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Mr. Lansley: To ask the Secretary of State for Health what assessment his Department has made of the effect on (a) patient care and (b) clinical priorities of the four-hour waiting time target for accident and emergency departments. 
Mr. Bradshaw: In 2007-08, 72 per cent. of trusts achieved the four hour standard of 98 per cent. of patients being seen, diagnosed and treated within four hours of their arrival at accident and emergency (A and E). As shown in the latest Healthcare Commission emergency department patient survey (2008), the percentage of respondents rating their overall care as excellent, very good or good was high at 88 per cent. It is important that patients have access to high quality timely care in A and E. However, we recognise that there are still areas for improvement and would encourage all trusts to examine their results and use these as a means to continue to improve patients' experience of A and E services.
There are occasions when, for clinical reasons, patients may need to remain in A and E for longer than four hoursbut it is for clinicians to make that judgment. That is why the minimum operating figure of 98 per cent. was introduced in 2003, following discussions with clinicians, to allow for the minority of patients that clinically require more than four hours in A and E.
It is a local matter for national health service trusts to ensure that they meet the A and E four hour operational standard while not compromising patient care and clinical priorities. In cases of underperforming trusts it is for the primary care trusts and strategic health authorities (SHAs) to ensure that there are plans in place for improvement so all patients can expect the same high quality service. Where there is sustained underperformance, the Department seeks assurances via the SHA that NHS trusts have robust plans in place for improvement in A and E performance, in providing high quality, timely care to patients.
The most recent assessment of the effects of particulate pollution on mortality was published in 2007 by COMEAP: draft reportLong-term Exposure to Air Pollution: Effect on Mortality. This report indicated that the collected evidence pointed strongly to an association between long-term exposure to particulate air pollution and effects on mortality. The report suggests that air pollution has a greater effect on mortality in the United Kingdom than previously thought, with a 10 microgramme increase in fine particles being associated with a 6 per cent. increase in risk of death from all causes.
The Department for the Environment, Food and Rural Affairs (DEFRA) has calculated the estimated loss of life expectancy linked to particulate pollution in its 2007 review of the UKs Air Quality Strategy. This calculation utilised the recommendations made by COMEAP in its 2007 draft report. DEFRA estimated that the level of man-made particulate air pollution experienced in the UK in 2005 would be expected to reduce life expectancy averaged over the whole population of the UK by up to about seven to eight months.
Ms Keeble: To ask the Secretary of State for Health what estimate he has made of the number of males (a) between (i) 10 and 16, (ii) 17 and 21 and (iii) 22 and 26 and (b) over 26 years who have been admitted to hospital for alcohol-related conditions in each of the last five years. 
Dawn Primarolo: Data on the number of individual boys and young men hospitalised for alcohol-related conditions and not available, however data on the number of alcohol-related hospital admissions for boys and young men are available and are given in the following table. It is important to note that:
an individual may account for more than one admission;
the data given are for alcohol-related hospital admissions only, as data are not available centrally from which alcohol-related attendances in accident and emergency (A&E) departments can be identified; and
most attendances at A&E will not result in admission to hospital.
|Finished alcohol-related admissions of males aged 10 or over, 2003-04 to 2007-08|
1. Includes activity in English national health service hospitals and English NHS commissioned activity in the independent sector.
2. Alcohol-related admissions:
The number of alcohol-related admissions is based on the methodology developed by the North West Public Health Observatory (NWPHO). Following international best practice, the NWPHO methodology includes a wide range of diseases and injuries in which alcohol plays a part and estimates the proportion of cases that are attributable to the consumption of alcohol. Details of the conditions and associated proportions can be found in the report Jones et al. (2008) Alcohol-attributable fractions for England: Alcohol-attributable mortality and hospital admissions.
Figures for under 16s only include admissions where one or more alcohol-specific conditions were listed. This is because the research on which the attributable fractions are based does not cover under 16s. Alcohol-specific conditions are those that are wholly attributed to alcoholthat is, those with an attributable fraction of one. They are:
Alcoholic cardiomyopathy (142.6)
Alcoholic gastritis (K29.2)
Alcoholic myopathy (G72.1)
Alcoholic polyneuropathy (G62.1)
Alcohol-induced pseudo-Cushings syndrome (E24.4)
Degeneration of nervous system due to alcohol (G31.2)
Mental and behavioural disorders due to use of alcohol (F10)
Accidental poisoning by and exposure to alcohol (X45)
Ethanol poisoning (T51.0)
Methanol poisoning (T51.1)
Toxic effect of alcohol, unspecified (T51.9)
3. Number of episodes in which the patient had an alcohol-related primary or secondary diagnosis:
These figures represent the number of episodes where an alcohol-related diagnosis was recorded in any of the 20 (14 from 2002-03 to 2006-07 and seven prior to 2002-03) primary and secondary diagnosis fields in a Hospital Episode Statistics (HES) record. Each episode is only counted once in each count, even if an alcohol-related diagnosis is recorded in more than one diagnosis field of the record.
4 . Ungrossed data:
Figures have not been adjusted for shortfalls in data (i.e. the data are ungrossed).
5. Finished admission episodes:
A finished admission episode is the first period of in-patient care under one consultant within one health care provider. Finished admission episodes are counted against the year in which the admission episode finishes. Admissions do not represent the number of in-patients, as a person may have more than one admission within the year.
6. Primary diagnosis:
The primary diagnosis is the first of up to 20 (14 from 2002-03 to 2006-07 and seven prior to 2002-03) diagnosis fields in the HES data set and provides the main reason why the patient was admitted to hospital.
7. Secondary diagnosis:
As well as the primary diagnosis, there are up to 19 (13 from 2002-03 to 2007-08 and six prior to 2002-03) secondary diagnosis fields in HES that show other diagnoses relevant to the episode of care.
8. Data quality:
HES are compiled from data sent by more than 300 NHS trusts and primary care trusts in England. Data are also received from a number of independent sector organisations for activity commissioned by the English NHS. 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 via HES processes. While this brings about improvement over time, some shortcomings remain.
9. Assessing growth through time:
HES figures are available from 1989-90 onwards. The quality and coverage of the data have improved over time. These improvements in information submitted by the NHS have been particularly marked in the earlier years and need to be borne in mind when analysing time series.
10. Some of the increase in figures for later years (particularly 2006-07 onwards) may be due to the improvement in the coverage of independent sector activity.
11. Changes in NHS practice also need to be borne in mind when analysing time series. For example, a number of procedures may now be undertaken in out-patient settings and may no longer be accounted for in the HES data. This may account for any reductions in activity over time.
12. Assignment of Episodes to Years:
Years are assigned by the end of the first period of care in a patients hospital stay.
Hospital Episode Statistics (HES), The NHS Information Centre for health and social care
To ask the Secretary of State for Health how many finished accident and emergency admission episodes there were in each NHS trust where the primary or secondary diagnosis was alcohol-related and the (a) male and (b) female patient was aged
(i) under 10, (ii) between 11 and 15, (iii) between 16 and 18, (iv) between 19 and 25, (v) between 26 and 35 and (vi) 36 years and over in each of the last five years. 
Sandra Gidley: To ask the Secretary of State for Health how many (a) men and (b) women in each age group have been admitted to hospital for stomach pumping procedures as a result of alcohol poisoning in each month of the last three years. 
Ann Keen: There were zero admissions to hospital for stomach pumping procedures in 2005-06, 2006-07 and 2007-08. This is most likely due to the fact that stomach pumping usually takes place in accident and emergency departments, without the need for the patient to be admitted to hospital. Data on stomach pumping procedures in accident and emergency departments are not collected centrally.
Andrew George: To ask the Secretary of State for Health (1) how long the National Institute for Health and Clinical Excellence's review of the (a) use of and (b) segregated use of anti-TNF drugs for the treatment of rheumatoid arthritis has lasted; and when he expects the appraisal of sequential use of anti-TNFs to be completed; 
(2) what assessment he has made of the (a) scheduling and (b) timescale of the reappraisal process undertaken by the National Institute for Health and Clinical Excellence in respect of the sequential use of anti-TNF drugs for rheumatoid arthritis; and what representations he has received on this matter. 
Dawn Primarolo: The National Institute for Health and Clinical Excellence (NICE) issued its current technology appraisal guidance to the NHS on the initial use of adalimumab, infliximab and etanercept for the treatment of rheumatoid arthritis in October 2007, which is 40 months from the date that Ministers referred adalimumab for the treatment of rheumatoid arthritis to NICE's technology appraisal work programme. The guidance partially updated NICE's existing guidance on etanercept and infliximab for rheumatoid arthritis.
NICE is currently developing separate appraisal guidance on the use of adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a tumour necrosis factor (TNF) inhibitor. NICE currently expects to publish updated guidance on this topic in July 2010. Until NICE publishes final guidance for this appraisal, NICE'S existing guidance on the use of etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of an anti-TNF in technology appraisals TA36, TA126 and TA141 remains in place.
The scheduling of work on specific technology appraisal reviews is a matter for NICE, but we understand that in this case the guidance development process has been particularly complex because of the need to address issues identified at the appeal stage.
Mrs. Gillan: To ask the Secretary of State for Health what assessment he has made of the cost to local authorities of identifying the number of disabled children and adults with autism in their area. 
With regard to adults with autism, Departmental officials are currently estimating possible costs of a survey of prevalence, as well as the likely annual costs of additional staffing input to joint strategic needs assessments to include this group of people.
Ann Keen: The provision of burns services in the North West is a matter for the Northern Network of the National Burn Care Group (NBCG). The NBCG is a sub-group of the National Specialised Commissioning Group, a body established on 1 April 2007. The Northern Burn Care Network is developing recommendations on the future of burn care services across the North West, North East and Yorkshire and the Humber Strategic Health Authority regions and North Wales.
Dr. Gibson: To ask the Secretary of State for Health when the National Institute for Health and Clinical Excellence will produce its guidance on the use of (a) bevacizumab, (b) sorafenib, (c) sunitinib (second-line) and (d) temsirolimus for the treatment of advanced and metastatic renal cell carcinoma in the NHS. 
Dawn Primarolo: The National Institute for Health and Clinical Excellence currently expects to issue final guidance to the national health service on bevacizumab, sorafenib and temsirolimus for the first line treatment and sorafenib and sunitinib for the second-line treatment of advanced and/or metastatic renal cell carcinoma in June 2009.
We recognise the critical role that clinical nurse specialists (CNSs) have in multi-disciplinary teams (MDTs), as set out in the National Institute for Health and Clinical Excellence series of Improving Outcomes guidance. The
National Cancer Review Programme for 2004-07 looked at whether MDTs had full core membership and found that there were significant gaps in some areas, including in CNSs. Another round of peer review is now under way, and this will provide information about what progress has been made in this area.
Jenny Willott: To ask the Secretary of State for Health pursuant to the answer of 19 March 2009, Official Report, column 1302W, on contaminated blood and blood products, what timetable he has set for responding to the recommendations made by Lord Archer; by what mechanism that response will be made; and if he will make a statement. 
|Count of finished admission episodes with a primary diagnosis of mental and behavioural disorders due to psychoactive substance use for the last five years: Activity in English NHS Hospitals and English NHS commissioned activity in the independent sector: Data years 2003-04 to 2007-08|
|Finished admission episodes|
These figures include admissions for alcohol-induced mental health conditions.
Hospital Episode Statistics (HES), The NHS Information Centre for health and social care.
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