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Mr. Kaufman : To ask the Secretary of State for Social Security when he expects to give a substantive reply following his holding answer of 30 January, to the right hon. Member for Manchester, Gorton with respect to the case of Mr. N. Scott ; and if he will set up an internal inquiry into the reasons for both the delay which was the subject of the original question and the delay in replying substantively to that question.
Mr. Jack : To ask the Secretary of State for Energy (1) when he next plans to meet the chairman and officers of the Association for the Conservation of Energy, in order to discuss the application of British energy efficiency systems and equipment to deal with global warming and the greenhouse effect ;
(2) what information is available to British embassies or trade legations to enable them to deal with inquiries for British energy efficiency systems and equipment designed to combat global warming and the greenhouse effect ;
(3) what steps he proposes to take in order to promote the availability of British energy efficiency systems and equipment as solutions to global warming and the greenhouse effect.
Mr. Peter Morrison : British embassies and trade missions have available to them the literature and contacts provided by the trade associations of the energy efficiency industry, and the services of the Department of Energy and the Department of Trade and Industry. Ministers and officials of both Departments frequently promote the British energy efficiency industry overseas. The identification and follow-up of export opportunities is one of the objectives of the energy efficiency office.
My right hon. Friend will be meeting the chairman of the Association for the Conservation of Energy shortly and will be very happy to discuss these matters with him.
Mr. Mellor : Between 1979 and 1987-88 more than 1 million more in- patient cases were treated in National Health Service hospitals in England, a rise of 22 per cent. from 5.40 million to 6.62 million cases. In the same period provisional figures suggest that day cases have risen by 71 per cent. from 592,000 to more than 1 million, and new out-patient attendances by 10 per cent.
13. Mr. Hinchliffe : To ask the Secretary of State for Health what proportion of perinatal deaths, stillbirths and miscarriages which have occurred over the past year have been examined for the presence of listeria monocytogenes.
Mr. Kenneth Clarke : Post-mortem examinations for still births or perinatal deaths to establish the presence of listeria monocytogenes would be carried out only at the request of clinical staff or a coroner, and we do not hold information on those requests centrally.
Mr. Kenneth Clarke [holding answer 16 February 1989] : To date, there have been no confirmed reports to the public health laboratory service of miscarriages and stillbirths associated with the consumption of soft cheese. There were nine reported stillbirths associated with listeriosis in 1988.
14. Mr. Gill : To ask the Secretary of State for Health whether cottage hospitals, either separately or collectively, will be permitted to opt for National Health Service hospital trust status under his proposals outlined in the recent White Paper, "Working for Patients".
Mr. Kenneth Clarke : It is the Government's intention that any hospital or group of hospitals which meets the criteria set out in the White Paper will be eligible to apply for National Health Service hospital trust status. Each application will, of course, need to be carefully considered on its merits.
Mr. Freeman : As the hon. Member will be aware, the Government announced early last year that they accepted expert advice that, under prescribed conditions, irradiated food is safe and wholesome. However, we also stated that the general prohibition of the process would remain until we had received advice on the scope and format of regulatory controls necessary to ensure good industrial and marketing practices. In that connection, my right hon. Friend the Minister of Agriculture, Fisheries and Food and I expect a report from officials shortly. I should add that any proposals to amend or adjust the current prohibition will be subject to full public consultation as is required under the Food Acts.
Column 597post-registration training from which the NHS benefits if staff move back into the service. Representatives from the Department and the private sector have recently agreed to a joint working group with the aim of increasing the total stock of skilled staff available to both sectors.
Mr. Mellor : The average pay of all nurses has gone up by 45 per cent. in real terms since 1979 and now stands at its highest ever real terms level. A typical experienced staff nurse on the maximum of the scale now has basic pay of £10,650, compared with £3,813 in 1979--an increase of £3,645 or 52 per cent. in real terms. Nurses will receive a further increase of 6.8 per cent. from 1 April 1989.
We shall create 100 additional consultant posts over the next three years, above planned expansion levels, targeted at the worst waiting problems. We shall give hospitals, for the first time, a real incentive to treat patients quickly and efficiently by paying them for the work they actually do. There will also be better waiting times information for GPs to enable them to refer patients more easily to where waiting times are shortest. In addition, some GP practices will manage their own budgets, so as to get the best possible deal for their patients.
We have also made £86 million available from the waiting list fund over three years to tackle the worst waiting problems.
25. Mr. Favell : To ask the Secretary of State for Health what steps patients will be able to take to reduce waiting times for treatment following implementation of his proposals contained in the White Paper "Working for Patients".
Column 598their own budgets for hospital services, so as to get the best possible deal for their patients. Better information will be available to all GPs and patients about hospital services, including waiting times. Hospitals will have a real incentive to treat patients quickly and efficiently because they will be paid for the work they do. The White Paper also proposes that it should be easier for patients to change their doctor if they wish to do so.
As a result, the NHS as a whole will become much more responsive to the individual patient. Patients will be able to discuss real choices with their GPs, and both will be able to act effectively in the best interest of the patient.
Mr. Kenneth Clarke : The reforms in our White Paper "Working for Patients" (Cm. 555) will end the present arrangements which provide little incentive for health authorities to treat patients from outside their boundaries. In future, hospitals will be free to offer their services to different health authorities and will receive NHS funds for the patients they treat. For the first time, hospitals will have real incentives to treat patients quickly and efficiently regardless of where they live. and patients will be able to go to hospitals where waiting times are shortest.
Mr. Freeman : In 1987 there was only one notification of an abortion which took place with a gestation period at 28 weeks. This was carried out under ground 4 of the 1967 Abortion Act which states "there is a substantial risk that if the child is born it would suffer such physical or mental abnormalities as to be seriously handicapped."
|c|Number of notifications of abortions carried out under the Abortion Act 1967 to residents and non-residents of England and Wales by statutory|c| |c|grounds (mentioned) 1981-87. These figures represent the number of times each of the statutory grounds reported (mentioned) rather than the|c| |c|number of operations.|c| Statutory grounds<1> |1981 |1982 |1983 |1984 |1985 |1986 |1987 --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- All grounds |182,090 |180,182 |179,310 |186,618 |187,390 |187,433 |190,692 1 |790 |674 |549 |596 |534 |488 |480 2 |158,520 |159,418 |158,389 |165,996 |168,113 |168,732 |170,860 3 |20,713 |17,796 |18,098 |17,757 |16,687 |16,176 |17,404 4 |2,053 |2,282 |2,268 |2,252 |2,040 |2,031 |1,941 5 |5 |7 |3 |9 |5 |2 |3 6 |9 |5 |3 |8 |11 |4 |4 <1> The statutory grounds under which an abortion may be performed are that: 1. the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated. 2. the continuance of the pregnancy would involve risk of injury to the physical or mental health of the pregnant woman greater than if the pregnancy were terminated. 3. the continuance of the pregnancy would involve risk or injury to the physical or mental health of any existing child(ren) in the family of the pregnant woman greater than if the pregnancy were terminated. 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, or in emergency, certified by the operating practitioner as immediately necessary- 5. to save the life of the pregnant woman, or 6. to prevent grave permanent injury to the physical or mental health of the pregnant woman.
Mr. Freeman : The number of notifications of women having their fourth abortion (legal terminations or spontaneous miscarriages) in England and Wales for the period January-June 1988 is 906. Of these, 322 notifications were for women who had previously had three legal terminations with no spontaneous miscarriage.
Mr. Freeman : There was one notification of abortion in England and Wales in the period January-June 1988 at 18 weeks or more gestation which had been performed under ground 5 of the 1967 Abortion Act which states
"to save the life of the pregnant woman".
78. Mr. McAvoy : To ask the Secretary of State for Health what percentage of abortions at 21 weeks, 23 weeks and 24 weeks gestation were performed during 1987 because the child was likely to be born handicapped.
Notifications of abortions which took place with a gestation period of 21, 23 and 24 weeks, showing the number with a mention of ground 4 of the 1967 Abortion Act, which states
"there is a substantial risk that if the child was born it would suffer such physical or mental abnormalities as to be seriously handicapped"
for England and Wales--1987.
Weeks |A All grounds total|B Ground 4 total |Per cent. B of A ---------------------------------------------------------------------------------------------------- 21 |890 |58 |6.5 23 |903 |27 |3.0 24 |107 |19 |17.8 |------- |------- |------- Toal |1,900 |104 |5.5
75. Mr. Andrew Bowden : To ask the Secretary of State for Health if he will list the number of abortions according to the grounds of termination in 1987 for 18 weeks and each week thereafter to 28 weeks.
|c|Abortions 1987-England and Wales|c| Weeks |18 |19 |20 |21 |22 |23 |24 |25 |26 |27 |28 ------------------------------------------------------------------------------------ All grounds |2,800|1,725|1,363|890 |905 |903 |107 |11 |9 |3 |1 1 (with other) |6 |5 |2 |3 |5 |5 |- |1 |- |- |- 2 (Alone) |2,442|1,503|1,181|797 |824 |855 |85 |2 |2 |- |- 3 (with or without 2) |157 |96 |54 |32 |21 |16 |3 |- |1 |- |- 4 (Alone) |176 |108 |117 |49 |50 |20 |19 |8 |6 |2 |1 4 (with any other except 1) |19 |13 |9 |9 |5 |7 |- |- |- |1 |- 5 or 6 |- |- |- |- |- |- |- |- |- |- |-
Mr. Mellor : The White Paper "Working for Patients" fully recognises the continuing key role of consultants in the National Health Service and emphasises the need for them to play an increased role in the management of the service. In particular there will be five significant developments. First, the new funding arrangements will steer resources to those consultants best able to provide a good quality service and to treat more patients. Secondly, the Government hope that within the next two years all consultants will be taking part in "medical audit" and thus be taking the lead in improving the quality of service to patients. Thirdly, the rapid expansion planned for the resource management initiative will provide budgetary and information systems to allow consultants to make the best use of the resources available to them. Fourthly, the day-to-day management of consultants' contracts will take place at district (rather than regional) level and the managerial element of consultants' duties will be better
Column 600recognised in the distinction award system. Finally, we intend to introduce a scheme under which 100 extra consultant posts can be created over the next three years.
24. Mr. Tom Clarke : To ask the Secretary of State for Health when he intends to meet the Association of Metropolitan Authorities social services committee to discuss Sir Roy Griffiths' report on community care.
Mr. Mellor : We hold regular meetings with the local authority associations, including the Association of Metropolitan Authorities (AMA) to discuss issues of current interest in the social services field. Recent items have included Sir Roy Griffiths' report on community care.
The then Minister of State for Health, my right hon. Friend the Member for Braintree (Mr. Newton), met the AMA separately last June to hear their views on Sir Roy's report and we shall take account of its representations along with the others that we have received.
Mr. Freeman : We are looking closely at all possible models for the delivery of community care, along with the many reactions we have received in response to Sir Roy Griffiths' report, as part of the work we have in hand to frame our own proposals.
Mr. Freeman : We have received over 250 representations from hon. Members, organisations and members of the public about Sir Roy's recommendations. Recent responses have been received from a number of national groups and local authorities. We are studying all the responses carefully as we frame our own proposals.
The 1979 figure has not been adjusted to take account of the transfer of operating department assistants (ODAs) (some 2,600 at 31 March 1984) from ancillary to professional and technical staff group on 1 April 1984 and reduction in nurse working hours (from 40 to 37 per week) during 1980-81.
Mr. Freeman : There were 6.62 million in-patient cases treated in National Health Service hospitals in England during the 1987-88 financial year. Earlier figures were for calendar years and in 1979 5.4 million in- patient cases were treated. The figures for 1987-88 represents a rise of over1 million, or more than 22 per cent. compared with 1979.
Mr. Freeman : The Social Services Select Committee in its recent report recommended further research into the causes of infant death, particularly those attributed to sudden infant death syndrome. The Government will be responding shortly.
Mr. Freeman : It is for health authorities to determine the pace of rundown of the old, large and often remote mental illness hospitals, which should be matched by the development of comprehensive locally-based psychiatric services.
As indicated by my hon. and learned Friend the Minister for Health in his reply to my hon. Friend on16 December 1988 at column 766, the annual review process provides Ministers with the opportunity to assess the performance of each regional health authority in matching the development of locally- based services against the rundown of older hospitals. In addition, I shall be meeting some of the individual regional and district health authorities most affected during the course of the year to review specific aspects of this transfer to locally-based care.
Ms. Richardson : To ask the Secretary of State for Health what guidance he gives to health authorities on the provision of breast cancer screening services ; in what circumstances authorities may charge users for such services ; in what circumstances authorities may refuse to screen those attending such clinics with a referral letter from a general practitioner ; and if he will make a statement.
Mr. Freeman : Department of Health guidance to health authorities on the provision of breast cancer screening is contained in two letters, copies of which are in the Library : DA(87)14 of 31 March 1987 with which a draft health circular and the report "Breast Cancer Screening" by the Forrest working group were enclosed ; and EL(88)P/48 of 15 April 1988. These require health authorities to provide three-yearly screening under the National Health Service on a routine basis for women aged 50 to 64 and on request for older women.
Column 603A woman with symptoms should be referred by her general practitioner to a clinician specialising in breast disease. In the case of a woman outside the eligible age group who does not have symptoms but who is considered to be at high risk, for example because either her mother or her sister has a history of breast cancer, her general practitioner can consult the screening service. It is for the service in consultation with clinicians specialising in breast disease and the local general practitioners to decide how such cases should be handled.
Health authorities can charge users for services which they are not required to provide under the National Health Service.
Mr. Kenneth Clarke : Reaction is still at a very general level, but is encouragingly positive. Some of the early respondents had been unnecessarily alarmed by the Labour party's insinuations that self- governing hospitals would be in the private sector, but I believe that the message is now successfully getting through that they will remain fully part of the National Health Service.
37. Mr. Madel : To ask the Secretary of State for Health if he will list the steps he envisages will have to be taken before a National Health Service hospital can apply to become self-governing ; and if he will make a statement.
Mr. Kenneth Clarke : I would refer my hon. Friend to section 5 of the NHS review working paper (1) : "Self-Governing Hospitals", which was published yesterday. That briefly outlines the process for achieving self- governing status.
36. Mr. Ron Brown : To ask the Secretary of State for Health if he has received recent representations from the British Medical Association about reform of the National Health Service ; and if he will make a statement.