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NHS Hospitals: Standards of Cleanliness

Lord Lester of Herne Hill asked Her Majesty's Government:

Lord Hunt of Kings Heath: I was delighted to announce a major new "Hospital Clean-Up" initiative on 31 July to improve standards of cleanliness in National Health Service hospitals. This forms an important part of the NHS Plan published on 27 July.

We recently published "Standards for Environmental Cleanliness in Hospitals" and issued this to all NHS trust chief executives. These standards were developed jointly with the Association of Domestic Managers and the Infection Control Nurses Association;

    Over £30 million now allocated direct to hospital trusts to bring immediate, tangible improvements to the patient environment in all hospitals;

    The setting up of patient environment action teams to visit every NHS trust in England within the next six months; and

    All NHS trusts will be required to produce action plans to show how they will meet and maintain standards.

As a result of this initiative we expect to see clean wards, tidy corridors, welcoming front entrances and

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safer hospitals. Cleanliness of hospitals will be included in the national performance assessment framework to ensure that standards are maintained.

NHS Hospitals: Cleaning Staff

Lord Lester of Herne Hill asked Her Majesty's Government:

    How the number of staff currently employed to clean National Health Service hospitals compares with the number so employed in 1983.[HL3606]

Lord Hunt of Kings Heath: The information requested is not available centrally.

Rabies Vaccines

Lord Lucas asked Her Majesty's Government:

    Whether any rabies vaccines available in the United Kingdom are prepared using nervous tissue from a species known to harbour a transmissible spongiform encephalopathy.[HL3425]

Lord Hunt of Kings Heath: The rabies vaccines available in the United Kingdom do not require the use of any mammalian neuronal (nervous) tissue in their preparation.

Medicinal Products: Use of Animal Material

Lord Lucas asked Her Majesty's Government:

    Whether it would be a reasonable precaution against developments in the nvCJD outbreak for the Government to establish which injectible medical products in current use in the United Kingdom use bovine or ovine material in their preparation.[HL3426]

Lord Hunt of Kings Heath: The Medicines Control Agency (MCA) is undertaking an exercise that requires all marketing authorisation holders of medicinal products licensed for use in the United Kingdom to supply information on use of animal material in the manufacture of medicinal products. A comprehensive database of the information received will be established once the exercise is complete in March 2001. This will enable the MCA specifically to confirm that all medicinal products on the UK market that use such material comply with new European legislation. This legislation requires all new applications for a marketing authorisation made after 1st July 2000 to demonstrate that they comply with European guidelines on minimising the risk of transmission of spongiform encephalopathies via medicinal products. Marketing authorisation holders of existing medicinal products must produce evidence of compliance with the guidelines by 1st March 2001.

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Creutzfeldt-Jakob Disease

Lord Lucas asked Her Majesty's Government:

    Whether, when investigating the Leicestershire nvCJD cluster, particular attention will be paid to investigations of hospital and general practitioner records to find whether injectible medical products of bovine origin were a common factor.[HL3424]

Lord Hunt of Kings Heath: The National CJD Surveillance Unit routinely investigates all available general practitioner and hospital records for all Creutzfeldt-Jakob Disease (CJD) patients, including medical injections that the patient has received, in order to identify any common factors. The investigation of the variant CJD cases in Leicestershire will include close examination of medical records of patients for this purpose.

Lord Lucas asked Her Majesty's Government:

    Whether they are aware of any indications that the onset of nvCJD may be triggered by particular events.[HL3626]

Lord Hunt of Kings Heath: As part of its role in monitoring and investigating cases of variant Creutzfeldt-Jakob Disease, the National CJD Surveillance Unit (CJDSU) examines the histories of patients closely to see if there are any factors that might be associated with the onset of symptoms. To date no evidence of such a factor has emerged. The CJDSU will continue to keep this issue under close review.

Lord Lucas asked Her Majesty's Government:

    Whether those grandparents caring for their grandchildren because their child has died of nvCJD are receiving a uniformly good standard of support from the various organs of the state.[HL3625]

Lord Hunt of Kings Heath: Support is provided through a range of measures to grandparents looking after grandchildren, following the death of a parent from whatever cause. Under the Children Act 1989, local councils are empowered to assist financially with the care of children and young people through payments of foster care allowances, residence order allowances, and discretionary payments. Carers may also be entitled to child benefit, and in some circumstances, working families' tax credit. In addition, the Human BSE Foundation offers support, in both practical and financial terms, to the families of variant Creutzfeldt-Jakob Disease patients which can continue beyond the death of the patient. The Department of Health helps fund the work of the foundation.

Lord Lucas asked Her Majesty's Government:

    Whether they will fund a support network for the families of those diagnosed with nvCJD.[HL3627]

Lord Hunt of Kings Heath: The Department of Health is awarding the Creutzfeldt-Jakob Disease

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(CJD) Support Network a grant of some £70,000 per year for three years to fund a "case co-ordination initiative" aimed at facilitating the co-ordination of healthcare for patients affected by all types of CJD. This should help ensure that the healthcare response is tailored to the needs of each patient. The department similarly funds part of the central administrative costs of the Human BSE Foundation that offers support to variant CJD patients, their relatives and health-care providers. This latter funding amounted to some £23,000 in 1999-2000. In addition, a new post has been created this year at the National CJD Surveillance Unit in Edinburgh to act as a central source of advice and support for healthcare professionals and carers.

Lord Lucas asked Her Majesty's Government:

    Whether they are conducting surveillance for asymptomatic nvCJD by means of tests on random human autopsies or otherwise.[HL3629]

Lord Hunt of Kings Heath: A number of studies to detect asymptomatic variant Creutzfeldt-Jakob Disease (vCJD) have been commissioned as part of the Government's research strategy. These include:

    (i) Retrospective surveys to examine some 18,000 samples of tonsil/appendix tissue for the presence of the abnormal prion protein associated with vCJD. Interim findings were published on 28th April 2000 (Department of Health Press Release R368-34). No positives were found.

    (ii) A study of the brains of the elderly population in Nottingham on whom autopsies are carried out.

    (iii) A systematic survey of brain samples from an unselected autopsy population, including younger individuals, in Oxford. Preliminary results of some 200 samples from this study have not detected any unsuspected or asymptomatic cases of vCJD.

    (iv) A national retrospective review of CJD and related disorders--involving most neuropathology laboratories in the United Kingdom--to establish that cases of neurodegenerative disorders have not been misclassified before vCJD had been identified.

    (v) A comprehensive examination of the Corsellis brain collection to identify any unidentified cases of prion disease.

Lord Lucas asked Her Majesty's Government:

    Whether, in investigating the cluster of nvCJD cases in Leicestershire, they will make a reference to the collection of samples relating to the "unfit meat" scandal of 20 years ago held at the Ventress laboratories.[HL3628]

Lord Hunt of Kings Heath: The public health team undertaking the detailed investigation into the apparent cluster of variant Creutzfeldt-Jakob disease cases in Leicestershire are pursuing a number of avenues of inquiry. The results of the nationwide investigation into the illegal trade of unfit meat carried

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out in the early 1980s (known as "Operation Meat Hook") are being drawn to their attention.

Lord Lucas asked Her Majesty's Government:

    Which research proposals relating to nvCJD have been refused state funding within the latest 12 months for which records are available.[HL3703]

Lord Hunt of Kings Heath: In the last 12 months the Department of Health has turned down only one research proposal relating to Creutzfeldt-Jakob Disease (CJD), following advice from referees. There is also a small number of research proposals relating to variant CJD currently being held in abeyance until further information has been provided by the applicants.

The Medical Research Council has considered 12 applications for grants to support research related to variant CJD during the funding session October 1999-July 2000. Nine proposals were successful in securing funding totalling £2.5 million. Those failing to reach the competitive standard (3 in total) were identified to have significant weaknesses in their scientific strategy.

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