This information is not held centrally. All newborn babies are screened currently for four serious but rare conditions, including Medium-chain acyl-CoA dehydrogenase deficiency (MCADD). This is part of the postnatal pathway and is paid for as part of the Maternity Pathway Payment (MPP). The cost for screening MCADD is not identified separately within the MPP.

The NHS Newborn Bloodspot Screening Programme in England routinely offers newborn screening for phenylketonuria, congenital hypothyroidism, sickle cell disease, cystic fibrosis and MCADD. Newborn screening in England is offered between 5 and 8 days after the baby is born. The midwife takes a small sample of blood droplets from the baby’s heel for testing on a blood spot card.

With early detection further diagnostic testing and early treatment can then be provided and avoid any unnecessary wait and help improve and prevent severe disability.

The UK National Screening Committee have recommended extending the newborn bloodspot screening programme in 2015 to include screening for maple syrup urine disease, homocystinuria, glutaric acidaemia type 1 and isovaleric acidaemia.

The Department's National Institute for Health Research (NIHR) funds a range of applied clinical research, but does not fund fundamental laboratory-based research, which is funded by other organisations including the Medical Research Council (MRC) and medical research charities.

The usual practice of the NIHR and of the MRC is not to ring-fence funds for expenditure on particular topics: research proposals in all areas compete for the funding available.

The Department's NIHR welcomes funding applications for research into any aspect of human health, including respiratory disease. These applications are subject to peer review and judged in open competition, with awards being made on the basis of the importance of the topic to patients and the national health service, value for money and scientific quality. In all disease areas, the amount of NIHR funding depends on the volume and quality of scientific activity.

Spend on research funded directly by the Department’s NIHR from 2010-11 to 2012-13 in respiratory disease is shown as follows. The complete information on NIHR spend in 2013-14 is not currently available. These figures do not take account of NIHR expenditure on research infrastructure and systems where spend cannot be attributed to health categories.

We have made no such assessment and the National Institute for Health and Care Excellence has not issued any guidance on the use of idebenone for the treatment of Leber's hereditary optic neuropathy (LHON).

Subject to contract, the Department's National Institute for Health Research has approved £0.5 million funding for a trial stratifying patients with LHON for idebenone therapy using mitochondrial DNA analysis.

We have made no such assessment and the National Institute for Health and Care Excellence has not issued any guidance on the use of idebenone for the treatment of Leber's hereditary optic neuropathy (LHON).

Subject to contract, the Department's National Institute for Health Research has approved £0.5 million funding for a trial stratifying patients with LHON for idebenone therapy using mitochondrial DNA analysis.

Expenditure by the Department's National Institute for Health Research (NIHR) through research programmes, research centres and units, and research training awards on research on these specific topics is shown in the following table.

Total spend by the NIHR on research on these topics is higher than the figures shown because expenditure by the NIHR Clinical Research Network (CRN) on these topics cannot be disaggregated from total CRN expenditure.

In addition, the Department's Policy Research Programme funded research relating to asthma through an award to the Social Medicine and Health Services Research Unit at Imperial College London that ended in 2011. The total value of the unit award was £2.9 million.

The Medical Research Council (MRC) is funded by the Department for Business, Innovation and Skills. Figures for MRC expenditure on these specific topics are not available.

The UK National Screening Committee (UK NSC) advises Ministers and the national health service in all four countries about all aspects of screening policy and supports implementation. Using research evidence, pilot programmes and economic evaluation, it assesses the evidence for programmes against a set of internationally recognised criteria.

The UK NSC is currently reviewing the evidence for newborn screening for severe combined immunodeficiency against its criteria. A public consultation on the screening review has just closed and Ministers expect to receive a recommendation from the UK NSC shortly.

As part of the NHS Newborn Bloodspot Screening Programme in England all newborn babies are offered screening for phenylketonuria, congenital hypothyroidism, sickle cell anaemia, cystic fibrosis and medium-chain acyl-CoA dehydrogenase deficiency.

On 8 April 2012 the Department announced that an evaluation to investigate extending the NHS Newborn Bloodspot Screening Programme to include the conditions maple syrup urine disease, homocytinuria, glutaric acidaemia type 1, isovaleric acidaemia and long chain fatty acidaemia would begin in July 2012. Screening is offered to the populations served by the screening laboratories in Leeds, Manchester, Sheffield, Birmingham, London (Guy's and St Thomas' and Great Ormond Street). The evaluation will provide evidence that will enable the UK NSC to carry out a thorough review of screening for the above conditions against its internationally recognised criteria.

Where stakeholder organisations or individuals feel that there is enough evidence published in peer reviewed journals to consider screening for other rare conditions they can submit a policy proposal to the UK NSC. Further information is available on the UK NSC's website at:

www.screening.nhs.uk/policyreview

The first strategic clinical networks were chosen by the NHS Commissioning Board (NHS CB) using criteria developed with input from a broad range of stakeholders. In summary, the chosen conditions and patient groups are ones where:

a large scale change is required across complex pathways of care involving many professional groups and organisations and strategic clinical networks are the best approach to planning and delivering services; and

a co-ordinated, combined improvement approach is needed to overcome certain health challenges, which have not responded previously to other improvement efforts.

The NHS CB has made it clear that as priorities change, or when the work of one of the initial strategic clinical networks concludes, the board will identify new conditions or patient groups that would benefit from a strategic clinical network approach.

In addition to strategic clinical networks, the NHS CB expects that some local clinical networks will also be established in the new health system. These are likely to be supported by clinical commissioning groups and providers and established to support the delivery of local priorities and ways of working.

The NHS CB is currently in the process of recruiting a National Clinical Director for respiratory diseases.

The UK National Screening Committee (UK NSC) advises Ministers and the national health service in all four United Kingdom countries about all aspects of screening policy, including screening policy for group B streptococcus (GBS) carriage in pregnancy. On 13 November 2012 the UK NSC recommended that a national screening programme to test for GBS carriage in pregnancy using the enriched culture medium test should not be offered. This is because there is insufficient evidence to demonstrate that the benefits to be gained from screening all pregnant women and treating those carrying the organism with intravenous antibiotics during labour would outweigh the harms. A copy of the UK NSC's review, ‘Screening for Group B Streptococcal infection in pregnancy’ has been placed in the Library. A copy of the evidence assessed by the UK NSC is referenced in the screening review.

No assessment has been made by the Department of trends in early onset disease rates although the latest figures show a drop in disease rates between 2010 and 2011. Laboratories across England, Wales and Northern Ireland submit data to the Health Protection Agency on GBS infection. Submission of data is voluntary, therefore completeness of reporting has varied over time and across different parts of the country.

The Department does not hold data on GBS infection in other countries and therefore no comparison has been made with the United States of America, Argentina, France, Kenya or Slovenia.

No target has been set by the Department on GBS infection in newborn babies but we are clear about the importance of taking the right steps to prevent GBS infection at the start of life.

The Royal College of Obstetricians and Gynaecologists (RCOG) published its updated guidelines on prevention of GBS on incidence of GBS infection in neonates in July 2012. The updated guideline took into account new evidence on the prevention of early-onset neonatal GBS disease. It is important that services undertake local clinical audits to ensure the effective use of intrapartum antibiotic prophylaxis recommended by the guideline.

In 2012 the National Institute for Health and Clinical Excellence published two clinical audit tools which include clinical audit standards, a data collection form and an action plan template for use by services that care for women in labour or for babies at risk of, or being treated for, early on-set neonatal infection.

The Department aims to work together with the NHS, the RCOG, the Royal College of Midwives, the National Institute for Health Research Health Technology Assessment and the pharmaceutical industry on a number of areas:

the topic of a “point of care” test so that high-risk women can be tested at the start of labour is currently in the Health Technology Assessment prioritisation process and will be worked up for discussion in terms of relative importance, feasibility and noting any other existing and on going research;

development of an implementation tool for use locally to audit current practice and improve implementation of the revised RCOG guideline on the prevention of early-onset neonatal GBS disease;

including GBS as a topic within education and continuing professional development programmes for clinicians and midwives; and

monitoring developments on vaccines against GBS infection.

The Department has not made a comparative assessment on outcomes of routine and ad hoc detection of GBS in pregnant women.

Data on how many newborn babies suffered death or disability due to GBS infection in the last year and data on the three most common causes of life-threatening infection in newborn babies in each of the last five years is not routinely available.

A National Institute for Health Research Health Technology Assessment study: “Kaambwa B, Bryan S, Gray 3, Milner P, Daniels J, Khan K, Roberts T. Cost-effectiveness of rapid tests and other existing strategies for screening and management of early-onset group B streptococcus during labour. BJOG. 2010;117:1616-1627” which has already been placed in the Library, concluded that the most cost-effective strategy was shown to be the provision of routine intrapartum antibiotic prophylaxis

to all women without prior screening, but, given broader concerns relating to antibiotic use, this was unlikely to be acceptable. The study concluded that screening at 35 to 37 weeks was more cost effective than the 2003 risk factor approach as long as all women delivering prematurely were treated with antibiotics in labour and the cost of the test did not rise by a small amount above the estimate used in the study's model. The 2003 risk factor approach became the more cost effective approach if either of these two provisos were not met.

The Health and Social Care Information Centre has provided the mean age for finished consultant episodes (FCEs) with a primary or secondary diagnosis of diabetic retinopathy, cataracts, and age-related macular degeneration for Plymouth Teaching Primary Care Trust (PCT) and Devon PCT of residence for 2011-12.

It should be noted that these figures only include those people admitted to hospital for the above conditions. It should also be noted that since the same patient may be treated more than once in the year, their age will be counted more than once in the calculation of mean age.

No ICD-10 coding exists specifically for age related macular degeneration—only ‘degeneration of macula and posterior pole’.

The following table shows mean age (in years) for FCEs¹ with a named primary or secondary diagnosis² of diabetic retinopathy³, cataracts⁴ and age-related macular degeneration⁵ for Plymouth Teaching PCT and Devon PCT of residence⁶, for 2011-12.

Information is not available in the format requested. The following table shows finished consultant episodes (FCEs) with a named primary or secondary diagnosis of diabetic retinopathy, glaucoma, cataracts and macular degeneration for Plymouth Teaching Primary Care Trust (PCT) and Devon PCT of residence for 2011-12.

Frontline health care professionals are routinely trained to recognise the early signs of sepsis. The Department supports the advice provided in the existing international guidance on the diagnosis and treatment of sepsis. In addition, the Department published ‘Start Smart Then Focus’ in 2011 which is aimed at health care professional and recommends that if there is evidence of bacterial infection, local guidelines should be used to initiate prompt effective antibiotic treatment within one hour of diagnosis (or as soon as possible) in patients with life threatening infections. This guidance also recommends auditing the time to treatment to ensure effective local performance.

Data on the number of deaths caused by sepsis are not collected centrally. However, data on the total number of deaths from septicaemia for England

and Wales for the period 2007-11 are shown in the following table and also available from the National Office for Statistics.

A recent survey on implementation of ‘Start Smart Then Focus’ carried out on behalf of the Department's Advisory Committee on Healthcare Associated Infection and Antimicrobial Resistance is due to be published next year. Responses were received from 78 acute hospital trusts. Of those who had assessed their progress against the guidance, between 65 and 75% said it had led to a reduction in the use of broad-spectrum antibiotics and between 77 and 85% in a reduction of inappropriate prescribing of antibiotics.

Sepsis is the invasion and infection of a person with pathogenic micro-organisms that cause a severe response in the body. Sepsis can take many forms and at its most serious can result in death.

Frontline health care professionals are routinely trained to recognise the early signs of severe sepsis and how to treat it. The Department supports existing international guidance on the management of sepsis and used this to inform ‘Start Smart Then Focus’ guidance published in November 2011. A copy has already been placed in the Library.

In addition, registered health care providers are expected to ensure ongoing education of staff on the principles and practice of the prevention and control of infection, as advocated in ‘The Code of Practice for the prevention and control of infection and related guidance’.

The Department has no plans to develop a public education campaign on sepsis.

Sepsis is the invasion and infection of a person with pathogenic micro-organisms that cause a severe response in the body. Sepsis can take many forms and at its most serious can result in death.

Frontline health care professionals are routinely trained to recognise the early signs of severe sepsis and how to treat it. The Department supports existing international guidance on the management of sepsis and used this to inform ‘Start Smart Then Focus’ guidance published in November 2011. A copy has already been placed in the Library.

In addition, registered health care providers are expected to ensure ongoing education of staff on the principles and practice of the prevention and control of infection, as advocated in ‘The Code of Practice for the prevention and control of infection and related guidance’.

The Department has no plans to develop a public education campaign on sepsis.

Sepsis is the invasion and infection of a person with pathogenic micro-organisms that cause a severe response in the body. Sepsis can take many forms and at its most serious can result in death.

Frontline health care professionals are routinely trained to recognise the early signs of severe sepsis and how to treat it. The Department supports existing international guidance on the management of sepsis and used this to inform ‘Start Smart Then Focus’ guidance published in November 2011. A copy has already been placed in the Library.

In addition, registered health care providers are expected to ensure ongoing education of staff on the principles and practice of the prevention and control of infection, as advocated in ‘The Code of Practice for the prevention and control of infection and related guidance’.

The Department has no plans to develop a public education campaign on sepsis.

Sepsis is the invasion and infection of a person with pathogenic micro-organisms that cause a severe response in the body. Sepsis can take many forms and at its most serious can result in death.

Frontline health care professionals are routinely trained to recognise the early signs of severe sepsis and how to treat it. The Department supports existing international guidance on the management of sepsis and used this to inform ‘Start Smart Then Focus’ guidance published in November 2011. A copy has already been placed in the Library.

In addition, registered health care providers are expected to ensure ongoing education of staff on the principles and practice of the prevention and control of infection, as advocated in ‘The Code of Practice for the prevention and control of infection and related guidance’.

The Department has no plans to develop a public education campaign on sepsis.