Andrew George: To ask the Secretary of State for Health with reference to his Department's announcement of 6 January 2012 on the Time to Care initiative, if he will provide further details on the initiative; and what assessment he has made of the effects of the initiative on (a) the proportion of time spent by nurses on (i) hourly ward rounds and (ii) administrative procedures and paperwork considered non-essential and (b) nurse to patient ratios on acute hospital wards. [93163]

Anne Milton: Further details about the Productive Series ‘Releasing Time to Care' are available on the NHS Institute for Innovation and Improvement's website at:

The package of measures announced on 6 January are about showing staff what is already working in some places and what the rest can do to achieve the level of the best.

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Jonathan Reynolds: To ask the Secretary of State for Health (1) what the average number of patients is per qualified nurse in NHS hospitals; [93194]

(2) what his policy is on a mandatory qualified nurse to patient ratio in NHS hospitals. [93195]

Anne Milton: Information about the average number of patients per nurse is not available centrally and it would not be appropriate to mandate patient-to-nurse ratios. Decisions about staff-to-patient ratios are best made by local clinicians and managers, and may vary according to factors such as the individual needs of patients, their levels of acuity and dependency, the nature of the clinical care they require and the layout of the clinical area.

There is guidance available to trusts to assist them in setting safe and sustainable staffing levels. For example the RCN guidance and Safer Nursing Care Tool developed by the NHS Institute for Innovation and Improvement.

The Care Quality Commission requires registered providers to take appropriate steps to ensure that, at all times, there are sufficient numbers of suitably qualified, skilled and experienced persons employed for the purpose of carrying on the regulated activity. CQC Guidance about Compliance, references guidance set out by, for example, professional bodies.


David Morris: To ask the Secretary of State for Health what steps he is taking to improve the services offered to patients following discharge from an NHS hospital. [93531]

Paul Burstow: No one should be made to stay in hospital longer than necessary. The national health service and social care must work together to ensure people have the support they need on leaving hospital.

The new Clinical Commissioning Groups will bring together general practitioners, specialist doctors and nurses to shape the best local care for patients, helping to avoid unnecessary delays.

We continue to take significant steps to improve the services offered to patients following discharge from hospital. For example, we announced on 3 January 2012, a one-off additional allocation of £150 million to primary care trusts in England, for immediate transfer to local authorities for investment in social care services which also benefit the health system. The aim of these monies is to reduce the pressure on health services, and particularly hospitals during the winter period. This new investment will enable local services to discharge patients from hospital more quickly and provide effective ongoing support for people in their own homes.

The Department is investing extra cash to help people return to their homes after a spell in hospital—by 2012-13 this will be £300 million per year. This money will help people to leave hospital more quickly, where appropriate, and get settled back at home with the support they need.

Perinatal Mortality

Jack Lopresti: To ask the Secretary of State for Health what steps his Department is taking to reduce the number of stillbirths. [93290]

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Anne Milton: The. Government have made reducing perinatal mortality, including stillbirth, an improvement area under domain one of the NHS Outcomes Frameworks for 2011-12 and 2012-13. To support the national health service in improving outcomes in pregnancy, labour and immediately after birth, the National Institute for Health and Clinical Excellence is developing new quality standards, based on the best available evidence, on antenatal care, intrapartum care and postnatal care.

The Department also continues to invest in research. A major focus of the Department's National Institute for Health Research programme on women's health is understanding the factors linked to stillbirth and to use that information to improve the clinical care of pregnant women. In addition, the Department is currently working with Sands (the Stillbirth and Neonatal Death charity) and other organisations to identify what more can be done to reduce the number of stillborn babies.

Smoking: Health Services

Stephen Williams: To ask the Secretary of State for Health (1) how many people attended NHS Stop Smoking services in each quarter of 2010-11; [93378]

(2) how many people made calls to the NHS Stop Smoking Quitline in each quarter of 2010-11; [93379]

(3) what funding his Department has allocated to health promotion advertising campaigns on the dangers of smoking in each quarter since the start of 2010-11. [93380]

Anne Milton: The NHS Information Centre collects data on NHS Stop Smoking Services in England, including the number of people setting a quit date with these services, and the number who successfully quit four weeks after setting a quit date.

In 2010-11 period, 787,527 people set a quit date through NHS Stop Smoking Services. This is a 4% increase from 2009-10 when 757,537 people set a quit date.

The breakdown for each quarter of 2010-11 for the number of people setting a quit date and the number of people who successfully quit four weeks after their quit date is set out in the following table.

People setting a quit date and successful quitters by quarter 2010-11
Quarter 2010-11 Number setting a quit date Number of successful quitters
















Data on NHS Stop Smoking Services are available in the NHS Information Centre's publication “Statistics on NHS Stop Smoking Services: England, April 2010-March 2011”. A copy has been placed in the Library and is available at:

The number of calls to the NHS Smokefree helpline operating in England during 2010-11 are set out in the following table.

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April-June 2010


July-September 2010


October-December 2010


January-March 2011




The Department's expenditure on health promotion advertising campaigns on the dangers of smoking and encouraging people to quit since 2010-11 is set out in the following table.

  Expenditure (£)

















These figures do not include recruitment or classified advertising costs. Advertising spend is defined as covering only media spend (inclusive of agency commissions but excluding production costs, Central Office of Information commission and VAT). All figures exclude advertising rebates and audit adjustments and therefore may differ from Central Office of Information official turnover figures.

The 2011-12 Q4 spend listed is allocated expenditure, and may be subject to change.

Smoking: Motor Vehicles

Alex Cunningham: To ask the Secretary of State for Health (1) what assessment he has made of the All Party Parliamentary Group on Smoking and Health report on smoking in private vehicles; [93507]

(2) if he will consider bringing forward legislation to prevent exposure of children to smoke in cars in the event that the planned national marketing campaign does not significantly reduce the incidence of exposure; [93508]

(3) what steps he has taken to explore new roles for marketing communications in encouraging people to make their family cars smoke-free; [93509]

(4) what targets he has set to evaluate the effectiveness of the marketing strategy in achieving a reduction in the number of people smoking in cars with children. [93510]

Anne Milton: The All Party Parliamentary Group on Smoking and Health's report and the hon. Member's recent private Member's Bill on smoking in cars, particularly where children are present, have helped to highlight this important public health issue. The Department is currently considering the range of issues raised and what other action is required to address this challenge in addition to the planned marketing campaign.

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The Department is developing a national marketing campaign, planned for spring 2012, to remind smokers of the risks of exposing children and adults to second hand smoke so that they take voluntary action to make their homes and cars smokefree. The Department is also developing an evaluation framework to measure the effectiveness of the campaign.

Social Services: Females

Tracey Crouch: To ask the Secretary of State for Health what proportion of jobs in adult social care are filled by women. [93121]

Paul Burstow: Skills for Care estimate there are 1.77 million jobs in adult social care. The proportion of jobs filled by women is estimated to be 83%(1).

(1 )Skills for Care NMDS-SC November 2011.

Social Services: Finance

Tracey Crouch: To ask the Secretary of State for Health what assessment he has made of the effect of changes in funding for social care on (a) avoidable emergency admissions and (b) NHS costs. [93140]

Paul Burstow: Effective partnership working and integration are key enablers in delivering against the Quality, Innovation, Productivity and Prevention challenge within the national health service, and supporting improved efficiency within social care. This includes ensuring the people do not stay in hospital longer than they need to.

The Department has put in place practical measures to support social care services, in the context of a challenging local government settlement, and to encourage improved joint working between primary care trusts (PCTs) and local authorities. In 2011-12, £648 million has been allocated to PCTs to transfer to councils for spending on social care services that also benefit health. The Department has been clear that PCTs and local authorities will need to work together closely in order to agree appropriate areas of social care investment, taking account of joint priorities identified by the Joint Strategic Needs Assessment for their local populations. Evidence from a survey of PCTs suggests that this funding is being used both to prevent unnecessary admissions to hospital (through crisis response services for example), and to ensure people are able to leave hospital quickly (through intermediate care and re-ablement services for example).

A further £150 million (rising to £300 million in 2012-13) has been allocated to PCTs for the development of post-discharge support and re-ablement services. There is local discretion over how this money is to be spent, but in a letter to the service the Department has been clear that:

“This funding is intended specifically to develop current reablement capacity in councils, community health services, the independent and voluntary sectors, with the objective of ensuring rapid recovery from an acute episode and reducing people's dependency on social care services following discharge”.

Finally, in addition to these funding streams, the Department announced on 3 January 2012 that it was making a further £150 million available to PCTs, to transfer to local authorities for spending on social care.

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The Department has set out that this funding should be used to target delayed transfers of care which are attributable to social care services.

Recently published data show that the number of patients experiencing delayed discharge from hospital has fallen to its lowest level since these data have been collected. In December 2011, 3,659 patients experienced a delayed transfer of care, a 5.6% fall on the same month last year. This suggests that additional funding provided by the Government to promote joint working between health, and social care services is having a positive impact in reducing costs to the NHS.

Social Services: Reform

Tracey Crouch: To ask the Secretary of State for Health what recent representations he has received on the reform of social care; and if he will make a statement. [93122]

Paul Burstow: The care and support White Paper and progress report on funding reform, planned for spring 2012, will set out the Government's plans for transforming the care and support system.

To understand what the priorities for reform should be, the Government launched “Caring for our future” in autumn 2011. We worked with leaders from the care and support community, supported by expert reference groups, to seek a broad range of views from people who use care and support services, carers, local councils, care providers and the voluntary sector. Further details on the engagement, discussion leads and the output from key events can be found at:

During the engagement and since it formally ended, Ministers have met with a range of organisations about reform of care and support.

The Department is currently reflecting on the findings and will continue to work with stakeholders to develop policy and to help us decide the approach to the care and support White Paper and progress report on funding reform.


Andrew Gwynne: To ask the Secretary of State for Health how many cases of venous thromboembolism (VTE) were diagnosed in each of the last five years; in how many cases VTE was identified as the (a) primary and (b) secondary cause of death on death certificates; and what steps his Department is taking to reduce the number of cases of VTE. [93951]

Mr Simon Burns: There is currently no single definition of venous thromboembolism (VTE) available in the International Classification of Diseases, Tenth Revision (ICD-10). We have provided in the following table data for finished consultant episodes (FCEs) where a diagnosis code of one or more of the relevant ICD-10 codes for VTE has been recorded. A full list of these codes is included in the footnotes.

It should be noted that these data should not be described as a count of people as the same person may have been admitted on more than one occasion, or may have been treated for more than one type of VTE.

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Finished consultant episodes (1) with a primary or secondary diagnosis of VTE, 2006-07 to 2010-11: Activity in English NHS hospitals and English NHS commissioned activity in the independent sector











Notes: 1. Finished consultant episode (FCE): A finished consultant episode (FCE) is a continuous period of admitted patient care under one consultant within one health care provider. FCEs are counted against the year in which they end. Figures do not represent the number of different patients, as a person may have more than one episode of care within the same stay in hospital or in different stays in the same year, 2. Number of episodes in which the patient had a (named) primary or secondary diagnosis: The number of episodes where this 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, even if the diagnosis is recorded in more than one diagnosis field of the record. The combined ICD-10 codes for VTE are detailed as follows: ICD-10 codes used for pulmonary embolism are: I26.0—Pulmonary embolism with mention of acute cor pulmonale I26.9—Pulmonary embolism without mention of acute cor pulmonale The following ICD-10 codes are for Deep Vein Thrombosis where site is known: I80.0—Phlebitis and thrombophlebitis of superficial vessels of lower extremities I80.1—Phlebitis and thrombophlebitis of femoral Vein I80.2—Phlebitis and thrombophlebitis of other deep vessels of lower extremities I80.3—Phlebitis and thrombophlebitis of lower extremities, unspecified I80.8—Phlebitis and thrombophlebitis of other site I80.9—Phlebitis and thrombophlebitis of unspecified site O22.2- Superficial thrombophlebitis in pregnancy O22.3—Deep phlebothrombosis in pregnancy O87.0—Superficial thrombophlebitis in the puerperium O87.1—Deep phlebothrombosis 3. Data quality: HES are compiled from data sent by more than 300 NHS trusts and primary care trusts in England and from some 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. While this brings about improvement over time, some shortcomings remain. 4. Assessing growth through time: HES figures are available from 1989-90 onwards. Changes to the figures over time need to be interpreted in the context of improvements in data quality and coverage (particularly in earlier years), improvements in coverage of independent sector activity (particularly from 2006-07) and changes in NHS practice. For example, apparent reductions in activity may be due to a number of procedures which may now be undertaken in out-patient settings and so no longer include in admitted patient HES data. Source: Hospital Episode Statistics (HES), The NHS Information Centre for health and social care

The condition ‘venous thromboembolism’ includes deep vein thrombosis and pulmonary embolism.

The following table gives the number of deaths where deep vein thrombosis or pulmonary embolism were the underlying cause of death or were mentioned on the death certificate, England, 2006-10(1,2,3,4,5). As these conditions are usually due to another disease or injury, they may not be the underlying cause of death. Deep vein thrombosis and pulmonary embolism have been combined within this answer, because when one is part of the sequence leading to death, the other nearly always is as well, whether it is mentioned on the certificate or not.

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Deaths (persons)
  2006 2007 2008 2009 2010

Underlying cause






Any mention






(1) Cause of death was defined using the International Classification of Diseases, Tenth Revision (ICD-10) codes 180 (phlebitis and thrombophlebitis), O22.2-O22.3 (superficial thrombophlebitis and deep phlebothrombosis in pregnancy), O87.0-O87.1(superficial thrombophlebitis and deep phlebothrombosis in puerperium), and I26 (pulmonary embolism) where one of these conditions was the underlying cause of death or was mentioned anywhere on the death certificate either as the underlying cause or as a contributory factor. (2) The figures in row 1 (underlying cause) and row 2 (any mention) should not be combined to give the total number of deaths, as the figures in row 1 are already included in the figures in row 2. (3) Deaths from phlebitis or thrombophlebitis of superficial vessels have been included in order to ensure consistency with the diagnoses figures. However, these causes are not normally included in ONS figures for VTC. (4) Figures for persons usually resident in England, based on boundaries as of November 2011. (5) Figures are for deaths registered in each calendar year. Source: Office for National Statistics

Saving lives by preventing VTE remains a priority for the NHS and this Government and our national VTE prevention programme is regarded internationally as the most comprehensive of any health care system.

We have established a National CQUIN goal on VTE to ensure that 90% of admitted patients are risk assessed for VTE over three consecutive months, and have seen significant improvements in compliance with risk assessment over the last year.

While we aim to ensure that patients at risk of VTE are identified on admission to hospital and receive appropriate preventive measures, we acknowledge that more could be done. We continue to work with key

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partners to secure ongoing improvements in the standard of VTE prevention to reduce avoidable death and long-term disability and we remain determined to tackle this important patient safety issue.


Mr Stewart Jackson: To ask the Secretary of State for Health what steps his Department is taking to assist primary care trusts in treating patients with tinnitus; and if he will make a statement. [93831]

Paul Burstow: The planning and delivery of services is a matter for local commissioners and providers.

Considerable improvements in hearing services have been made over recent years including reduced waits for assessment and treatment of hearing problems. Action taken to support the delivery of services for people with tinnitus includes:

Publication of “Provision of Services for Adults with Tinnitus—A Good Practice Guide” by the Department of Health in January 2009. This guide provided practical evidence-based advice on how to improve access to, and experience of, tinnitus services. This document has been placed in the Library.

Publication of “Shaping, the Future: Strengthening the evidence to transform audiology services” by NHS Improvement in March 2011. This report demonstrates the potential to improve both clinical outcomes and patient experience for people with hearing problems while improving national health service efficiency. It includes examples of several trusts that have successfully tested the introduction of direct access tinnitus services. This document has been placed in the Library.

In addition, from 15 August to 14 October 2011 the National Institute for Health and Clinical Excellence (NICE) and the National Quality Board ran an engagement exercise on the development of a library of NICE Quality Standard topics for the NHS. The list of proposed Quality Standard topics included tinnitus. An announcement on next steps will be made in due course.