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Mr. Nicholls : Health and Safety Executive inspectors who have inspection responsibility for the Channel tunnel complex are based in the executive's south-east area local office at Ashford, Kent. Three inspectors are engaged mainly on Channel tunnel work. They have site inspection responsibilities and also, together with specialists from the executive's technology division based at East Grinstead, advise the Translink Joint Venture consortium on health and safety standards during construction of the tunnel.
Column 799have occurred during work on the construction of the Channel tunnel giving, respectively, the dates, details of the accidents, the names of people injured and the results of any investigations carried out.
Mr. Strang : To ask the Secretary of State for Employment when he expects to receive the Health and Safety Executive report on the accident which led to the death of Andrew McKenna in January on a Channel tunnel construction site ; and if he will make a statement.
Mr. Nicholls : Inspectors from the Health and Safety Executive are still investigating the circumstances which led to the death of Andrew McKenna on 23 January 1989. The investigation will continue until all available evidence has been considered.
Mr. Nicholls : The responsibility to provide safe working conditions at the Channel tunnel rests with the contracting companies. The Health and Safety Executive will continue to pursue its inquiries to the highest levels and any enforcement action with determination where safety measures do not achieve the standards required.
Mr. Strang : To ask the Secretary of State for Employment if he will ask the Health and Safety Executive to publish an interim report within two weeks on the inquiry they announced into the accident which killed John Symes, a construction worker on the Channel tunnel ; and if he will make a statement on the result of the existing inquiry.
Mr. Nicholls : No. Inspectors from the Health and Safety Executive are carrying out an investigation into the circumstances of the accident in the Channel tunnel on 6 February 1989. Information from the investigation will be made available to the employer, employees' representatives and to the Channel Tunnel Safety Authority.
Mr. Strang : To ask the Secretary of State for Employment what information he has about the death of John Symes as a result of a recent accident on a Channel tunnel construction site ; and if he will make a statement.
Mr. Nicholls : John Symes was crushed between an overhead travelling crane and the fixed steelwork of the tunnel boring machine frame on 6 February 1989. Inspectors from the Heath and Safety Executive have begun an investigation into the incident.
Ms. Mahon : To ask the Secretary of State for Employment what initiatives have been undertaken by the Government to comply with the European Commission programme of action to (a) study rules on working conditions in the United Kingdom, (b) establish a standard form of contract, (c) improve procedures on informing and consulting workers and (d) improve contracts of employment and employment relationships not relating to full-time employment of indefinite duration.
Mr. Lee : The Commission of the European Community is undertaking a comparative study on working conditions and labour relations in the Member states. On the other issues, there are no proposals currently being considered by the Council of Ministers.
42. Ms. Harman : To ask the Secretary of State for Health how many general practitioner practices currently employ practice managers ; and what his estimate is of the number of general practitioner practices which would employ practice managers to administer budgets as proposed in the National Health Service White Paper.
Mr. Kenneth Clarke : We do not collect centrally figures relating to the employment of practice managers by general practitioners. However, a survey in 1986 indicated that in Great Britain there were about 3,000 practice managers working approximately 30 hours a week. Over a quarter of all practices employed practice managers : this ranged from 10 per cent. of single-handed practices to almost 60 per cent. of practices with five or more doctors. We would expect these figures to have increased in the intervening period.
It will be for general practitioners themselves to decide on the level of support required to administer their practice budgets and whom to employ.
Ms. Harman : To ask the Secretary of State for Health what is his estimate of the future changes in general practitioners' list sizes if the proportion of income attributable to capitation fees is increased from 46 per cent. to 60 per cent., as proposed in the White Paper, "Working for Patients".
Mr. Kenneth Clarke : We expect GPs' list sizes to settle at levels which enable GPs to provide good quality care to their patients. Patients will be able to judge that care and the service they receive for themselves and will be free to transfer between practices as they choose.
Mr. Kenneth Clarke : At present, the maximum number of patients an individual general practitioner can have on his/her list is 3,500 or, if he/she is in partnership, 4,500 subject to an average of 3,500 for each of the partners in the practice.
The current arrangements are being considered within the context of the primary care White Paper "Promoting Better Health".
Ms. Harman : To ask the Secretary of State for Health whether patients of a budget-holding general practitioner practice as proposed under the White Paper, "Working for Health", will be able to top up the budget (a) individually or (b) collectively.
Mr. Kenneth Clarke : The White Paper, "Working for Patients", makes clear that general practitioner practices participating in the practice budget scheme will be allocated NHS resources for the treatment of patients. I
Column 801have no plans to allow patients individually or collectively to make a personal contribution to the NHS practice budget.
Mr. Boateng : To ask the Secretary of State for Health if he has considered the recommendations made to his Department in the National Association of Health Authorities' report entitled "Action not Words" ; and if he will make a statement.
Ms. Short : To ask the Secretary of State for Health if he has received a copy of "Action Not Words : A Strategy to Improve Health Services for Black and Minority Ethnic Groups", published by the National Association of Health Authorities ; and if he will make a statement.
Mr. Mellor : When I spoke at its launch last November I welcomed the report and its constructive criticism. In responding to the recommendations addressed specifically to the Department, I said that we
1. had already begun to integrate ethnic minority health into the review process and that henceforth it would be a standard feature ; 2. saw the value of ethnic monitoring of service delivery and were exploring how it could be developed ;
3. had demonstrated the importance we attached to training ; 4. had taken positive steps to ensure that black and minority ethnic groups were represented on health authorities and FPCs ; 5. acknowledged that the proposed central resource unit had some attractions but needed to consider whether establishing a separate unit was the best way forward.
In these and other ways we shall continue to seek to improve health services for people from ethnic minorities.
Mr. Allen : To ask the Secretary of State for Health how many social workers approved in connection with the Mental Health Act 1983 have been appointed in each social services authority (a) under transitional assessment arrangements, (b) by examination between 1983 and 1987 and (c) since the examination was discontinued.
Mr. Mellor : This information is not collected centrally. It is for individual social services authorities to determine how many approved social workers they need to appoint in the light of local circumstances.
Mr. Allen : To ask the Secretary of State for Health what factors determined the reduction in the proportion of funds allocated by his Department for directly commissioned research relevant to mental illness from 9.3 per cent. in 1987-88 to 8.2 per cent. in 1988-89.
Mr. Freeman : The relative scale of research relevant to mental illness commissioned by the Department varies from year to year in the light of existing and emerging research knowledge, the development of relevant services, and changes in the need for research on other subjects. In 1988-89 £1,307,900 has been made available for directly commissioned research relevant to mental health. In 1987-88 the comparable sum was £1,267,000. Because the total health and personal social services budget has grown, the sum set aside for 1988-89 is a lower percentage of total funds than in 1987-88.
Mr. Allen : To ask the Secretary of State for Health, further to the reply of 1 December 1988, Official Report, column 383, to the hon. Member for Brentwood and Ongar (Mr. McCrindle), if he will make it his policy to ensure that staff of community care hostels receiving discharged psychiatric patients receive information about the illness from which they previously suffered, or continue to suffer, regardless of the constraints of medical confidence or the wishes of the patient.
Mr. Mellor : When a patient is discharged to a hostel in the community, there should be a continuing care plan agreed by hospital staff and those who will be caring for him in the community, and this will usually include information about the patient's illness. The basis of successful care is, however, mutual trust between patients and those involved in their treatment. Giving community care hostel staff information about an individual patient against the wishes of that patient would not be appropriate as it would vitiate that trust.
Dr. Thomas : To ask the Secretary of State for Health if he will specify each donation which his Department has made in response to public appeals for financial aid during each financial year since 1979-80.
Mr. Freeman : The Department provides financial support to a variety of voluntary organisations whose activities may include raising funds by public appeal. However, it is not the policy of the Department to make donations directly into such funds.
Mr. Tom Clarke : To ask the Secretary of State for Health what action he has taken following publication of the results of the survey funded by his Department in 1987 into the integration of mentally handicapped people into local communities.
Mr. Freeman : I assume that the hon. Member is referring to the summary of a survey undertaken for MENCAP (The Royal Society for Mentally Handicapped Children and Adults) which appeared in the editor's introduction to "Mental Handicap in the Community", edited by Alan Leighton, 1988. The survey was largely funded by the Department as part of its continuing consideration of what it can do to encourage public acceptance of the increasing number of people with a mental handicap receiving care in the community. The survey was in the nature of a pilot project and it would be wrong to over-estimate its reliability. The great majority of people with a mental handicap have always lived in the community and are well accepted there and experience has shown that local action is generally successful in extending this acceptance to others who move into residential care in the community.
Mr. Sayeed : To ask the Secretary of State for Health how many bottles of Otosporin were purchased by the National Health Service during the years 1986-87 and 1987-88 from Burroughes Wellcome in (a) 5ml. sizes and (b) other quantities ; and what was the cost in both cases.
Mr. Mellor : We do not have information in the form requested. The latest information relates to prescriptions assessed by the prescription pricing authority during the calendar year 1987, and is derived from a sample of one in 200 National Health Service prescriptions dispensed by retail pharmacy contractors. Usage by the hospital service, and prescriptions dispensed by dispensing doctors, are excluded. On that basis, the total list price of Otosporin purchased was £1,868,000 ; separate figures are not available for 5ml. or other sizes of Otosporin.
Mr. Blunkett : To ask the Secretary of State for Health what is his estimate of the effect on each health region of the cessation of the resources allocation working party system ; and if he will make a statement.
Mr. Kenneth Clarke : The arrangements set out in the White Paper "Working for Patients" meet the need to replace RAWP with a simpler method of allocating resources. They retain however the broad principle of relating funding to population ; and they will ensure hospitals are funded directly and quickly for treating patients from other regions. The effect of the change will therefore be dominated by population changes and general growth in resources over the next three years ; and will be influenced by the arrangements regions negotiate with each other to pay for cross- boundary flows. The pace of change will be carefully managed.
Mr. Blunkett : To ask the Secretary of State for Health what consideration has been given to the need for variations in computer software systems related to wage and salary payments of his proposals to introduce variable regional pay levels in the National Health Service ; and if he will make a statement.
Column 804Cumberland infirmary, Carlisle. The scheme is one of a number competing for funding within the health authority's development programme.
Mr. Dobson : To ask the Secretary of State for Health whether the Bloomsbury health authority inquiry into the sale of kidneys at the Wellington Humana has revealed who billed each recipient for the kidney they received as distinct from the operation or the stay in the hospital.
Mr. Freeman : The Bloomsbury health authority inquiry so far has not revealed the identity of anyone who may have billed recipients for kidneys received in the cases investigated. Inquiries are continuing.
Ms. Harman : To ask the Secretary of State for Health what is his estimate of the percentage change in the time general medical practitioners who work in budget holding practices will devote to administration under the proposals in the White Paper, "Working for Patients".
Mr. Kenneth Clarke : I recognise that general medical practitioners may look to other disciplines for the skills associated with managing and controlling budgets. Many large practices already employ practice managers and other administrative support staff. As proposed in the White Paper, "Working for Patients" each practice budget will include a fee, which the Government intends to set at a realistic level, to recognise the management and other costs. This will avoid the need for GPs to spend additional time on administration at the expense of caring for patients.
Ms. Harman : To ask the Secretary of State for Health how many administrators are (a) currently employed in the National Health Service and (b) would be employed under the proposals in the White Paper, "Working for Patients".
At 30 September 1987, there were 114,600 whole time equivalent administrative and clerical staff in post in England.
It is not yet possible to say what effect the White Paper proposals might have on these figures.
(2) what steps he intends to take to ensure that medical audit, as proposed under the National Health Service White Paper, is carried out in private hospitals.
Ms. Harman : To ask the Secretary of State for Health (1) who in a district will make the decision about whether a patient can be referred to supra-regional services or supra-district services ; (2) under the White Paper "Working for Patients", whether prior approval would have to be sought from the patient's district of residence before a patient could be referred to a supra-regional or supra-district service.
Mr. Kenneth Clarke : The responsibility for referring patients to hospital will continue to rest with GPs and, in the case of referrals from one hospital service to another, with consultants. The Government's proposals for funding supra-regional and supra-district services will be set out in more detail in a working paper which I will be publishing shortly.
Mr. Freeman : The most recent estimate of the population of England and Wales indicates that at mid-1987 20.9 per cent. of the population of England and Wales was over 60. The Government Actuary's 1987-based projections indicate that the corresponding percentages for 2000 and 2020 are 20.4 and 23.7 respectively.
Mr. Freeman : The latest available data from the Government Actuary's Department indicate that for the period 1984-86 the life expectancy at birth in the United Kingdom was 71.7 years for males and 77.5 years for females.
Sir John Stanley : To ask the Secretary of State for Health what is the current number of deaths in the United Kingdom per 1,000 live births of (a) infants under one year old, and (b) children under five years old.
The latest year for which data are available is 1987.
" Number of deaths and rates per 1, 000 live births for (a) infants under one year old, and (b) children under five years old- United Kingdom |Number |<1>Rate ---------------------------------- Under 1 |7,077 |9.1 0.4 years |8,284 |10.7 <1> Per 1,000 livebirths.
Ms. Harman : To ask the Secretary of State for Health whether extra resources will be provided to support community health councils to represent local community interests once local authority representatives have been removed from health authorities, as proposed in the National Health Service White Paper.
Mr. Kenneth Clarke : I do not accept that health authority members appointed by local authorities were intended to fulfil the role described. As the White Paper says, the interests of the local community will continue (as they have in the past) to be represented by community health councils which act as a channel for consumer views. They receive adequate resources for that purpose and the White Paper does not impose any additional duties or burdens upon them.
Ms. Harman : To ask the Secretary of State for Health what are the median waiting times for each district health authority in England and Wales for (a) hip replacements, (b) hernia operations and (c) cataract removals.
Mr. Mellor : Reliable information about median waiting times for specific procedures is not yet available under the new hospital episode system (HES). The sample numbers under the old hospital in-patient inquiry (HIPE) system were too small for reliable estimates to be made about individual procedures at district level. Questions about Wales are for my right hon. Friend the Secretary of State for Wales.
Mr. Freeman : In 1985, the latest year for which this information is available centrally, an estimated 1.38 million people were treated in NHS non-maternity, non-psychiatric hospitals outside their district of residence.
Mr. Marlow : To ask the Secretary of State for Health what are the numbers of AIDS patients reported in each of the following health authority areas : Riverside, Parkside, Bloomsbury, West Lambeth, Hampstead, Tower Hamlets, Wandsworth and Camberwell ; and what are the major hospitals in each district.
Mr. Mellor : The table shows the cumulative total of AIDS cases and deaths up to the end of December 1988 in each of the districts requested. These data are by health authority of the reporting doctor. The major hospitals listed in each district are those from which 10 or more cases were first reported to CDSC by the end of January 1989.
|Cumulative total of cases|Deaths |Major hospitals ---------------------------------------------------------------------------------------------------------------------------------- Riverside |477 |220 |Charing Cross |St. Stephen's |Westminster |West London Parkside |287 |152 |St. Mary's Bloomsbury |210 |115 |University College |and Middlesex West Lambeth |69 |32 |St. Thomas' Hampstead |43 |16 |Royal Free Tower Hamlets |43 |28 |The London |(Whitechapel) Wandsworth |36 |18 |St. George's Camberwell |35 |20 |St. Giles'
(2) what precautions are taken for the disposal of sharps used in the treatment of AIDS patients.
Mr. Mellor : A code of guidance produced by the Health and Safety Commission for the safe dispersal of clinical waste has been sent to all health authorities with health notice HN(82)22, a copy of which is in the Library. Health authorities were required to review their policies for the handling, transporting and disposal of clinical waste which includes infectious waste and sharps used in the treatment of AIDS patients.
Sir Ian Lloyd : To ask the Secretary of State for Health whether, in view of the recent allocation of additional funds for research and development, he will change the criteria of the supra-regional services advisory group to include laboratory services as well as clinical services and take steps to promote recognition of the supra-regional services in the field of genetic metabolic diseases at Guy's hospital.
Mr. Freeman : No. The present arrangements for designating and funding supra-regional services were agreed after extensive discussions between the Department, regional health authorities and the joint consultants committee. I would not expect changes to the supra-regional services except those that may occur as a result of the implementation of the White Paper "Working for Patients".
Sir Ian Lloyd : To ask the Secretary of State for Health (1) what arrangements have been made within the National Health Service to diagnose and treat patients with genetic diseases after the closure of the purine research laboratory at Guy's hospital in March ; (2) what information he has about the availability in other western European countries of diagnostic and research services related to purine disorders ; and whether it is his intention that work in this field should continue in the United Kingdom ;
(3) what arrangements he is making to ensure that after the closure of the purine research laboratory at Guy's hospital in March the work now being done to achieve the first human gene implant involving the purine disorder adenosine deaminase deficiency will be continued.
Mr. Freeman : Purine disorders include a wide range of metabolic diseases (e.g. phenylkelonuria, gout). It is likely that most western European medical teaching centres provide some diagnostic and research facilities for diseases included in this category. In this country decisions as to facilities for diagnosis are a matter for local health authorities in the light of their assessment of local needs and priorities. The main Government agency for the promotion of medical research is the Medical Research Council. I understand that they are conducting research into purine.
Column 808No firm decision has yet been taken on the cessation of the diagnostic and treatment service provided by the purine research laboratory at Guy's hospital. The laboratory's research work, which is separately funded through grants, is continuing.
Mr. Robin Cook : To ask the Secretary of State for Health what action he proposes to take against the company Specialist Waste Management ; and if he will require health authorities to instigate an investigation into the clinical waste disposal practices of the contractors they are using.
Mr. Mellor : Health authorities are responsible for the arrangements to dispose of their clinical waste and any action that needs to be taken against a waste disposal contractor is a matter for the contracting health authority.
We believe that such waste should be incinerated and we understand that the contract between Riverside HA and Specialist Waste Management required the contractor to incinerate its clinical waste. The contract has been terminated.