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Mr. Mellor : Regional health authorities have been asked through the issue of HC(88)43 "Health Services Development--Resource Assumptions and Planning Guidelines" issued July 1988, to prepare for all staff groups manpower supply strategies assessing demand and supply measures necessary to meet assessed demand together with proposed steps to deal with any shortfalls. Also where necessary that supply strategies be linked to training strategies.
A copy of HC(88)43 has been placed in the Library (refer to paragraphs 32- 38).
Mr. Anthony Coombs : To ask the Secretary of State for Health (1) if he has any plans to review the scope of the Registered Homes Act 1984, so as to encompass homes caring for three occupants or fewer ; (2) when his Department last evaluated and reassessed the effectiveness of criteria for minimum statutory requirements for residential and nursing homes for the elderly.
Mr. Mellor : The Department's social services inspectorate reviewed the implementation of the Registered Homes Act 1984 in relation to residential care homes for elderly people and other dependent groups of people. The report on this review, "Certain Standards", was published last year. The Wagner report, "Residential Care : A Positive Choice", which was also published last year, contained recommendations on the regulation of these homes including those with fewer than four residents. Both reports are in the Library. We are considering carefully the findings of these reports before deciding whether any change is desirable in the current arrangements. In January 1985 the National Association of Health Authorities issued guidance, endorsed by the Department, in its handbook on registration and inspection of nursing homes. A supplement giving advice on quality of life in nursing homes was issued in September 1988.
Mr. Anthony Coombs : To ask the Secretary of State for Health how district health authority and local authority inspectors are selected and trained for residential and nursing homes for the elderly ; and who draws up the criteria by which these inspectors measure a home's standards.
Mr. Mellor : The statutory duty to register and inspect residential care homes and nursing homes is placed by the Registered Homes Act 1984 upon local social service authorities and district health authorities respectively. It is for each authority to recruit and train the necessary staff and to deaw up the criteria for the registration of homes in their area within the legislative requirements, the recommendations in the code of practice for residential care "Home Life", and the "Handbook for Health Authorities : Registration and Inspection of Nursing Homes", and the general guidance that has been issued by the Secretaries of State for Health and for Wales.
Column 790The Departments have commissioned distance- learning training material for registration and inspection staff of authorities from the centre for environmental and social studies in aging at the Polytechnic of North London. This material should be available later this year.
Mr. Mellor [holding answer 17 February 1989] : The Registered Homes Act 1984 and associated regulations place the responsibility on local authorities as registering authorities to register private and voluntary residential care homes and inspect them at least twice a year. In addition general guidance on the running of these homes is available in "Home Life", a code of practice for residential care, and in circulars issued by the Department. Authorities are also responsible for ensuring adequate standards in their own homes. The Department's social services inspectorate monitors and advises authorities on the discharge of these duties.
Lady Wagner's report "Residential Care--A Positive Choice" included recommendations on the regulation of homes in all sectors. We are giving them careful consideration before deciding whether any change is desirable in the current arrangements.
Mr. Hinchliffe : To ask the Secretary of State for Health which private residential and nursing homes have had their registrations cancelled since the Registered Homes Act came into force ; who were the proprietors concerned ; and what were the reasons for the cancellation.
Mr. Mellor [holding answer 22 February 1989] : This information is held by the Department for the purpose of the Registered Homes Act 1984 and is received from and passed to registration authorities in confidence for that purpose only. It would not be right to make the information more widely available.
Mr. Hinchliffe : To ask the Secretary of State for Health what has been the full cost ot public funds of action taken by local authorities or health authorities to protect the welfare of residents following the de- regulation of private residential or nursing homes since the Registered Homes Act came into force.
Mr. Hinchliffe : To ask the Secretary of State for Health what action he is taking following the publication of the National Consumer Council report proposing an independent national inspectorate for residential homes, a copy of which has been sent to him.
Mr. Mellor [holding answer 22 February 1989] : The report of the committee chaired by Lady Wagner, "Residential Care--A Positive Choice", included recommendations on the regulation of homes. We are giving careful consideration to the recommendations in the report and to responses to it such as the National Consumer Council's report before deciding whether any change is desirable in the current arrangements.
Column 791publication of the joint report from the social services inspectorate and the health advisory service in respect of the concern expressed about the number of social service staff employed by Northamptonshire county council who also own or manage private residential homes ;
(2) if he will take steps to ensure that local authority social services staff are not permitted also to own, manage, or have interests in private residential or nursing homes.
Mr. Mellor [holding answer 22 February 1989] : The duty to register a person running a residential care home or nursing home is placed by the Registered Homes Act 1984 upon local social service authorities and district health authorities respectively. It is for them to decide, subject to appeal, whether a person is not fit to run a home. Similarly it is for authorities as employers to determine the terms and conditions of service of their staff. I look to authorities to ensure that potentially undesirable conflicts of interest do not arise.
In the case of the report by the National Health Services health advisory service and the Department's social services inspectorate on "Services for Elderly People provided by Kettering Health Authority and the Social Services Department of Northamptonshire County Council," the report states that the health authority and the social services department have asked staff to declare any interest they may have in private homes.
Mr. Anthony Coombs : To ask the Secretary of State for Health if his Department is monitoring the growth of the private sector in relation to National Health Service facilities in the field of elderly care.
Mr. Mellor : It is for the individual health authorities to decide what level of service to provide for the elderly people in the populations they serve. The Government give guidance on the range of services which should be available to elderly people ; but health authorities may take into account the level of private sector health care in determining the level of services that they will provide themselves.
The Government welcome the growth in the private health care sector, because it adds to the total resources available, offers greater choice to the patient and provides flexibility to health authorities in service delivery.
Mr. Madel : To ask the Secretary of State for Health what conclusions were reached by the ToucheRoss inquiry into the supply of generic pharmaceuticals ; if he will publish those parts of the evidence which are not commercially confidential, along with the consultants' recommendations ; if he will place a copy of the report in the Library ; and if he will make a statement.
Mr. Mellor : We are considering the report prepared by Touche Ross. When announcing the study on 11 March 1988 the then Secretary of State for Social Services, made it clear that the contents of the report would contain
Column 792commercially sensitive information and would remain confidential. To publish the report would breach this commitment to those who contributed to the study.
(2) what applications for recognition under circular HM(54)32 he has received from organisations seeking to offer indemnity to medical and dental practitioners ; and if he will make a statement.
Mr. Mellor : The organisations listed in circular HM(54)32 (Legal Proceedings) are the Medical Defence Union, the Medical Protection Society, and the Medical and Dental Defence Union of Scotland. Any enquiries from other organisations seeking to offer indemnity to medical and dental practitioners would be treated in confidence. I am considering what arrangements should be made in future to provide indemnity cover for doctors and dentists employed in the Health Service.
Ms. Richardson : To ask the Secretary of State for Health how much he expects to receive from charges for (a) dental check-ups and (b) eye tests in 1989-90 ; and by how much he estimates expenditure on dental and eye health will change as a result of the introduction of such tests.
Mr. Mellor : The estimated income from dental examination charges in England in 1989-90 is £35 million. It is not anticipated that the introduction of dental examination charges will have any direct effect on the forecast level of gross NHS expenditure on the general dental services.
There are no charges for sight tests. The effect of the Health and Medicines Act, 1988, is that from 1 April 1989 the NHS sight test will no longer be universally available ; it will be restricted to certain priority groups of people, including children, the registered blind and partially sighted, people on low incomes and diabetics. Savings on family practitioner service spending from the restriction of the NHS sight test to certain priority groups are expected to be £70 million in a full year in England. The new arrangements are not expected to affect demand for eye care.
Ms. Richardson : To ask the Secretary of State for Health if he will publish a table showing prescription, dental and optical charges in April 1979 and the latest date available in current and constant prices showing both the cash and real increase for each charge.
Mr. Mellor : The table sets out the latest available information in relation to prescription and average dental charges. No comparable figures for optical charges are available because the supply of NHS spectacles ceased in July 1986. Information relates to financial years.
Prescription charges |£ ------------------------------------------------------------------- 1979-80 |0.20 1988-89 (current prices) |2.60 1988-89 (1979-80 prices) |1.39 Average dental charge 1979-80 |6.83 1987-88 (current prices) |18.43 1987-88 (1979-80 prices) |10.50
Mr. Sean Hughes : To ask the Secretary of State for Health if he will list the criteria used when exercising the right of choice between different nominations from local authorities for a family practitioner committee.
Mr. Mellor : In appointing members of family practitioner committees our overriding aim is to find suitable candidates for the job. We also seek to achieve a balanced representation among members of age, sex, geographical spread, professional and other experience. In the case of the local authority vacancies arising on 1 April 1989, neither St. Helens metropolitan borough council nor Knowsley metropolitan borough council offered, at first, a choice of candidates. I am glad to say that St. Helens MBC has this week offered a choice and I hope to make an appointment very shortly.
Mrs. Wise : To ask the Secretary of State for Health if he will issue instructions that no further hospitals should switch to cooked- chilled food, and that no further hospital plans should make provisions for utilising it, until further research has been carried out to establish its safety or risk.
Mr. Kenneth Clarke : No. In 1980 my Department issued guidelines on cook-chill catering in the NHS and elsewhere. We remain quite satisfied that, provided these guidelines are followed, food produced by this sytem is safe.
Mr. Vaz : To ask the Secretary of State for Health how many of the 92 members of the Mental Health Act Commission are members of ethnic minority communities ; what are their ethnic origins ; and if he will make a statement.
Mr. Freeman : At the moment the Mental Health Act Commission has 84 members of whom six are from ethnic minority communities, either Asian or Afro-Caribbean. It is Ministers' intention to increase ethnic minority representation on the commission and this is being actively pursued in the current round of appointments.
Mr. Allen : To ask the Secretary of State for Health what co- ordination of research into child sexual abuse takes place between his Department and the National Society for the Prevention of Cruelty to Children.
Mr. Mellor : We have no specific arrangements for co-ordinating research into child sexual abuse with the NSPCC, but officials are in touch regularly to discuss subjects of mutual concern, including research.
Mr. Latham : To ask the Secretary of State for Health whether he will seek from the Trent regional health authority, for publication in the Official Report, the names and addresses of the members of (a) the Leicestershire district health authority and (b) the Leicestershire community health council, indicating the date when each person commenced their service and when the expiry of their term is due.
Mr. Latham : To ask the Secretary of State for Health (1) whether he will set out in tabular form, identifying the unit in each case (a) how many isolated general practitioner maternity units have been closed in each year sice 1979 and (b) how many integrated general practitioner maternity units have been closed over each period ; (2) whether he will set out in tabular form, identifying the unit in each case, the number of (a) isolated and (b) integrated general practitioner maternity units where a formal decision has been taken and published to close the unit, indicating where appropriate when the decision by Ministers is awaited following a formal objection by the community health council.
Mr. Freeman : The table lists GP maternity units which we are aware have been approved for partial or total closure following public consultation. The period covered is from 1979 to end 1987, the latest date for which details are available, although there were no cases in 1987.
Cases currently awaiting ministerial decision are lifted at the end.
"Isolated" is taken to mean not part of a district general hospital. All cases are isolated unless stated.
Hospital |Area/District |Type |Year ----------------------------------------------------------------------------------------------------------------------------------------------------------- Croft Baker Maternity |Humberside |T |1979 Immingham |Humberside |T |1979 Townend Maternity<1> |Humberside |T |1979 Nightingale |Derbyshire |T |1979 Davenham |Cheshire |T |1979 Skegness and District<1> |Lincolnshire |P |1981 Urmston Cottage |Trafford |T |1981 Harpenden Memorial |North West Hertfordshire |P |1982 Ashgate Maternity Home |North Derbyshire |T |1983 Chase Hospital |Mid Staffordshire |P |1983 Wendover Maternity Unit |Southmead |T |1983 Alexandra Maternity Hospital |Plymouth |T |1983 Woodgages Maternity Home<1> |East Yorkshire |T |1984 Darley Hall Maternity |North Derbyshire |T |1984 Corbar Hall Maternity |North Derbyshire |T |1984 Westbury Maternity |Milton Keynes |T |1984 Westminster Memorial<1> |Wiltshire |P |1984 Wellington Maternity Home |Somerset |T |1984 Leek Memorial |North Staffordshire |T |1984 Queen Mary Maternity House |South Derbyshire |T |1986 Phyllis Memorial Home |East Suffolk |T |1986 Market Harborough |Leicestershire |P |1986 Rutland Memorial |Leicestershire |P |1986 St. Mary's Melton Mowbray |Leicestershire |P |1986 Ashby de la Zouch |Leicestershire |P |1986 Isebrook |Kettering |P |1986 Ashcombe House |Bristol and Weston |T |1986 Rossendale General<2> |Burnley, Pendle and Rossendale|P |1986 <1> Ministerial decision. <2> Integrated unit. Note: The Leek Memorial hospital is, in fact, still open but is scheduled to close this year. Cases currently with Ministers Partial closures at Sandleford, Wokingham and Townlands hospitals-all West Berkshire. St. Paul's maternity unit, Hemel Hempstead hospital, North-West Hertfordshire.
Mr. Latham : To ask the Secretary of State for Health whether he will set out in tabular form, identifying the unit in each case, the number of (a) isolated and (b) integrated general practitioner maternity units which are currently the subject of public consultation on closure.
Mr. Latham : To ask the Secretary of State for Health whether he will list by name and date since 1979 (a) the isolated and (b) the integrated general practitioner rural maternity units where Ministers have rejected a closure proposal, following an adverse report from the community health council ; and which of these units remain open.
In 1984 proposals to close GP maternity beds at Amersham general hospital (integrated unit) and Crowborough war memorial hospital (isolated unit) were rejected by Ministers. The beds at Amersham are currently closed for redecoration ; those at Crowborough remain open.
Mr. Spearing : To ask the Secretary of State for Health if he has assessed the quality and adequacy of the installed communication links between local ambulance stations of the London ambulance service and local police, fire brigade and other emergency services.
Mr. Spearing : To ask the Secretary of State for Health, pursuant to his reply to the hon. Member of Newham, South, Official Report, 7 February, columns 635-7, what are the annual rental costs of the private wire circuits between the central control room of the London ambulance service and ambulance stations ; and what is budgeted for the next financial year, for this purpose.
Mr. Freeman : I understand from South West Thames RHA, which is responsible for the management of the London ambulance service (LAS) that the annual rental cost of the private wire circuits between the LAS central control room and ambulance stations is £60,615 for the current financial year. When the circuits are integrated into the new computer system, the wires will be connected to equipment owned by the LAS rather than by British Telecom. This will reduce rental costs to an estimated £53,115 in 1989-90. The same number of lines will be available, but they will be of higher quality.
Mr. Spearing : To ask the Secretary of State for Health if he will set out in tabular form in the Official Report the principal items of income and expenditure of the London ambulance service for each of the financial years since he has been responsible for its direct funding, showing for each year the expenditure related to (a) administration, (b) communication, (c) equipment, (d) personnel, (e) premises, and (f) vehicles, etc., with an indication of the sums allocated or ascribable to emergency and non-emergency services, respectively, together with a statement of the method he uses to ensure that the resources available to the emergency services enable them to reach as near the national ORCON standards as are practicable in London traffic conditions.
Mr. Freeman : The table sets out, in the form held by the South West Thames RHA, London ambulance service (LAS) expenditure for the year 1987- 88, the first year in which the allocation of funds was made direct to the managing authority. An estimate of expenditure for the current financial year is not yet available. It is not possible to separate out the personnel component of each of the items listed except at disproportionate cost. The revenue budgets available to the LAS for the years 1987-88 and 1988-89 were £43.099 million and £46.060 million respectively.
Management of the LAS, including questions of resource requirements and attainment of standards, is a matter for South West Thames RHA. Officials of the
Column 797Department are in regular touch with officials of the RHA on these matters and a management review of the LAS is conducted annually.
Department |Net expenditure 1987-88 |£ --------------------------------------------------------------------------------------- A. Operational Services General Manager |0 Headquarters Administration |824,165 Control Services-Emergency |2,428,204 Control Services-Non-Emergency |2,251,230 Ambulance Stations-Emergency |23,967,237 Ambulance Stations-Non-Emergency |7,977,645 Other Ambulance Services-Emergency |38,029 Other Ambulance Services-Non-Emergency |904,143 |------- Total Operational Services |38,390,653 B. General Services Administration Office |1,638,330 Training and Education |1,228,124 Catering |38,908 Domestic Cleaning |203,622 Portering |24,040 Laundry |37,316 Linen Services |0 Transport |123,075 Engineering Maintenance |95,298 Energy |358,607 Water and Sewerage |57,374 Building Maintenance |540,903 Grounds and Gardens |21,006 General Estate Expenses |780,347 Miscellaneous Services and Expenses |0 General Services Direct Credits |0 |------- Total General Services |5,140,850 |------- Grand Total |43,531,508
Mr. Thurnham : To ask the Secretary of State for Health how many juvenile offenders can be accommodated in secure units in the United Kingdom as a whole ; and if there are any plans to increase the number of units.
Mr. Freeman : Secure accommodation in England is provided by local authorities and directly by the Department of Health in youth treatment centres. Such accommodation is available for children in care generally, some of whom will be juvenile offenders. Young people who have been convicted of grave crimes, and sentenced to be detained under section 53 of the Children and Young Persons Act 1933, may also be placed in such accommodation.
The number of places available in approved secure units in England on 31 December 1988 was 294. A number of secure units, providing a further 46 places, were temporarily closed on that date because of rebuilding/refurbishment work. In addition, there were 60 secure places in the youth treatment centres.
A number of local authorities have brought forward proposals to expand provision which are being actively considered.
Information relating to Wales and Northern Ireland is a matter for my right hon. Friends the Secretaries of State for Wales and Northern Ireland and for Scotland for my right hon. and learned Friend the Secretary of State for Scotland.
Mr. Hoyle : To ask the Secretary of State for Health what have been the costs to his Department of the changes in the artificial limb service in 1986, 1987 and 1988 ; and what are the budgets for this service in 1989 and 1990.
Mr. Mellor : The cost of supplying and maintaining artificial limbs for 1985-86 and 1986-87 was £36.068 million and £38.689 million respectively. The cost for the period April to June 1987 was £9.642 million. Expenditure on the artificial limbs in England from 1 July 1987 is a matter for the Disablement Services Authority, to which the hon. Member should address this part of the question.
Mr. Hoyle : To ask the Secretary of State for Health whether he has estimated the cost to hospitals in England of ensuring that their incinerators meet the requirements of the Health and Safety at Work etc. Act following the ending of Crown immunity later in the current year ; and what major defects in hospital incinerators will need to be corrected.
Mr. Mellor : Regulations under the Health and Safety at Work, etc. Act which will bring large incinerators within the control of Her Majesty's inspectorate of pollution will not affect most hospital incinerators. Controls on smaller incinerators, which will be introduced as soon as possible and from which it is not intended that the National Health service should have Crown immunity, will create the need for a major programe of upgrading and replacement. The main requirements are likely to be an increase in the height of chimneys, improved combustion and monitoring and sampling of emissions. If these improvements were made immediately we estimate the cost to the National Health Service would be in the region of £50 million, but it is anticipated that there will be a transitional period allowed for the replacement of existing installations. Many incinerators will therefore be upgraded or replaced at the end of their useful lives as part of the normal cycle of planned equipment renewal. Authorities will also be expected to review their waste disposal services taking account of the scope for rationalising and reducing the number of incinerator facilities and the contribution which the private sector can make to the disposal of "clinical waste".
Mr. Boateng : To ask the Secretary of State for Health if he will publish in the Official Report a table showing the funds now held which are completely at their own disposal for each of the London teaching hospitals.
Mr. Kenneth Clarke : Details of the funds currently available to individual hospitals are not held centrally. Section 10 of the health services costing returns provides expenditure figures for all major acute and mainly acute hospitals in teaching districts in London and elsewhere. A copy is held in the Library.
Mr. Boateng : To ask the Secretary of State for Health if he has any plans to enable a hospital which elects to opt out of National Health Service management under the recent proposals to charge patients for special or any other services needed for effective treatment.
Mr. Kenneth Clarke : I assume that the hon. Member is referring to self-governing hospitals. As they will remain within the NHS, they will continue to provide all necessary treatment to NHS patients without charge at point of delivery.
(2) why he has excluded gynaecology, maternity and preventive medicines for women from his core services for the opted-out hospitals.
Mr. Kenneth Clarke : I assume that the hon. Member is referring to self-governing NHS hospitals. I have not excluded gynaecology, maternity and preventative medi-cines from being regarded as core services to be provided by such hospitals. Examples of core services are identified in broad terms in the White Paper "Working for Patients" but I have not prescribed and I have no intention of prescribing a definitive list. The first and second of the working papers published on 20 February make it clear that it will be for each district to consider in the light of local circumstances what its core services should be. The district will then decide whether these services can best be provided by a self-governing hospital, or by other NHS hospitals and make arrangements accordingly. fuller details are given in the working papers.
Mr. McLoughlin : To ask the Secretary of State for Health how the discussions with the British Medical Association's General medical services committee about the White Paper "Promoting Better Health" are progressing.
Mr Kenneth Clarke : A Green Paper "Primary Health Care--an agenda for discussion" was published in April 1986. Following public consultation, the primary care White Paper "Promoting Better Health" was published in November 1987. Detailed proposals for implementing the reforms to the family doctor services as set out in the White Paper, were sent in March 1988 to the negotiators of the general medical services committee (GMSC), the GPs' representative body. Since then the reforms have been the subject of full consultation for almost a year with the GMSC negotiators.
Column 800Consultations are now nearing completion and my right hon. Friend the Secretary of State for Wales and I have decided to send to all general practitioners a report setting out in full the changes to the GPs' remuneration system and terms of service that the Government wish to introduce. This report will form the basis of final discussions with GMSC negotiators early in March. Copies of this report have been lodged in the Libraries of both Houses.
A number of themes run through our proposals. In the first place we want to make it much easier for the patient to find the GP that best suits that individual's needs. More information about the services that GPs provide will therefore be made available. The bureaucracy involved in changing doctors will be removed and the patients' complaints procedure simplified. Family practitioner committees will be conducting consumer surveys to ensure that patients' views are being taken into account in the development of health care services. Secondly, health promotion and disease prevention will become a central feature of general practice in future. GPs will be expected to provide regular check-ups for their patients--this means giving good advice on keeping well and avoiding future health problems. There will be particular emphasis on the assessment of childhood development for the under-fives and on mobility and well-being of the over-75s. New target payments are to be introduced to encourage GPs to provide improved cover for childhood immunisation and screening for cancer of the cervix. Increasingly, GPs will be running clinics for a range of health promotion activities such as anti-smoking, alcohol control, well-person, dieting, exercise and stress management.
Thirdly, important changes are to be made to the GPs' terms of service and remuneration system. The terms of service will in future set out in more specific terms what is expected of a family doctor who is in contract with the National Health Service. Aspects such as health promotion and disease prevention--not previously stated in specific terms--will be made a clear requirement of the GPs contract. Changes to the remuneration system are designed to make general practice more responsive to patient needs and to ensure that the taxpayer gets better value for money. As proposed in "Working for Patients", capitation fees will form a much greater proportion of the GPs' income from fees and allowances. This means that capitation fees for each patient will be much higher and, as a consequence, greater recognition will be given to the importance of the individual patient to the practice and to the importance of providing all of the services that that patient needs. New incentive payments will be introduced to encourage the health promotion and disease prevention measures already mentioned. In addition, the importance of medical education will be given greater prominence in the remuneration system. Continuing education--keeping up to date with the latest techniques, therapies and disease management methods-- will be encouraged through a new postgraduate education allowance payable to GPs who regularly attend approved courses. GPs who teach medical students will receive a new allowance.
Lastly, we are preparing family practitioner committees (FPCs) to play a greater management role in the provision of local services. In particular they will manage service development budgets aimed at improving surgery premises and extending practice teams. The Government believe
Column 801that GPs working with other health care professionals will provide a better service to patients. FPCs will have service development plans aimed at encouraging greater use of practice nurses, counsellors, chiropodists and other health professionals. The package of changes that we plan to introduce will provide a better range and quality of services for patients. Many GPs already run first-class practices and under the new arrangements these GPs will be better rewarded. Others may need to consider extending their services to ensure that they too benefit from the reforms that the Government are planning.