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Mr. Freeman : We have recommended to health authorities a maximum interval of five years between tests, which we know can reduce deaths among women screened by a substantial proportion. However, we also know that the majority of women who die from cervical cancer have never had a smear test. We therefore believe that it is more important to achieve as a first priority a high response rate from all women in the eligible age group rather than aim to reduce the interval between screening. If a health authority decides it can offer more frequent screening--and we know that some have adopted a three-yearly programme--we would expect it also to be achieving a high response rate and to be able to cope with the much higher number of tests three-yearly screening creates. Of course, if any woman patient presents with gynaecological symptoms or has any reason to believe something is wrong, she can be referred for further investigation outside the screening programme. The recommended recall interval is kept under review.

Nurses

40. Mr. Sims : To ask the Secretary of State for Health what proposals he has to extend the role of nurses in hospitals.

Mr. Kenneth Clarke : We have given advice on delegation to a nurse of tasks not included in basic training in HC(77)22 : "The Extending Role of the Clinical Nurse--Legal Implications and Training Requirements". A copy is in the Library.

With the increasing complexity of treatment and the growth of the specialist expertise of the nurse, various initiatives have been taken to extend the role of nurses in hospitals. In the White Paper "Working for Patients" the Government state that local managers, in consultation with their professional colleagues, will be expected to re-examine all areas of work to identify the most cost-effective use of professional skills.

Patients (Treatment)

41. Mr. Michael : To ask the Secretary of State for Health what measures his Department intends to take to ensure that patients receive the most suitable treatment and medication for their conditions.

Mr. Freeman : The diagnosis and treatment of patients is and will continue to be a matter for the professional judgment of doctors.


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Working for Patients"

Mr. Thurnham : To ask the Secretary of State for Health what representations he has received following the publication of the White Paper "Working for Patients", and if he will make a statement.

Mr. Canavan : To ask the Secretary of State for Health what representations he has received about the Government's White Paper on the future of the National Health Service.

42. Mr. Squire : To ask the Secretary of State for Health what representations he has received on the recent White Paper, "Working for Patients."

47. Mr. Yeo : To ask the Secretary of State for Health what representations he has received regarding the White Paper "Working for Patients."

48. Mr. Kennedy : To ask the Secretary of State for Health what representations he has received on his White Paper, "Working for Patients"; and if he will make a statement.

83. Mr. Nicholas Bennett : To ask the Secretary of State for Health how many representations he has so far received on the National Health Service White Paper "Working for Patients."

65. Mr. Summerson : To ask the Secretary of State for Health what reactions he has had to the White Paper "Working for Patients" from the medical profession and the public in general.

Mr. Kenneth Clarke : I refer my hon. Friends and hon. Members to my reply to my hon. Friends the Members for Dorset, South (Mr. Bruce), for Harrow, East (Mr. Dykes) and for Basingstoke (Mr. Hunter) earlier today.

Mr. Amess : To ask the Secretary of State for Health if he will give further details of the relationship between the new chief executive officer and the regions and districts as set out in the White Paper.

Mr. Kenneth Clarke : I have already indicated my intention to delegate to the chief executive the central management of the NHS. He will act within a framework of resources and policies set by Ministers, and will in turn be responsible for applying similar frameworks to regional health authorities and, through them, to districts.

52. Mr. Patrick Thompson : To ask the Secretary of State for Health if he has received any representations from Norwich district health authority following the publication of the White Paper, "Working for Patients."

Mr. Kenneth Clarke : No.

Salford Health Authority

43. Mr. Sumberg : To ask the Secretary of State for Health when he next intends to meet the chairman of Salford health authority ; and what matters will be discussed.

Mr. Freeman : My right hon. and learned Friend has no current plans to meet the chairman of Salford health authority.


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Private Medical Insurance

49. Mr. Skinner : To ask the Secretary of State for Health what figures he has available for the number of people over the age of 60 years who currently hold private medical insurance.

Mr. Kenneth Clarke : The general household survey 1986 (latest available data) suggests that among the population of Great Britain aged 65 and over 4 per cent. were covered by private medical insurance.

NHS (Review)

50. Mr. Grocott : To ask the Secretary of State for Health what has been the cost to date of preparing, publishing and presenting the Health Service review.

Mr. Kenneth Clarke : Regarding the cost of preparation of the NHS review, I refer the hon. Member to my reply to the hon. Member for Sheffield, Brightside (Mr. Blunkett) on 7 February at column 642. The costs of publication of the White Paper "Working for Patients" and its attendant working papers will be borne by HMSO. However, copies of the White Paper and working papers have been purchased for distribution by my Department at a cost of £35,675 and an estimated £65,000 respectively.

Regarding the cost of presenting the White Paper, I refer the hon. Member to my reply to the hon. Member for Peckham (Ms. Harman) on 9 February at columns 75-76.

GPs (Practice Budgets)

53. Mr. Franks : To ask the Secretary of State for Health if he will make a statement on general practitioners' reaction to the proposed plans for general practitioner practice budgets.

Mr. Kenneth Clarke : I have been encouraged by the positive response of many general medical practitioners to these proposals. We expect that general medical practitioners will increasingly see the scheme as an opportunity to improve the range and quality of service they can offer to their patients and to increase their own job satisfaction.

59. Mr. Kirkwood : To ask the Secretary of State for Health if he will estimate the number of general practitioner practices he expects to apply, and to be ready, to manage their budgets in April 1991.

Mr. Kenneth Clarke : My aim initially is to encourage a substantial number of the larger general medical practitioner practices to apply to manage their own budgets with effect from April 1991. It is too early to estimate what the level of take-up of the scheme will be.

Hospitals (Trust Status)

55. Mr. Madden : To ask the Secretary of State for Health what proposals he has for consultation with local communities which are served by National Health Service hospitals which decide to establish trusts under his recent proposals.

Mr. Kenneth Clarke : It will be for regional health authorities to publicise locally all proposals for hospitals to become National Health Service hospital trusts. They


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will consider the views of everyone who expresses an interest, including the health authorities concerned, staff at the hospital, general practitioners and community health councils. Regional health authorities will be asked to submit responses from the public, together with any comments they may have on them, to me so that I can take them into account in considering applications.

75. Mr. Simon Hughes : To ask the Secretary of State for Health how many National Health Service hospital trusts he expects to be established in April 1991.

Mr. Kenneth Clarke : It is too early to estimate numbers.

71. Mr. Tony Banks : To ask the Secretary of State for Health if he will disclose the names of hospitals in London about which his Department has been in discussion with regard to the formation of National Health Service hospital trusts, as envisaged in his White Paper.

Mr. Kenneth Clarke : My Department has discussed the proposals only in general terms. It is too early to discuss which hospitals might become National Health Service trusts until all interested parties have had the opportunity to consider the working paper on self-governing hospitals, published yesterday.

GPs (Drug Budgets)

56. Mr. Paice : To ask the Secretary of State for Health if he will make a statement on the White Paper proposals for general practitioner drug budgets.

Mr. Kenneth Clarke : I will be publishing shortly a working paper which discusses arrangements for the introduction of indicative drug budgets.

Drugs and Medicines (Warnings)

57. Mr. Flynn : To ask the Secretary of State for Health what initiatives he plans to improve the legibility of danger warnings on drugs and medicines.

Mr. Freeman : All medicines must be treated with respect. The Medicines (Labelling) Regulations already require clarity, legibility, and ready discernibility to purchaser or user. We are now considering comments on proposals we made last year to promote safer use of medicines by, amongst other things, label warnings which would be better understood by the public.

Drugs (Expenditure)

58. Mr. Baldry : To ask the Secretary of State for Health what has been the total amount spent on drugs in the National Health Service for each year for the last 10 years.

Mr. Freeman : The information requested is set out in the table for England, itemised between the cost of drugs in hospitals and in the family practitioner service.


          |Hospitals|FPS      |Total              

          |£ Million|£ Million|£ Million          

--------------------------------------------------

1978-79   |128.063  |554.048  |682.111            

1979-80   |155.719  |632.880  |788.599            

1980-81   |185.280  |766.382  |951.662            

1981-82   |213.923  |876.490  |1,090.413          

1982-83   |244.765  |1,008.891|1,253.656          

1983-84   |266.552  |1,130.119|1,396.671          

1984-85   |278.778  |1,191.598|1,470.376          

1985-86   |296.613  |1,274.620|1,571.233          

1986-87   |318.246  |1,377.784|1,696.030          

1987-88   |351.839  |1,539.010|1,890.849          

AIDS

20. Sir Michael McNair-Wilson : To ask the Secretary of State for Health how much his Department is spending on AIDS education advertising.

Mr. Mellor : Our budget for the current year is £10 million ; £8.7 million of this funds the work of the health education authority, and £1.3 million has been allocated to the national AIDS helpline, which provides a free, confidential telephone advice service. We are also spending £2 million on a nationwide campaign warning of the dangers of injecting drug misuse.

60. Mr. McCartney : To ask the Secretary of State for Health what plans he has to give statutory force to the British Medical Association's recently issued guidelines to doctors on the disclosure of information to insurance companies about people who have undergone an HIV test.

Mr. Freeman : I have no such plans. The Access to Medical Reports Act 1988 already contains safeguards about the disclosure of information by doctors to insurance companies.

44. Mr. Key : To ask the Secretary of State for Health what steps he is taking to expand community-based AIDS education programmes.

Mr. Freeman : Health authorities were asked in the planning guidelines circular (HC(88)43) issued last July, to develop community based prevention initiatives aimed at helping people in selected target groups to change behaviour which puts them at risk of HIV infection. We expect a total of £14 million to be spent on this work by health authorities in 1989-90. In addition, the Health Education Authority's AIDS programme includes work to reach particular target groups and to support local programmes, and a number of voluntary organisations which we support have AIDS education programmes aimed at specific sections of the population.

Nurses (Regrading)

61. Mr. Cox : To ask the Secretary of State for Health if he will make a statement on the present position regarding nurses' regrading.

Mr. Freeman : All nurses and midwives have been told their new grades and have received their backpay from 1 April 1988. This has resulted in an average pay increase for 1988 of 17.9 per cent. and provides a greatly improved career structure.

Rural Health Services

62. Mrs. Ray Michie : To ask the Secretary of State for Health what plans he has for safeguarding rural health services.

Mr. Kenneth Clarke : The plans outlined in "Working for Patients" will not only safeguard, but improve, services in all parts of the country, including rural areas.


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Hospital Building

66. Mr. Wood : To ask the Secretary of State for Health what was the amount spent on hospital building for the National Health Service in 1979 and at the latest available year in real terms.


Column 610

Mr. Freeman : The annual accounts of health authorities do not specifically identify expenditure on hospital building as such. Following are figures of total capital expenditure derived from the annual summarised accounts of health authorities in England :


Column 609


                                              |1978-79 £000 (cash)     |1978-79 £000 (at 1987-88|1987-88<1> £000 (cash)  |Real-terms increase per                          

                                                                       |prices)                                          |cent.                                            

---------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Hospital services                             |289,140                 |593,304                 |749,635                 |26.3                                             

Hospital and community health services (HCHS) |367,352                 |753,792                 |1,001,444               |32.9                                             

<1> Provisional figures (as yet subject to audit).                                                                                                                         

Notes:                                                                                                                                                                     

1. Capital expenditure includes the acquisition of land and buildings, the cost of new building construction and major adaptations to existing buildings together with     

associated professional fees, equipment and engineering work costs. It also includes general expenditure on the purchase of all vehicles and other major items of          

equipment.                                                                                                                                                                 

2. HCHS includes hospital, community health, ambulance, blood transfusion and other services.                                                                              

3. The 1978-79 figures have been expressed at 1987-88 prices by the use of the gross domestic product deflator.                                                            

By-pass Operations

67. Mr. Evennett : To ask the Secretary of State for Health how many coronary by-pass operations were carried out in the four Thames health regions in the last year for which figures are available ; and what was the corresponding figure for 1978.

Mr. Freeman : The figures for the latest available year are in the table. Thames region residents treated by the London postgraduate special health authorities are not included. Figures for 1978 are not available by region.


Regions           |1987-88        

----------------------------------

North West Thames |516            

North East Thames |999            

South East Thames |1,363          

South West Thames |480            

Chronically Sick and Disabled People

68. Mr. Hannam : To ask the Secretary of State for Health if he will take steps to ensure that chronically sick or disabled people in the community who have high health care costs continue to receive the health care they require after the proposed changes to the National Health Service take effect in 1991.

Mr. Kenneth Clarke : No chronically sick or disabled person will be disadvantaged by the White Paper proposals. Each district health authority will be responsible for ensuring the health care needs to everyone living within its boundaries are properly provided for, and will be funded accordingly.

NHS (Plans)

69. Rev. Martin Smyth : To ask the Secretary of State for Health if he will make a statement about his future plans for the National Health Service.

Mr. Kenneth Clarke : I refer the hon. Member to my statement to the House on 31 January 1989 at columns 165-70.


Column 610

Hip Replacements

70. Mr. David Davis : To ask the Secretary of State for Health what was the number of hip replacement operations carried out in 1979 and in the latest available year.

Mr. Freeman : The number of total hip replacements and other arthroplasty of hip performed in NHS non-psychiatric hospitals in England in 1979 and 1986 (the latest year for which information is available centrally) are 29,520 and 40,900 respectively.

Non-emergency Treatment

74. Mr. Spearing : To ask the Secretary of State for Health what consideration has been given and what evidence was received by his Department, concerning the preference of patients in deciding between speed and location of non-emergency treatments at hospitals consequent on the adoption of his recent proposals.

Mr. Kenneth Clarke : The Government's policy is to provide for a more effective choice for individual patients and their GPs when they decide where non-emergency treatment should be sought. The proposals in the White Paper "Working for Patients" will allow NHS funds to follow patients across administrative boundaries where GPs and their patients choose treatment elsewhere because, for example, a shorter waiting time is on offer.

Paediatric Consultants (South Tees)

76. Mr. Holt : To ask the Secretary of State for Health how many paediatric consultants are presently employed by the South Tees health authority.

Mr. Freeman : Contracts of employment for consultant medical and dental staff, except in the case of teaching health authorities, are held by regional health authorities. We do not have details centrally of the place of employment of consultants whose contracts are held by regions. My hon. Friend may wish to seek the information locally, directly from the health authorities concerned.

Scientists (Grading)

79. Mr. Tredinnick : To ask the Secretary of State for Health whether he proposes to examine the present


Column 611

grading structure for physicists, biochemists, clinical psycholgists and other scientists ; and if he will make a statement.

Mr. Freeman : The management side of the scientific and professional staffs council has set up a working party to investigate the scale of reported problems of recruitment and retention of physicists, biochemists, clinical psychologists and other scientists. I understand that the management side has said that if these investigations reveal a problem for NHS management it would wish to consider if an appropriate way of solving it would be by examination of the present grading structure.

Stillborn Children

80. Mr. Soley : To ask the Secretary of State for Health whether he has any proposals to change the regulations for registration of the deaths of stillborn children.

Mr. Freeman : My right hon. and learned Friend has made proposals to change the statutory provisions for the registration of stillbirths in ways which would align them more closely with death registration procedures, and these are contained in the Green Paper entitled "Registration : a modern service" Cm. 531 which was published on 1 December 1988. Comments on those proposals, and on others affecting the registration service more widely, have been invited by 31 March.

Food

84. Mr. Ashton : To ask the Secretary of State for Health if he will list those individuals and bodies he has met in the last fortnight to discuss health and safety of food issues.

Mr. Kenneth Clarke : In the last two weeks I have discussed food safety issues with a number of ministerial colleagues, Members of Parliament and other individuals.

Food Poisoning

Mr. Skinner : To ask the Secretary of State for Health (1) how many cases of listeria poisoning have been notified in Derbyshire within the last 12 months ;

(2) how many cases of salmonella poisoning have been notified in Derbyshire in 1984, 1985, 1986, 1987 and at the nearest available date in 1988.

Mr. Kenneth Clarke : The exact information requested is not available from the notifications of infectious diseases requirements under the Public Health Acts.

Legionnaire's Disease

Ms. Walley : To ask the Secretary of State for Health, if he will give details of all epidemiological research undertaken by the public health laboratory service in respect of legionnaire's disease.

Mr. Freeman : Public health laboratory service epidemiological research on legionnaire's disease began in 1977, the year the legionnella pneumophila was first described in the USA. Early work by the PHLS included the development of an active national surveillance system, methods of diagnosis and the detection of legionellae in environmental samples. Much of the epidemiological research has been directed at studying sources of infection


Column 612

and routes of transmission during the investigation of outbreaks of legionnaire's disease detected by the surveillance system. This work has been accompanied by the development and evaluation of control methods.

I am placing in the Library two lists which give detailed references to published research on this subject carried out by the PHLS.

List 1 covers papers describing work mainly of an epidemiological nature. List 2 deals with closely related and overlapping work on serological method, typing of the organism for epidemiological purposes, experimental studies of transmission and studies of the ecology and control of legionellae in water systems.

NHS Operations

Mr. Harry Greenway : To ask the Secretary of State for Health how many different types of operation are currently performed and on how many people, under the National Health Service ; what were the comparable figures 10, 15 and 30 years ago ; and if he will make a statement.

Mr. Freeman : Information on the number of different types of operation performed is not readily available and could be produced only at disproportionate cost.

The figures available centrally show an increase in the number of in- patient cases operated on from 1.33 million in 1961 to 2.39 million in 1986. In addition, 0.8 million day cases were operated on in 1986. Corresponding figures for 1987-88 are not available, but the number of in- patient cases treated in the surgical specialties increased from 2.43 million in 1986 to 2.52 million in 1987-88.

Consumer Research

Mr. Robin Cook : To ask the Secretary of State for Health if he will publish the results of the research on consumers' experience of and attitudes to the National Health Service undertaken for his Department by Research Services of Great Britain Ltd.

Mr. Kenneth Clarke : I have no knowledge of such research.

Meningitis

Mr. Redmond : To ask the Secretary of State for Health if he will list by area health authority in both the Trent regional health authority and the Yorkshire regional health authority, the number of cases of meningitis for 1988 and to date ; and what are the national averages for the same periods.

Mr. Freeman : Cases of infectious diseases are notified by the doctor in attendance to the proper officer for each local authority area. Notifications of meningitis are therefore not generally available at the district health authority level. However, the table shows the number of notifications of meningitis for the counties most closely approximating to the Yorkshire and Trent regional health authorities.


|c|Notifications of meningitis by   

county 1988<1> 1989<1><2>|c|        

                  |1988 |1989       

------------------------------------

England and Wales |3,001|302        

                                    

Yorkshire                           

  Humberside      |78   |5          

  North Yorkshire |41   |5          

                                    

Trent                               

  South Yorkshire |124  |3          

  Derbyshire      |36   |5          

  Leicestershire  |58   |4          

  Lincolnshire    |26   |3          

  Nottinghamshire |67   |8          

<1> Provisional                     

<2> For the period 31 December 1988 

to 20 January 1989.                 

West Yorkshire 171 10

Social Trends"

Mr. Redmond : To ask the Secretary of State for Health what proposals he has to include in future editions of Social Trends detailed analysis of regional, economic and occupational variations in respect of life expectancy, infant mortality rates and overall mortality rates.

Mr. Freeman : Responsibility for the contents of Social Trends lies with the Central Statistical Office. The contents of next year's edition of Social Trends has not yet been decided.

Tampons

Ms. Walley : To ask the Secretary of State for Health what are the most recent figures for cases of toxic shock syndrome in the United Kingdom.

Mr. Freeman : Toxic shock syndrome is not separately identified in the statisical returns made by health authorities to the Department. However, 41 confirmed and probable cases of toxic shock syndrome were reported to the central public health laboratory in the two years 1985 and 1986 taken together. These figures do not include Northern Ireland.

Hip Replacements

Mr. Evennett : To ask the Secretary of State for Health how many hip replacement operations were carried out in the four Thames health regions in the last year for which figures are available ; and what was the corresponding figure in 1980.


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