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Resuscitation Decision-making

Lord Morris of Manchester asked Her Majesty's Government:

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): As stated in the reply given on 4 October (WA 218), the Secretary of State for Health has asked the Commission for Health Improvement to pay particular attention to resuscitation decision-making processes as part of its rolling programme of reviews of clinical governance arrangements put in place by National Health Service organisations. The commission will report its findings to the Secretary of State.

Clinical practice in resuscitation decision-making is one example of clinical decision-making which takes place in hospitals every day. Resuscitation decisions are made on an individual basis taking full account of the circumstances of each case, and such decisions are subject to local audit.

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We do not require independent hospitals to provide this information. However, we are introducing a new regulatory framework for the inspection of the independent healthcare sector through the Care Standards Act 2000. As part of the work on developing standards for independent hospitals, we will consider the need for them to have a policy on resuscitation.

Sexual Intercourse: Risk Comparison

Baroness Blatch asked Her Majesty's Government:

    Whether scientific evidence shows that anal sex carries a higher risk to health than vaginal sex.[HL4160]

Lord Hunt of Kings Heath: Scientific evidence shows that the greatest risk to health comes from unprotected sex. With consistent use of condoms and (for anal sex) lubricants, the health risks are reduced and are broadly similar for vaginal sex and anal sex.

Diploma in Social Work

Lord Northbourne asked Her Majesty's Government:

    Whether they are satisfied with the number and qualifications of the applicants for entry into training for the Diploma in Social Work this year; how this number compares with the same figure for each of the previous three years; and whether they propose to take any action to attract a larger number of suitably qualified applicants in future.[HL4385]

Lord Hunt of Kings Heath: The number of people applying for Diploma in Social Work Courses has been reducing over the past four years. This is unsatisfactory. Without the right number of staff with the right skills, we shall not be able to deliver and maintain the substantial improvement agenda that we have embarked upon.

The number of applications that were received for Diploma in Social Work Courses over the past three years was:


    1996: 9,100


    1997: 7,722


    1998: 6,254


    1999: 5,175

These figures do not include the number of applications that were made directly to training programmes, as this information is not held centrally.

Information about the qualifications of applicants is not centrally available.

To try to reverse this situation, the Central Council for Education and Training of Social Workers is developing a recruitment initiative to attract candidates for the Diploma in Social Work.

On 20 October, my right honourable friend the Secretary of State for Health announced that

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additional funding totalling £41 million over the next three years will be made available to support trainees through professional social work entry level training.

Social Care National Vocational Qualifications

Lord Northbourne asked Her Majesty's Government:

    Whether they are satisfied with the number of persons achieving NVQs in Social Care in the last period for which figures are available; and whether they propose to take any action to attract a larger number of suitably qualified applicants in future.[HL4386]

Lord Hunt of Kings Heath: The last period for which data are available on National Vocational Qualifications (NVQs) is for the quarter 1 July 1999 to 30 September 1999. For this period, a total of 106,288 NVQ Certificates were awarded for the Care, Caring for Children and Young People, and Promoting Independence NVQs. These figures are for certificates issued throughout the United Kingdom.

In the White Paper Modernising Social Services, it was acknowledged that 80 per cent. of the social care workforce had no recognised qualifications and this was a serious problem that had to be tackled.

The National Training Strategy for the Social Care Workforce, published by the National Training Organisation for Social Care as a consultation document in July 2000, gives details of the relevant qualifications for each section of the social care workforce. The Government are working with social care employers to implement the training strategy and increase levels of qualification.

Funds have been provided through the Training Support Programme for particular groups of social care staff to undertake NVQs. These include staff working in residential child care, foster carers, domiciliary care workers and heads of adult residential homes.

The National Care Standards Commission is being established in April 2002 to regulate statutory and independent sector care services in accordance with new national minimum standards. These minimum standards will include standards of training that both the registered manager and the staff of the establishments should attain, and these will be linked to NVQs.

Flu Vaccination

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

    What is their assessment of the needs for the provision of flu vaccination by the National Health Service; and what are the arrangements for meeting those needs; and[HL4286]

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    What arrangements they have made for the National Health Service to meet the need for flu vaccination for people under the age of 65 years.[HL4287]

Lord Hunt of Kings Heath: Selective influenza immunisation is recommended to protect those who are most at risk of serious illness or death should they develop influenza. This year, influenza immunisation should be offered to people with underlying ill health due to:


    chronic heart disease


    chronic respiratory disease including asthma


    chronic renal disease


    diabetes mellitus


    immunosuppression due to disease or treatment


    everyone aged 65 and over


    and people living in long stay residential care accommodation

Complications such as bronchitis and pneumonia are more common in people with these underlying diseases, especially if they are also elderly, and deaths due to flu are almost entirely in these groups. In long-stay residential accommodation influenza infection can spread very rapidly.

This year, around 11 million doses of flu vaccine are available, compared to 7.8 million doses last year. This is more than sufficient vaccine to meet our target of at least 60 per cent. uptake in those aged 65 and over as well as those in the other targeted risk groups.

Influenza immunisation is given almost entirely by general practitioners and practice nurses. GPs order vaccine in advance for their "risk" patients, direct from the manufacturers, GPs were informed of this year's policy in May, and given more detailed information from the Chief Medical Officer, Professor Liam Donaldson, on 1 August. This year, each health authority has also appointed a "flu co-ordinator" to assist with organisation of the local programme.

Unfortunately, one of the manufacturers, Solvay, has encountered problems in growing a strain of the vaccine which has led to delays in some deliveries. Solvay has been in touch with the affected GPs to tell them details of any delays, but has confirmed that all ordered vaccine will be delivered by the end of November, in time to protect people this winter.

Social Security: Third Way Policy

Lord Patten asked Her Majesty's Government:

    What is their Third Way policy towards social security.[HL4320]

The Parliamentary Under-Secretary of State, Department of Social Security (Baroness Hollis of Heigham): I refer the noble Lord to the Answer Lord Falconer gave to him on 25 October 2000, Vol. 618, col. WA34.

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Child Poverty: Definition

Lord Higgins asked Her Majesty's Government:

    Whether the definition of poverty referred to by Baroness Hollis of Heigham on 28 September (H.L. Deb., col, 943) in relation to child poverty is that which the Government use in relation to pensioners; and[HL4388]

    Why their definition of child poverty given by the Baroness Hollis of Heigham on 28 September (H.L. Deb., col, 943) makes no allowance for the number of children in a household.[HL4389]

Baroness Hollis of Heigham: Poverty is a multi-faceted problem. There is no single definition that we use.

We published the second annual report, Opportunity for All: one year on--making a difference, on 21 September 2000. The report contains a full set of indicators that are used to monitor progress in tackling poverty.

The measure of income used when looking at the proportion of either children or pensioners below different thresholds of income is net equivalised household income. The process of equivalisation involves the adjustment of household income to take into account variations in the size and composition of the households in which individuals live. It reflects the common-sense notion that, in order to enjoy a comparable standard of living, a household of two adults with four children will need a higher income than a person living alone. The income of the family is therefore adjusted downwards in relation to that of the single person in order to allow sensible income comparisons between the different household types. The adjustment made takes into account both the number of adults and also the number and ages of children living in a household.


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