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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. 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.
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.
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.
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.
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.
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.
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.
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
Column 530million 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.
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.
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.
Column 531patients 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.
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.
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.
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.
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.
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).
Column 533have visited private abortion clinics licensed by his Department in order to monitor the implementation of 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.
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.
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.
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.
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.
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.
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.
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
General dental services-England Year |Number of courses of treatment 000s|Number of dentists 1978 |27,105 |11,919 1986 |32,279 |14,516
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.