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Table 2: The five causes of death( 1) mentioned most frequently on death certificates on which Clostridium difficile( 2,3 ) was also mentioned, England and Wales( 4) , 1999 and 2001 to 2007( 5,6)
Deaths (persons)
Causes of death	1999	2001	2002	2003	2004	2005	2006	2007	ICD codes
Cerebrovascular diseases	*	*	*	*	*	468	769	1,057	I60-I69
Diseases of the urinary system	173	216	302	381	535	894	1,657	2,086	N00-N39
Heart failure and complications and ill-defined heart disease	131	166	182	232	290	*	*	*	I50-I51
Influenza and pneumonia	333	364	445	513	618	992	1,706	2,180	J10-J18
Ischaemic heart diseases	183	223	244	373	433	675	1,199	1,604	I20-I25
Septicaemia	145	202	280	349	461	816	1,459	1,627	A40-A41
(1) Selected using International Classification of Diseases, Tenth Revision (ICD-10) code groups published in: Griffiths C, Rooney C and Brock A (2005) Leading causes of death in England and Wales—how should we group causes? “Health Statistics Quarterly” 28, p6-17. Codes used to identify Clostridium difficile deaths were excluded. (2 )Identified using the methodology described in Office for National Statistics (ONS): Report: Deaths involving Clostridium difficile: England and Wales, 2001-05. “Health Statistics Quarterly” 33, 71-75. (3) Deaths involving Clostridium difficile can be identified using the Tenth Revision of the International Classification of Diseases (ICD-10). This has been used by ONS for coding mortality from 2001 onwards and in 1999 for a bridge coding study. Data are therefore not available for 2000 when the Ninth Revision of the ICD was in use. (4) Figures for England and Wales includes deaths of non-residents. (5) Data are for deaths registered in each calendar year. (6) An asterisk (*) denotes this was not one of the five causes of death mentioned most frequently in this year

General Practitioners: Enfield

Joan Ryan: To ask the Secretary of State for Health how many new (a) GP surgeries, (b) GP-led health centres and (c) polyclinics are planned in (i) the Enfield North constituency and (ii) Enfield Primary Care Trust area. [263868]

Mr. Bradshaw: This is a matter for the local national health service. We are advised that Enfield Primary Care Trust will be consulting on a Primary Care Strategy for the whole of Enfield in 2009. The hon. Member may wish to contact them for further information.

Joan Ryan: To ask the Secretary of State for Health how many GP surgeries have been (a) refurbished and
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(b) rebuilt in (i) Enfield North constituency and (ii) the Enfield Primary Care Trust area in each of the last 11 years. [263869]

Mr. Bradshaw: This information is not held centrally. The hon. Member may wish to contact her local national health service organisations for more information.

Hospitals: Cleaning Services

Mr. Burstow: To ask the Secretary of State for Health pursuant to the answer of 3 March 2009, Official Report, column 1474W, on hospitals: cleaning services, what steps his Department has taken to evaluate the effectiveness of each of the steps to improve hospital cleanliness. [263445]

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Ann Keen: The Department has given a strong public commitment to hospital cleanliness and has set in place a comprehensive programme of work that has improved cleaning standards across the national health service. Evaluation of the effectiveness of all the measures set in place is independently available via the Healthcare Commission's annual health check, its annual in-patient survey and its programme of specialist inspections of acute trusts to assess their compliance with the duties set out in the “Health Act 2006 Code of Practice for the Prevention and Control of Healthcare Associated Infections” (‘hygiene code’). Cleaning standards are also measured via the annual Patient Environment Action Team (PEAT) inspection programme.

In addition, a number of other evaluations of the effectiveness of, or compliance with, particular measures are set out in the table.

Measure	Action taken
National deep clean programme	The Department published a compendium of good practice studies arising from the national deep clean programme, “From Deep Clean to Keep Clean learning from the deep clean programme” in October 2008, as a basis for shared learning across the NHS.
National Specifications for cleanliness in the NHS	The Department is currently working with National Patient Safety Agency (NPSA) and key stakeholders to explore the scope for using these specifications to develop a national standard for cleanliness in the NHS. It is also seeking the views of those stakeholders to identify measures that could sharpen the focus of the existing national specifications.
Trusts' strategic and operational cleaning plans make provision for on-going deep clean activity	With the support of the NPSA, the PEAT protocol has been amended to include a specific question on plans for on-going deep cleaning.
‘Board to Ward’ guidance highlighting the commitment needed to ensure that all staff understand the role they play in preventing infections and providing a clean environment	“Going Further Faster II; Applying the learning to reduce HCAI and improve cleanliness” was published in June 2008 reflecting the accumulated learning, evidence and good practice on the key actions that NHS trusts can take towards the goal of eradicating avoidable healthcare associated infections and delivering a clean NHS.
“Clean Safe Care Reducing Infections and saving lives”—comprehensive strategy drawing together key initiatives to tackle healthcare associated infections (HCAIs) and cleanliness	The Department has commissioned an evaluation of the effectiveness of the Healthcare Associated Infection and Cleanliness Improvement programme (one strand of the ‘Clean, safe care’, strategy) with a specific focus on the work streams focused on reductions in the incidence of MRSA.

Hospitals: Infectious Diseases

Anne Milton: To ask the Secretary of State for Health what estimate he has made of the number of infections which were caused by vancomycin-resistant enterococcus in each of the last five years. [263439]

Ann Keen: The information requested is not available but reporting of clinically-significant glycopeptide resistant enterococci bloodstream infection has been mandatory for national health service acute trusts in England since September 2003.

Glycopeptide resistant enterococci (GRE) include organisms that are resistant to either vancomycin or teicoplanin and the available data are shown as follows.

Reporting year (October to September each year)	Number of GRE bloodstream infection reports
2003-04	628
2004-05	757
2005-06	903
2006-07	910
Source: Health Protection Agency

Anne Milton: To ask the Secretary of State for Health how many cases of ventilator-associated pneumonia have been recorded in each of the last five years. [263440]

Ann Keen: The information requested is not collected.

Anne Milton: To ask the Secretary of State for Health what estimate he has made of the proportion of healthcare-acquired infections which were classified as surgical site infections in each of the last five years. [263441]

Ann Keen: The information requested is not available.

A prevalence study, commissioned by the Department, carried out in 2006, showed that surgical site infection accounted for 14.5 per cent. of the healthcare-associated infections.

Human Papilloma Virus

Dr. Gibson: To ask the Secretary of State for Health (1) what plans he has for the implementation of EU guidelines for quality assurance in cervical cancer screening on human papilloma virus testing as a follow-up for women with borderline or abnormal smear test results; and if he will make a statement; [263472]

(2) when he plans to publish the results of his Department's human papilloma virus sentinel sites implementation project. [263473]

Ann Keen: Work on the implementation phase of human papilloma virus (HPV) triage for women with borderline and low-grade abnormalities using HPV testing has begun in six sentinel sites. Results from these sites are expected by the end of December 2009, at which point further roll-out will be considered.

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Maternity Services: Finance

Mr. Lansley: To ask the Secretary of State for Health (1) how much has been spent on maternity services in each financial year since 1997-98; and how much he plans to spend on such services in each financial year to 2010-11; [257565]

(2) how much the Government have spent on maternity services in each financial year since 1997-98; and how much they plan to spend on such services in each financial year to 2010-11. [262286]

Ann Keen: Figures for the commissioning of secondary health care (maternity) services by primary care trusts (PCTs), health authorities (HAs) and primary care groups for the period 1997-98 to 2007-08 are in the following table. These figures are for secondary health care only and a similar collection is not made for primary/community maternity care.

Purchase of secondary health care: maternity services, 1997-98 to 2007-08
Financial year	Expenditure (£000)
1997-98	1,043,881
1998-99	1,096,158
1999-2000	1,080,520
2000-01	1,258,219
2001-02	1,324,780
2002-03	1,256,757
2003-04	1,350,286
2004-05	1,544,838
2005-06	1,677,204
2006-07	1,616,777
2007-08	1,786,896
Source: NHS Summarised Accounts 1997-98 to 2007-08.

The table shows the aggregated expenditure for each year, however any inter-PCT or inter-HA expenditure is eliminated to avoid double counting.

The programme budgeting figures for gross expenditure across both primary and secondary care on maternity and reproductive health for the period 2003-04 to 2006-07 are in the following table. It is not possible to separate maternity data from reproductive health data, and changes in data collection methodology mean that comparative data are not available. Programme budgeting data were collected for the first time in 2003-04. The quality of programme budgeting data has improved over time, and there are a number of changes that will affect the use of the data for time-series analysis. These include changes to clinical coding and changes in the methodology used for calculating the data.

Programme budgeting category 18 includes expenditure on both maternity and reproductive health, therefore direct comparisons cannot be made with NHS summarised accounts data.

Programme budgeting data
Financial year	Expenditure (£000)
2003-04	2,570,147
2004-05	2,617,116
2005-06	2,929,764
2006-07	2,932,120

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