71 provides for equality of treatment under the regulation. Therefore health care should be provided in the UK to another European economic area national on the same basis as it would be to a UK national. Under EU Regulation 1408/71 a citizen of a member state can seek prior authorisation (via an E112) from their health authorities to go to another member state for planned state-sector treatment. The decision about whether to authorise a referral is a clinical one by that citizens member state, taking into account factors such as whether undue delay applies or whether it is a specialist treatment that the home state cannot supply. The citizens member state covers the cost of the referral.
Patients receiving transplants in the UK would normally receive organs from UK donors. The exception to this would be organs supplied from elsewhere in the EU under reciprocal arrangements which exist to offer organs to other member states if there is no clinically suitable patient in the member state of origin.
|Table 1: Organs from non-UK hospitals into UK hospitals, in the last 10 years|
|Table 2: Organ and (ocular)( 1) tissue transplants in the UK where the recipient is recorded as being resident outside the UK( 1) , by trust of transplanting hospital, April 1998 to March 2008|
|Deceased donor||Living donor|
|(1) Ocular tissue is the only tissue which is traced back to a patient. Residents of the Republic of Ireland are not included in these figures.|
(2) Includes one liver/kidney/pancreas transplant.
(3) Domino donor.
(4) Includes one liver/kidney transplant.
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