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22 Feb 2010 : Column 145W—continued
Primary Care Trusts: Procurement
Mr. David Anderson: To ask the Secretary of State for Health what account his Department's guidance on primary care trust procurement takes of the policy on preferred providers of health services. [316312]
Mr. Mike O'Brien: The "PCT Procurement Guide for Health Services" first published in May 2008 applies to all national health service-funded healthcare procurement. Primary care trusts as commissioners are expected to comply with this guidance as part of their obligations in the Operating Framework published in December 2007. The PCT Procurement Guide is currently being revised to take account of developments since 2008.
The Secretary of State's Vision document "NHS 2010-2015: From Good to Great" and the "NHS Operating Framework 2010/11" outline how we expect the NHS as preferred provider to work in practice. Copies of both documents have already been placed in the Library.
Primodos
Mike Penning: To ask the Secretary of State for Health whether he has made an estimate of the number of people there are in England who have been adversely affected by the drug Primodos. [317688]
Mr. Mike O'Brien: Reports of suspected adverse drug reactions (ADRs) are collected by the Medicines and Healthcare products Regulatory Agency (MHRA) and Commission for Human Medicines (CHM) through the spontaneous reporting scheme; the yellow card scheme. Approximately 25,000 reports of ADRs are reported to the MHRA/CHM through this scheme each year. The scheme collects ADR reports from across the whole United Kingdom and includes all medicines, including those from prescriptions, over-the-counter or general retail sales. It is not possible to calculate from yellow card data the number of people who have been adversely affected by a drug, as the scheme is associated with an unknown level of under-reporting.
Reporters of ADRs will often cite the active substance(s) rather than a particular brand name. As of 12 February 2010, there are three retrospective cases for Primodos and 3,540 that have been recorded in our database for the combined drug substances norethisterone and ethinylestradiol.
Mike Penning: To ask the Secretary of State for Health what steps his Department has taken to assess the needs of those adversely affected by Primodos; and if he will make a statement. [317689]
Mr. Mike O'Brien: We have made no assessment. It is for local clinicians and multi-disciplinary teams to assess the health and care needs of people adversely affected by Primodos.
Prostate Cancer: Health Services
Christopher Fraser: To ask the Secretary of State for Health what the (a) mean and (b) median waiting time was for patients with a diagnosis of prostate cancer as an (i) in-patient and (ii) out-patient (A) in England and (B) in each NHS trust was in each year since 1997-98. [317711]
Ann Keen: Information on the mean and median time waited to be seen as an in-patient, for the first out-patient attendance where there was a primary diagnosis of prostate cancer, with figures provided for England and by hospital provider, has been placed in the Library.
Christopher Fraser: To ask the Secretary of State for Health what the (a) mean and (b) median length of an in-patient hospital stay was for patients with a diagnosis of prostate cancer (i) in England and (ii) in each NHS trust was in each year since 1997-98. [317712]
Ann Keen: Information on the mean and median length of stay for patients by NHS hospital provider for each year since 1997-98 where the primary diagnosis was prostate cancer has been placed in the Library.
Christopher Fraser: To ask the Secretary of State for Health what the (a) mean and (b) median referral-to-treatment waiting time has been for patients with a diagnosis of prostate cancer (i) in England and (ii) in each NHS trust in each month since January 2007. [317714]
Ann Keen:
Statistics on average waiting times for cancer patients and average waiting times specifically
for prostate cancer treatment are not collected centrally. The cancer waiting time standard of a maximum wait of 62 days from urgent referral for suspected cancer to first cancer treatment was introduced for all cancer patients from December 2005. In the last quarter for which figures are available (July to September 2009) national performance against this standard was 85.7 per cent.
Streptococcus: Pregnancy
Mr. Gerrard: To ask the Secretary of State for Health (1) what guidance his Department issues to strategic health authorities on the availability of tests to pregnant women for Group B streptococcus infection; [317273]
(2) how many infant deaths were due to (a) early and (b) late onset Group B streptococcus infection in the latest period for which figures are available. [317274]
Ann Keen: The National Institute for Health and Clinical Excellence clinical guidelines for routine antenatal care, published in 2008, recommends that pregnant women should not be offered routine antenatal screening for group B streptococcus because evidence of its clinical and cost-effectiveness remains uncertain.
The following table provides the number of infant deaths where there was mention of streptococcus, group B. It is not possible to determine onset of infections but numbers are presented for the neonatal and post-neonatal periods. In 2008, there were 3,281 infant deaths in total; 2,260 occurred in the neonatal period and 1,021 occurred in the post-neonatal period.
| Number of infant deaths where there was mention of streptococcus group B( 1) , for England and Wales, 2008( 2) | |
| Number of deaths | |
| (1 )Cause of death was defined using the International Classification of Diseases, Tenth Revision (ICD-10). Deaths were included where there was mention of streptococcus group B (corresponding ICD-10 codes are shown in Box 1). (2) Figures for 2008 are provisional. (3) Neonatal deaths under 28 days after live birth. (4) Post-neonatal deaths at least 28 days but under one year after live birth. (5) Infant deaths under a year after live birth. | |
| Box 1. ICD-10 codes used to define infant deaths due to Group B streptococcus infection | |
| Description | ICD-10 |
Strokes: Health Services
Sir Nicholas Winterton: To ask the Secretary of State for Health what steps his Department is taking to improve the provision of needs-based services to support stroke survivors and their carers in the long-term; and if he will make a statement. [317926]
Ann Keen: The National Stroke Strategy recommends that local action is needed to ensure that stroke features in local joint health needs assessments so that primary care trusts and local authorities can shape their local commissioning priorities accordingly. The Stroke Improvement Programme and the stroke networks are disseminating across the service good practice for needs-based services that has already been developed in some areas. In addition, local authorities are benefiting from £45 million over three years in ring-fenced grants to improve support services to adult stroke survivors and their carers in the community.
Sir Nicholas Winterton: To ask the Secretary of State for Health what steps his Department is taking to require the provision of appropriate stroke-specific training for care home staff. [317927]
Ann Keen: It is the responsibility of individual social care employers to ensure that their staff are adequately trained for the role that they perform. However, we recognise that stroke survivors in care homes have particular needs and are currently considering what steps we can take to improve stroke specific training for care home staff.
Sir Nicholas Winterton: To ask the Secretary of State for Health what steps his Department is taking to raise (a) public and (b) professional awareness of (i) risk factors for stroke and (ii) effective primary prevention measures at individual, family, community and societal levels; and if he will make a statement. [317930]
Ann Keen: The Department has run a series of campaigns to raise both public and professional awareness of the importance of a healthy lifestyle in reducing the risk of a number of diseases, including stroke. These include Change 4 Life, which is aimed at reducing obesity, Smokefree marketing to motivate people to stop smoking and direct them to national health service information and support and a jointly branded campaign with our stakeholders, including the Stroke Association, about the unseen damage that drinking can cause to long-term health. The link between alcohol and stroke was one of the key messages.
Sir Nicholas Winterton: To ask the Secretary of State for Health how much his Department has spent on public health measures to reduce exposure to risk factors for stroke in each of the last 12 months; and if he will make a statement. [317931]
Ann Keen: This information is not available. The Department invests in a number of primary prevention measures to help people across different socio-economic groups address risk factors that are commonly associated with a number of diseases, including stroke. These help people to stop smoking, maintain a healthy weight, moderate their alcohol consumption and participate in more physical activity. For example, we are working across Government to make two million adults more physically active by 2012 and phasing in the implementation of the NHS Health Check programme that is designed to reduce an individual's risk of a number of vascular diseases including stroke.
Sir Nicholas Winterton: To ask the Secretary of State for Health what steps he is taking to develop community-based stroke prevention services with the voluntary sector, the NHS and local authorities; and if he will make a statement. [317932]
Ann Keen: The National Stroke Strategy recognises the importance of educating people about the risk of stroke and associated prevention measures. It asks that local assessments should be made of how effectively areas are supporting healthier lifestyles and taking action to tackle vascular risk including hypertension, atrial fibrillation and high cholesterol.
Phased implementation of the NHS Health Check programme began in April 2009. This programme is designed to reduce an individual's risk of a number of vascular diseases including stroke. Primary care trusts (PCTs) are responsible for commissioning. The programme has been designed so that it can be delivered from a variety of settings and by different providers where they have undergone appropriate training. PCTs may, therefore, use a range of providers, including the third sector, to deliver the programme.
Sir Nicholas Winterton: To ask the Secretary of State for Health when his Department plans to implement the National Institute for Health and Clinical Excellence guidelines for diagnosis and treatment of transient ischaemic attack and minor stroke; and if he will make a statement. [317933]
Ann Keen: Implementation of the 'Diagnosis and initial management of acute stroke and transient ischaemic attack (TIA)' guidance is the responsibility of local commissioners and providers. It is the responsibility of commissioners in consultation with their providers to procure the stroke services for their populations.
Sir Nicholas Winterton: To ask the Secretary of State for Health if his Department will issue guidance to ambulance services on the agreement of stroke protocols with hospitals with acute and hyper-acute stroke units. [317938]
Ann Keen: We are not planning to issue such guidance. The Royal College of Physicians' Stroke Sentinel Audit of 2008 showed that there has been a striking improvement in the number of protocols ambulance services have for the management of stroke patients. It shows that between 2006 and 2008 the percentage of primary care trusts having arrangements with their local ambulance service for emergency/rapid transfer to hospital for specialist acute stroke care services has risen from 12 per cent. to 49 per cent. It is the responsibility of the NHS locally to develop these arrangements.
Sir Nicholas Winterton: To ask the Secretary of State for Health if his Department will issue guidance on the treatment of stroke as an emergency, with particular reference to appropriate access to brain scanning and thrombolysis and immediate admission to an acute stroke unit. [317939]
Ann Keen: The National Stroke Strategy recommends that everyone who can benefit from urgent stroke care should be transferred to an acute stroke centre that provides 24-hour access to scans and care in a specialist stroke unit.
The 2009 National Sentinel Audit of stroke undertaken by the Royal College of Physicians shows that the number of stroke units providing thrombolysis is increasing and that the provision of these services out of hours
remains a challenge. Local stroke care networks have been established to assist in improving the delivery of stroke services. This includes working with health care professionals to ensure urgent admission to an acute stroke unit, timely access to scanning and the provision of thrombolysis where appropriate. All hospitals provide CT scanning and most provide MRI and carotid doppler and the Department published an imaging guide in 2008, to help ensure that imaging services develop in line with the quality markers in the National Stroke Strategy.
To further encourage improvements in stroke care, in April 2010 we will introduce a Best Practice Tariff for stroke which incentivises direct admission to a stroke unit and timely brain imaging. We will continue to improve care for stroke patients by ensuring that more patients, for whom there is potential benefit, have a brain scan within one hour of their admission. However, thrombolysis can only be delivered safely by experienced teams. Hospitals should not aim to provide thrombolysis before the associated components of the service are functioning well and are of high quality. It is not appropriate, therefore, for every hospital to deliver a thrombolysis service.
Sir Nicholas Winterton: To ask the Secretary of State for Health if he will make it his policy to provide for every patient with stroke to be treated in a high quality stroke unit for the duration of their hospital treatment. [317940]
Ann Keen: The National Stroke Strategy recognises that stroke unit care is the single biggest factor that can improve a person's outcome following a stroke. We have, therefore, made this a top priority for the national health service. The tier 1 vital sign in the NHS Operating Framework aims to ensure that, by March 2011, 80 per cent. of patients with stroke spend at least 90 per cent. of their time in hospital on a stroke unit. This recognises that there are times when a patient, for clinical reasons, might need to spend time in the care of others outside a stroke unit.
Sir Nicholas Winterton: To ask the Secretary of State for Health if he will make it his policy to require all stroke units to meet the criteria set out in clinical stroke guidelines and by the British Association of Stroke Physicians. [317941]
Ann Keen: The National Stroke Strategy sets out twenty quality markers outlining the features of a good stroke service. In developing the strategy, we consulted experts in the field and used the most up-to-date clinical guidelines, including those from the National Institute for Health and Clinical Excellence and the nine key indicators used in the Royal College of Physicians' National Sentinel Stroke Audit.
Sir Nicholas Winterton: To ask the Secretary of State for Health if his Department will issue guidance on the (a) appropriate knowledge and skills relating to stroke and (b) appropriate training in stroke for all NHS staff working in emergency and acute care. [317942]
Ann Keen:
Standard setting for the knowledge and skills required of those working with stroke patients is for the relevant professional bodies. It is for local areas
to review, plan for and develop a stroke-skilled work force. Standard setting also guides commissioners on the criteria against which to judge services that they will commission.
The Department set up the UK Forum for Stroke Training through which the Stroke Specific Education Framework has been developed. This framework reflects the elements of the stroke care pathway from prevention through to long-term care which will facilitate links between training, education, work force competences and professional development. It aims to build on the generic skills that health, social, voluntary and independent care staff already possess through the clear identification of additional stroke-specific knowledge and skills. Its purpose is to ensure quality in stroke care by supporting stroke specialist and stroke relevant career pathways and course design and promoting recognised and transferable training and qualifications.
Jim Cousins: To ask the Secretary of State for Health how much funding has been allocated under the National Stroke Strategy to each local authority in Tyne and Wear; and in which years those allocations were (a) made and (b) spent on each (i) project and (ii) service. [318007]
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