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Junior Doctors
14. Mr. Colvin : To ask the Secretary of State for Health what discussions he has had with representatives of hospital consultants about the hours worked by junior doctors.
Mr. Mellor : There were detailed discussions between the Health Departments and the profession's representatives, including hospital consultants, before the Government asked health authorities in June 1988 to work towards a reduction in junior doctors' rota commitments. I met representatives of the British Medical Association, including hospital consultants, on 9 January and plan to meet them again next month.
68. Mr. Wareing : To ask the Secretary of State for Health what steps he has taken to obtain opinions concerning the maximum number of hours which should be worked by junior hospital doctors in any one working week, or continuously ; and if he will publish the responses he receives.
Mr. Mellor : In June 1988, following agreement with doctors' representatives, we asked health authorities to work towards the elimination of rotas requiring a junior doctor to be on duty on average more than one night and one weekend in three. We discussed junior doctors' hours at a meeting with representatives of the British Medical Association on 9 January ; and we plan to meet them again next month.
Mr. Terry Davis : To ask the Secretary of State for Health what information he possesses concerning the number of hours worked by junior hospital doctors, additional to their contracted hours.
Mr. Mellor : In 1985, when average weekly contracted hours of junior hospital doctors were 86, the average weekly hours worked when off duty was one, compared with three in 1981, when average weekly contracted hours were 89.
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79. Mr. Win Griffiths : To ask the Secretary of State for Health if he will list the specific proposals and resources offered by his Department to enable health authorities to reduce the hours worked by junior doctors on call in hospitals.
Mr. Mellor : In June 1988 we announced a scheme to reduce the hours of work of junior hospital doctors and dentists. Details were set out in circular EL(88) P82, a copy of which was placed in the Library. I have asked regional health authorities to report to me by 20 January as to the progress being made.
Needle Exchange Scheme
15. Mr. Strang : To ask the Secretary of State for Health what is his policy towards the establishment of needle exchange schemes to reduce the spread of HIV among injecting drug users ; and if he will make a statement.
Mr. Mellor : We have now received the final report of the evaluation of exchange schemes and are urgently considering its implications. We have already issued guidance to health authorities on establishing syringe exchange schemes and estimate that there are currently some 60 to 100 schemes operating in England.
Hospital Waiting Lists
16. Mr. Butler : To ask the Secretary of State for Health what progress he has made in reducing hospital waiting lists in the Mersey region.
Mr. Freeman : Waiting lists in the Mersey region are some 10,000 lower than at March 1979. The number of patients waiting over one year is now down to 6,300--4,000 lower than at March 1979.
62. Mr. Ian Bruce : To ask the Secretary of State for Health if he will make a statement on the latest figures for change in throughput of patients in National Health Service hospitals.
Mr. Freeman : The information is given in the table.
In-patient cases treated per available
bed per annum (throughput),
NHS hospitals, England, 1978, 1986 and
1987-88
Percentage changes between:-
|Throughput
---------------------------------------
1978 |14.5
1986 |20.3
1987-88 |22.3
1978 and 1987-88 |53.4
1986 and 1987-88 |9.8
Over the period since 1978 increased throughput has been possible, not only because of greater health authority efficiency, but because new treatments and techniques have meant that stays in hospital are now shorter.
Community Care
17. Mr. Wallace : To ask the Secretary of State for Health whether he now expects to make a statement on his Department's plans for implementation of the proposals contained in the Griffiths report on community care.
Mr. Kenneth Clarke : We are actively engaged at present in working up our own proposals for the future of community care. I hope to be in a position to bring forward our plans in the near future.
Health Authorities
19. Mr. Cohen : To ask the Secretary of State for Health if he will supply his latest estimate of the projected budget deficit in (a) the current financial year and (b) the next financial year of (i) London health authorities and(ii) health authorities.
Mr. Mellor : Health authorities report on their income and expenditure position as part of quarterly monitoring introduced in 1988-89. At the half-year stage, the projected income and expenditure deficit for 1988-89 of the four Thames regional health authorities, together with the eight postgraduate special health authorities, was £23.5 million. The deficit projection for all English health authorities was £59.9 million.
The information relating to the rest of the United Kingdom is a matter for my right hon. Friends the Secretaries of State for Wales, Northern Ireland and my right hon. and learned Friend the Secretary of State for Scotland. Projections of the income and expenditure position for the next financial year will be provided by health authorities in their short-term programmes.
45. Mr. Rowe : To ask the Secretary of State for Health what steps he has taken to promote flexible employment conditions in health authorities ; and if he will make a statement.
Mr. Mellor : This is one of the key aims of our personnel policies and we have in particular encouraged health authorities to offer more opportunities for flexible working arrangements, part-time working and job sharing.
We have commissioned a senior National Health Service personnel officer to carry out a comprehensive review of conditions of service, including the scope for greater decentralisation. This is now nearing completion and we shall be making full use of the findings in deciding on further action in this field.
Nurses (Pay)
21. Mr. Simon Hughes : To ask the Secretary of State for Health if he will make a statement on his Department's evidence to the pay review body on plans for regional variations in nurses' pay.
Mr. Mellor : The Health Department's written evidence to the review body which we published in October says that there is scope for a more flexible system of pay to respond to geographical and skill shortages. We have since asked the Review Body to consider setting aside around £5
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million within their overall recommendations for a pilot exercise in supplementing national rates of basic pay where this is deemed appropriate on recruitment and retention grounds.Staff Regrading
23. Mrs. Maureen Hicks : To ask the Secretary of State for Health how many clinical regrading appeals have been considered to date ; and what percentage of those have been regraded as a result.
Mr. Mellor : We do not hold this information centrally.
37. Dr. Reid : To ask the Secretary of State for Health what is the total number of nurse regrading appeals which have been made.
94. Mr. Hardy : To ask the Secretary of State for Health how many appeals against nurses' gradings have been heard by health authorities ; and how many appeals remain to be considered.
Mr. Mellor : We do not hold this information centrally.
50. Mr. Andrew F. Bennett : To ask the Secretary of State for Health how many representations he has received about midwives' pay since the new pay structure was introduced.
Mr. Mellor : The Department has received some 400 written representations since the implementation process was completed. In addition, my right hon. and learned Friend met the president and the general secretary of the Royal College of Midwives on 7 December and had a friendly and useful discussion with them.
76. Mr. Cox : To ask the Secretary of State for Health if he will make a statement on the progress being made on nurses' appeals over their recent regrading.
Mr. Mellor : I refer the hon. Member to my right hon. and learned Friend the Secretary of State's reply to the hon. Member for Ynys Mo n (Mr. Jones) earlier today.
78. Ms. Quin : To ask the Secretary of State for Health how many representations he has received concerning the nurses' regrading review.
Mr. Mellor : The Department has received some 2,300 written representations since the implementation process was completed. In addition, we had friendly and constructive meetings with the president and the general secretary of the Royal College of Nursing on 5 December, and the president and general secretary of the Royal College of Midwives on 7 December.
Hospital Doctors
24. Mr. Harris : To ask the Secretary of State for Health how many hospital doctors there were in 1978 and in 1986 ; and what proportion of them in each year were women.
Mr. Mellor : In 1978 and 1986 there were 38,527 and 43,992 hospital doctors respectively in England. Of these, 19.4 per cent. in 1978 and 24.8 per cent. in 1986 were women.
Coventry and Warwickshire Hospital
25. Mr. Nellist : To ask the Secretary of State for Health why letters from general practitioners referring
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patients with non-urgent surgical conditions are presently being stockpiled by the medical records officer at the Coventry and Warwickshire hospital ; and if he will make a statement.Mr. Freeman : With the help of central funding under our waiting list initiative in 1987-88, Coventry reduced the number of patients who had waited more than a year for general surgery from 355 in March 1987 to 217 in March 1988. Provisional data indicated a further reduction by September 1988 to 146, but this put pressure on the hospital's budget. Combined with the pressure on beds from urgent medical conditions over winter and high staff sickness particularly among nurses, this has led to a reduction in activity since October, and some 200 non-urgent out-patient cases referred by general practitioners to surgeons--5 per cent. of their normal workload- -have not yet been given appointments. The district general manager is discussing with the surgeons how best to schedule appointments for all patients who have not yet been seen.
NHS Review
Mr. Kirkwood : To ask the Secretary of State for Health if he will make a statement concerning his plans to extend the mechanism of the internal market in the National Health Service.
Mr. Stern : To ask the Secretary of State for Health when he expects to announce the results of the review of the National Health Service.
26. Mr. Fearn : To ask the Secretary of State for Health what plans he has to allow hospitals to opt out of the present National Health Service management structure.
29. Mr. Riddick : To ask the Secretary of State for Health when he expects to make an announcement on the Government's review of the National Health Service.
36. Mr. Gerald Howarth : To ask the Secretary of State for Health when he expects to publish his White Paper on the future of the National Health Service ; and if he will make a statement.
38. Ms. Abbott : To ask the Secretary of State for Health if he will provide details of proposals currently being considered which would have the effect of some district general and other hospitals opting out of the structure of the National Health Service.
47. Rev. Martin Smyth : To ask the Secretary of State for Health if he will make a statement about the implications for the distribution of hospitals in the National Health Service of measures to promote increased competition.
52. Mr. McAllion : To ask the Secretary of State for Health when he expects to publish the findings of the review of the National Health Service.
56. Mr. Bernie Grant : To ask the Secretary of State for Health when he intends to publish the results of the current review of the National Health Service ; and if he will make a statement.
85. Mr. Frank Field : To ask the Secretary of State for Health what plans he has for experiments in the delivery of health care to National Health Service customers.
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88. Mr. Tim Smith : To ask the Secretary of State for Health when he expects to publish the results of the National Health Service review.
90. Mr. Roger King : To ask the Secretary of State for Health if he will make a statement on the National Health Service review.
91. Mr. Neil Hamilton : To ask the Secretary of State for Health when he expects to publish his White Paper on the future of the National Health Service ; and if he will make a statement.
Mr. Mellor : I refer my hon. Friends and the hon. Members to the reply given by my right hon. and learned Friend the Secretary of State to the hon. Members for Nottingham, North (Mr. Allen), for Western Isles (Mr. MacDonald), for Hornchurch (Mr. Squire), for Sheffield, Hallam (Mr. Blunkett) and for Suffolk, South (Mr. Yeo) earlier today.
67. Mr. Boswell : To ask the Secretary of State for Health what plans he has for ensuring greater cost-effectiveness in the National Health Service.
Mr. Mellor : The NHS is not a business, but it has to be more business-like. There is still a huge gulf between the best and the worst in terms of efficiency, customer choice, standards, good management and clear decision-taking. The Government intend to spread the best qualities of the enterprise economy more widely throughout the NHS, and we shall be bringing forward proposals to this end shortly.
Abortions
27. Mr. Burt : To ask the Secretary of State for Health if he will make it his policy to instruct health authorities to take disciplinary action against staff who do not take all possible actions to preserve the life of foetuses born alive after attempted abortion operations.
Mr. Mellor : It is for health authorities to determine within well- established disciplinary procedures action to be taken in cases involving professional misconduct or incompetence.
34. Mr. McLoughlin : To ask the Secretary of State for Health what percentage of abortions performed in England in the latest year for which figures are available were performed because the child was likely to have been born severely handicapped.
Mr. Freeman : There were 170,197 notifications of abortions which were carried out in England in 1987 under the Abortion Act 1967, of which 1,826 (1.07 per cent.) mentioned ground 4 (there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped).
35. Sir Michael McNair-Wilson : To ask the Secretary of State for Health whether he has any plans to seek to amend the Abortion Act 1967.
Mr. Freeman : Like their predecessors of both parties, the Government consider that amendments to the 1967 Act are a matter for private Members' legislation.
41. Mr. Amos : To ask the Secretary of State for Health on how many occasions during the last 12 months, for which figures are available, officials of his Department
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have visited private abortion clinics licensed by his Department in order to monitor the implementation of the Abortion Act 1967.Mr. Freeman : In 1988 the Department's medical, nursing and administrative officers made 79 visits of inspection to places approved under the Abortion Act 1967.
42. Mr. Ashby : To ask the Secretary of State for Health how many recent representations he has received from right hon. and hon. Members urging more thorough monitoring of the Infant Life (Preservation) Act.
Mr. Freeman : We have had no such representations.
57. Mr. Ken Hargreaves : To ask the Secretary of State for Health what information he has as to the numbers of abortions performed by individual doctors ; and if he will make a statement.
Mr. Freeman : I regret that this information is not available centrally.
60. Mr. Evennett : To ask the Secretary of State for Health what is the most common technique for performing abortions after 18 weeks currently used in National Health Service abortion centres ; and what that technique involves.
71. Mrs. Peacock : To ask the Secretary of State for Health what is the most common technique for performing abortions after 18 weeks currently used in private abortion clinics.
Mr. Freeman : The most common technique for performing abortions carried out under the Abortion Act 1967 after 18 completed weeks gestation in both NHS and non-NHS premises in England and Wales is the use of prostaglandins, either alone or with other agents. This technique involves the introduction of prostaglandins within the uterus.
81. Mr. Brazier : To ask the Secretary of State for Health whether he has yet taken any steps to implement the 1973 recommendation of the Select Committee on Abortion that there should be no financial links between doctors and agencies who counsel women in difficult pregnancies and the centres in which abortions may subsequently be performed upon those women.
Mr. Freeman : We have no plans to alter the long-standing administrative conditions governing financial links between doctors and agencies who refer women for abortions and the private sector clinics in which such abortions are performed.
86. Mr. Dickens : To ask the Secretary of State for Health what information he has as to how many foetuses born alive following abortion operations survived in the latest year for which figures are available ; and if he will make a statement.
Mr. Freeman : No information is collected at birth registration which distinguishes between foetuses born alive following abortion operations and other live births. Hence, no information would be available on the survival of such foetuses. The notification of abortions carried out under the Abortion Act 1967 does not require information about the outcome of the aborted foetus to be recorded.
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Mr. Hind : To ask the Secretary of State for Health how many abortions were carried out in the United Kingdom in 1988 ; and if he will make a statement.
Mr. Freeman : Complete statistics are not yet available for abortions performed in the United Kingdom for 1988. The table shows the latest figures for England and Wales for half of 1988, and figures for the constituent parts of the United Kingdom for the whole of 1987. The Abortion Act 1967 does not apply in Northern Ireland.
Notifications of abortions carried out under the Abortion Act 1967 in
the United Kingdom and its constituents parts 1987, 1988
Area |1987 |March and June quarters
|1988<1>
------------------------------------------------------------------------------------------------
England and Wales |174,276 |92,715
Scotland |9,351 |n/a
United Kingdom |183,627 |n/a
<1> Provisional-includes notifications received by end of August.
Mr. Robert G. Hughes : To ask the Secretary of State for Health what percentage of all abortions performed under the terms of the Abortion Act 1967 have been performed (a) in the case of a pregnancy resulting from rape or (b) in emergency to save the life of the mother.
Mr. Freeman : The total number of notifications of legal abortions, to resident and non-resident women, carried out under the Abortion Act 1967, from 27 April 1968 to 30 June 1988, is 2,899,405 . Of these, 130 (0.004 per cent.) were performed in an emergency in order to save the life of the pregnant woman.
As rape is not in itself a statutory ground for performing an abortion under the 1967 Act, and is not required to be specified on the notification form by the certifying doctor, the exact number of notifications of abortions associated with rape is not known. However, in some cases the information is volunteered, and arrangements have been made to code separately and analyse all notifications forms which mention rape from 1 January 1987. Of the 266,991 notifications received for the period January 1987 to June 1988 inclusive, 45 (0.02 per cent.) mentioned rape. Earlier, but non-comparable, data were collected clerically and published for the years 1968-73, in table 12 of the Registrar General's "Statistical Review, Supplement on Abortion", copies of which are in the Library. The reliability of these earlier data is uncertain.
The total number of abortions is based on notifications received (1968 to 1980) and on occurrences (1981 to 1986). Data for 1988 are provisional.
Hospices
28. Mr. Ian Taylor : To ask the Secretary of State for Health what the number is of terminally ill patients now being cared for in hospices ; what the figure was for five years ago ; and what has been the change in Government funding for hospice projects over the same period.
Mr. Freeman : Information is not available in the form requested. We are, however, currently collecting information from health authorities on the estimated demand for specialist services for the terminally ill and on their arrangements for the financial support of voluntary hospices.
Column 535
Smoking (Health Warnings)
2. Mr. Tony Banks : To ask the Secretary of State for Health if he will provide details of the options considered by his Department for changing the wording of Government health warnings in relation to smoking and health.
Mr. Freeman : Health warnings are included on some tobacco products in the United Kingdom by virtue of a voluntary agreement with the tobacco industry. We will seek renegotiation of this agreement and new health warnings will be considered. The Commission of the European Communities has also brought forward proposals on tobacco labelling including health warnings, which are at present under discussion.
30. Mr. Corbyn : To ask the Secretary of State for Health if he will make a statement on his proposals for strengthening Government health warnings on cigarette packets.
Mr. Freeman : Health warnings are included on packets of cigarettes and hand rolling tobacco by virtue of a voluntary agreement with the tobacco industry. That agreement will stand at least until 31 October 1989. We intend to seek renegotiation of the agreement and new health warnings will be one of the matters which will be considered.
Cancer Screening
31. Mr. Burns : To ask the Secretary of State for Health if he will report on progress in setting up the breast cancer screening programme.
Mr. Freeman : I am pleased to announce the arrangements for the provision of breast cancer screening services to all district health authorities in England. The service will provide routine screening for women aged 50 to 64 and for older women on request. The list shows both the first regional centres which were established early last year and the further centres and consortia which regions plan to set up by 1990 to serve the remaining population, although these may be subject to slight alteration as proposals are finalised. Against each name is a list of the district health authorities which it will serve. In some cases more than one unit will operate from the base named. Those centres which to date have become operational are marked with an asterisk. Equitable access to services will be ensured by the provision, where appropriate, of a combination of static and mobile facilities. Detailed information about local arrangements can be obtained through regional health authorities.
We are very pleased with the commitment which health authorities and their staff are showing towards this programme which will make a significant contribution to the health of the women in this country.
Breast cancer screening service
Screening centre or |Districts served
consortium
------------------------------------------------------------------------------------------------------
Northern Regional Health Authority
Gateshead* |Gateshead
|Durham
|South Tyneside
|Sunderland
Newcastle |Newcastle
|North Tyneside
|Northumberland
|North West Durham
North Tees |North Tees
|South Tees
|Darlington
|Hartlepool
|South West Durham
West Cumbria |West Cumbria
|South Cumbria
|East Cumbria
Yorkshire Regional Health Authority
Huddersfield* |Huddersfield
|Calderdale
|Dewsbury
Hull |Hull
|East Yorkshire
|Grimsby
|Scunthorpe
York |York
|Scarborough
|Northallerton
Bradford |Airedale
|Bradford
Leeds |Leeds Eastern
|Leeds Western
|Pontefract
|Wakefield
|Harrogate
Trent Regional Health Authority
Nottingham* |Nottingham
|Central Nottinghamshire
|Bassetlaw
Leicester |Leicestershire
Lincolnshire* |North Lincolnshire
|South Lincolnshire
South Yorkshire |Barnsley
|Doncaster
|Rotherham
Derbyshire |North Derbyshire
|Southern Derbyshire
Sheffield |Sheffield
East Anglian Regional Health Authority
Peterborough
and West Norfolk* |West Norfolk and Wisbech
|Peterborough
Suffolk |East Suffolk
|West Suffolk
|Great Yarmouth
| and Waveney (part)
Norwich |Norwich
|Great Yarmouth
| and Waveney (part)
Cambridge and Huntingdon |Cambridge
|Huntingdon
North West Thames Regional Health Authority
Charing Cross Hospital |Riverside
|Hounslow and Spelthorne
|Ealing
|Hillingdon
Edgware General Hospital* |Barnet
|Harrow
|Parkside
|South West Hertfordshire
Luton and Dunstable Hospital |North West Hertfordshire
|North Bedfordshire
|South Bedfordshire
|North Hertfordshire
|East Hertfordshire
North East Thames Regional Health Authority
Epping* |West Essex
|Redbridge
Bloomsbury* |Bloomsbury
|Hampstead
|Islington
East London |City and Hackney
|Newham
|Tower Hamlets
Chelmsford and Colchester |North East Essex
|Mid Essex
Whipps Cross |Waltham Forrest
Barking,
Havering and Brentwood |Barking,
|Havering and Brentwood
North Middlesex |Enfield
|Haringey
South Essex |Southend
|Basildon and Thurrock
South East Thames Regional Health Authority
Camberwell* |Camberwell
|West Lambeth
|Lewisham
| and North Southwark
|Greenwich
|Bexley
|Bromley
Canterbury |Canterbury and Thanet
|South East Kent
|Maidstone
|Tunbridge Wells
|Medway
|Dartford and Gravesham
East Sussex |Brighton
|Eastbourne
|Hastings
South West Thames Regional Health Authority
Guildford(1)* |Mid Surrey
|North West Surrey
|South West Surrey
(2)* |West Surrey
| and North East Hants.
|East Surrey
Worthing |Worthing
|Chichester
|Mid Downs
Wandsworth(1) |Wandsworth
|Croydon
|Kingston and Esher
|Merton and Sutton
(2) |Richmond, Twickenham
|and Roehampton
Wessex Regional Health Authority
Southampton* |Southampton
| and South West Hampshire
|Salisbury
Isle of Wight* |Isle of Wight
Portsmouth* |Portsmouth
| and South East Hampshire
Dorset |East Dorset
|West Dorset
Bath/Swindon |Bath
|Swindon
Winchester/Basingstoke |Winchester
|Basingstoke
| and North Hampshire
Oxford Regional Health Authority
Aylesbury* |Aylesbury Vale
Northampton |Northampton
Wycombe |Wycombe
Milton Keynes |Milton Keynes
Kettering |Kettering
Reading* |West Berkshire
Windsor |East Berkshire
Oxford/Banbury |Oxfordshire
South Western Regional Health Authority
Cornwall* |Cornwall and Isles of Scilly
West Devon |Plymouth
|North Devon
East Devon |Exeter
|Torbay
Somerset |Somerset
Avon |Bristol and Weston
|Frenchay
|Southmead
Gloucestershire |Gloucester
|Cheltenham and District
West Midlands Regional Health Authority
Stoke-on-Trent(1)* |North Staffordshire
(2) |Mid Staffordshire
|South East Staffordshire
Coventry(1) |Coventry
|North Warwickshire
(2) |Rugby
|South Warwickshire
|Solihull
Dudley |Dudley
|Wolverhampton
Walsall |Walsall
|Sandwell
Birmingham(1) |North Birmingham
|East Birmingham
|West Birmingham
Birmingham(2) |Central Birmingham
|South Birmingham
Bromsgrove General Community Hospital |Worcester
|Hereford
|Kidderminster and District
|Bromsgrove and Redditch
Shrewsbury |Shropshire
Mersey Regional Health Authority
Liverpool(1)* |Liverpool
(2) |Southport and Formby
|South Sefton
|St. Helen's and Knowsley (part)
Warrington |Warrington
|Halton
|St. Helen's and Knowsley (part)
Crewe |Crewe
Macclesfield |Macclesfield
Wirral |Wirral
Chester |Chester
North Western Regional Health Authority
South Manchester* |North Manchester
|Central Manchester
|South Manchester
|Stockport
|Tameside and Glossop
|Oldham
|Trafford
|Salford
Wigan* |Wigan
|West Lancashire
|Chorley and South Ribble
Bolton* |Bolton
|Bury
|Rochdale
North East Sector |Blackburn, Hyndburn
| and Ribble Valley
|Burnley, Pendle
| and Rossendale
North West Sector |Preston
|Blackpool, Wyre and Fylde
|Lancaster
Dental Treatment
32. Mr. Janman : To ask the Secretary of State for Health how many courses of dental treatment were carried out in 1978 and in 1986 ; and how many dentists there were in each year.
Mr. Freeman : The information requested is set out in the table.
General dental services-England Year |Number of courses of treatment 000s|Number of dentists 1978 |27,105 |11,919 1986 |32,279 |14,516
Hepatitis B
33. Mr. Pike : To ask the Secretary of State for Health what representations he has received for additional funds to meet the cost to district health authorities of funding of vaccination of National Health Service employees against Hepatitis B.
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