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Mr. Burstow: To ask the Secretary of State for Health if he will list for each NHS region and trust the number of three month vacancy rates for nurses and expenditure on agency nurses, indicating both the original estimate of costs and the outturn figures. 
Mr. Hutton: Figures from the Department of Health Vacancies Survey March 2000 on the number of three month vacancy rates for nurses per region and trust, and the expenditure on agency nurses in 19992000 are available in the Library. Information on the original estimate of costs and the outturn figures are not available centrally but may be available from individual National Health Service employers.
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establishment of a fund to support the development of carers services under the Carers and Disabled Children Act 2000; 
(3) when he plans to publish the performance framework indicator for the number of carer assessments; if he will ensure that the assessments evaluate the proportion of carers assessed at the point of hospital discharge; and if he will make a statement; 
(4) if he will undertake an evaluation of the appropriateness of support offered to carers as part of strategies to reduce the number of delayed discharges from hospital; 
(5) when his Department last reviewed guidance on hospital discharge with respect to carers' needs; and what arrangements are in place to monitor compliance with the guidance; 
(6) if he will make a statement on progress towards implementing the National Carers Strategy requirement that general practitioners should have procedures in place to identify carers by April 2002. 
Jacqui Smith: The Hospital Discharge Workbook, issued in 1994, gives guidance to the national health service, social services and other agencies on hospital discharge procedures. The workbook emphasises that the patient and carer should be made fully aware of arrangements for discharge and understand fully what is going to happen. Before an individual is discharged, checks should be made by the discharge nurse to ensure that discharge arrangements take place as planned. The chief executive of the hospital trust is responsible for ensuring that discharges take place appropriately. Work will begin soon on revising the hospital discharge workbook.
The NHS Plan acknowledged that health and social services need to do more to shape services around the needs and preferences of individual patients, their families and their carers. During 2002, older people, and where appropriate their carers, will be involved in agreeing a personal care plan, which they will hold. The personal care plan will document their current package of health and social care, their care co-ordinator, monitoring arrangements, and a list of key contacts for rapid response at home and in emergencies.
We are continuing to provide additional resources to local authorities specifically to improve the working arrangements between local authorities and the NHS. The new Promoting Independence Grant is specifically aimed at fostering partnership between health and social services in promoting the independence of adults needing community care services. The grant will encourage these partnerships to improve their arrangements for multi- disciplinary assessment and hospital discharge (including rehabilitation and recuperation services).
In addition, we have pledged to consider the establishment of a fund to support the development of carers services under the Carers and Disabled Children Act 2000. We have already begun preliminary discussions with key stakeholders.
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The performance indicator for the number of informal carers receiving an assessment as a proportion of the total number of clients and carers receiving assessments will be published for the first time in autumn 2001. The indicator is based on information provided by local councils with social services responsibilities. Details of where the assessment took place are not available; therefore, the proportion of carers assessed at the point of hospital discharge can not be separately calculated.
Requirements for Accreditation (RFA99) issued in October 1999 included the requirements for general practitioner computer systems to include a field where the details of carers could be entered. This, aligned with all GPs having access to a desktop computer as part of project connect programme by the end of March 2002, will mean that GPs will be prompted to ask for carer details as part of the registration details of patients. When entered this information will form part of the patient record.
Progress in implementing the national carers strategy is measured against the criteria set out in the National Carers Strategy and summarised on pages 57 of the Strategy. Specific initiatives which take forward the strategy, such as the increases to the Carers Grant, are announced to the House at the appropriate time, and information about the implementation of the measures published as appropriate. For example the analysis which we commissioned from the Kings Fund of local authorities' carers plans for 19992000 was published in February 2001. The social services inspectorate's monitoring of local authorities includes questions regarding the implementation of the national carers strategy. The results will be published in the autumn.
Mr. Hutton: My right hon. Friend the Secretary of State has asked the Commission for Health Improvement (CHI) to pay particular attention to resuscitation decision- making processes as part of its rolling programme of reviews of the clinical governance arrangements put in place by national health service organisations. CHI's programme of reviews is being conducted over a four-year cycle. All trusts will have been reviewed by October 2004. CHI will work with the organisation to produce an action plan to address identified deficiencies, the implementation of which will be monitored by the NHS regional office who will ensure that any necessary action is taken to ensure compliance.
Mr. Burstow: To ask the Secretary of State for Health if he will set out the work programme of the National Workforce Development Board and its associated care group workforce teams; and if he will make a statement on the establishment of the care group workforce team dealing with services for older people. 
Jacqui Smith: The broad terms of reference for the National Workforce Development Board and the care group workforce teams are set out in "Investment and Reform for National Health Service StaffTaking
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Forward the NHS Plan", copies of which are available in the Library. We are currently considering in more detail how these bodies, including the care group workforce team for services for older people, will take forward their role, and will make an announcement shortly.
Mr. Hutton: The latest figures for 15 January 2001 are given in the table. The number of available adult intensive care and high dependency beds in England are published in the bi-annual publication "Available adult intensive care and high dependency provision, England", copies of which are available in the Library.
|Intensive care beds||Number|
Annual census of "Available adult intensive care and high dependency provision, England". Data for 15 January 2001.
Yvette Cooper: The Department introduced specific measures in September 1998 reducing pack sizes of paracetamol and aspirin aimed at reducing the toxicity from impulsive overdose. New warnings on the packaging emphasised the risks and action to take in the event of overdose. Recent published studies on the impact of these measures have provided evidence that they are having a significant beneficial effect.
The majority of deaths in association with antidepressants are as a result of suicide. We take the issue of suicide very seriously. We are currently developing, under the direction of the National Director for Mental Health, Professor Louis Appleby, a coherent, national suicide prevention strategy to ensure that we are doing all we can to prevent suicide.
Advice is given to health professionals in British National Formulary, which advises that patients treated for depression should be assessed frequently for suicidal tendencies and that limited quantities of antidepressant drugs should be prescribed at any one time to reduce the
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risk of overdose. The summaries of product characteristics for antidepressants warn that patients at risk of suicide should be monitored closely.
Paul Flynn: To ask the Secretary of State for Health what progress has been made in (a) identifying and (b) reducing the levels of (i) mis-use and (ii) over-use of neuroleptic drugs in residential homes for the elderly. 
Jacqui Smith: Data on the misuse or overuse of neuroleptic drugs are not available centrally. However, we are well aware of concerns about the use of these drugs in older people. Several current initiatives will help to address this issue.
The National Minimum Standards for Care Homes for Older People, published in March 2001 under section 23(1) of the Care Standards Act 2000, contains a standard for the administration of medicines. This includes requirements to take advice from pharmacists, consult general practitioners and regularly review medication. These standards come into force in April 2002.
The National Service Framework for Older People was also published in March, together with 'Medicines and Older People', covering the implementation of medicines related aspects of the NSF. One of its aims is to ensure that older people gain maximum benefit from their medication and do not suffer unnecessarily from illness caused by excessive or inappropriate consumption of medicines. One of the milestones set in the NSF is that, by April 2002, people over 75 will have their medicines reviewed at least annually, and those taking four or more medicines will have a review six-monthly. And, by 2004, every primary care trust (PCT) will have schemes in place so that older people get more help from pharmacists in using their medicines.
Finally, the NHS Plan contains a target that repeat dispensing schemes will be in place nationally by 2004. Together with management of repeat prescribing commissioned locally by PCTs, these schemes will provide further help in avoiding medication problems in older people.
Paul Flynn: To ask the Secretary of State for Health what estimate he has made of the percentage of those who use (a) heroin and (b) methadone under medical prescription who have died in each of the past five years. 
The Department collects information relating to the number of prescriptions dispensed in the community in England (which includes prescriptions for diamorphine and methadone) but there is no means of identifying whether the recipient of the prescription subsequently dies.
Information about all deaths in England and Wales in 1995 to 1999 where the underlying cause of death is regarded as resulting from drug-related poisoning is included in the Health Statistics Quarterly report, published by the Office for National Statistics in spring 2001. The report also contains information about the number of deaths where selected substances, including heroin and/or morphine and methadone, were mentioned on the death certificate.
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The table shows the numbers of deaths where heroin and/or morphine and methadone were mentioned on any death certificate and are regarded as resulting from drug- related poisoning from 1995 to 1999. The figure is given for heroin and morphine combined because heroin breaks down in the body into morphine, and the latter may be detected at post mortem and recorded on the death certificate.
|Year||All mention of heroin and morphine||Methadone|
These figures do not include deaths where heroin, morphine and methadone were not mentioned on the death certificate, but were a causal factor; or where these substances were prescribed, but were not a causal factor in the death and so are not mentioned in the death certificate.
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