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Patients: Intermediate Care

Baroness Barker asked Her Majesty's Government:

Lord Hunt of Kings Heath: Data have not been collected on where people who have left intermediate care have gone.

The national research currently being commissioned by the Department of Health to evaluate intermediate care will provide information on this in due course.

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Baroness Barker asked Her Majesty's Government:

    What plans, reports or studies are currently being undertaken concerning the provision of intermediate care following the National Health Service Plan; and who is undertaking them.[HL550]

Lord Hunt of Kings Heath: The National Service Framework for Older People, published on 27 March, made it clear that the National Health Service and councils should, by January 2002, agree three-year implementation plans for intermediate care, as part of their local action plans and joint investment plans. These plans will be reviewed by NHS regional offices and social care regions to ensure that they deliver the requirements set out in the NHS Plan and the National Service Framework for Older People. The NHS was asked to submit specific data on investment and activity for intermediate care and community equipment as part of 2001-02 service and financial frameworks (SaFFs). This data is currently being validated. Local action plans for older people's services, submitted as part of the SaFF process, indicated how the 2001-02 'must do' targets and milestones were to be planned for, and included information on how the agreed investment and activity for intermediate care in 2001-02 will be delivered.

In addition to local evaluations, the Department of Health is currently commissioning national research which will evaluate intermediate care. The specification for this work asked researchers to focus on hospital acute admissions, lengths of stay, discharges, and re-admissions; health and social outcomes for users and carers; user and carer satisfaction; costs and savings to the NHS and other agencies; as well as the cost-effectiveness of intermediate care.

Nursing Homes: Self-funders

Baroness Barker asked Her Majesty's Government:

    Whether they will publish and place in the Library of the House, as soon as the information is available, a copy of the composite returns for each health authority of the survey of self-funders in nursing homes in England setting out:

    (a) the number and type of establishment;

    (b) the number of registered nursing beds;

    (c) the number of occupied nursing beds;

    (d) the number of people registered with a GP indicating where this is (i) within the registering health authority, (ii) within another health authority, (iii) not registered;

    (e) how many clients pay for full costs of their care (i) to the home directly, (ii) via the local authority, (iii) via an independent third party; and

    (f) how many receive income support at a preserved rights rate.[HL553]

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Lord Hunt of Kings Heath: The Department of Health is carrying out a survey of those funding their own care (self-funders) in nursing homes via health authorities. Health authorities have until 27 July to provide all the information on self-funders. We intend to make available a breakdown of all the data by health authority on the department's website at during August after this has been analysed.

Periodontal Disease

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

    What measures the National Health Service will introduce to tackle the problem revealed by the Adult Dental Health Survey (1998) that some 42 per cent of adults over the age of 21 have a loss of about one-third of root length as a result of periodontal disease; and[HL466]

    How they intend to respond to the Adult Dental Health Survey (1998) which highlights the widespread incidence of periodontal disease among the adult population; and whether they will invest in periodontal disease care and treatment sufficiently to ensure high quality care and treatment for people suffering from periodontal disease across the United Kingdom.[HL467]

Lord Hunt of Kings Heath: As well as rewarding dentists for giving preventive care and advice to National Health Service patients, the general dental services contract already provides for both surgical and non-surgical periodontal treatment. The Government are committed to improving access to NHS dentistry. By September anyone requiring dental treatment will be able to find an NHS dentist by calling NHS Direct. We will monitor the effect of improved access to NHS dentistry on periodontal disease.

National Heart Hospital, Westmoreland Street

Lord Clement-Jones asked Her Majesty's Government:

    Whether they plan to acquire the National Heart Hospital in Westmoreland Street, London; and, if so, what progress is being made on the acquisition.[HL523]

Lord Hunt of Kings Heath: The National Health Service is aware that the current owners of the Heart Hospital, a private hospital situated in Westmoreland Street, London, may be trying to dispose of the business. The local NHS trust has made informal soundings and is currently assessing the potential of the facility for NHS use.

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Mentally Handicapped People: Housing

Lord Pearson of Rannoch asked Her Majesty's Government:

    Whether they intend that:

    (a) mentally handicapped people should be able to live in village communities when that is what they or their families choose;

    (b) new village communities should be developed to meet demand, including those which could be created by modifying existing hospital sites; and

    (c) if so, whether they will consider issuing statutory guidance to make sure that such intentions are respected at local level in future.[HL525]

Lord Hunt of Kings Heath: Valuing People, the White Paper on learning disability published on 20 March 2001, makes clear that local councils in considering the future housing, care and support needs of people with learning disabilities and their families must ensure that all options are considered. These options should include small-scale ordinary housing, supported living and village and intentional communities. Councils should respect the preferences of individuals and their families, wherever the preferred options will meet individuals' assessed needs and are affordable.

It remains the responsibility of local statutory authorities to determine the precise pattern of services to be developed in their area as they are best placed to make such decisions in the light of the Department of Health's guidance and their local knowledge of needs and resources. This could include the development of village communities on suitable hospital sites.

We shall be issuing statutory guidance on implementing the proposals set out in Valuing People: A New Strategy for Learning Disability for the 21st Century. This will confirm that local authorities must not rule out any of the options when considering the future housing, care and support needs of people with learning disabilities and their families. We are currently consulting on the guidance.

NHS Oncology Budgets

Baroness Northover asked Her Majesty's Government:

    What were the overall oncology budgets for National Health Service trusts in London for each of the last three years; and[HL595]

    What were the oncology budgets for each of the last three years for (a) Guy's Hospital, (b) the Royal Marsden Hospital and (c) St Thomas' Hospital; and[HL596]

    What discussions they have had with, and what directions they have given to, the chief executives of health authorities to ensure that budgets in oncology are (a) maintained and (b) spent exclusively on cancer care and cancer services; and[HL597]

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    What assessment they have made of shortfalls in National Health Service oncology drugs budgets; and[HL598]

    What plans they have to monitor the distribution of National Health Service oncology drugs budgets to treaters; and[HL599]

    What is their estimate of the percentage of National Health Service oncology drugs budgets received by oncologists.[HL600]

Lord Hunt of Kings Heath: Resources for oncology, including oncology drugs, are included in general allocations to health authorities. No information is held centrally on oncology or oncology drugs budgets. In 2001-02, health authority allocations nationally included a hypothecated amount of £255 million for increases in expenditure on cancer services and health authorities were asked to set aside specific additional resources from this amount to meet a number of priorities on cancer, including implementing the National Institute for Clinical Excellence guidance on new oncology drugs.

NHS Quality Assurance

Lord Clement-Jones asked Her Majesty's Government:

    What steps they are taking to determine which models of quality systems management in common use would be most appropriate to ensure increased quality assurance in the National Health Service; and[HL601]

    What plans they have to evaluate the different approaches to quality management taken within the National Health Service, together with the current proven techniques, to determine which approach would best prevent further failures from occurring within the service.[HL602]

Lord Hunt of Kings Heath: Clinical governance provides National Health Service organisations and health care professionals with a framework for quality improvement which, over time, will develop into a single, coherent local programme for assuring and improving the quality of clinical services.

National Health Service organisations are using a number of different tools to help them implement their own local arrangements to achieve the key components of clinical governance. Some organisations have found the generic quality management schemes (for example ISO 9000, the Excellence Model, Charter Mark and Investors in People) to be useful ways into this process, recognising that these schemes share general management principles with the aims of clinical governance and the Government's overall NHS quality strategy.

The Cabinet Office document Getting it Together--A Guide to Quality Schemes and the Delivery of Public Services, published March 2001, sets out this work in more detail.

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The Commission for Health Improvement's (CHI's) rolling programme of clinical governance reviews of all NHS bodies is under way. These local reviews evaluate the implementation and adequacy of clinical governance arrangements in NHS organisations.

The commission also has the capacity for rapid investigation and intervention to help the NHS identify and tackle serious or persistent clinical problems. In addition, CHI is conducting national reviews to evaluate the implementation of national standards set in national service frameworks (on topics such as mental health) and the take up of the National Institute for Clinical Excellence guidance.

The Commission for Health Improvement has now assessed acute and mental health trusts and health authorities (covering primary care). Further reports have been published, including a review of Bedford Hospital NHS Trust, and these routine review reports will now be published on a regular basis.

We are creating a national patient safety agency in response to the Chief Medical Officer's report An organisation with a memory. This new agency will manage and evaluate the results from the new NHS-wide mandatory reporting scheme for adverse healthcare events to learn and share lessons across the NHS, to help minimise patient risk and improve the quality and safety of care.

The existence of the agency will, we believe, through its work, very significantly reduce the likelihood of major issues like Shipman and Bristol. It will do this in large part through helping promote a reporting culture throughout the NHS that benefits patient safety.

An ongoing research project is evaluating the impact of the NHS Modernisation Agency's clinical governance support programme on participating NHS clinical teams. This project is due to finish at the end of 2002.

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