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Mr. Kenneth Clarke : We are considering a number of proposals for improving the delivery of health care and will bring forward our proposals in a White Paper to be published in the new year.
Royal College of Nursing
47. Mr. Andrew MacKay : To ask the Secretary of State for Health when he last met representatives of the Royal College of Nursing ; and what matters were discussed.
Mr. Kenneth Clarke : I met representatives of the Royal College of Nursing on 5 December.
We agreed that we should redouble our efforts to explain the regrading exercise and to publicise the very substantial pay increases that the overwhelming majority of nurses and midwives are now receiving. As a result, for the first time the nursing profession will have the proper career structure for which the RCN in particular has consistently argued.
Our discussion concentrated on the working of the appeals procedure, which we both agreed was the outstanding issue. We regretted that the process had been clogged up by the number of spurious claims that nurses and midwives had unfortunately been encouraged to submit. These were clearly delaying progress for those few with genuine grievances. In order to help those nurses and midwives, we agreed that in future health authorities should set up a sifting process at officer level which would enable them to identify and correct any obvious errors in grading in advance of a full appeal hearing. In addition, I have asked RHA chairmen to see that the sifting process is completed, if at all possible, by the end of January. General managers will also be asked to make sure that the operation of the appeals procedure is regarded as a management priority.
The RCN joined us in condemning industrial action and stressed its commitment to putting patients first.
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Benzodiazepines
50. Mr. Wareing : To ask the Secretary of State for Health what plans he has to introduce restrictions on the represcribing of benzodiazepines.
Mr. Mellor : I share the hon. Member's concern about represcribing of benzodiazepines, but we have no plans to introduce restrictions because doctors must be free to prescribe in a way that best suits the needs of each patient. All drugs should be represcribed under controlled conditions and I welcome the initiative of those general practitioners who have begun the difficult process of reviewing the treatment of those of their patients who are on long-term benzodiazepine therapy.
Maternity Units (Leicestershire)
51. Mr. Latham : To ask the Secretary of State for Health whether he has now received details of the decision by Leicestershire community health council to oppose the closure of the maternity units at St. Mary's hospital, Melton Mowbray, and the Rutland Memorial hospital ; and whether he will now advise Leicestershire health authority to abandon those proposals rather than proceed to statutory determination by himself.
Mrs. Currie : The views of the community health council have not been formally sent to my right hon. and learned Friend the Secretary of State.
Leicestershire health authority is currently consulting on these proposals ; the consultation period ends on 31 December. It would not be right for me to intervene in the way proposed. I must remain impartial as the final decision on the proposals may have to be taken by Ministers, if the community health council opposes the proposals.
Nurses and Midwives
52. Mr. Madel : To ask the Secretary of State for Health what is his estimate of the number of nurses and midwives who have accepted the current pay offer ; what percentage of the total number of nurses and midwives employed by the National Health Service this represents ; and if he will make a statement.
Mr. Kenneth Clarke : The Government's decision to implement in full the recommendations for 1988-89 of the review body for nursing staff, midwives and health visitors was accepted in April by the representatives of all nursing staff, midwives and health visitors within the National Health Service. The acceptance was very prompt, which is not surprising given that this year's pay award and regrading have resulted in an average increase of 17.9 per cent. for nurses and midwives. We do not know how many nurses and midwives are still appealing against the grade that they were given in the light of that acceptance, but the vast majority have accepted their grade and all nurses and midwives have received their pay rise.
Nurses (West Midlands)
54. Mr. Rooker : To ask the Secretary of State for Health what proportion of (a) state enrolled nurses, (b) staff nurses and (c) ward sisters in (i) the west midlands region and (ii) nationally have received less then 5 per cent. pay increase in 1988.
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Mr. Kenneth Clarke : No staff nurse or enrolled nurse has received an increase of less than 7 per cent. and 39 per cent. of hospital nursing sisters have been graded at scale F and have received increases ranging from 4.2 per cent. to 13.3 per cent. depending on the incremental point on the pay scale at which the individual is entitled to be paid. We do not hold information about the incremental position of those in each of the new grades centrally.
Drugs
55. Mr. Stevens : To ask the Secretary of State for Health if he will make a statement on progress on the current campaign against drugs.
Mr. Mellor : The Government national publicity campaigns against drugs misuse are part of an overall strategy to reduce both the supply of and the demand for illegal drugs. Independent evaluation shows that the campaigns so far have been widely noticed and reinforced young people's resistance to drug misuse. On 21 November a new phase of GB-wide publicity was launched to emphasise the dangers associated with injecting any drug.
Leukaemia (North Humberside)
56. Mr. Cran : To ask the Secretary of State for Health when he expects to announce the findings of the research programmes funded by his Department on factors affecting the incidence of leukaemia among children in parts of north Humberside.
Mrs. Currie : Research into biomedical questions is primarily the responsibility of the Medical Research Council, which receives its grant-in -aid from the Department of Education and Science. The report by Dr. Ray Cartwright on the incidents of childhood leukaemias on north Humberside, which also included information on the incidence of other cancers in children and adults, has been referred for an independent expert assessment and advice as to whether further research may be needed. We will announce the results as soon as possible.
Wandsworth Health Authority
57. Mr. Bowis : To ask the Secretary of State for Health when he next intends to visit the Wandsworth health authority ; and what issues he expects to discuss.
Mrs. Currie : My right hon. and learned Friend the Secretary of State has no plans to visit Wandsworth health authority, but I visited the authority on Monday 5 December when I went to the drug dependency unit at Springfield hospital and also the women's day unit at St. George's hospital, Tooting. In both cases services have transferred smoothly from other facilities and are functioning well.
Cancer Screening
60. Mr. George Howarth : To ask the Secretary of State for Health what steps he is taking to improve the administration of the cervical cytology testing service in Merseyside ; and if he will make a statement.
Mrs. Currie : We issued Departmental guidance on the provision of cervical cancer screening in circular HC(88)1, a copy of which is available in the Library. Its local
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application is a matter for the health authorities and family practitioner committees concerned. The hon. Member may wish to pursue any local matters with the chairman of the appropriate health authority or family practitioner committee.62. Mr. Andrew Bowden : To ask the Secretary of State for Health what plans he has routinely to include women aged 65 years and over in screening programmes for breast cancer.
Mrs. Currie : The NHS breast cancer screening programme is modelled on the recommendations made in the Forrest report. Having considered the incidence of the disease and the evidence on the benefits of screening in different age groups, the report recommended that the 50-64 age group should be the first to be selected for routine screening. We are following this recommendation. The Forrest report also suggested that screening should be available on request for women aged 65 and over. We have accepted this advice and, once the service becomes available in an area, any woman aged 65 and over who wants to be screened should be able to contact her local screening office to make an appointment.
Our main effort now is to get the arrangements running throughout the country and we would not expect to make any changes until we have had some experience of the present system. The advisory committee on breast cancer screening, which is advising on the development of the service, is keeping the question of age under review.
Any woman, irrespective of her age, who has the slightest cause for concern --for example, a small lump--should arrange to see her GP at once.
Cook-chill Food
67. Mr. Hinchliffe : To ask the Secretary of State for Health how many hospitals are currently providing maternity patients with food produced through the cook-chill process.
Mrs. Currie : Health authorities are responsible for the delivery of catering services which meet the needs of all their patient groups. Information on the production of food for specific categories of patients is not collected centrally.
Promoting Better Health"
68. Mr. John Marshall : To ask the Secretary of State for Health if he will report on progress on the primary health care reforms as outlined in "Promoting Better Health."
Mr. Mellor : Discussions are well advanced with representatives of the primary care professions on the implementation of measures to achieve the objectives of the White Paper, "Promoting Better Health" (Cm. 249). Some changes are currently being introduced. For example, dental practice advisers are being appointed and will take up posts early in the new year and extra funds have been made available in the present financial year for the training of family doctors' practice nurses. The Health and Medicines Act 1988, which received Royal Assent on 15 November this year, gives the Secretary of State powers to implement proposals in the White Paper for which powers did not already exist.
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Look After Your Heart"
69. Mr. Brandon-Bravo : To ask the Secretary of State for Health if he will make a statement on progress of the "Look After Your Heart" campaign.
Mrs. Currie : The "Look After Your Heart" campaign, which aims to contribute to a substantial reduction in the high incidence of coronary heart disease in England, has been most successful during its first 18 months in supporting and encouraging widespread activity at national and local level. Industry and commerce have supported the campaign through joint promotions and a scheme of "healthy living" contracts, which almost 100 companies employing about 2.5 million people have signed. "Look After Your Heart" has also encouraged local activity, providing funding of £395,000 in 18 months for 160 projects. A "heartbeat award" scheme for restaurants and eating establishments which offer healthy food choices and no-smoking areas is also proving most successful.
The campaign, run jointly by the Department and the Health Education Authority, has been continuously evaluated and results show that knowledge of the main risk factors for coronary heart disease has grown, particularly amongst target social class groups. We plan to develop the campaign with a major drive involving industry, local groups, primary health care activity and special promotions. A new publicity campaign involving television and other advertising will be starting at the end of December 1988.
Air Ambulance Services
70. Mr. Key : To ask the Secretary of State for Health whether he will update his Department's circular to health authorities on ambulance service emergency conveyance of patients by air (HSC (I.S.) 196) dated September 1975.
Mrs. Currie : The advice contained within HSC (I.S.) 196 remains valid. However, we are reviewing, with the NHS, the policy on helicopters in the light of developing interest in this form of transport for patients with major trauma.
Hospital Building
71. Mr. David Davis : To ask the Secretary of State for Health what is the progress of major hospital building schemes costing more than £1 million in the Yorkshire regional health authority area.
Mrs. Currie : The Yorkshire regional health authority's building programme continues to make good progress. Information held centrally shows there are currently 12 schemes, each costing over £1 million, under construction and 32 more at various stages of design and planning. The total value of the region's building programme is over £300 million.
80. Mr. Burns : To ask the Secretary of State for Health how many new hospital building projects have been initiated since 1979 ; and what was the comparable figure for the 1974 to 1979 period.
Mrs. Currie : Information held centrally on health building schemes, each costing over £1 million, shows that 466 schemes have been initiated since 1979 compared to 148 in the period 1974 to 1979.
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Coronary Units
73. Mr. John Evans : To ask the Secretary of State for Health what is per capita spending on coronary units in hospitals (a) in England and (b) in the north west region.
Mrs. Currie : I regret that we cannot identify spending on coronary units as such centrally. If the hon. Member wishes to pursue these inquiries, I suggest that he discusses the matter with Mr. Bruce Martin QC, chairman of North Western regional health authority, who is responsible for overall management of hospital services within the region.
Trauma Centre
75. Mr. Cousins : To ask the Secretary of State for Health when he expects to announce the first British trial of the trauma centre concept.
Mrs. Currie : We are considering the Royal College of Surgeons' report on the management of major injuries, which recommended the establishment of trauma centres. No decisions will be taken until that consideration has been completed.
Ancillary Workers (Pay)
81. Mr. Andrew F. Bennett : To ask the Secretary of State for Health what representations he has received regarding the pay of ancillary workers in the Health Service ; and if he will make a statement.
Mr. Mellor : Since the last time this matter was raised during questions on 1 November we have received one more letter from an hon. Member.
NHS Review
82. Mr. Eastham : To ask the Secretary of State for Health what progress he is making with his review of the National Health Service.
83. Mr. Lofthouse : To ask the Secretary of State for Health what progress he is making with his review of the National Health Service.
84. Mr. Duffy : To ask the Secretary of State for Health what progress he is making with his review of the National Health Service.
Mr. Kenneth Clarke : I refer the hon. Members to the reply that I gave to the hon. Members for Norwich, South (Mr. Garrett) and for Leyton (Mr. Cohen) on 1 November at columns 816-18.
Water
Mr. Blunkett : To ask the Secretary of State for Health what are the future implications for his Department's brief of the recently published Water Bill.
Mrs. Currie : The Department will continue to carry out its present functions.
Mental Health
Mrs. Ray Michie : To ask the Secretary of State for Health what representations he has received from interested groups concerning women and mental health.
Mrs. Currie : We have received several representations from a variety of sources, including, most recently, the report of the Women's National Commission.
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I am particularly concerned about the problems some women experience with tranquillisers. There are a number of initiatives to encourage more careful prescribing on benzodiazepines, handle the problems of withdrawal, promote alternatives to tranquillisers, and to provide alternative help for those dependent upon them. I am sure that the hon. Member is aware of the particular interest that I am taking in this topic.In-patients
Mr. Harry Greenway : To ask the Secretary of State for Health how many people were treated as in-patients in 1978 and in the latest period of 12 months for which figures are available.
Mrs. Currie : In National Health Service hospitals in England, there were 5,370,319 in-patients treated in 1979 and in 1987-88 there were 6,619,354. This represents an increase of 23 per cent.
Wheelchairs
Mr. Hannam : To ask the Secretary of State for Health how many (a) powered and (b) non-powered wheelchairs are currently on issue from his Department.
Mr. Mellor : These are matters for the Disablement Services Authority, to which the hon. Member should address his questions.
Organ Transplants
Mr. Shersby : To ask the Secretary of State for Health when he expects to publish the circular setting out procedures for the donation of organs for transplantation.
Mrs. Currie : We issued health circular HC(88)63 yesterday. It provides guidance on procedures for organ donation. We believe this will increase the number of organs available for transplantation. The circular also asks health authorities to carry out an audit of deaths in intensive care units. The audit will reveal the total potential for organ donation and the reasons why donation sometimes does not take place.
Prosthetists
Mr. Alfred Morris : To ask the Secretary of State for Health (1) how many prosthetists there are in England ; and how many amputees in England there are per prosthetist ;
(2) what plans he has for increasing the training facilities for prosthetists : and how many he proposes should be trained each year.
Mr. Mellor : These are matters for the Disablement Services Authority, to which the hon. Member should address his questions.
Health Authority Buildings (Closure)
Mr. Meale : To ask the Secretary of State for Health whether any adopted criteria exist within (a) the central Nottinghamshire or (b) other health authority areas which give financial incentives to managers of services for (i) closure or (ii) temporary closure of health authority buildings.
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Mrs. Currie : No. Managers are required to provide, on behalf of their authority, health care for their local community. Closures are made for many reasons and may be essential to improve services.
Mr. Meale : To ask the Secretary of State for Health whether in-use health authority properties can be closed on a temporary basis after consultation documents have been issued and prior to the expiry date of such consultations.
Mrs. Currie : Yes. Under the Community Health Council Regulations 1985 a closure may be made without consultation if the district health authority is satisfied that this is in the interests of the Health Service.
Central Nottinghamshire Health Authority
Mr. Meale : To ask the Secretary of State for Health (1) if he will give a breakdown of transfer moneys payable to Central
Nottinghamshire health authority from other health authorities for the provision of services for the mentally ill residing in the Central Nottinghamshire health authority since June 1987 ; (2) if he will list sales of National Health Service property and land in the Central Nottinghamshire health authority area since 1979 ;
(3) if he will list all temporary closures of National Health Service premises in the Central Nottinghamshire health authority area since 1979, showing which facilities so closed are currently open ; (4) if he will list the occasions since 1979 when consultation documents have been issued in the Central Nottinghamshire health authority area on properties in use by them, which have been closed on a temporary basis by the authority prior to the expiry date of consultation.
Mrs. Currie : The responsibility for the provision of local health services rests with the district health authority concerned, in this case Central Nottinghamshire health authority, which is best placed to determine the most effective and efficient way of delivering health care, taking account of patient demand and budgetary constraints.
The hon. Member may, therefore, wish to contact the chairman of the Central Nottinghamshire health authority to obtain the information that he seeks. I understand that the district general manager has indicated that she would be happy to meet the hon. Member at any convenient time.
Health Buildings
Mr. Meale : To ask the Secretary of State for Health whether he has any plans for changing the current guidelines contained within HSC (IS) 207 entitled, "Closure or Change : Use of Health Buildings" ; and if consultations will take place before any new guidelines are issued.
Mrs. Currie : Yes. We plan to revise the guidelines in the near future. Before the new guidelines are issued we shall consult all interested parties.
NHS Beds
Mr. Cohen : To ask the Secretary of State for Health how many National Health Service beds were lost in (a) Waltham Forest and (b) the United Kingdom since 1979.
Mrs. Currie : From 1979 to 1988, the number of patients treated in Waltham Forest per available bed rose from 9.9
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to 17.8 and in England from 14.9 to 22.3. The figures for the rest of the United Kingdom are matters for my right hon. and learned Friend the Secretary of State for Scotland, my right hon. Friend the Secretary of State for Wales and my right hon. Friend the Secretary of State for Northern Ireland.Average daily available beds and number of in-patients treated in Waltham Forest and in England are as follows :
|1979 |1987-88 |Difference
--------------------------------------------------------------------
Waltham Forest
Average daily available
beds |3,311 |2,254 |-1,057
In-patients treated |32,753 |40,052 |+7,299
England
Average daily beds
available |361,670 |296,777 |-64,893
In-patients treated |5,400,120 |6,619,354 |+1,219,234
Primary Health Care
Mr. Patnick : To ask the Secretary of State for Health how he intends to raise standards of primary health care and make services more responsive to the needs of the consumer.
Mr. Mellor : I refer my hon. Friend to the replies given on 12 July 1988 to my hon. Friends the Members for St. Ives (Mr. Harris) and for Edgbaston (Dame J. Knight) at column 554.
Medicine Commission
Mr. McLoughlin : To ask the Secretary of State for Health when he expects to receive the Medicine Commission's annual report for 1987.
Mr. Mellor : I have received the report and copies have today been laid before both Houses of Parliament in accordance with section 5(2) of the Medicines Act 1968.
Bound volumes will shortly be placed in the Libraries containing the 1987 reports of the Medicines Commission, the Committee on Safety of Medicines, the Veterinary Products Committee, the British Pharmacopoeia Commission, the Committee on the Review of Medicines and the Committee on Dental and Surgical Materials.
The bound volumes also include the code of practice on declaration of interests in the pharmaceutical industry which is followed by members of the Medicines Commission, the Committee on Safety of Medicines, the Committee on Review of Medicines and the Committee on Dental and Surgical Materials, and their sub-committees. The code provides that members should declare personal interests in the industry to the Department of Health. They should also declare them where relevant at meetings of the commission or committees when they should in addition declare any interests their academic departments may have in the products under discussion. The code provides that information about members' personal interests shall be published with the annual reports. This information is published for the first time with the 1987 reports. I have decided to extend the range of interests to be declared and published so as to cover the interests of members' departments as well as personal interests. These interests will be published with the 1988 annual reports. This code is not appropriate for the British Pharmacopoeia Commission, which is not involved in licensing matters. I
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understand that a similar code has recently been adopted by the Veterinary Products Committee under which members must declare interests to the Ministry of Agriculture, Fisheries and Food and that the necessary follow-up action is in hand.I am glad to pay tribute to the valuable work done in the public interest by the distinguished members of the Medicines Act advisory bodies. Members follow the ethical standards set by the code of practice, and any involvements they may have in research sponsored by the pharmaceutical industry helps them to keep in touch with important aspects of drug development while avoiding conflicts of interest which might otherwise impair the objectivity of the scientific and clinical advice they give. I have full confidence in the personal integrity of the members concerned.
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Nursing Qualifications
Mr. Stern : To ask the Secretary of State for Health if he will take steps to give a greater role in the examination of nursing qualifications to the Royal College of Nursing.
Mr. Mellor : The statutory responsibility for establishing and improving the standard of nurse training and for approving educational institutions and courses rests with the United Kingdom Central Council and the four national boards for nursing, midwifery and health visiting. The Royal College of Nursing's institute of advanced nursing education is an important provider of
post-registration education and training, whose work we fully support. I hope that the institute will continue to develop higher standards of clinical excellence within the profession through its activities.
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