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Mr. N. Scott
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. Peter Lloyd : I replied to the right hon. Member yesterday. We have no plans to hold an internal inquiry into either of the delays to which he refers.
ENERGY
Energy Efficiency
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.
HEALTH
Patient Statistics
8. Mr. David Martin : To ask the Secretary of State for Health what was the total number of patients treated by the National Health Service in 1979 and in the latest available year.
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.
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Infant Mortality (Listeria)
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. Robin Cook : To ask the Secretary of State for Health how many miscarriages and stillbirths have been related to the consumption of soft cheeses in the United Kingdom.
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.
Cottage Hospitals
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.
Food Irradiation
16. Mr. Robert Hughes : To ask the Secretary of State for Health if he will make a statement on his policy towards the irradiation of food.
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.
Health Service Personnel (Training)
18. Ms. Armstrong : To ask the Secretary of State for Health how many Health Service personnel are trained by the private sector.
Mr. Mellor : Precise figures are unavailable. It is known that while little basic professional training takes place in the private sector, there is a range of in-house
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post-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.Nurses (Pay)
19. Mr. David Shaw : To ask the Secretary of State for Health what was the level of nurses' pay in 1979 and in the latest available year, in real terms.
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.
Waiting Lists
21. Mr. Loyden : To ask the Secretary of State for Health what steps he is taking to reduce hospital waiting lists.
Mr. Mellor : The reforms in our White Paper "Working for Patients" (Cm. 555) will provide a better service for patients, including shorter waiting times.
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".
Mr. Kenneth Clarke : The White Paper proposes that some family doctors should have the freedom to manage
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their 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. Hayes : To ask the Secretary of State for Health what plans he has to cut waiting lists through the more efficient use of cross-boundary flows.
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.
Abortion
22. Sir Bernard Braine : To ask the Secretary of State for Health what percentage of abortions at 28 weeks were performed during 1987 because the child was likely to be born handicapped.
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."
30. Mr. Amos : To ask the Secretary of State for Health how many abortions have been carried out during the last 10 years for which figures are available by each of the six statutory grounds.
Mr. Freeman : The information is shown in the table. Comparable data is not available for earlier years.
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|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.
39. Mr. Ken Hargreaves : To ask the Secretary of State for Health how many women in England and Wales in 1988 underwent their fourth abortion operation.
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.
77. Mr. Hind : To ask the Secretary of State for Health how many abortions were performed at 18 weeks or more gestation in England and Wales in 1988 to save the life of the mother.
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.
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Mr. Freeman : The information is shown in the table.
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.
Mr. Freeman : The information is given in the table :
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|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 |- |- |- |- |- |- |- |- |- |- |-
Consultants
23. Mrs. Gorman : To ask the Secretary of State for Health if he will make a statement on the future position of consultants within the National Health Service.
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
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recognised 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.Community Care
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.
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63. Mr. Fearn : To ask the Secretary of State for Health what proposals other than those in the Griffiths report he has considered for the delivery of community care.
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.
51. Mr. Waller : To ask the Secretary of State for Health what recent represenations he has had on the recommendations of the Griffiths report on community care.
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.
Patient Care
26. Mr. Tim Smith : To ask the Secretary of State for Health what was the number of staff providing direct patient care in the National Health Service in 1979 and in the latest available year.
Mr. Freeman : The number of whole-time equivalent staff in post in England, providing direct (patient) care at 30 September 1979 was 457,600 and at 30 September 1987, 526,000.
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.
Day Cases (Treatment)
27. Mr. Brazier : To ask the Secretary of State for Health what was the number of day cases treated by the National Health Service in 1979 and in the latest available year.
Mr. Freeman : During 1979, 592,000 day cases were treated in NHS hospitals in England whilst in 1987-88 the number had risen to 1,016, 000 (provisional), an increase of 72 per cent.
In-Patients
28. Mr. Knapman : To ask the Secretary of State for Health what was the number of in-patients treated by the National Health Service in 1979 and in the latest available year.
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.
Hospices
29. Mr. Ian Taylor : To ask the Secretary of State for Health how many terminally ill patients are now being cared for in hospices in England and Wales ; and how many there were five years ago.
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Mr. Freeman : This information is not collected centrally.
Cot Deaths
31. Miss Lestor : To ask the Secretary of State for Health if he will hold an investigation into cot deaths ; and if he will make a statement.
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.
Mental Illness Hospitals
33. Sir Geoffrey Pattie : To ask the Secretary of State for Health if he will undertake an urgent review of the current and planned pace of rundown of mental illness hospitals.
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.
Breast Cancer Screening
34. Mr. Patnick : To ask the Secretary of State for Health what progress has been made on achieving the implementation of the recommendations of the Forrest report on breast cancer screening.
Mr. Freeman : I refer my hon. Friend to my reply to my hon. Friend the Member for Chelmsford (Mr. Burns) on 24 January at columns 533-37.
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.
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A 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.
Self-governing Hospitals
35. Mr. Andrew MacKay : To ask the Secretary of State for Health what are the reactions from the public to his proposed plans for self- governing hospitals.
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.
72. Mr. Bellingham : To ask the Secretary of State for Health how many inquiries he has received so far about his plans for self-governing hospitals, contained within the White Paper.
Mr. Kenneth Clarke : It is too early to expect firm proposals from hospitals seeking self-governing status. But we have received a number of inquiries for further information.
Mr. Stern : To ask the Secretary of State for Health if he intends to propose any minimum size for a hospital wishing to leave the control of the district health authority.
54. Mr. McCrindle : To ask the Secretary of State for Health if he has any plans to permit hospitals other than major acute hospitals to become self-governing.
Mr. Kenneth Clarke : Any hospital which meets the criteria in chapter 3 of the White Paper "Working for Patients" would be eligible for self-governing status, regardless of size or specialism.
46. Mr. Parry : To ask the Secretary of State for Health what assessment he has made of the suitability of hospitals in Liverpool for conversion to trust status.
81. Mr. John Evans : To ask the Secretary of State for Health how many hospitals on Merseyside will be eligible for self-management under the Government's new National Health Service proposals.
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Mr. Kenneth Clarke : It is too early to make such assessments. Over time, I expect that as many hospitals as are willing and able to do so will become self-governing.
NHS (Reform)
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.
Mr. Kenneth Clarke : I refer the hon. Member to my reply to the hon. Member for Liverpool, West Derby (Mr. Wareing) today.
Cervical Smear Tests
38. Mr. Colvin : To ask the Secretary of State for Health whether he will review the advice issued by his Department on the regularity of cervical smear tests.
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