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25 Feb 2009 : Column 874W—continued
the establishment of improvement teams to go into those hospitals that need more support, to help them focus on improving patient experience in this area.
We know from our success in driving down health care associated infections (HCAIs), that the improvement team approach has a good track record in delivery. We are therefore setting up a short-term central improvement team for mixed sex accommodation with an expected life of around six months. The intention is that thereafter responsibility will be devolved to the NHS. The fine details of who will be employed in the teams, and how they will be deployed will depend on local needs, and are currently being developed.
Funding from the privacy and dignity fund will not be specifically attached to improvement teams, rather it will be distributed against detailed plans drawn up by each SHA. Distribution of resources within SHAs will be based on those schemes that demonstrate the greatest return for the planned investment.
Our existing definitions in respect of the environment are still relevant, and are set out below. However, we have expanded this to move towards a definition based on individual patient experience, rather than on buildings.
It is not acceptable for people to share sleeping accommodation unless it can be clinically justified for each patient. Some of the circumstances in which this might apply are as follows:
patient needs very high-tech care, with one-to-one nursing (e.g. ICU, HDU);
patient needs very specialised care, where one nurse might be caring for a small number of patients and cannot safely leave the room other than for very short periods (e.g. immediately following major surgery); and
patient needs very urgent care (e.g. rapid admission following a heart attack)
Inevitably, applicability of the above circumstances calls for a fine judgement that needs to be made on an individual basis. For instance, in a four-bed bay, it means that mixing must be justifiable for all patients, not just one. It is also a judgement that needs to be revisited regularly—for example, in the very early stages following a stroke, when the patient has reduced consciousness and needs regular observation, then mixing might be justifiable. However, in the later stages of recovery, when the patient is receiving rehabilitation (or palliative care), then we would expect greater segregation.
Men and women should not normally have to share sleeping accommodation or toilet facilities. Irrespective of where patients are, staff should always take the utmost care to respect their privacy and dignity.
Single-sex accommodation can be provided in:
single-sex wards (i.e. the whole ward is occupied by men or women but not both);
single rooms with adjacent single-sex toilet and washing facilities (preferably en-suite); and
single-sex accommodation within mixed wards (i.e. bays or rooms which accommodate either men or women, not both; with designated single-sex toilet and washing facilities preferably within or adjacent to the bay or room).
In addition, patients should not need to pass through opposite sex accommodation or toilet and washing facilitates to access their own.
There are no exceptions to delivering high standards of privacy and dignity. The exceptions established under ‘Mixed-sex accommodation: Health Service Circular 1998/143’ were reporting exceptions only, and no longer apply.
In Vitro Fertilisation
Mrs. Dean: To ask the Secretary of State for Health (1) what assessment he has made of the effect of a policy of single embryo transfer on the full implementation of National Institute for Health and Clinical Excellence guidelines on fertility by primary care trusts; [257359]
(2) what recent assessment his Department has made of how a policy of single embryo transfer will be implemented in fertility clinics; and if he will make a statement; [257360]
(3) what recent discussions (a) he and (b) his Department have had with (i) primary care trusts and (ii) other organisations on implementing a policy of single embryo transfer. [257363]
Dawn Primarolo: The Human Fertilisation and Embryology Authority (HFEA) in partnership with professional bodies and other stakeholders, including patient groups and representatives of the national health service (NHS), has developed a national strategy to significantly reduce the incidence of multiple births resulting from in vitro fertilisation (IVF) and related treatments. This strategy is known as the One at a Time campaign and includes promoting greater use of single embryo transfers (SET) where this is clinically appropriate for individual patients, leaving scope for the exercise of clinical discretion. The Department has observer status on the group that has determined the strategy.
The HFEA policy aims to lower the average national multiple birth rate from the current rate of just under 23 per cent. of all live birth events following IVF and related treatments to 10 per cent. For 2009, HFEA licensed treatment centres are expected not to exceed the 24 per cent. figure, a figure determined by the HFEA, on the basis of national average at the time the Year 1 target was agreed. This target will be progressively lowered towards a 10 per cent. national target. The HFEA will carefully monitor the impact of its policy, including any impact on fresh embryo treatment cycle pregnancy rates, to ensure that all the target rates set are appropriate. The HFEA will set a Year 2 maximum multiple birth rate in the light of progress during 2009. The HFEA wrote to all directors of public health in primary care trusts about this on 4 February 2009.
The HFEA has required all licensed treatment centres to have in place a documented multiple births minimisation strategy, setting out how they intend to reduce their annual multiple birth rates and to ensure that they do not exceed the maximum rate set. These strategies must include criteria for SET. Centres are required to send copies of their strategies to the HFEA.
The Department has established an expert group on commissioning NHS infertility provision to identify the barriers to the implementation of the National Institute for Health and Clinical Excellence (NICE) fertility guideline in England and to help NHS commissioners to progress towards full implementation of the guideline. The expert group produced an interim report in August 2008, which recognised that patients are more likely to accept SET if they are assured that provision of services is established in line with the NICE guideline.
Local Public Health Laboratories
Mr. Illsley: To ask the Secretary of State for Health (1) what plans he has for the future funding of local public health laboratories; [257802]
(2) how many public health laboratories have closed in the last 10 years. [257803]
Dawn Primarolo: The information requested is not available concerning closures of public health laboratories between 1999 and 2003, when public health laboratories were the responsibility of the Public Health Laboratory Service (PHLS). Responsibility in England for the public health laboratory function was transferred from the PHLS to the Health Protection Agency (HPA) on 1 April 2003. There have been no closures of public health laboratories since 1 April 2003, although there have been some changes in the service configuration.
The Department plans to continue funding the HPA to carry out this function locally, as well as regionally and nationally, in line with its responsibilities under the Health Protection Agency Act 2004.
NHS: Construction
Mrs. Curtis-Thomas: To ask the Secretary of State for Health what assessment he has made of the compliance of NHS trusts undertaking construction projects with Government guidance requiring payment of invoices submitted by tier one contractors within 10 days. [258747]
Mr. Bradshaw: National health service prompt payments to suppliers’ performance information, is collected on a quarterly and on an annual basis against a 30 day target. Information on performance by industry sector or supplier is not collected.
David Nicholson, NHS chief executive, wrote to all NHS trust chief executives on 21 October asking them to examine and review existing payment practices and payment performance and to move as closely as possible to the 10-day payment commitment that has been set for Government Departments wherever practical. Bill Moyes, executive chair, Monitor, has written similarly to all foundation trusts.
However we do not currently collect performance data of total NHS bills paid within 10 days because no specific requirement has yet been placed on NHS bodies to meet this target.
NHS: Drugs
Mr. Russell Brown: To ask the Secretary of State for Health (1) whether his Department has issued guidance to primary care trusts on the funding of drugs commonly used towards a patient’s end of life via exceptional case procedures; [257210]
(2) what his Department's policy is on the provision of drugs commonly used towards the end of life for patients with rarer cancers; [257211]
(3) what his Department’s policy is on the disparities which exist between different health care trust areas in the provision of those drugs commonly used by NHS patients approaching the end of their lives; and if he will make a statement. [257212]
Phil Hope: On 21 January 2009, the Department issued draft Directions to primary care trusts (PCTs) on decisions about drugs and other treatments along with a guiding principles document aimed at helping PCTs improve the consistency and quality of local decision making on drug funding in England. Copies of the draft Directions and the guiding principles have been placed in the Library. The National Prescribing Centre will shortly be publishing a handbook of good practice offering practical advice to help PCTs in making drug funding decisions.
On 2 January 2009, the National Institute for Health and Clinical Excellence (NICE) issued supplementary advice to its Appraisal Committees, to provide more flexibility in the evaluation of higher-cost drugs, which have been shown to extend the lives of terminally ill patients with less common conditions. This advice is available on NICE’s website at:
“The NHS Constitution”, which was published on 21 January 2009, includes a right for patients to access drugs and treatments that have been recommended by NICE for use in the NHS if they are clinically appropriate. A copy has already been placed in the Library. It also sets out the right of patients to expect local decisions on the funding of other drugs and treatments to be made rationally following a proper consideration of the evidence.
NHS: Manpower
Mr. Stephen O'Brien: To ask the Secretary of State for Health how much the Department has spent on legal fees in completed actions against individual NHS staff in each of the last five years, broken down by case. [256712]
Ann Keen: The Department does not take legal action against individual national health service staff.
Mr. Stephen O'Brien: To ask the Secretary of State for Health how much his Department has budgeted for legal fees in respect of actions against NHS staff in 2008-09. [256796]
Ann Keen: The Department does not take legal action against individual national health service staff, and therefore does not set a budget for such activity.
Nutrition: Screening
Mr. Burstow: To ask the Secretary of State for Health what discussions he has had with healthcare professionals on the inclusion of nutritional screening as a directed enhanced service in the community pharmacy contract. [257181]
Phil Hope: The Department has had no discussions on the inclusion of nutritional screening as a directed enhanced service in the community pharmacy contract.
The provision of healthy lifestyle advice, including advice on diet and nutrition is already an essential service to be provided by all community pharmacies for people presenting prescriptions for diabetes, those at risk of heart disease, those who are hypertensive, who smoke and are overweight. Educational resources were
distributed to all community pharmacies in March 2007, to help them provide healthy lifestyle advice in a consistent manner. They are available at:
Pharmacy: Health Services
Mr. Lansley: To ask the Secretary of State for Health (1) what recent estimate he has made of the proportion of pharmacy consultations which result in referral to other healthcare services; [255442]
(2) what estimate he has made of the proportion of pharmacies which provide an influenza vaccination service; [255454]
(3) what progress his Department has made towards applying world-class commissioning competencies to the commissioning of pharmaceutical services, as referred to on page 23 of his Department's White Paper, Pharmacy in England, Cm 7341; [255458]
(4) what progress his Department has made in discussions on appropriate measures to support adherence to medicines, as referred to on page 33 of his Department's White Paper, Pharmacy in England, Cm 7431; [255501]
(5) what progress his Department has made on research to establish the extent to which medicines are not used, as referred to on page 32 of his Department's White Paper, Pharmacy in England, Cm 7431; [255502]
(6) what methodology was used to calculate the figure of £100 million for the costs of unused and unwanted medicines referred to in his Department's White Paper, Pharmacy in England, Cm 7431; and what estimate he has made of this cost in the last 12 months; [255503]
(7) what progress his Department has made in developing further incremental implementations of repeat dispensing, as referred to on page 31 of his Department's White Paper, Pharmacy in England, Cm 7431; [255504]
(8) which primary care trusts commission services from community pharmacies to stock medicines that people may need at the end of their life, as referred to on page 36 of his Department's Pharmacy White Paper, Pharmacy in England, CM 7431; [255514]
(9) what reasons he has identified for the decline in the number of local enhanced home delivery services commissioned by primary care trusts in England between 2006-07 and 2007-08, as referred to in table 6 of the General Pharmaceutical Services in England and Wales 1998-99 to 2007-08 bulletin; [255525]
(10) if he will place in the Library a copy of the Public Health Leadership Forum for Pharmacy's work programme for 2008-10, referred to on page 52 of his Department's White Paper, Pharmacy in England, Cm 7431; [255527]
(11) what progress has been made by NHS Connecting for Health in scoping arrangements for electronically capturing information about (a) interventions made and (b) advice given by pharmacists in promoting health lifestyles, as referred to on page 53 of his Department's White Paper, Pharmacy in England, Cm 7431; [255528]
(12) what progress his Department has made in incorporating minor ailments schemes within the community pharmacy contractual framework since 3 April 2008; [255529]
(13) what assessment he has made of the extent to which pharmacies have been included in local schemes to help reduce unintended pregnancies, as referred to on page 56 of his Department's White Paper, Pharmacy in England, Cm 7431; [255530]
(14) what contributions which pharmacies can make to the care of people with diabetes have been identified to date by the National Clinical Director for Diabetes and the Chief Pharmaceutical Officer, as referred to on page 58 of his Department's White Paper, Pharmacy in England, Cm7431; [255531]
(15) what progress has been made in introducing a support service for people who are newly prescribed a medicine to treat a long-term condition within the community pharmacy contractual framework, as referred to on page 65 of his Department's White Paper, Pharmacy in England, Cm 7431; [255532]
(16) what steps he is taking to develop (a) professional and (b) contractual arrangements to ensure that people with symptoms from cancer are efficiently referred onwards by pharmacists, as referred to on page 67 of his Department's White Paper, Pharmacy in England, Cm 7431; [255533]
(17) on what dates in 2008 the working group on pharmacy medical and public representatives referred to on page 74 of his Department's White Paper, Pharmacy in England, Cm 7431, met; if he will place in the Library a copy of the (a) agenda for and (b) minutes from each of the meetings; what progress the working group has made in promoting more effective professional relationships between pharmacists and other healthcare professionals; and if he will make a statement; [255545]
(18) what progress he has made in planning communications which will (a) highlight the breadth of services and skills available in pharmacies, (b) illustrate the role that pharmacies can play in promoting good health, (c) raise awareness of the knowledge of the role that pharmacies can play in managing long-term conditions and reducing health inequalities and (d) increase the use of pharmacy services, as referred to on page 72 of his Department's White Paper, Pharmacy in England, Cm 7431; what the target audience is for each strand of communications; what further qualitative research he has commissioned to develop a better understanding of the particular needs of these audiences as referred to on page 72 of the White Paper; when he plans to introduce the communications programme; what expenditure he estimates his Department will incur on the communications programme in (i) 2008-09, (ii) 2009-10 and (iii) 2010-11; and if he will make a statement; [255556]
(19) what research the National Institute for Health Research has undertaken into pharmacy since its establishment; and what priorities have been identified for research into pharmacy by the Chief Pharmaceutical Officer, as referred to on page 78 of his Department's White Paper, Pharmacy in England, Cm 7431; [255566]
(20) what steps he is taking to utilise the pharmacy network to promote pharmacovigilance, as referred to on page 79 of his Department's White Paper, Pharmacy in England, Cm 7431; [255567]
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