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Mental Health Services

Anne Milton: To ask the Secretary of State for Health what estimate he made of the number of empty beds in (a) low, (b) medium and (c) high security mental health hospitals on each day in the last 12 months. [277818]

Phil Hope: These data are not collected centrally to this level of detail.

Data are collected by the Department on the average daily bed occupancy level in all low, medium and high secure units in a given year. In 2007-08, the average daily number of available beds in all secure units in England was 3,159, with an average daily occupancy rate of 2,885 beds or 91.3 per cent.

Snapshot data were collected on 30 September 2008, but only in respect of high secure services, when 879 beds were available, with an overall occupancy rate of 90.4 per cent. The data include 48 designated learning disability beds. Separate data for low secure and medium secure units’ bed occupancy levels have not been collected by the Department.

NHS: Standards

Sir Nicholas Winterton: To ask the Secretary of State for Health what information his Department holds on England’s position among Western European states for (a) prevalence of and (b) treatment standards for (i) heart, (ii) kidney disease and (c) stroke; and what plans he has to improve this ranking over the next 10 years. [276976]

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Ann Keen: Data from the 2006 Health Survey for England suggest the prevalence of coronary heart disease (CHD) in England was 6.5 per cent. in men and 4.0 per cent. in women. Prevalence rates increase with age, with more than one in three men and around one in four women aged 75 and over living with CHD.

Overall we estimate that there are just over 1.1 million men living in the United Kingdom who have had angina and around 970,000 who have had a heart attack and around 850,000 women who have had angina and around 439,000 who have had a heart attack. Combined, these estimates suggest that 2.1 million men and 1.3 million women, around 3.4 million adults, in the UK reporting angina and/or a heart attack. This is likely to be an overestimate as those suffering from angina are not an independent group to those suffering from a heart attack.

Comparable data on prevalence of the cardiovascular diseases are difficult to access. At present there is no routinely updated source of Europe-wide data.

With regards to plans for tackling heart disease, the Department is commissioning an external review of the implementation and delivery of the Coronary Heart Disease National Service Framework. We are also undertaking an analysis of the trends in the burden of cardiac disease including patient expectations and needs, technology and working practices and how these are likely to affect future demand and patterns of service provision.

We understand that a report on Access to Cardiac Care in the UK commissioned by the Cardio and Vascular Coalition, the British Heart Foundation and the British Cardiovascular Society was launched on 2 June 2009, which includes some comparison with other European countries. This will be a helpful contribution to our work on future needs.

The Department contributed information to the Euro Consumer Heart Index in 2008, which provides comparisons between European countries across a number of indicators including access to treatment, prevention, national guidelines and outcomes. In this index, the UK ranked 9 out of 29 European countries. No separate score was available for England.

The number of people with chronic kidney disease (CKD) is not accurately known, because a lack of symptoms in the early stages means it often remains undiagnosed. However, a survey of blood samples in South East England in 2000-01 indicated the prevalence of CKD to be 5,554 per million population. Also the introduction of CKD into the Quality and Outcomes Framework has determined that there are 1.5 million people with CKD stages 3-5 (5 being established as renal failure).

Part 1 of the National Service Framework for Renal Services, published in January 2004, sets five standards and identifies 30 markers of good practice in the areas of dialysis and transplantation, aimed at improving fairness of access, patient choice about the type of treatment they receive and reducing variation in the quality of dialysis and kidney transplant services. These standards and markers of good practice will help the national health service and its partners to manage the increasing demand for renal services.

Future plans for renal services are to identify people at risk of kidney disease in a timely manner to optimise
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care, ensure kidney patients receive high quality care and to offer patients a choice of all forms of replacement therapy.

Stroke is the third leading cause of death and the leading cause of adult disability in England, with over 110,000 strokes happening every year.

The National Stroke Strategy for England (December 2007) sets 20 ‘quality markers’ which outline the features of a good service in the assessment and treatment of strokes, and those support services needed for stroke survivors to return to as full as possible a life in their community.

The National Stroke Strategy was launched on 5 December 2007 following extensive consultation. It provides a 10-year framework setting out key elements of an improved stroke service. At the launch of the strategy, my right hon. Friend the Secretary of State for Health (Alan Johnson) announced £105 million of central funding over three years would be spent to support implementation.

Sir Nicholas Winterton: To ask the Secretary of State for Health what assessment has been made of inequalities in the (a) prevalence and (b) treatment of (i) cardiac and (ii) vascular diseases between (A) the sexes, (B) geographical areas, (C) social groups, (D) economic groups and (E) ethnic groups; and what projects (1) are in place and (2) are planned to reduce such inequalities over the next decade. [276977]

Ann Keen: The Government have made tackling health inequalities a top priority, and have set a challenging target to reduce inequalities in infant mortality and life expectancy. The most comprehensive programme ever in this country is in place to address them. This draws on a wide range of data and analysis, some carried out within the Department and the national health service and some carried out by academic units.

Cardiovascular diseases (CVD) account for about a third of the gap in life expectancy and a range of programmes are reducing deaths and closing the inequalities gap.

In 1999 a target to reduce the mortality rate from CVD (coronary heart disease (CHD), stroke and related diseases) by at least 40 per cent. in people under 75 by 2010 was established. This has been the subject of annual monitoring. Data from 2004-06 indicate that this target was met five years early and the mortality rate has now fallen by 44 per cent. when compared to the 1995-97 baseline. The gap in death rates from CVD between the most health-deprived areas and the national average has narrowed by 36 per cent. over the same period, and we are on track to deliver the 2010 target of at least a 40 per cent. reduction in the gap.

With regard to cardiac disease, a major assessment of the burden of CHD informed the development of the Coronary Heart Disease National Service Framework (CHD NSF) published in March 2000. The findings of this assessment are included in the first chapter of the NSF ‘Modern Standards and Service Models’. A copy has already been placed in the Library and is available online at:

A key project to address the inequalities recognised in the NSF has been a major investment programme of £735 million in facilities and equipment aimed at improving
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and increasing access for appropriate cardiac interventions. Full details are available in the 2007 CHD NSF progress report, ‘Building for the Future’. A copy has been placed in the Library and is available online at:

Progress on the standards in the CHD NSF has been monitored annually including the impact on inequalities.

The Department developed a National Service Framework for Diabetes in 2003 and a National Service Framework for Renal Services in 2004. In 2007, the National Stroke Strategy was published. The implementation plans for all three include a strong focus on tackling inequalities.

A range of other initiatives to tackle inequalities is being taken forward. For example, the Department has commissioned the Improvement Foundation to work in the 20 areas with the worst health status to improve the identification and treatment of people at risk of cardiovascular disease:

In addition to this the primary care trusts (PCTs) in the most deprived areas are working with the National Health Inequalities Support Team. Using the Health Inequalities Intervention Tool they are being supported in priority setting (including prioritising vascular conditions), planning and commissioning of services.

On the prevention front, from April 2009, the NHS has been asked to start implementing a systematic and integrated vascular risk assessment and management programme—the NHS Health Check programme. This will provide a mechanism to identify earlier people who are at risk of heart disease, stroke, diabetes and kidney disease and support them to reduce their risk through the provision of lifestyle advice and interventions, and preventative medication, for example statins. Before the implementation of this programme, the Department undertook an Equality Impact Assessment. This assessment used existing evidence that gave details of inequalities in the prevalence of vascular disease of both genders, people of transgender, by age, sexual orientation, geographical regions, socio-economic groups, ethnic groups and disability. The programme has significant potential to narrow inequalities and many PCTs are using it as a major tool in tackling health inequalities.

The Department is also funding a number of third sector projects to deliver work focused on particular minority communities. These include nine stroke projects including the Stroke Association's ‘Blood Pressure Awareness—African Caribbean and South Asian Communities’, Connect’s ‘Provision of training and support for people with Aphasia’ and the Afiya Trust's ‘Stroke Awareness for Black and Minority Ethnic Communities’. For renal services, the Department is funding a project managed by the Black Organ Donor Association that will promote awareness of the need for organ donation in black and minority ethnic communities.

With regard to longer term plans, the Department is commissioning an external review of the implementation and delivery of the CHD NSF. In addition to this, we will undertake an analysis of the trends in the burden of cardiac disease and look at how patient expectation and need, technology and working practices are likely to affect future demand and patterns of service provision.
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We will also continue to develop our cross-vascular work programme. We will feed our findings to the Department's National Quality Board, which has been set up to oversee the priorities for the service in the future.

Vulnerable Adults: Protection

John Howell: To ask the Secretary of State for Health who (a) monitors and (b) investigates complaints made against adult protection multi-agency committees set up in accordance with his Department’s “No Secrets” guidance, LAC (2000)7. [277868]

Phil Hope: Adult protection committees (APCs) are the partnership bodies that develop multi-agency procedures for staff in partner agencies, including local authorities, the national health service and police, to follow when responding to allegations of abuse against vulnerable adults. APCs are also known as Safeguarding Adults Boards or Partnerships.

“No Secrets” does not prescribe arrangements for managing complaints about APCs. However, it would be good practice for each APC to agree a policy on handling complaints, including how complaints should be monitored and investigated.

APCs are accountable to the individual partner agencies, which should satisfy themselves that complaints are handled in accordance with the agreed policy.

Foreign and Commonwealth Office

Afghanistan: Peacekeeping Operations

Dr. Fox: To ask the Secretary of State for Foreign and Commonwealth Affairs what plans there are to implement the Afghan Public Protection Programme in Helmand province. [277634]

Bill Rammell: The Government of Afghanistan, with support from the US, are currently piloting the Afghan Public Protection Programme in Wardak province. This scheme empowers individual communities to take a greater role in providing their own security. There are no plans as yet to run a pilot program in Helmand. Only once the pilot has been vigorously evaluated will any decisions on expansion be taken.

Afghanistan: Police

Dr. Fox: To ask the Secretary of State for Foreign and Commonwealth Affairs what his most recent estimate is of the (a) size and (b) capability of the Afghan National Police. [277635]

Bill Rammell: As of 30 April 2009 the size of the Afghan National Police (ANP) was estimated to be 81,584. The authorised strength (tashkil) of the ANP is 86,800. This includes an increase of 4,800 to bolster security in Kabul in the lead-up to the August elections. The ANP includes the Afghan Uniformed Police (AUP), Border Police (ABP) and Civil Order Police (ANCOP). The capability of the ANP varies across the forces and continues to suffer from major problems including low levels of literacy and high levels of corruption.

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The AUP provides basic security and policing and is currently receiving US-led training under the Focused District Development Programme. ANCOP plays a niche but vital role in the counter-insurgency campaign and regularly supports the Afghan national army on operations. It also backfills the AUP during its participation in training. It is judged to be a more effective force compared with the other elements of the ANP. The Afghan Border Police needs more development although it has made some progress in policing Afghanistan's airports, following training.

Dr. Fox: To ask the Secretary of State for Foreign and Commonwealth Affairs how many (a) private security organisations, (b) national armed forces and other official organisations and (c) intergovernmental organisations are providing training for the Afghan National Police; how many Afghan National Police officers in each force have received such training from each such organisation; and how many British (i) military and (ii) civilian personnel work in each such organisation. [277711]

Bill Rammell: The major private security organisations providing training for the Afghan National Police (ANP) in Afghanistan are MPRI, Dyncorp and Xe. We do not have an estimate of the total number of private security companies delivering police training in Afghanistan. Nor do we have figures for British personnel in these organisations.

We are unable to provide numbers of armed forces, or civilian personnel, engaged in police training and reform from other countries. The principal country delivering police training is the US. 12 Ministry of Defence Police are delivering police training and reform at the provincial level. There are 24 British armed forces delivering ANP training at the district level, with additional force protection.

The US organisation leading on delivering police training is the Combined Security Transitional Command-Afghanistan (CSTC-A). CSTC-A has agreements with Germany, France, Italy, Norway, the Netherlands, Poland and the UK. We are unable to give total figures for those delivering training to the ANP. There are three British police officers in CSTC-A engaged on police reform. Seven British military personnel are working in CSTC-A on security sector reform, including policing.

The main organisation delivering police training and reform at the strategic level is the EU Policing mission (EUPOL). At the beginning of May 2009 the EUPOL mission was 326-strong and included police experts from the EU, Canada, Croatia, New Zealand and Norway. We have no breakdown of numbers. We are funding 15 British civilians in EUPOL, but have no figures for additional British staff directly contracted by the EU. There are no UK military in EUPOL.

We do not have a figure for the number of Afghan National Police officers in each force who have received training from each organisation. The US estimated that 20,000 ANP had undergone Focused District Development (FDD) training at the end of 2008. CSTC-A is planning to train a further 34,000 ANP in 2009. On 27 April 2009, over 4,700 ANP were in training.

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Aung San Suu Kyi

Mr. Keith Simpson: To ask the Secretary of State for Foreign and Commonwealth Affairs what his policy is on proposals to add the judges, court officials and police involved in the recent trial of Aung San Suu Kyi to the list of members of the Burmese regime whose assets within the EU are frozen and who are banned from travel to the EU; and if he will make a statement. [277406]

Bill Rammell: In the event that the Burmese regime continues to ignore international protests about Aung San Suu Kyi’s arrest and trial, the EU will need to consider what additional actions it should take in order to bring further pressure to bear. Adding further names to the current list of those covered by the visa ban and asset freeze would be an option for further measures. My right hon. Friend the Foreign Secretary raised the prospect of such measures with his counterparts on 18 May 2009.

Burma: Sanctions

Mr. Keith Simpson: To ask the Secretary of State for Foreign and Commonwealth Affairs which preparatory bodies the General Affairs and External Relations Council has asked to review proposals to reinforce existing restrictive measures on Burma; what role the UK has played in the process; and when the review is expected to be completed. [277408]

Bill Rammell: The Asia-Oceania Working Group (COASI) in Brussels has been charged with reviewing proposals to reinforce the restrictive measures. The UK has also instigated bilateral discussions on options with our partners. There is no set deadline for the completion of the review, but the UK is seeking to ensure that the EU is ready to respond swiftly to developments on the ground.

Mr. Keith Simpson: To ask the Secretary of State for Foreign and Commonwealth Affairs what proposals for further discussions with Asian countries on Burma have been made at EU level; what steps the UK is taking in this regard; and if he will make a statement. [277409]

Bill Rammell: Members of the EU share the UK’s view that our Asian partners have a key role to play in encouraging the process of change in Burma. The EU raises the issue of Burma in its discussions with China, India and other Asian states at every opportunity. I joined Asian and other EU Ministers at the Asia Europe Meeting on 25-26 May 2009 in Hanoi and at the EU-ASEAN (Association of South East Asian Nations) Summit on 27-28 May 2009 in Phnom Penh. Burma and the trial of Aung San Suu Kyi were among the issues discussed in detail at that meeting.

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