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Gender Identity Disorder

Lynne Jones: To ask the Secretary of State for Health what steps he is taking to ensure that all primary care trusts provide accessible, timely and high quality gender identity services. [291225]

Mr. Mike O'Brien: The Department is committed to the delivery of high quality national health service gender identity services. Primary care trust commissioning of gender identity services remains a matter for local prioritisation, with access to services determined by clinical need and local decision-making.

The Department is in the process of writing out to all NHS chief executives and their teams, via the weekly NHS leadership team bulletin the week, to reiterate this commitment to high quality gender identity services and the importance of considering such cases individually, according to clinical need.

Health Services: Travelling People

Mr. Stewart Jackson: To ask the Secretary of State for Health what funding is being provided to friends, families and Travellers for its work on access to healthcare for Travellers. [291305]

Mr. Mike O'Brien: £55,355 funding was provided to Friends, Families and Travellers to support access to healthcare for Travellers. The grant has been made through the Third Sector Investment programme and supports our wider aim of reducing health inequalities and paying particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population.

Hospitals

Mr. Bone: To ask the Secretary of State for Health how many days on average an in-patient in a hospital in England received treatment in each year since 1997; and how many such patients waited 183 days or more to receive treatment in each such year. [291315]

Mr. Mike O'Brien: Data on the average (mean) in-patient length of stay is shown in the following table.

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Average length of stay( 1) in days for in-patients in England, 1997-98 to 2007-08
	Average length of stay (Days)
1997-98	8.8
1998-99	8.4
1999-2000	7.8
2000-01	8.2
2001-02	8.1
2002-03	7.9
2003-04	7.4
2004-05	7.1
2005-06	6.6
2006-07	6.3
2007-08	5.7
(1) Length of stay (LOS) is calculated as the difference in days between the admission date and the episode end date (duration of episode) or discharge date (duration of spell), where both dates are given. LOS is based on hospital stays and only applies to ordinary admissions, i.e. day cases are excluded (unless otherwise stated). Information relating to LOS figures, including discharge method/destination, diagnoses and any operative procedures, is based only on the final episode of the spell. Notes: 1. Hospital Episode Statistics (HES) are compiled from data sent by more than 300 NHS trusts and primary care trusts (PCTs) in England. Data is 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. 2. Time waited statistics from HES are not the same as the published waiting list statistics. HES provides counts and time waited for all patients admitted to hospital within a given period, whereas the published waiting list statistics count those waiting for treatment on a specific date and how long they have been on the waiting list. Also, HES calculates the time waited as the difference between the admission and decision to admit dates. Unlike published waiting list statistics, this is not adjusted for self-deferrals or periods of medical/social suspension. 3. This is the total number of eligible admissions from which the mean and median time waited are derived. Admissions contributing towards this total are waiting list and booked admissions, with planned admissions being excluded. A waiting list admission is one in which a patient has been admitted electively into hospital from a waiting list, having been given no date of admission at the time a decision to admit was made. Alternatively, booked admissions are those in which the patient was admitted electively having been given a date at the time it was decided to admit, determined on the grounds of resource availability. Planned admissions are excluded as they are usually part of a planned sequence of clinical care determined mainly on clinical criteria, which, for example, could require a series of events, perhaps taking place every three months, six months or annually. Source: Hospital Episodes Statistics (HES), the NHS Information Centre for Health and Social Care.

Data on the number of in-patient admissions where time waited was 183 days or longer is shown in the following table.

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Total admissions with eligible time waited information( 1) with a time waited of 183 days or longer in England, 1997-98 to 2007-08
	Total admissions with a time waited of 183 days or more
1997-98	603,777
1998-99	727,812
1999-2000	596,906
2000-01	591,287
2001-02	606,601
2002-03	673,649
2003-04	681,753
2004-05	512,758
2005-06	381,912
2006-07	261,534
2007-08	147,522
(1) 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. Please note that admissions do not represent the number of in-patients, as a person may have more than one admission within the year. Notes: 1. Hospital Episode Statistics (HES) are compiled from data sent by more than 300 NHS trusts and primary care trusts (PCTs) in England. Data is 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.
2. Time waited statistics from HES are not the same as the published waiting list statistics. HES provides counts and time waited for all patients admitted to hospital within a given period, whereas the published waiting list statistics count those waiting for treatment on a specific date and how long they have been on the waiting list. Also, HES calculates the time waited as the difference between the admission and decision to admit dates. Unlike published waiting list statistics, this is not adjusted for self-deferrals or periods of medical/social suspension. 3. This is the total number of eligible admissions from which the mean and median time waited are derived. Admissions contributing towards this total are waiting list and booked admissions, with planned admissions being excluded. A waiting list admission is one in which a patient has been admitted electively into hospital from a waiting list, having been given no date of admission at the time a decision to admit was made. Alternatively, booked admissions are those in which the patient was admitted electively having been given a date at the time it was decided to admit, determined on the grounds of resource availability. Planned admissions are excluded as they are usually part of a planned sequence of clinical care determined mainly on clinical criteria, which, for example, could require a series of events, perhaps taking place every three months, six months or annually. Source: Hospital Episodes Statistics (HES), the NHS Information Centre for Health and Social Care.

Human-Animal Hybrid Embryos

Jim Dobbin: To ask the Secretary of State for Health what the statutory authority is for the granting of a licence to examine human admixed embryos which have been stored in licensed premises for the purposes of investigating a suspected offence under the Human Fertilisation and Embryology Act 1990; and whether regulations will be required to be made. [291430]

Mr. Mike O'Brien: Human admixed embryos must be held at a centre licensed by the Human Fertilisation and Embryology Authority if they are being kept or used in connection with the investigation of, or proceedings for, an offence under the Human Fertilisation and Embryology Act 1990 (as amended by the Human Fertilisation and Embryology Act 2008). This requirement is provided for in section 4A(2)(c) of the Human Fertilisation and Embryology Act 1990 (as amended). Using human admixed embryos includes examination of embryos.

There is no intention to make regulations concerning the keeping, examination or storage of human admixed embryos in connection with the investigation of, or proceedings for an offence under the Human Fertilisation and Embryology Act 1990 (as amended).

IVF

Greg Mulholland: To ask the Secretary of State for Health what steps he is taking to increase the number of in vitro fertilisation treatment cycles available on the NHS in (a) England and (b) Leeds. [291265]

Mr. Mike O'Brien: We are working with the national health service and the patient support group Infertility Network UK to encourage primary care trusts (PCTs) in the provision of three full cycles of in vitro fertilisation (IVF) treatment, as recommended by the National Institute for Health and Clinical Excellence guidelines.

In 2008, we set up an expert group on commissioning NHS infertility provision. Their interim report identified barriers to the commissioning of IVF by PCTs and the final report of the expert group will be published in the autumn.

In June this year, the expert group produced a commissioning aid to help commissioners understand the particular sensitivities and complexities of infertility and its treatment. Alongside the commissioning aid, we
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also published access criteria, which were developed by Infertility Network UK in discussion with the expert group. To launch both the commissioning aid and the access criteria we ran a conference for commissioners, to help raise awareness.

We are monitoring IVF treatment provision across the country to help identify where further work is required to assist PCTs in assessing the needs of fertility patients and helping them to deliver those services in an equitable way.

The Yorkshire and the Humber strategic health authority (SHA) has advised that the Yorkshire and the Humber Specialised Commissioning Group is currently consulting on a region wide policy for fertility treatment. Further information is on their website:

www.yhscg.nhs.uk/consultation/fertility.htm

The SHA has advised that one of the issues being considered is the number of cycles of in vitro fertilisation treatment and it is expected that the policy will be in place by April 2010.

Learning Disability: Supported Housing

Simon Hughes: To ask the Secretary of State for Health what arrangements his Department has put in place for monitoring and inspection of the quality of care in supported living accommodation for adults with learning difficulties; and if he will make a statement. [291371]

Mr. Mike O'Brien: Everyone living in supported living has a community care plan and increasingly a person-centred plan. The resources allocated to support them are based on these plans and are monitored through the care management assessment, and review process. These reviews take place at least once a year and ensure that arrangements set out in the plans are in place and that the person is receiving high quality support as agreed.

The Care Quality Commission (CQC) regulates health and adult social care services, whether provided by the national health service, local authorities, private companies or voluntary organisations. CQC ensures that essential common quality standards are being met where care is provided and work towards the improvement of care services.

Domiciliary Care Agencies, who provide care support for people in supported living, must be registered with the CQC and they inspect them. Local authority commissioners of these care services will have contract management arrangements in place to monitor individual Agencies.

NHS: Finance

Mr. Bone: To ask the Secretary of State for Health what estimate his Department made of expenditure from the public purse on the NHS in England in respect of each of the last 10 years expressed (a) in cash terms, (b) as a percentage of gross domestic production and (c) as a percentage of all public expenditure. [291316]

Mr. Mike O'Brien: Table 1 shows total net national health service expenditure in England in cash terms in each year since 1998.

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Table 2 shows United Kingdom health expenditure as a proportion of (i) gross domestic product (GDP) and (ii) total managed expenditure.

Table 1: NHS total expenditure: England-1998-99 to 2010-11
		Net NHS expenditure nominal( 1) (£ billion)
Cash( 2)
1998-99	Outturn	36.6
1999-2000	Outturn	39.9
Resource Budgeting Stage 1( 3)
1999-2000	Outturn	40.2
2000-01	Outturn	43.9
2001-02	Outturn	49.0
2002-03	Outturn	54.0
Resource Budgeting Stage 2( 4,5)
2003-04	Outturn	64.2
2004-05	Outturn	69.1
2005-06	Outturn	75.8
2006-07	Outturn	80.6
2007-08	Outturn	89.3
2008-09	Estimated outturn	94.5
2009-10	Plan	102.7
2010-11	Plan	105.8
(1).Figures are not consistent over the period (1998-99 to 2010-11), therefore it is difficult to make comparisons across different periods. (2).Expenditure pre 1999-2000 is on a cash basis. (3).Expenditure figures from 1999-2000 to 2002-03 are on a Stage 1 Resource Budgeting basis. (4).Expenditure figures from 2003-04 to 2010-11 are on a Stage 2 Resource Budgeting basis. (5) Figures from 2003-04 include a technical adjustment for trust depreciation. Notes: 1. Expenditure excludes NHS (AME). 2. GDP deflator 30 June 2009. 3. Total Expenditure is calculated as the sum of revenue and capital expenditure net of non-Trust Depreciation and impairments. This is in line with HMT Guidance.

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