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23 Feb 2009 : Column 260W—continued
Information as to whether the transplantations listed were fully funded by the NHS is not collated centrally.
Mr. Stephen O'Brien: To ask the Secretary of State for Health pursuant to the answer of 14 January 2009, Official Report, columns 826-27W, on transplant surgery: foreigners, how many transplants of each type or organ have taken place in (a) private hospitals and (b) private units within NHS trusts and foundation trusts in each of the last 10 years. [257493]
Ann Keen: The following table shows the number of transplants to overseas residents in the United Kingdom units which the National Transplant Database has recorded as private hospitals, April 1998 - March 2008:
| Transplant type | 1998- 9 9 | 1999-2000 | 2000-01 | 2001-02 | 2002 -03 | 2003-04 | 2004-05 | 2005-06 | 2006-07 | 2007-08 | Total |
| (1) From living donor | |||||||||||
Pursuant to the answer given on 14 January 2009, Official Report, columns 826-27W, information is not collated centrally on whether the transplants took place in private units within national health service and foundation trusts.
Tuberculosis
Mr. Sharma: To ask the Secretary of State for Health what co-operation his Department undertakes with its counterparts in Scotland and Wales to combat tuberculosis in Great Britain. [256098]
Dawn Primarolo: Health policies for England, Scotland and Wales are determined by each country individually. However, each health department maintains regular contact and sharing of policies on tuberculosis (TB) through a number of formal routes, such as the UK Health Protection Oversight Group, which meets regularly to maintain good communication between the four nations (including Northern Ireland), and informally as needed.
Through these meetings, key publications such as the Department’s TB Action Plan, the NICE TB Prevention and Control Guidance and the awareness raising work are shared with Scotland and Wales, who consider England’s actions when formulating their own policies.
The Health Protection Agency in England has close links with each health department, and collects and publishes annual data on TB rates for each country.
Mr. Sharma: To ask the Secretary of State for Health what steps his Department is taking to improve general practitioners’ ability to detect tuberculosis at an early stage. [256105]
Dawn Primarolo:
In 2006, the Department has supported the National Institute for Health and Clinical Excellence (NICE) in development of guidance “Clinical Diagnosis and Management of Tuberculosis, and Measures for its Prevention and Control” to increase awareness of
tuberculosis (TB) among general practitioners to improve referrals for TB testing, diagnosis and treatment in specialised facilities.
Currently, the Department is sponsoring TB Alert to develop TB awareness raising messages for people at risk of TB to increase referrals for TB testing and effective treatment as well as with primary care workers to increase awareness of TB.
Tuberculosis: HIV Infection
Mr. Sharma: To ask the Secretary of State for Health what proportion of patients diagnosed with tuberculosis (TB) are subsequently tested for HIV infection; and what proportion of those diagnosed with HIV are subsequently tested for TB. [256090]
Dawn Primarolo: To protect identity of patients with HIV/AIDS, the national HIV/AIDS database is anonymised. For this reason, it is not possible to identify the sequence in which the diagnosis of tuberculosis (TB)/HIV co-infection was established. It is only possible to identify an overall proportion of patients with TB/HIV co-infection.
The most recent data from the Health Protection Agency indicate that approximately 8 per cent. of TB cases in England are co-infected with HIV (2005).
Mr. Sharma: To ask the Secretary of State for Health what proportion of tuberculosis (TB) patients in England are co-infected with HIV; and what plans there are to reduce HIV-TB co-infection rates. [256091]
Dawn Primarolo: The most recent data from the Health Protection Agency indicate that approximately 8 per cent. of tuberculosis (TB) cases in England are co-infected with HIV (2005).
The Department supported development of the following guidance that recommends shared case management between TB and HIV professions:
‘Clinical Diagnosis and Management of Tuberculosis, and Measures for its Prevention and Control’ (National Institute for Clinical Excellence (NICE), 2006)
‘Tuberculosis Prevention and Treatment: A Toolkit for Planning, Commissioning and Delivering High-Quality Services in England’ (2007);
‘Recommended Standards for NHS HIV Services’ (2003);
‘HIV in Primary Care’ (2004); and
‘HIV for non- HIV Specialists’ (2008).
Copies have been placed in the Library.
Tuberculosis: Medical Treatments
Mr. Sharma: To ask the Secretary of State for Health what proportion of tuberculosis (TB) patients received directly observed therapy in the last five years; what proportion of those had a treatment outcome of lost to follow up; and what steps NHS trusts take to encourage patients to complete the course of their treatment for TB. [256088]
Dawn Primarolo:
The Health Protection Agency (HPA) does not collect these data. The HPA has recently redeveloped its surveillance system to collect this information about risk factors and whether patients
started on treatment are under direct observation, and the new system is currently being rolled out nationally.
In 2007, the Department initiated a ‘Find and Treat’ (F&T) project to actively look for cases of tuberculosis (TB) among the homeless and other vulnerable groups in London, and to promote the use of directly observed treatment (DOT), which provides supervised medication and support to patients to improve adherence to treatment. Currently, the F&T team is helping over 300 people with TB who have challenging lifestyles to complete their treatment.
Mr. Sharma: To ask the Secretary of State for Health what steps his Department is taking to prevent the spread of multi-drug resistant tuberculosis. [256089]
Dawn Primarolo: Prevention of the emergence and spread of any type of drug-resistant tuberculosis (TB) is being addressed through the Chief Medical Officer's (CMO) TB Action Plan. The Plan provides guidelines to primary care trusts on improving the public health surveillance system, fast and comprehensive detection of cases, rapid identification of drug resistance if it exists, and good clinical management, including measures to ensure treatment is both appropriate and completed by the patient.
National Institute for Health and Clinical Excellence (NICE) Guidelines on the Treatment and Diagnosis of TB (2006) include specific guidance on treatment and rapid contact tracing of people in contact with any type of drug resistant TB.
The key step in preventing development of drug-resistant TB is improving adherence to treatment among those TB patients who have already started their treatment.
In 2007, the Department has initiated a 'Find and Treat' project to actively look for cases of TB among the homeless and other vulnerable groups in London, and to promote the use of directly observed therapy, which provides supervised medication and support to patients to improve adherence to treatment.
Mr. Sharma: To ask the Secretary of State for Health what percentage of those diagnosed with tuberculosis complete treatment; and what steps are being taken to increase treatment completion rates. [256092]
Dawn Primarolo: Information from the Health Protection Agency (HPA) Enhanced Tuberculosis Surveillance System shows that of the 93 per cent. of tuberculosis (TB) cases reported in 2006 in England for which the outcome is known, 79 per cent. completed treatment within 12 months of starting treatment.
The Department of Health has issued the following guidance which supports primary care trusts (PCTs) in improving treatment completion:
‘Clinical Diagnosis and Management of Tuberculosis, and Measures for its Prevention and Control’ (National Institute for Clinical Excellence (NICE), 2006); and
‘Tuberculosis Prevention and Treatment: A Toolkit for Planning, Commissioning and Delivering High-Quality Services in England’ (2007).
In 2007, the Department has initiated a ‘Find and Treat’ project to actively look for cases of TB among the homeless and other vulnerable groups in London, and to promote the use of directly observed therapy,
which provides supervised medication and support to patients to improve adherence to treatment.
Currently, the Department is sponsoring an awareness campaign by TB Alert to raise awareness of TB among groups vulnerable to TB, including the importance of TB treatment completion.
Mr. Sharma: To ask the Secretary of State for Health how much has been spent on treating drug-resistant tuberculosis (TB) patients in the last five years; and if he will estimate the cost of treating those patients as if they had drug-susceptible TB. [256097]
Dawn Primarolo: Data on the costs associated with treatment of multi-drug resistant tuberculosis (MRD-TB), either by case or in total, are not routinely collected. The National Institute for Clinical Excellence have undertaken analysis of TB treatment costs as part of the development of guidance ‘Tuberculosis—National clinical guideline for diagnosis, management, prevention, and control’.
An estimated average cost of treating one patient with MDR-TB is £60,000, compared to an £6,000 for an average case of drug-susceptible TB.
The number (and proportion) of confirmed tuberculosis cases with MDR-TB in England by year 2002-07 is as follows:
| Number | Proportion (percentage) | |
| Note: The proportions are among culture confirmed cases reported to ETS that had drug susceptibility testing results for at least isoniazid and rifampicin. Source: Health Protection Agency Enhanced Tuberculosis Surveillance System (ETS) | ||
Mr. Sharma: To ask the Secretary of State for Health what assessment his Department has made of the threat from extensive drug resistant tuberculosis (XDR-TB) to public health; and what capacity the NHS has to treat multiple XDR-TB patients. [256104]
Dawn Primarolo:
In the United Kingdom, less than 1 per cent. of tuberculosis (TB) cases are multi drug resistant (MDR-TB), that is, less than 50 TB cases per year. A very small proportion of the UK MDR cases might now be classed as extensive drug resistant tuberculosis (XDR-TB). The Health Protection Agency (HPA)
maintains monitoring of all types of TB, and since 1993, a total of eight cases would fall into the definition of XDR-TB.
Drug-resistant TB cases need to be treated in airflow controlled isolation. In 2003, the National Audit Office carried out an audit of the national health service (NHS) isolation facilities. A total of 176 trusts were surveyed. Out of these, 63 had at least one airflow controlled room, with a total of about 300 (this figure includes paediatric facilities). It is for the NHS to determine the local level of provision of isolation facilities.
Tuberculosis: Schools
Mr. Sharma: To ask the Secretary of State for Health how many outbreaks of tuberculosis have occurred in schools in (a) London and (b) England in the last five years. [256099]
Dawn Primarolo: The data for tuberculosis (TB) outbreaks are shown in the following table.
| Number of school outbreaks in England( 1) | Number of school outbreaks in London | |
| (1) Inclusive of London incidents. (2) As of 6 February 2009. Source: Health Protection Agency's TB incident and outbreak surveillance system (TBIOS) | ||
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