Stationery

Mr Redwood: To ask the Secretary of State for Defence what levels of stock his Department holds of (a) stationery, (b) printer cartridges, (c) treasury tags and other fasteners and (d) other office consumables. [196201]

28 Apr 2014 : Column 448W

Anna Soubry: The information is not held centrally and could be provided only at disproportionate cost.

Trident

Mr Ainsworth: To ask the Secretary of State for Defence what recent assessment he has made of the (a) associated costs and (b) utility of the Trident Alternatives Review. [196225]

Mr Philip Hammond: I have made no such assessment.

Uganda

Naomi Long: To ask the Secretary of State for Defence if he will withdraw security assistance to Uganda following the ratification of the Anti-Homosexuality Act in that country. [195357]

Mr Francois: The Government have no plans to review or suspend our assistance, which is in the UK's security interests. Respect for human rights underpins all UK training and support for overseas security programmes.

USA

Paul Flynn: To ask the Secretary of State for Defence what the timetable is for renewing the 1958 Agreement between the UK and US for Co-operation in the Uses of Atomic Energy for Mutual Defence Purposes; whether he will lay the draft renewed agreement before Parliament; and what role the British embassy in Washington DC will play in the renewal. [195941]

Mr Dunne: We are continuing to work with the US and satisfactory progress is being made. Parliament will be informed of the amending text at the appropriate time. The British embassy in Washington DC will facilitate discussions between the Foreign and Commonwealth Office and the US Department of State.

Paul Flynn: To ask the Secretary of State for Defence how many staff from (a) his Department and (b) the Atomic Weapons Establishment are on secondment to an institution in the United States involved in nuclear weapons development or nuclear warhead stockpile, stewardship, stability and safety research. [195942]

Mr Dunne: There are no Ministry of Defence staff and 15 Atomic Weapons Establishment staff employed by AWE plc on secondment to these institutions in the United States.

Health

Anorexia

Luciana Berger: To ask the Secretary of State for Health what level of body mass index a patient with anorexia nervosa must have to be admitted to in-patient care. [196064]

Norman Lamb: The National Institute for Health and Care Excellence guideline on eating disorder states that low body mass index alone is not a reliable indicator. Patients with anorexia nervosa need to be

28 Apr 2014 : Column 449W

admitted to hospital when, in the clinical judgment of the relevant medical professional, the patient is in imminent danger of death or serious harm.

Antibiotics

Nic Dakin: To ask the Secretary of State for Health what steps his Department is taking to encourage investment in antibiotic resistance research and development. [196284]

Dr Poulter: The Department's National Institute for Health Research (NIHR) is running a themed call on antimicrobial resistance (AMR) research across eight different funding programmes. Successful research bids will be announced between summer 2014 and spring 2015.

About £7.2 million over five years is being invested in two new NIHR health protection research units focusing on healthcare-associated infections and AMR. These units became operational from April 2014 and are partnerships between universities and Public Health England.

To promote joint action, the Department is working together with the other major United Kingdom (UK) funders of AMR research through a new research funders forum. The forum first met in December 2013.

To further international AMR research collaboration, the UK, through the Medical Research Council, has been playing a key role in a European Union joint programming initiative on AMR.

Arthritis

Luciana Berger: To ask the Secretary of State for Health what information his Department holds on how (a) morbid obesity and (b) obesity affects the development of osteoarthritis. [196093]

Jane Ellison: Public Health England has considered the link between obesity (including morbid obesity) and osteoarthritis.

The role of obesity as a strong risk factor for the development of knee osteoarthritis is well documented.1,2 There is less evidence on the relationship between obesity and osteoarthritis of the hip or hand.

A recent meta-analysis found that obese people were almost four times more likely to develop knee osteoarthritis than those with a healthy body weight.2, 3

1 Lee R, Kean WF. Obesity and knee osteoarthritis. Inflammopharmacology. 2012 Apr; 20(2): 53-8.

2 Blagojevic M, Jinks C, Jeffery A, Jordan KP. Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2010; 18(1): 24-33.

3 Muthuri SG, Hui M, Doherty M, Zhang W. What if we prevent obesity? Risk reduction in knee osteoarthritis estimated through a meta-analysis of observational studies. Arthritis Care Res (Hoboken). 2011 Jul; 63(7): 982-90.

Autism

Mr Sheerman: To ask the Secretary of State for Health (1) whether he plans to issue specific guidance relating to pathological demand avoidance; [195308]

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(2) what steps he is taking to ensure that the diagnosis and treatment of pathological demand avoidance is not subject to regional variations; [195314]

(3) what guidance he gives GPs and clinical commissioning groups on pathological demand avoidance and its appropriate treatment; [195315]

(4) what steps he is taking to improve the well-being of children and adults with pathological demand avoidance. [195316]

Norman Lamb: Pathological demand avoidance (PDA) is not recognised within either the International Statistical Classification of Diseases and Related Health Problems (ICD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM). As a result, there are no specific recommendations for the diagnosis or treatment of PDA.

In the course of the development of the National Institute for Health and Care Excellence (NICE) clinical guideline on the treatment of autism in children and young people (CG128), the developers looked at differential diagnoses for autism. In this, they did consider PDA, identifying it as a particular subgroup of autism that could also be described as oppositional defiant disorder (ODD). The guidance recommends that consideration should be given to differential diagnoses for autism (including ODD) and whether specific assessments are needed to help interpret the autism history and observations. However, due to the lack of evidence and the fact that the syndrome is not recognised within the DSM or ICD classifications, NICE was unable to develop specific recommendations on the assessment and treatment of PDA.

The Department therefore has no current plans to issue specific guidance on PDA.

However, we would expect the diagnosis, appropriate treatment and well-being of people with autism spectrum disorders to be addressed in plans outlined in both the adult autism strategy, “Fulfilling and Rewarding Lives”, and the recently published update of the adult autism strategy, “Think Autism”.

The strategy and the recent update both clearly recognise the importance of diagnosis as a vital step to ensuring appropriate support and treatment. Since the publication of the strategy in 2010, we have taken a number of steps to support local areas to develop a clear pathway to diagnosis. Health services should have a pathway to diagnosis just as local authorities should have a clear framework for assessing the care and support needs of children and adults with autism. The Department for Education has worked closely with the Department of Health over a number of years to encourage early identification of potential autism and to link this with relevant support in school.

The NICE Clinical Guidelines, “Recognition, referral and diagnosis of children and young people on the autism spectrum” and “Recognition, referral, diagnosis and management of adults on the autism spectrum” recommend the creation of diagnostic leads in every area together with a multi-disciplinary autism group to support the development and delivery of clear, local autism pathways. Our recent self-assessment exercise to map progress locally and nationally with delivery of the adult autism strategy showed that these structures are in place in many areas which should avoid unacceptable regional variations.

28 Apr 2014 : Column 451W

Improving well-being of children and adults with autism is a core component of “Think Autism” which focuses on three key areas: enabling people to be included in their local community; promoting innovative, local ideas, services or projects which can help people in their communities through new models of care; providing comprehensive, joined-up advice and information for people.

Baby Care Units

Mr Hollobone: To ask the Secretary of State for Health how many babies have required neo-natal care in each NHS trust in each of the past four years. [195750]

Dr Poulter: Information on the number of babies requiring neonatal care over the past four years for each neonatal unit in England for 2010-13 has been placed in the Library. This information has been extracted from the National Neonatal Research Database.

Cancer: West Sussex

Mr Gibb: To ask the Secretary of State for Health what proportion of patients with suspected cancer see a specialist within two weeks in the area served by the Coastal West Sussex clinical commissioning group. [196062]

Jane Ellison: In the second quarter of 2013-14 (July to September 2013), 98.4% of patients in the area served by the Coastal West Sussex clinical commissioning group (CCG) with suspected cancer were referred to a specialist within two weeks. In the third quarter of 2013-14 (October to December 2013), 98.5% of patients were referred within two weeks.

A patient should wait a maximum of two weeks to see a specialist after being urgently referred with suspected cancer by their general practitioner. The operational standard specifies that 93% of patients should be seen within this time.

Cannabis

Charlotte Leslie: To ask the Secretary of State for Health what his policy is on the medicinal use of cannabis. [196293]

Norman Lamb: Cannabis and its preparations are class B controlled drugs under the Misuse of Drugs Act 1971. Cannabis is also subject to international drug control under United Nations Conventions. In the United Kingdom, it is illegal to produce, possess, supply, import or export cannabis except under Home Office licence. Cannabis does not have marketing authorisation for medicinal use in the UK. It is therefore listed in schedule 1 to the Misuse of Drugs Regulations 2001.

Cardiovascular System: Diseases

Chris Ruane: To ask the Secretary of State for Health (1) what steps his Department is taking to encourage clinical commissioning groups to implement the Cardiovascular Disease Outcomes Strategy; [195320]

28 Apr 2014 : Column 452W

(2) what monitoring and assessment his Department has undertaken on the performance of clinical commissioning groups in implementing the Cardiovascular Disease Outcomes Strategy; [195321]

(3) what responsibilities his Department has identified for clinical commissioning groups in implementing the Cardiovascular Disease Outcomes Strategy; [195322]

(4) what steps he is taking to ensure clinical commissioning groups are fulfilling their roles and responsibilities as identified in the Cardiovascular Disease Outcomes Strategy; [195323]

(5) what the role of clinical commissioning groups is in implementing the Cardiovascular Disease Outcomes Strategy. [195324]

Jane Ellison: NHS England has established a working group with Public Health England which meets quarterly to discuss progress on implementing the recommendations of the Cardiovascular Disease (CVD) Outcomes Strategy.

It is for the boards of clinical commissioning groups (CCGs), working with their health and wellbeing boards, to monitor and benchmark their progress on implementation of the strategy and local action taken to improve CVD health outcomes in general.

NHS England has produced various tools and resources to support CCGs to do this, including “Our Ambition to Reduce Premature Mortality: A resource to support commissioners in setting a level of ambition”, which can be found at:

www.england.nhs.uk/premature-mortality/

This web-based resource encompasses a range of evidence-based clinical interventions, many of which are linked to the actions in the CVD Outcomes Strategy.

CCGs are also being encouraged to implement the CVD Outcomes Strategy with the support of the 12 strategic clinical networks. These networks are working with CCGs and other partners in the health and care system to identify local and regional priorities for cardiac and renal disease, diabetes and stroke.

Cystic Fibrosis

Mr Denham: To ask the Secretary of State for Health (1) with reference to the Cystic Fibrosis Trust's report, Hope for more: Improving access to lung transplantation and care for people with cystic fibrosis, what estimate he has made of the donor lung utilisation rate for transplantation; and what measures he has identified as having the greatest potential to increase utilisation; [196084]

(2) what assessment he has made of the effectiveness of existing arrangements for donor lung allocation for people with cystic fibrosis; [196085]

(3) what assessment he has made of the effectiveness of the psychological support available to individuals with cystic fibrosis after lung transplantation. [196086]

Jane Ellison: At present, NHS Blood and Transplant (NHSBT) allocates donated deceased lungs to designated transplant centres on a zonal basis, and the centre is responsible for selecting the patient. The transplant surgeon will use their clinical knowledge to assess both the donor lungs and potential recipients to find the best match, based on aspects such as the risks

28 Apr 2014 : Column 453W

associated with the lungs and the severity of the patient's condition. The current lung allocation system is monitored closely to ensure there is equity for patients across the UK. NHSBT continue to consider practical steps within the current system which could improve patient outcomes.

The Cardiothoracic Organs Advisory Group, part of NHSBT, is presently reviewing the current approach focusing on equity and better outcomes for patients. Any recommendations to change allocation policy will be considered by NHSBT, which will check to ensure that they meet the aims of the allocation system and that they have the support of transplant stakeholders before making any changes.

Decisions about psychosocial support available to people with cystic fibrosis after lung transplantation are a matter for clinicians and commissioners when drawing up the provision of care services for patients.

Eating Disorders: Young People

Luciana Berger: To ask the Secretary of State for Health how many Child and Adolescent Mental Health Service beds for young people suffering from eating disorders there are; and what their occupancy levels were in each year since 2010. [196066]

Norman Lamb: NHS England advises that there are 232 specifically commissioned eating disorder beds for young people. NHS England also advises that the majority of Child and Adolescent Mental Health Service Tier 4 units (618 beds) will also provide services for eating disorders.

Data on occupancy levels in each year since 2010 are not available.

Forensic Science

Dan Jarvis: To ask the Secretary of State for Health what estimate he has made of the number of female physicians available to carry out forensic examinations of victims of crime (a) nationally and (b) in each region. [195861]

Jane Ellison: The information requested is not collected centrally. Provision of forensic medical examiners for sexual assault work is the responsibility of police forces.

In 2009, the “Revised National Service Guide: A Resource for Developing Sexual Assault Referral Centres”, was jointly published by the Home Office, the Association of Chief Police Officers and the Department. It recommended that people who have been sexually assaulted should be offered choice in relation to the gender of the examining physician wherever possible. “Feasibility of Transferring Budget and Commissioning Responsibility for Forensic Sexual Offences Examination Work from the Police to the NHS”, commissioned by the Department and the Home Office and published in 2011 by the university of Birmingham, found that police forces were experiencing difficulties in recruiting female forensic physicians especially where the rota is combined with police custody health care work. Access to female doctors is considered to be an important indicator of service

28 Apr 2014 : Column 454W

quality and police forces now work with NHS England to co-commission better quality forensic and sexual assault public health services for victims of sexual violence.

The Department also funded the establishment of the Diploma in Forensic and Clinical Aspects of Sexual Assault, an examination established by the Society of Apothecaries and now hosted by the Faculty of Forensic and Legal Medicine, which accommodates flexible working patterns, especially to enable female doctors to complete the programme.

General Practitioners

Derek Twigg: To ask the Secretary of State for Health what the ratio of GPs to patients is in each clinical commissioning group area in England. [196193]

Dr Poulter: The information has been placed in the Library.

Health and Wellbeing Boards

Stephen Timms: To ask the Secretary of State for Health what role he envisages for health and wellbeing boards in supporting people into employment; and if he will make a statement. [196092]

Norman Lamb: There is clear evidence that being in good employment is protective of health. Conversely, unemployment, particularly long-term unemployment, has significant impact on physical and mental health and is a driver of health inequalities. Jobs also need to be secure and of good quality, offer the flexibility to balance work and family life, and protection from adverse working conditions that can damage health.

The Department has not set out a vision for the role of health and wellbeing boards (HWBs) in respect of any particular health issue over another, as this would risk undermining one of the core roles of HWBs—that they should set their vision and strategy in a way that best reflects local needs.

However, through their wide-ranging membership, and ongoing engagement with the local community and key local stakeholders, boards can provide valuable opportunities to co-ordinate action across a range of wider factors that impact on the community's health and health inequalities, such as employment.

A key route for doing so is through the development of Joint Strategic Needs Assessments, which in turn will inform local Joint Health and Wellbeing Strategies. HWBs are responsible for overseeing these locally-led processes to identify the current and future health and well-being needs of the local population. This may include an analysis of local employment issues and other wider determinants of health.

HWBs also play a key role in driving improvement against the key measures of the Public Health Outcomes Framework. The framework includes measures on 16 to 18-year-olds not in education, employment or training; employment for those with long-term health conditions; and sickness absence rate.

Health Services

Nic Dakin: To ask the Secretary of State for Health if he will carry out a review of the NHS Outcomes Framework in 2014. [195814]

28 Apr 2014 : Column 455W

Jane Ellison: The Department is planning to carry out a review the NHS Outcomes Framework in 2014, including public consultation. The review is intended to inform the refreshed NHS Outcomes Framework 2015-16, which will be published in autumn 2014.

Health Visitors

Lucy Powell: To ask the Secretary of State for Health how many health visitors there are in post; what change there has been in the number in post since May 2010; how many new health visitors are required in order to reach his target of 4,200 new health visitors by April 2015; how many student health visitors are undergoing health visitor training; when they are due to finish training and begin practice; what his regional targets are for the 4,200 new health visitors; and what proportion of health visitors are currently in post in each such region. [196100]

Dr Poulter: As at December 2013, there are 9,9591 full-time equivalents (FTEs) health visitors in post in England. Overall, there are 1,867 more health visitors compared with the May 2010 baseline of 8,092 (growth of 23%). Based on the December data, a further 2,333 (FTE) new health visitors are required in order to reach the target of 4,200 new health visitors by April 2015.

Health Education England advises that the number of health visitor students starting training between 1 April 2013 and 31 March 2014 was 2,840. Health visitor training is normally a course of one year's duration; therefore these students will be able to join the health visitor workforce at some point in the 12 months from April 2014 onwards.

NHS England has set the following goals at regional level to facilitate delivery of 4,2002 new health visitors by April 2015:

 Number

North

1,064

Midlands and East

1,372

London

691

South

1,126

Total

4,253

The regional breakdown of the current number of health visitors (FTE) increases over the May 2010 baseline position is:

 Number

North

673

Midlands and East

662

London

78

South

456

Total

1,867

1 Latest data (for December 2013) published by the Health and Social Care Information Centre on 25 March 2014.

2 The allocations shown aim to deliver a “contingency” level of 53 FTE health visitors over 4,200 FTEs.

3 The figures do not sum to total due to rounding

Human Papillomavirus

Sir Paul Beresford: To ask the Secretary of State for Health what the total annual cost and take up of the human papillomavirus vaccination programme for

28 Apr 2014 : Column 456W

teenage girls was in each county in each of the last five years. [195797]

Jane Ellison: Information held on human papillomavirus (HPV) vaccine uptake data is only available at old/former primary care trust (PCT) level, not county level. This information is held in the following reports and these have been placed in the Library:

Annual HPV vaccine uptake in England: 2008-09—Appendix 1 (pages 19-23)

http://webarchive.nationalarchives.gov.uk/20130107105354/http:[email protected][email protected][email protected]/documents/digitalasset/dh_111676.pdf

Annual HPV vaccine coverage in England in 2009-10—Table 5 (pages 20-28)

www.gov.uk/government/uploads/system/uploads/attachment_data/file/215800/dh_123826.pdf

Annual HPV vaccine coverage in England in 2010-11—Table 1 (pages 18-12)

http://media.dh.gov.uk/network/211/files/2012/03/120319_HPV_UptakeReport2010-11-revised_acc.pdf

HPV Vaccination Programme: HPV Annual Survey 2011-12

Provisional annual data for routine cohort, year 8 for the HPV Annual survey 2011-12

http://media.dh.gov.uk/network/211/files/2013/01/2900744_HPV_AnnualVaccineUptake11-12_acc.pdf

Annual HPV vaccine coverage in England: 2012-13

Provisional annual data for routine cohort, year 8 for the HPV Annual survey 2012-13

www.gov.uk/government/uploads/system/uploads/attachment_data/file/266190/HPV_AnnualData Table2012_13_SHA_acc2.pdf

Funding given to PCTs for the administration of the HPV vaccination programme is as follows:

For financial year 2008-09, funding was £8.9 million for the routine Programme (12 to 13 years) and £10 million for the catch-up Programme (17 to 18 years), with an overall total of £18.9 million.

For financial year 2009-10, funding was £8.9 million for the routine Programme (12 to 13 years), £16 million for the accelerated Catch-up Programme (14 to 16 years) and £17 million for the catch-up Programme (16 to 18 years), with an overall total of £41.9 million.

From financial year 2010-11, the funding is for the routine programme only (12 to 13 years). For each financial year, 2010-11 and 2011-12 the funding was £8.9 million and in 2012-13 the funding was £7.8 million. NHS England became responsible for funding the administration of the HPV programme from 2013-14.

The additional budget spent in association with the HPV vaccination programme (all communication materials, including advertising) is as follows:

£4.3 million in financial year 2008-09, £4.2 million in financial year 2009-10, £387,500 in financial year in 2010-11, £13,000 in financial year 2011-12 and no spend in financial year 2012-13.

In Vitro Fertilisation

Luciana Berger: To ask the Secretary of State for Health if he will publish research carried out by his Department on the (a) provision of IVF cycles by clinical commissioning groups and (b) criteria used by clinical commissioning groups to determine the number of cycles to which each woman is entitled. [196065]

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Dan Jarvis: To ask the Secretary of State for Health how many courses of IVF treatment patients can access in each clinical commissioning group area in each English region. [196090]

Jane Ellison: The level of provision of infertility treatment, as for all health services they commission, is decided by local clinical commissioning groups (CCGs) and will take into account the needs of the population overall. The CCG's decisions are underpinned by clinical insight and knowledge of local health care needs. As such, provision of services will vary in response to local priorities.

To support CCGs in their commissioning of infertility services, NHS England issued a factsheet in February 2013 which sets out how CCGs should approach these responsibilities. NHS England also expects all those involved in commissioning infertility treatment services to be fully aware of the importance of having regard to the National Institute for Health and Care Excellence fertility guidelines.

During 2010 and 2013 the Department funded Infertility Network UK, the leading infertility patient support group, to produce advice for NHS commissioners about standardising eligibility criteria for fertility services. The subsequent report by Infertility Network UK is signposted in the factsheet. Neither the Department nor NHS England collects information relating to individual CCG policies.

Independent Mental Health Advocates

Dr Julian Lewis: To ask the Secretary of State for Health what information his Department collects on referrals to services providing independent mental health advocacy under the Mental Health Act 2007; what annual reporting processes he has put in place in relation to those referrals; and if he will make a statement. [196327]

Norman Lamb: The Care Quality Commission, as the regulator of the Mental Health Act 1983 (the Act), reports annually on its monitoring of the Act. This is presented to Parliament by the Secretary of State. The 2012-13 annual report found that in the six months from October 2012 to March 2013, very few wards, on which patients were detained under the Mental Health Act 1983, did not have access to Independent Mental Health Advocate (IMHA) services. This was a considerable improvement in access to IMHAs compared with the previous year. On 1 April 2013 the responsibility to commission IMHA services passed to local authorities.

Medical Records: Data Protection

Charlotte Leslie: To ask the Secretary of State for Health what authority the Health and Social Care Information Centre requires for the disclosure to other bodies of identifiable hospital episode statistics data. [196232]

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Dr Poulter: The Health and Social Care Information Centre is able to generate statistics about hospital activity and to support research and analysis. A part of this process includes the disclosure of data from hospital episode statistics, under section 9 of the Health and Social Care Act 2012 (Commencement No. 4, Transitional, Savings and Transitory Provisions) Order 2013.

Recipients of data in identifiable form require authority in order to be able to receive the data. This authority takes one of two forms either by explicit patient consent or by other statutory basis, for example, a court order.

Medical Records: Databases

Barbara Keeley: To ask the Secretary of State for Health pursuant to the answer of 7 April 2014, Official Report, column 44W, on medical records: databases, and with reference to the oral evidence given by the Health and Social Care Information Centre (HSCIC) on 8 April 2014, what the names of the 249 holders of commercial re-use licences are; and what purpose of use of (a) HSCIC and (b) NHS Information Centre data was permitted under each such licence. [195919]

Dr Poulter: The Health and Social Care Information Centre (HSCIC) is committed to openness and transparency around the use of health data. The HSCIC has announced a review of all data releases made by the NHS Information Centre (NHSIC), which is now in progress. This review is being led by Sir Nick Partridge, a non-executive director on the HSCIC board and former chief executive of the Terence Higgins Trust. His report will be published, shortly after it has gone to the HSCIC board, before the end of May 2014. The 249 licences, referred to on 8 April 2014, relate to agreements approved by the NHSIC and will therefore be covered within the review.

Mental Health

Luciana Berger: To ask the Secretary of State for Health (1) how many times NHS England has discussed parity of esteem between mental and physical health at board meetings in the last five years; [196389]

(2) whether it is his policy that recommendations of the Francis Report should apply to mental health. [196480]

Norman Lamb: The Government have enshrined in law the equal importance of mental health and physical health and we have made improving mental health and treating mental illness a key priority. Parity of esteem has been discussed on each occasion the board of NHS England has met over the past year. Parity of esteem was a central topic during preparation of the draft planning guidance and the dedicated business development session discussion in November 2013. NHS England was established on 1 April 2013 so there were no board meetings prior to this date. The following table sets out information about each board meeting:

DateMeetingItem

6 March 2014

Public board meeting

Item 3 within CEO report—Tariff for mental health services in 2014-15

14 January 2014

Public board meeting

Item 6 Patient safety collaborative proposals services in 2014-15

14 January 2014

Public board meeting

Item 11 Urgent and emergency care review

28 Apr 2014 : Column 459W

28 Apr 2014 : Column 460W

17 December 2013

Public board meeting

Item 6 Draft planning guidance

7 November 2013

Board development session

Item 3 Mental health and parity of esteem

8 November 2013

Public board meeting

Mentioned as part of chair's opening

12 September 2013

Board development session

Item 2 Equalities and health inequalities

18 July 2013

Public board meeting

Item 7 Performance and assurance

3 May 2013

Public board meeting

Item 4 Prioritising patients in every decision we make

Source: NHS England—Parliamentary Hub: 14 April 2014.

All minutes from the board meetings of NHS England held in public are published on the NHS England website. Furthermore, all board meetings of NHS England held in public are broadcast live at the time and are uploaded to the NHS England website and YouTube so that they can be viewed by anyone at any time. Details can be located via the following link:

http://www.england.nhs.uk/category/board-meetings/

The Government's response to the Francis Inquiry sets out measures which are intended to reform the entire health and care system. The document “Hard Truths: the Journey to Putting Patients First” explicitly makes reference throughout to the numerous measures that apply to social care and mental health services. The Care Quality Commission is currently developing its improved methodology on mental health inspections. The National Institute for Health and Care Excellence will be developing evidence-based guidelines for safe staffing levels including for mental health in-patient and community settings.

Key actions applicable across mental health as well as physical health include:

appointments of new chief inspectors for hospitals, primary care and social care, and a deputy chief inspector for mental health;

a new set of simpler fundamental standards that make explicit the basic standards beneath which care should never fall;

a failure regime for quality as well as finance;

improving the quality of training and expected conduct of health care assistants to ensure safer and compassionate care;

a new statutory duty of candour on organisations and strengthening candour in professionals' codes and guidance;

new leadership programme for nursing and clinical staff;

transparent monthly reporting of ward-by-ward staffing levels and other safety measures;

a new programme to promote patient safety across all health care settings; and

better support for patients who need to raise a complaint and better trust information about these complaints, including quarterly reporting of complaints data and lessons learned by trusts, and the ombudsman to significantly increase the number of cases she considers.


Luciana Berger: To ask the Secretary of State for Health what assessment NHS England has made of the report of the Independent Commission on Mental Health and Policing commissioned by the Metropolitan Police Commissioner. [196478]

Norman Lamb: NHS England is currently reviewing its actions in response to the “Crisis Care Concordat” and will review the recommendations of the Independent Commission on Mental Health and Policing in light of this.

Mental Health Services: Young People

Luciana Berger: To ask the Secretary of State for Health when NHS England's review of Tier 4 Children and Adolescent Mental Health Services provision will be complete. [196387]

Norman Lamb: NHS England advise that its review of Tier 4 Children and Adolescent Mental Health Services provision, which is intended to map current provision and identify areas within specialised commissioning for improvement, will be available in the near future.

Midwives

Lucy Powell: To ask the Secretary of State for Health how many women now have access to a named midwife; how many women each named midwife looks after; and what proportion of women get one-to-one midwifery care in labour. [195970]

Dr Poulter: This data are not collected centrally, however, both Health Education England (HEE) and NHS England are mandated to deliver on personalised care for maternity services. HEE is responsible for ensuring the maternity work force is trained with the right skills and behaviours in order for NHS England to be able to deliver the services.

HEE is working with NHS England to ensure that sufficient midwives and other maternity staff are trained and available to provide every woman with personalised one-to-one care throughout pregnancy, childbirth and during the post-natal period.

Lucy Powell: To ask the Secretary of State for Health how many midwives there were in each of the last five years. [195971]

Dr Poulter: The following table shows the number of registered qualified midwives in the national health service in the last five years:

 20092010201120122013

Qualified midwives (full-time equivalent) FTE

19,496

20,126

20,519

20,935

21,284

Source: NHS Health and Social Care Information Centre

NHS England

Mr Jamie Reed: To ask the Secretary of State for Health which former directors in his Department have been promoted to new roles at NHS England in the last four years. [196044]

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Dr Poulter: Miles Ayling, Ben Dyson, Dominic Hardy, John Holden, Richard Murray, Keith Ridge and Giles Wilmore were employed by the Department as directors and secured new roles at NHS England following its establishment in October 2012. These new roles, with a different employer, are not directly comparable with their departmental roles. Richard Murray has subsequently left NHS England.

NHS: Drugs

Richard Burden: To ask the Secretary of State for Health what steps he is taking with his EU counterparts to standardise the reimbursement prices given to pharmaceutical companies by national health authorities in different EU member states. [195724]

Norman Lamb: The pricing and reimbursement of medicines is a national competence as part of member states' responsibilities to organise and manage health services, and different European countries take different approaches, reflecting the differing needs and characteristics of their patient populations and health care systems. In view of this, the Secretary of State for Health has not undertaken any steps aimed at standardising pharmaceutical reimbursement prices in different countries.

NHS: Insolvency

Mr Jamie Reed: To ask the Secretary of State for Health pursuant to the answer of 7 April 2014, Official Report, column 48W, on NHS: insolvency, if he will publish the agenda and minutes from the meeting on 2 April 2014. [195727]

Jane Ellison: We are in the process of agreeing with the right hon. Member for Sutton and Cheam (Paul Burstow) the terms of reference and other arrangements for the committee he is due to chair. We plan to place a final copy of the minutes of the meeting on 2 April in the Library in due course.

Pancreatic Cancer

Ms Ritchie: To ask the Secretary of State for Health what steps he has taken to ensure that recent progress in the diagnosis and treatment of pancreatic cancer informs NHS practice. [195977]

Jane Ellison: Since 1 April 2013, NHS England has been responsible for delivering improvements in all cancer services.

NHS England and the National Institute for Health and Care Excellence (NICE) regularly review and update their guidance in line with the latest clinical evidence. In addition, clinicians are expected to stay alert to developments.

Since 2005, the “Referral Guidelines for Suspected Cancer”, published by NICE has supported general practitioners to identify patients with the symptoms of suspected cancer and urgently refer them as appropriate.

NICE is in the process of updating this guidance to ensure that it reflects the latest evidence.

Pancreatic cancer has also been referred to NICE as a topic for development into a Quality Standard. Quality Standards set out the markers of high quality care for a

28 Apr 2014 : Column 462W

disease area and contain up to 15 quality statements describing what that service should deliver, which informs NHS practice.

NHS England's pancreatic cancer service specification clearly defines what it expects to be in place for providers to offer evidence-based, safe and effective pancreatic cancer services.

Post-natal Depression

Lucy Powell: To ask the Secretary of State for Health with reference to his announcement of 16 May 2012, how many and what proportion of health visitors have been given enhanced training to identify the early signs of post-natal depression. [195974]

Dr Poulter: The Department does not keep a central record of training undertaken by health visitors, though it is aware that all specialist community public health nurses are given initial training in recognising and responding to a wide range of perinatal mental health issues, including post-natal depression.

It was acknowledged that in addition to the above core training, health visitors would find it helpful to be engaged in additional training, to enhance skills and knowledge in the context of their specific roles. We have therefore commissioned the training of 375 perinatal mental health champions who have now been trained across England. The perinatal champions have responsibility for cascading their training in their local areas to facilitate the spread of knowledge and practice among colleagues.

In addition to the training of champions, three perinatal mental health key learning modules have been developed with open access to participation from all health visitors. These focus on:

perinatal depression and other maternal mental health disorders;

recognition of perinatal anxiety and depression; and

interventions for perinatal anxiety and depression and other related disorders.

Prescription Drugs

Charlotte Leslie: To ask the Secretary of State for Health how many prescriptions for individual (a) benzodiazepine drugs and (b) antidepressants were dispensed in the community in 2013. [196292]

Norman Lamb: The information requested is shown in the following tables.

Table 1: Number of benzodiazepine prescription items written in the United Kingdom and dispensed in the community in England in the year 2013, as classified as hypnotics and anxiolytics in British National Formulary (BNF) section 4.1
BNF chemical namePrescription items (thousand)

alprazolam

1

chlordiazepoxide hydrochloride

151.0

diazepam

5,279.8

loprazolam mesilate

62.9

lorazepam

1,028.1

lormetazepam

38.1

nitrazepam

802.8

oxazepam

139.8

temazepam

2,011.0

28 Apr 2014 : Column 463W

Total2

9,513.6

1 Less than 50 prescription items dispensed. 2 Total figure may not sum due to rounding. Source: Prescription Cost Analysis (PCA) system data provided by the Health and Social Care Information Centre
Table 2: Number of benzodiazepine prescription items written in the United Kingdom and dispensed in the community in England in the year 2013, as classified as antiepileptic drugs in British National Formulary section 4.8
BNF chemical namePrescription items (thousand)

clobazam

233.9

clonazepam1

796.5

clonazepam2

1.3

midazolam hydrochloride

31.6

midazolam maleate

29.4

Total3

1,092.7

1 From BNF 4.8.1 Control of the epilepsies. 2 From BNF 4.8.2 Drugs used in status epilepticus. 3 Total figure may not sum due to rounding. Source: Prescription Cost Analysis (PCA) system data provided by the Health and Social Care Information Centre
Table 3: Number of benzodiazepine prescription items written in the United Kingdom and dispensed in the community in England in the year 2013, as classified as anaesthesia drugs in British National Formulary section 15.1.4
BNF chemical namePrescription items (thousand)

midazolam hydrochloride

132.8

Total1

132.8

1 Total figure may not sum due to rounding. Source: Prescription Cost Analysis (PCA) system data provided by the Health and Social Care Information Centre
Table 4: Number of antidepressant prescription items written in the United Kingdom and dispensed in the community in England in the year 2013, as classified as antidepressant drugs in British National Formulary section 4.3
BNF Chemical NamePrescription items (thousand)

agomelatine

24.0

amitriptyline hydrochloride

11,092.8

citalopram hydrobromide

13,702.9

citalopram hydrochloride

75.6

clomipramine hydrochloride

342.2

dosulepin hydrochloride

1,305.8

doxepin

48.7

duloxetine hydrochloride

1,173.0

escitalopram

959.3

fluoxetine hydrochloride

6,016.2

flupentixol hydrochloride

163.1

fluvoxamine maleate

27.4

imipramine hydrochloride

175.8

isocarboxazid

1.9

lofepramine hydrochloride

285.8

maprotiline hydrochloride

1

mianserin hydrochloride

8.3

moclobemide

19.8

nefazodone hydrochloride

0.2

nortriptyline

498.3

oxitriptan

0.1

paroxetine hydrochloride

1,513.0

phenelzine sulphate

18.8

reboxetine

37.3

sertraline hydrochloride

6,305.1

tranylcypromine sulphate

9.7

trazodone hydrochloride

996.0

trimipramine maleate

87.7

tryptophan

3.2

venlafaxine

3,144.4

28 Apr 2014 : Column 464W

Total2

53,326.6

1 Less than 50 prescription items dispensed. 2 Total figure may not sum due to rounding. Source: Prescription Cost Analysis (PCA) system data provided by the Health and Social Care Information Centre

Luciana Berger: To ask the Secretary of State for Health what assessment his Department has made of the effectiveness of the polypill. [196388]

Norman Lamb: We have made no such assessment. There are currently no approved marketing authorisations for a product that meets the description of a polypill. Any application for a marketing authorisation for a medicinal product must be supported by data demonstrating that the quality, safety and efficacy are satisfactory to ensure that the risk to benefit profile is favourable for the proposed treatment before a licence is granted.

Prisoners: Hepatitis

Sadiq Khan: To ask the Secretary of State for Health (1) how many prisoners were recorded as having caught hepatitis B while in prison in (a) 2010, (b) 2011, (c) 2012 and (d) 2013; [196381]

(2) how many vaccinations for hepatitis B were given in prisons in (a) 2010, (b) 2011, (c) 2012 and (d) 2013; [196382]

(3) how many prisoners were recorded as having hepatitis B at the time of their induction into prison in (a) 2010, (b) 2011, (c) 2012 and (d) 2013. [196386]

Norman Lamb: Surveillance data referring to the number of people diagnosed with chronic hepatitis B in prisons in England from Public Health England (PHE) show that, in 2010, 22 prisoners were diagnosed with chronic hepatitis B; in 2011, 45 prisoners were found to be infected; in 2012, 96 cases were detected, and that in 2013, 109 cases were recorded. The increasing number of cases most likely represents improved levels of testing among prisoners and improved reporting to PHE. Testing may occur at various stages of the prisoners' care pathway and not only at induction.

Surveillance data referring to the number of people diagnosed with acute hepatitis B in prisons in England, show that in 2010 there were two cases of acute hepatitis B; in 2011 there were also two reported cases of acute hepatitis B; there were no reported cases in 2012, and there were no reported cases in 2013. It is not clear from the surveillance data alone whether the infection was acquired in the prison or due to risk activity prior to incarceration. These data are based on reports from health protection teams who are informed by prisons and diagnosing laboratories.

Data on uptake of vaccination are reported and recorded per financial year. In 2010-11, 109,827 doses of hepatitis B vaccine were administered to prisoners in England; in 2011-12, 77,145 doses of vaccine were administered; in 2012-13, 74,785 doses were administered. These figures represent vaccine coverage of the total eligible prison population of 57% in all the years reported.

28 Apr 2014 : Column 465W

Quality of Care and Treatment Provided by 14 Hospital Trusts in England Review

Charlotte Leslie: To ask the Secretary of State for Health for what reason no formal minutes were taken of the meeting of the national advisory group to the Keogh Mortality Review of 5 July 2013. [196294]

Dr Poulter: The meeting referred to was the final meeting of the National Advisory Group (NAG) to the Keogh Mortality Review. The NAG was established to support Professor Sir Bruce Keogh's review into 14 trusts with higher than expected mortality rates. The group met on three occasions.

Formal minutes from the first two meetings of the NAG held on 11 March 2013 and 28 May 2013 are available on the NHS Choices website:

www.nhs.uk/NHSEngland/bruce-keogh-review/Pages/national-advisory-group.aspx

The final meeting consisted of an informal discussion on the overall findings of the review at which a slide pack on the lessons from the review, videos of some of the risk summits and drafts of some of the individual trust reports were shared. Due to the informal nature of the discussion minutes were not taken.

Radiotherapy

Mike Thornton: To ask the Secretary of State for Health what steps he is taking to ensure that all patients receive innovative radiotherapy treatment where clinically indicated. [195978]

Jane Ellison: Since April 2013, NHS England is the commissioner for radiotherapy for all cancer treatments in England meaning cancer patients are considered for the most appropriate radiotherapy treatment regardless of where they live. The “Vision for Radiotherapy” document sets out shared aspirations for the future of radiotherapy cancer care across England and will be a key document in informing NHS England's five-year strategy for specialised services, including the provision of innovative radiotherapy treatments for patients, where clinically indicated.

NHS England, with its partners, will define a national strategy for implementation of the vision to support the rapid adoption of affordable new technologies, including treatment devices, imaging techniques and treatment planning software, across the NHS where needed, and where evaluation has shown clinical and cost effectiveness.

Mike Thornton: To ask the Secretary of State for Health what progress has been made over the last 12 months on delivering the Prime Minister's pledge that cancer patients will have access to innovative radiotherapy techniques from April 2013. [196472]

Jane Ellison: The National Radiotherapy Implementation Group (NRIG), established to advise the Department and Ministers on radiotherapy services in England, recommended that 24% of all radical cases should be delivered with inverse planned Intensity Modulated Radiotherapy (IMRT) to minimise the long-term side effects of treatment. The figure of 24% comes from an NRIG calculation of the proportion of patients who would benefit from the treatment.

28 Apr 2014 : Column 466W

NHS England took over responsibility for commissioning radiotherapy services in April 2013 and developed a plan which has seen the national average for IMRT increase from 22% to 32% as of January 2014. All centres have met the 24% target although some variation at centre level is still seen month on month. NHS England continues to keep this under close scrutiny and works with providers at a local level to monitor progress on a monthly basis.

Radiotherapy: South East

Mr Gibb: To ask the Secretary of State for Health what proportion of cancer patients have access to Intensity Modulated Radiotherapy at (a) Brighton University Hospitals Trust and (b) Southampton University Hospitals Trust. [196087]

Jane Ellison: The following tables show the self-reported performance against the national Intensity Modulated Radiotherapy (IMRT) target over the latest available six-month period for Brighton University Hospitals NHS Trust and Southampton University Hospitals NHS Foundation Trust.

Radiotherapy is not an appropriate treatment for all patients with cancer, because some cancers respond better to other treatments such as surgery and chemotherapy. Moreover, IMRT is a form of radical radiotherapy, and some patients will require palliative, as opposed to radical, radiotherapy.

The national target for IMRT is that trusts providing external beam radiotherapy should deliver a minimum of 24% of radical fractions (treatment sessions) as inverse planned IMRT.

Brighton University Hospitals NHS Trust
 Percentage

2013

 

September

18

October

25

November

22

December

28

  

2014

 

January

30

February

29

Notes: 1. These self-reported positions are preliminary data, and may differ from the national radiotherapy dataset (RTDS) data against which the target is formally monitored. 2. However, since the RTDS data are released around two months in arrears, the self-reported positions are used as a proxy measure for monitoring performance on a monthly basis. Source: Wessex NHS England Area Team.
Southampton University Hospitals NHS Foundation Trust
 Percentage

2013

 

October

22.5

November

27.9

December

29.9

  

2014

 

January

28.2

February

24.4

28 Apr 2014 : Column 467W

March

28.5

Notes: 1. These self-reported positions are preliminary data, and may differ from the national radiotherapy dataset (RTDS) data against which the target is formally monitored. 2. However, since the RTDS data are released around two months in arrears, the self-reported positions are used as a proxy measure for monitoring performance on a monthly basis. 3. With respect to Southampton University Hospitals NHS Foundation Trust, there was a slight drop in treatment percentage in October 2013 due to a higher than normal number of radical patient starts. Source: Surrey and Sussex NHS England Area Team.

Sexual Assault Referral Centres

Dan Jarvis: To ask the Secretary of State for Health what sexual assault referral centres are operating in each region. [195858]

Jane Ellison: The health aspects of sexual assault referral centre services are devolved. The information for England is listed as follows:

Area, Centre Name and Address

Avon and Somerset

The Bridge

2nd Floor

Central Health Clinic

Tower Hill

Bristol BS2 03D

Bedfordshire

The Emerald Centre SARC

Bedford Health Village

The Enhanced Services Centre

3 Kimbolton Road

Bedford MK40 2NT

Cornwall

The Willow Centre

Truro Health Park,

Infirmary Hill,

Truro TR1 2JA

Cambridgeshire

OASIS@ Rivergate

Viersen Platz

Peterborough PE11SE

Derbyshire

Millfield House

PO Box 6960

Ripley

Derbys DE5 4AF

Devon and Torbay

The Oak Centre

Hawkins House

Pynes Hill

Rydon Lane

Exeter EX2 5SS

Dorset

ARC Dorset

Madeira Road

Bournemouth

Dorset BH1 1QQ

28 Apr 2014 : Column 468W

Durham

The Meadows

John Street North

Meadowfield

Durham DH7 8RS

Essex

Oakwood Place

Brentwood Community Hospital

Crescent Drive

Brentwood

Essex

Gloucestershire

Hope House

Gloucestershire Royal Hospital

Great Western Road

Gloucester GL1 3NN

Hampshire and Isle of Wight

The Treetops Centre

Northern Road

Cosham

Portsmouth P06 3EP

Hertfordshire

Sunflower SARC

98 Cotterells

Hemel Hempstead

Herts HP1 1JQ

Humberside and North Lincs and NE Lincs

CASA Suite

810a Hessle Road

Hull HU4 6RD

Kent

Renton Clinic

Darent Valley Hospital

Dartford

Kent DA2 8DA

Lancashire, Preston

The SAFE Centre

Royal Preston Hospital

Sharoe Green Lane

Fulwood

Preston PR2 8HT

Leicestershire

Juniper Lodge

Lodge One

Leicestershire General Hospital

Gwendolen Road

Leicester LE5 4PW

Lincolnshire

Spring Lodge

12 Dean Road

Lincoln LN2 4DR

London, Camberwell

Haven – Camberwell

King's College Hospital

Denmark Hill

London SE5 9RS

London, Paddington

Haven – Paddington

28 Apr 2014 : Column 469W

St. Mary's Hospital

Praed Street

London W2 1NY

London, Whitechapel

Haven – Whitechapel

The Royal London Hospital

9 Brady Street

London E1 5BD

Manchester

St Mary's Centre

St. Mary's Hospital

Oxford Road

Manchester M13 9WL

Merseyside

SAFE Place – Merseyside

6th Floor, Citrus House

40-46 Dale Street

Liverpool L2 5SF

Norfolk

The Harbour Centre

267a Reepham Road

Norwich

Norfolk NR6 5QH

Northamptonshire

SERENITY

Highfield Clinical Care Centre

Cliftonville Road

Northampton NN15DN

Northumbria, Newcastle-upon-Tyne & Sunderland

REACH - The Rhona Cross Suite

New Croft House

Market Street

Newcastle upon Tyne

NE1 6ND

REACH - Ellis Fraser Centre

Sunderland Royal Hospital

Kayll Road

Sunderland SR4 7TP

Nottinghamshire

The Topaz Centre

PO Box 9262

Nottingham North

Nottinghamshire NG5 ODW

Plymouth

Twelves Company

37 The Millfields

Plymouth PL1 3JB

Staffordshire and Stoke on Trent

Cobridge Health Centre

Church Terrace

Cobridge

Stoke-on-Trent

Staffordshire ST6 2JU

Suffolk

The Ferns

Unit 10 & 10A Delta Terrace

West Road

Ransomes Europark

28 Apr 2014 : Column 470W

Ipswich IP3 9FH

Surrey

The Solace Centre

Cobham Community Hospital

168 Portsmouth Road

Cobham

Surrey KT11 1HS

Sussex

The Saturn Centre

Crawley Hospital

West Green Drive

Crawley

West Sussex RH11 7DH

Thames Valley

The Solace Centre

Upton Hospital

Church Street

Slough SL1 2BJ

Solace Centre

Sherwood Drive

Bletchley

Milton Keynes

Bucks MK3 6TP

West Mercia

Covers Worcestershire, Shropshire and Herefordshire

The Glade

Bransford

Worcestershire WR6 5JD

West Midlands

The Rowan Centre

2 Ida Road

Walsall

West Midlands WS2 9SR

Wiltshire

The New Swindon Sanctuary

The Gables

Shrivenham Road

South Marston

Swindon SN3 4RB

Yorkshire, South

The Isis and the Artemis Sexual Assault Referral Centre

Rotherham NHS Foundation Trust

Rotherham General Hospital

Moorgate Road

Rotherham S60 2UD

Yorkshire, North

SARC-TBA

48 Bridge Road

Bishopthorpe

York YO21 1RR

Speed Limits

Dr Huppert: To ask the Secretary of State for Health what assessment his Department has made of the potential public health benefits of changing the national urban default speed limit to 20 mph and thereby reducing injuries to pedestrians and cyclists; and what information his Department holds on whether comparable assessments have been made in other developed nations. [195954]

28 Apr 2014 : Column 471W

Jane Ellison: Public Health England (PHE) is currently reviewing evidence and trend data to identify further potential areas for local authorities and Government to improve road safety for children and young people. We anticipate publication of this report in May 2014.

In England, there is evidence that where 20 miles per hour (mph) speed limits have been introduced, these have led to reduced vehicle speeds.1 At 20 mph vehicle speeds there are reductions in the numbers of children killed or seriously injured as a result of road traffic collisions.2 A growing number of local authorities are introducing 20 mph zones based on the assessment of local risk.

Comparable assessments have been made by developed nations including the United States where cost benefit analysis, studies of the ‘safe routes to schools' and before and after case studies have taken place, providing evidence on 20 mph limits and zones.

1 Grundy C, Steinbach R, Edwards P, et al. Effect of 20 mph traffic speed zones on road injuries in London, 1986 to 2006: controlled interrupted time series analysis. BMJ. 2009;339:b4469.

2 Rosen E, Stigson H, Sander U. Literature review of pedestrian fatality risk as a function of car impact speed. Accid Anal Prev. 2011;43:25-33.

Standardised Packaging for Tobacco Independent Review

Priti Patel: To ask the Secretary of State for Health if he will provide a detailed breakdown of all the costs incurred as part of Sir Cyril Chantler's Independent Review into standardised packaging of tobacco. [195912]

Jane Ellison: The cost of undertaking and producing the Chantler report was approximately £125,000. The costs broadly breakdown as follow:

Staffing, including members of the secretariat: £103,602

Room for review panel: £9,360

Printing of report: £3,965

Other costs including travel and subsistence, catering etc.: £6,988

Throat Cancer

Sir Paul Beresford: To ask the Secretary of State for Health what proportion of oro-pharyngeal cancers treated have been diagnosed as human papillomavirus-related in each of the last five years. [195794]

Jane Ellison: Human papillomavirus (HPV) status is not a routinely collected data item in any national cancer data set. Public Health England has advised that it is therefore unable to determine the proportion of oro-pharyngeal cancers that are HPV-related.

However, studies have highlighted an association between head and neck squamous cell cancers in some specific sites and HPV and there is evidence of larger increases in the number of these cancers over the last two decades than for other sites.

Sir Paul Beresford: To ask the Secretary of State for Health what the average (a) length is and (b) intensive care, surgical and other costs are of a hospital admission due to a case of oro-pharyngeal cancer. [195796]

Jane Ellison: The average intensive care, surgical and other costs of a hospital admission due to a case of

28 Apr 2014 : Column 472W

oro-pharyngeal cancer is £831. The average length of stay of a hospital admission due to this condition is two days for elective in-patients and five days for non-elective in-patients. However, these data do not take into account complications and co-morbidities associated with the condition which can increase the cost and length of stay.

Tobacco: Packaging

Priti Patel: To ask the Secretary of State for Health on what date he plans to publish draft regulations on the introduction of standardised packaging of tobacco products. [195913]

Jane Ellison: I refer my hon. Friend to the statement I made to the House on 3 April 2014, Official Report, column 1018.

No further decisions have been made on the date for the publication of the consultation.

Tobacco: Retail Trade

Luciana Berger: To ask the Secretary of State for Health what (a) correspondence and (b) representations from lawyers representing tobacco companies (i) Ministers and (ii) civil servants in his Department have received since the announcement of the Chantler review on 28 November 2013; and from which law firms and tobacco companies in each such case. [196098]

Jane Ellison: The Department received five letters from the law firm Herbert Smith Freehills representing British American Tobacco, dated 20 December 2013, 9 January 2014, 7 February 2014 and with two letters on 4 April 2014. No other representations have been received within this period.

Tobacco: Young People

Priti Patel: To ask the Secretary of State for Health what assessment he has made of the role that small shops and independent retailers play in preventing underage sales of tobacco. [195914]

Jane Ellison: The Government acknowledge the key role that responsible retailers play in ensuring tobacco products are not sold to customers under the legal age of sale of 18 years. This was recognised in recent debates during the passage of the Children and Families Act 2014, during which provision was made to support retailers by introducing a new offence which makes it illegal for adults to buy tobacco on behalf of children and young people.

Data on the sources of tobacco for children and young people aged 11 to 15 years is collected through the Health and Social Care Information Centre's survey “Smoking Drinking and Drug Use among Young People in England 2012”. The survey has been placed in the Library.

Warfarin

Mr Brady: To ask the Secretary of State for Health how many warfarin patients attending anti-coagulant clinics had to wait for a prescriber to administer vitamin K in the most recent year for which information is

28 Apr 2014 : Column 473W

available; what the average waiting times for those patients was; and how many of those patients had to go to accident and emergency because a prescriber was not available. [196283]

Jane Ellison: This information is not collected centrally.

Prime Minister

India

Mr Spellar: To ask the Prime Minister what meetings he plans to have with representatives of the Sikh community on events surrounding the storming of the Golden Temple in Amritsar in 1984 and subsequent massacres. [196312]

The Prime Minister: I refer the right hon. Member to the answer I gave to the hon. Member for Leeds North East (Fabian Hamilton) on 5 February 2014, Official Report, column 240W.

Ministers: Accountability

Jim Dowd: To ask the Prime Minister if he will list the fiduciary duties applying to Ministers. [196152]

The Prime Minister: The Ministerial Code sets out the duties and responsibilities of Ministers.

National Security Council

Mr Ainsworth: To ask the Prime Minister what assessment (1) he has made of the ability of the National Security Council to foster collective decision-making across Government; [196231]

(2) what role the National Security Council plays in the long-term strategic planning and development of security policy. [196229]

The Prime Minister: The National Security Council is a Sub-Committee of the full Cabinet. It addresses all elements of national security strategy. It seeks to understand the context, risks and opportunities facing the country; debates policy options; decides courses of action; and monitors and evaluates their implementation. It brings together Ministers and experts on a weekly basis, fostering genuine discussion and collective decision-making on both strategic and operational issues. Regularity of meetings enables Ministers to build up knowledge of particularly complex matters over time and to take well-informed decisions. Specialised sub-committees ensure that appropriate attention is paid to the most complex and technical issues.

Pakistan

Paul Flynn: To ask the Prime Minister what matters in respect of (a) Pakistan's possession of nuclear weapons and (b) the prospects of Pakistan joining the Nuclear Non-proliferation Treaty he discussed at his April 2014 meeting with his Pakistani counterpart. [196132]

The Prime Minister: I have not met my Pakistani counterpart this month.

At our meeting on 30 April I will discuss a range of foreign policy issues with Prime Minister Sharif.

28 Apr 2014 : Column 474W

Leader of the House

Standards Select Committee

Mr Winnick: To ask the Leader of the House if he will introduce and consult upon proposals for the Standards Committee to be replaced by a body consisting of a majority of lay members with representation of more than three hon. Members without voting rights. [196096]

Mr Lansley: The House strengthened its own procedures in January 2013 by reconstituting the Committee on Standards to include lay member representation, with a specific right to submit an opinion on any report of that Committee and to have it published.

I have had recent discussions with the Chair of the Committee on Standards, the Parliamentary Commissioner for Standards and other interested parties on ensuring that the standards regime for Members is as robust as it can be.

I expect the Committee on Standards to announce shortly terms of reference for an inquiry examining the current system, which draws on the recent report by the lay members of that Committee. I expect to follow up my discussions with the Committee on Standards in order further to strengthen lay members’ scrutiny of standards matters. If any Member wishes to bring forward specific proposals for improvements to the system, this is of course something that both the Committee and the House will wish to consider.

Stationery

Mr Redwood: To ask the Leader of the House what levels of stock his Office holds of (a) stationery, (b) printer cartridges, (c) treasury tags and other fasteners and (d) other office consumables. [196213]

Mr Lansley: The Office of the Leader of the House of Commons is part of the Cabinet Office. The information requested is not held centrally.

Environment, Food and Rural Affairs

Air Pollution

Luciana Berger: To ask the Secretary of State for Environment, Food and Rural Affairs whether his Department intends to create a strategy to mitigate the effect of air pollution on public health. [195292]

Dan Rogerson: The Government recognise the impact poor air quality can have on human health and the environment and have put in place a framework for delivering improvements via the Air Quality Strategy and Local Air Quality Management. The European Commission also has requirements for member states to meet legally binding limits for key pollutants to protect public health and ecosystems.

The Government are committed to ongoing work to reduce this impact and has invested many billions of pounds in measures that will help to reduce air pollution from transport, energy and industrial sources, including over £1 billion in ultra-low emission vehicles and sustainable transport measures, incentives and infrastructure projects

28 Apr 2014 : Column 475W

for electric and hybrid vehicles, a Local Sustainable Transport Fund of £490 million, a fund of around £100 million for less polluting bus services and investment in measures to promote cycling and walking. All these measures are helping to reduce transport emissions, which are the main contributor to air pollution in towns and cities.

In addition to these national measures, local authorities have a responsibility to manage local air quality and to put in place plans to improve air quality where national objectives are not met. Local action is also supported by the Government’s air quality grant programme, which has provided over £50 million since 1997 for innovative projects.

DEFRA works with Public Health England, the Department of Health and other Government Departments to maintain and develop methodologies for assessing air quality impacts on health and the environment, and to develop evidence-based measures to ensure air quality is appropriately prioritised and integrated into local strategies. For instance the Government have established an Air Quality Indicator as part of the new Public Health Outcomes Framework. Local authorities will be expected to deliver against 68 measurable outcomes (indicators) for health, including for air quality.

Barry Gardiner: To ask the Secretary of State for Environment, Food and Rural Affairs how many monitoring stations were in place and returning air quality data for NO2, PM2.5 and PM10 in (a) 2010, (b) 2011, (c) 2012, (d) 2013 and (e) 2014. [195710]

Dan Rogerson: DEFRA operates an extensive monitoring network in order to assess air quality in the UK. The number of sites may vary year to year as sites are upgraded or replaced. A summary of the number of monitoring stations for each pollutant by year is provided as follows.

 NO2PM2.5PM10

2010

117

78

68

2011

118

78

68

2012

121

80

69

2013

118

83

72

2014

115

80

70

Barry Gardiner: To ask the Secretary of State for Environment, Food and Rural Affairs which air quality monitoring stations went off-line in each year since 2010-11; and on what dates they were off-line. [195712]

Dan Rogerson: DEFRA operates an extensive monitoring network of nearly 300 sites in order to assess air quality in the UK and report to the EU for compliance. Many of these sites have multiple instruments measuring different pollutants.

The Automatic and Urban Network has 130 sites that provide information on five key pollutants on an hourly basis. Information from this network is updated hourly on the UK-Air website to provide the most recent data to the public.

An extensive programme of maintenance, auditing and site inspections is required to maintain the network’s operation. EU directives state that instruments must be

28 Apr 2014 : Column 476W

operational for a minimum period of time for data to be reported and these requirements are met in our annual compliance reporting.

It is therefore not possible to provide information on the specific times when instruments were not operational during the last four years, but I refer the hon. Member to the UK's annual compliance report for statistics regarding data capture at each site, at:

http://uk-air.defra.gov.uk/library/annualreport/index

Barry Gardiner: To ask the Secretary of State for Environment, Food and Rural Affairs by what date each of the 40 air quality zones with exceedances of nitrogen dioxide limit values in 2010 will achieve compliance with 2010 nitrogen dioxide limit values. [195726]

Dan Rogerson: Meeting EU standards for nitrogen dioxide remains a challenge for many large urban areas in the UK and across Europe. In 2011 DEFRA submitted estimates of the year each part of the UK would meet these standards to the European Commission. The assumptions behind our projections are regularly reviewed to reflect new understanding and we expect to have new projections available later this year.

Barry Gardiner: To ask the Secretary of State for Environment, Food and Rural Affairs on what date the Government plans to send and publish their reply to the European Commission letter of formal notice of persistent air pollution problems sent on 20 February 2014. [195728]

Dan Rogerson: The deadline for a response to the European Commission is 21 April 2014. Correspondence between the Commission and member states in infringement proceedings is confidential. We do not, therefore, intend to publish the UK’s response.

Barry Gardiner: To ask the Secretary of State for Environment, Food and Rural Affairs when the Government will publish a second consultation on local air quality management. [195729]

Dan Rogerson: We expect to publish a second consultation on regulatory and guidance changes to the Local Air Quality Management system (in England) towards the end of this year. As stated in our Summary of Responses published last December, we intend to explore all alternatives put forward by respondents, drawing on core conclusions from the review and working in partnership with key stakeholders. This will ensure that a robust and sustainable package is put forward as part of the next consultation.

Bees

Mr Jim Cunningham: To ask the Secretary of State for Environment, Food and Rural Affairs what recent steps the Government have taken to protect the UK's honeybee population. [195672]

Dan Rogerson: Recent steps taken by DEFRA to protect the UK’s honeybee population include the launch of the National Pollinator Strategy and conducting a 12 month policy review, in collaboration with stakeholders,

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on the pests and diseases affecting honeybees. Longer term initiatives include the Healthy Bees Plan and continued funding of the National Bee Unit.

Jim Shannon: To ask the Secretary of State for Environment, Food and Rural Affairs what steps he has taken to protect each of the 26 species of bee that are under threat in the UK. [195900]

Dan Rogerson: Conservation of biodiversity is a devolved matter. Action in Scotland, Wales and Northern Ireland is a matter for the devolved Administrations.

England’s biodiversity strategy, Biodiversity 2020, takes an integrated, large-scale approach to biodiversity conservation, exemplified by our Nature Improvement Areas initiative. This approach is designed to meet the habitat needs of many species, including threatened species of bee.

The strategy recognises that there will also be a need to take targeted action for the recovery of certain priority species, including certain bee species, whose conservation is not delivered through wider, habitat-based measures. These species are catered for through Natural England’s Species Recovery Programme. The recent reintroduction of the short-haired bumblebee in the south east of England is one such example.

Incentives for farmers and other land managers to conserve and enhance important wildlife habitats, including those for bees, are provided under Environmental Stewardship schemes. Following a review, new payments were introduced from 1 January 2013 to improve habitats and food for pollinators, including bees. These payments provide for the addition of wildflowers to buffer strips and field corners, and the provision of legume-rich and herb-rich swards.

For the future, we are currently considering the scope for further enhancements for bees and other pollinators as part of wider environmental delivery through the reformed Common Agricultural Policy. Over £3.1 billion will be available up to 2020 to protect and enhance biodiversity under the New Environmental Land Management Scheme.

DEFRA is also developing the National Pollinator Strategy for England to reflect the importance of bees and other insect pollinators to agriculture and biodiversity and in recognition that they face many pressures. A public consultation was launched in March 2014 and the final strategy will be finalised in summer 2014.

Simon Reevell: To ask the Secretary of State for Environment, Food and Rural Affairs what estimate he has made of the geographical spread in the UK of the bacterium melissococcus plutonius. [196047]

Dan Rogerson: The bacterium is widespread across England and Wales. A recently completed two-year random survey of 4,600 apiaries estimated Melissococcus plutonius as being present in 1.6% in year 1 (2009-10) and 1.3% in year 2 (2010-11).

Birds

Jim Shannon: To ask the Secretary of State for Environment, Food and Rural Affairs what recent discussions Ministers in his Department have had with

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their counterparts in

(a)

Malta,

(b)

Cyprus and

(c)

Greece about measures to reduce the killing of songbirds. [195897]

George Eustice: No discussions have taken place with counterparts in Malta, Cyprus or Greece about measures to reduce the killing of songbirds.