| Previous Section | Back to Table of Contents | Lords Hansard Home Page |
Please refer to the footnotes in your response or the data may be misinterpreted.
A finished admission episode is the first period of in-patient care under one consultant within one healthcare provider. Please note that admissions do not represent the number of in-patients, as a person may have more than one admission within the year.
The cause code is a supplementary code that indicates the nature of any external cause of injury, poisoning or other adverse effects. The ICD-10 code used to identify knife wound injuries is: *W26—contact with a knife, sword or dagger.
Hospital episode statistics (HES) are compiled from data sent by over 300 NHS trusts, and primary care trusts (PCTs) in England. Data are also received from a number of independent sector organisations for activity commissioned by the English NHS. The NHS Information Centre for Health and Social Care liaises closely with these organisations to encourage submission of complete and valid data and seeks to minimise inaccuracies and the effect of missing and invalid data via HES processes. While this brings about improvement over time, some shortcomings remain.
HES figures are available from 1989-90 onwards. During the years that these records have been collected the NHS there have been ongoing improvements in quality and coverage. These improvements in information submitted by the NHS have been particularly marked in the earlier years and need to be borne in mind when analysing time series.
Some of the increase in figures for later years (particularly 2006-07 onwards) may be due to the improvement in the coverage of independent sector activity.
Changes in NHS practice also need to be borne in mind when analysing time series. For example, a number of procedures may now be undertaken in outpatient settings and may no longer be accounted in the HES data. This may account for any reductions in activity over time.
Embryology
Lord Alton of Liverpool asked Her Majesty's Government:
Further to the Written Answer by Lord Darzi of Denham on 16 July (WA 153—4), what consideration was given by the Human Fertilisation and Embryology Authority (HFEA) to the use of bovine oocytes in assays to assess the potential of human cells for reproductive cloning as described in the paper by Illmensee, Levanduski and Zavos in Fertility and Sterility; to what extent the corresponding authors of this paper were consulted by members of the HFEA; how the level of consultation reflects the HFEA’s opinion of the merits of such work; and what consideration was given to previously published studies regarding the potential of comparable cytoplasmic hybrids to develop when implanted in the womb of an animal. [HL5166]
The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): As part of its consultation on hybrid embryos, the Human Fertilisation and Embryology Authority (HFEA) carried out an extensive literature review and consulted several leading scientific institutions. The aim was to gather information on which research groups had already created human-animal cytoplasmic hybrid embryos abroad, and to explore the pre-implantation development of human-animal cytoplasmic hybrid embryos. The HFEA did try to correspond with the authors of the paper quoted but they refused to give any additional information. The HFEA did not review the study in order to assess the potential of human cells for reproductive cloning as reproductive cloning is illegal in the United Kingdom. Also, as it is illegal for a cytoplasmic hybrid to be transferred into the womb of a woman, it was not relevant for the authority to look at published work that may have done this in animals.
Lord Alton of Liverpool asked Her Majesty’s Government:
Further to the Written Answer by Lord Darzi of Denham on 16 July (WA 154—5) and 12 May (WA 108), and his definition of human admixed embryos on 15 January (HL Deb, cols. 1182—4), how the Human Fertilisation and Embryology Authority would establish that animal DNA is not predominant in human admixed embryos prior to licensing their creation and use in research; and to what extent this requirement applies to all human admixed embryos as defined by Section 4A(6) of the Human Fertilisation and Embryology Act 1990 (as proposed to be inserted by the Human Fertilisation and Embryology Bill). [HL5167]
Lord Darzi of Denham: It is for the Human Fertilisation and Embryology Authority (HFEA) to decide upon criteria for the assessment of the predominance of animal DNA in an admixed embryo. All applications to create and use human admixed embryos would be considered on their merits and the HFEA would have to be satisfied that none of the activities was prohibited, that the activities proposed were necessary or desirable for one of the purposes defined in the Act and that the use of human admixed embryos was necessary for that purpose.
29 Sep 2008 : Column WA353
If the proposed research was to create and use admixed embryos under the provision in Section 4A(6)(e) then the application would have to include the methodology that would be used to create the embryos and an explanation of what proportion of animal DNA would be present, as well as the reasons why creating and using these embryos was necessary. All applications are sent for peer review and the reviewers are asked to give an opinion as to whether the activities proposed were necessary or desirable for one of the purposes defined in the Act and that the use of human embryos was necessary for that purpose.
Lord Alton of Liverpool asked Her Majesty’s Government:
Further to the Written Answer by Lord Darzi of Denham on 16 July (WA 154—5), how the “hamster test” might be viewed as providing a precedent for current licensing by the Human Fertilisation and Embryology Authority of human admixed embryos (in which it is said that the animal DNA is not predominant) if such activities are intended to be governed by separate provisions of the Human Fertilisation and Embryology Bill. [HL5168]
Lord Darzi of Denham: The “hamster test” was not viewed as providing a precedent when the Human Fertilisation and Embryology Authority (HFEA) considered whether admixed embryos fell under the remit of the Human Fertilisation and Embryology Act 1990. The HFEA considered evidence on whether “cytoplasmic hybrid” human admixed embryos would be human and decided that they would be; therefore, any person creating and using such embryos would require a licence from the HFEA.
Lord Alton of Liverpool asked Her Majesty’s Government:
Further to the Written Answers by Lord Darzi of Denham on 21 April (WA 234), 2 May (WA 109—10), 19 June (WA 177—8), 24 June (WA 227), 1 July (WA 27—8) and 16 July (WA 153—4), what was the available evidence studied by the Human Fertilisation and Embryology Authority in order to establish the intrinsic lack of potential in any embryo cultured on a layer of feeder cells for more than 14 days, if no published data were considered aside from a study describing the ability of mouse embryos to develop contractions resembling a heartbeat after cultivation in vitro. [HL5169]
Lord Darzi of Denham: The Human Fertilisation and Embryology Authority’s scientific and clinical advisory group was asked to consider the various methods of deriving embryonic stem cells from human embryos and whether any of the methods would, potentially, be prohibited under the Human Fertilisation and Embryology Act 1990. This discussion involved the views of and information provided by Dr Daniel Brison and Professor Alan Trounson, leading experts in the field of embryonic stem cells. The view of the group was that none of the methods currently used would be prohibited because entities which form when
29 Sep 2008 : Column WA354
Lord Alton of Liverpool asked Her Majesty's Government:
Further to the Written Answer by Lord Darzi of Denham on 19 June (WA 187—8), what is the evidence suggesting that the use of intra-cytoplasmic sperm injection to generate true hybrids might be required for understanding serious mitochondrial diseases; how such use might be translated towards clinical treatments; who was responsible for proposing this as an application; and whether the use of gametes from different ape species would be precluded; and, if so, how. [HL5170]
Lord Darzi of Denham: The Medical Research Council provided briefing containing the view that combining gametes or nuclei from animal and human cells could be useful in exploring the mechanisms by which mitochondrial DNA is activated, including when and how much it replicates and how the genes carried by mitochondrial DNA are regulated, and how nuclear proteins influence this.
In considering the new provisions in the Human Fertilisation and Embryology Bill relating to the creation of admixed embryos, including the creation of true hybrids, the Human Fertilisation and Embryology Authority's (HFEA) scientific and clinical advisory group was asked for views as to what, if any, reasons would scientists wish to create and use these types of embryos. It was suggested to the group that these embryos could, potentially, be used to study mitochondrial disease.
To date the HFEA has had no queries from scientists about the future creation of true hybrids for this purpose. If the HFEA were to receive an application for the use of gametes from different species, this would have to be considered on its own merits and would be subjected to the usual mandatory scrutiny.
If a proposed gamete recovery programme involves pain, suffering, distress, or lasting harm to an animal, a licence under the Animals (Scientific Procedures) Act 1986 (ASPA) is required. It is government policy not to allow the use of great apes—gorillas, chimpanzees, orangutans—in procedures under ASPA.
Health: Alzheimer's
Lord Morris of Manchester asked Her Majesty’s Government:
What consideration they have given to the dementia tax report, published by the Alzheimer’s Society; and whether they will take any action in response to the report. [HL4968]
29 Sep 2008 : Column WA355
The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): The department welcomes the Alzheimer’s Society’s report and its focus on improvements in access and quality of care for people with dementia in care homes and their families. In June 2008, we launched a national debate on the future of care and support. Establishing a system of funding for care that is sustainable and fair to service users, their families and those who care for them, as well as the taxpayer, will be an important part of this debate.
The department is presently consulting on the first ever draft national dementia strategy and implementation plan.
Health: Assessment and Remuneration
Lord Maginnis of Drumglass asked Her Majesty’s Government:
What is the justification for paying a bonus to surgeons for performing their duties effectively; whether they plan reciprocal action where operations are deemed ineffective; and what will be the associated administrative costs of assessment and of any public reporting mechanism. [HL5110]
The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): NHS foundation trusts have the freedom to innovate and to invest in improved care for patients. The report High Quality Care for All welcomed recent initiatives that have seen some NHS foundation trusts share the proceeds of their success with all their staff, from the porter to the senior clinician, and encouraged more to do likewise.
The report also referred to the Clinical Excellence Awards (CEA) Scheme which was agreed and introduced at the same time as the new consultant contract in 2003. It rewards those consultants who contribute most towards the delivery of safe and high-quality care to patients and to the continuous improvement of NHS services, including those who do so through their contribution to academic medicine. The report announced our intention to strengthen this scheme and to make new awards, and the renewal of existing awards, more conditional on clinical activity and quality indicators. The scheme will continue to operate as at present, but the existing criteria used by local and national awarding committees will be refined to include relevant quality indicators. We have committed to involving the profession in developing and introducing this.
Lord Maginnis of Drumglass asked Her Majesty's Government:
Whether they will publish an effectiveness scale against which surgeons will be assessed for each type of operation; whether there will be a built-in recovery time factor; whether there will be a patient compensation scheme for failure; and if so, to what extent such a scheme could be open to abuse. [HL5111]
29 Sep 2008 : Column WA356
Lord Darzi of Denham: The Government do not intend to publish an effectiveness scale against which surgeons will be assessed for each type of operation.
The Government announced in High Quality Care for All: NHS Next Stage Review Final Report in June 2008 that:
“The next stage in achieving high quality care, requires us to unlock local innovation and improvement of quality through information—information which shows clinical teams where they most need to improve, and which enables them to track the effect of changes they implement”.
An initial set of clinical quality and outcome metrics will be developed for use by NHS acute services in the financial year 2009-10. Some mental health metrics are also being considered for this round. Further indicators will be developed over subsequent years. The indicators’ primary use will be to guide quality improvement through comparison and benchmarking by clinical teams to facilitate local improvement efforts. The indicators will not be available at the level of individual consultants. Although we will begin with acute services, from next year we will also develop and pilot a quality framework for community services.
Lord Maginnis of Drumglass asked Her Majesty’s Government:
Whether they intend to introduce a bonus scheme for all NHS personnel who perform their duties effectively; whether they intend to reduce their basic salaries in line with new potential earnings; and what methodology will be used in calculating bonuses. [HL5112]
Lord Darzi of Denham: Nothing in Agenda for Change would prevent specific bonuses being given to staff if they meet measurable targets and provide fair and equal opportunities for all staff within the organisation to participate. These bonuses are not part of regular pay. It is for the organisations themselves to decide whether bonuses were merited in any particular case.
Lord Maginnis of Drumglass asked Her Majesty’s Government:
Whether they have considered applying a scheme, similar to their proposal to pay surgeons a bonus, to hospital cleaning teams by relating the reduction in MRSA and C-difficile hospital infections to their effectiveness. [HL5113]
Lord Darzi of Denham: Nothing in Agenda for Change, the pay system that covers non-medical NHS employed staff in hospital cleaning teams, would prevent specific bonuses being given to staff, if they meet measurable targets and provide fair and equal opportunities for all staff within the organisation to participate. It is for the organisation themselves to decide if this were merited in any particular case.
Health: Bone Marrow
Lord Harrison asked Her Majesty's Government:
What further steps they are taking to increase the number of people having blood tests to determine whether they can be bone marrow donors; and whether they will focus such efforts on sixth form colleges and similar institutions. [HL5152]
The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): The National Blood Service (NBS) asks new blood donors about joining the British Bone Marrow Registry (BBMR) when they first become a blood donor. In order to increase the number of matches available for patients from black and minority ethnic (BME) groups, the NBS has launched the “One-Blood” campaign, to attract more people from these groups to become blood donors and join the BBMR.
To ensure young people understand the importance of donation of blood, organs, tissue and bone marrow, and to encourage them to become donors in the future, NHS Blood and Transplant (NHSBT) has
29 Sep 2008 : Column WA357
The Department of Health, the Department for Children, Schools and Families and NHSBT are working together to ensure that young people are made aware of the importance of donation. A joint ministerial letter will be sent to all secondary schools, highlighting how donation can be taught within the curriculum and encouraging schools to use the new pack.
Health: Cardiac Problems
Lord Colwyn asked Her Majesty’s Government:
How many people in England and Wales have been diagnosed with cardiac arrhythmia in each year of the past five years (a) in total; (b) in each strategic health authority; and (c) in each NHS trust; and [HL5086]
What plans there are to increase the implantation rate per million people for (a) cardiac resynchronisation therapy, and (b) implantable cardioverter defibrillators to levels recommended by National Institute for Health and Clinical Excellence; and [HL5089]
What plans there are to achieve the target of 700 pacemaker implants per million population included in the National Institute for Health and Clinical Excellence guidance, published in 2005. [HL5090]
The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): The information requested on the number of people diagnosed with cardiac arrhythmia is not available centrally.
The department, in collaboration with the Manchester Heart Centre, has set up a National Heart Rhythm Management Devices Taskforce to consider how it might support and encourage local services to increase their implantation rates. The taskforce also hopes to investigate why there are such large discrepancies between PCT performances in this area. The taskforce issued a guide for commissioners on the use of pacemakers, implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy (CRT) devices in 2007.
In 2006, backed by the department and industry funding, the Network Device Survey Group made public the first systematic survey of the National Health Service in England and Wales in respect of its level and equity of heart rhythm management device provision compared to local relative need. The information is provided by primary care trust area. Information has now been collected, and shared with cardiac networks, for 2003 to 2006.
| Next Section | Back to Table of Contents | Lords Hansard Home Page |