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27. Mr. Roger King : To ask the Secretary of State for Health what is his estimate of the savings made in the last available year from the contracting out of services within the National Health Service.
Mr. Freeman : Up to 1987-88 information collected centrally on competitive tendering related only to domestic, catering and laundry services. In the financial year 1987-88, authorities reported new cost improvement
Column 566savings for these services of £35.4 million. Since 1984-85, health authorities have achieved total savings worth over £100 million for the three services.
For 1988-89, authorities planned cost improvement savings for competitive tendering of all services total £43.2 million. The outcome of these plans will be available later this year.
28. Mr. Robert B. Jones : To ask the Secretary of State for Health whether he will make a statement on the value of new capital projects for the National Health Service in the West Hertfordshire constituency where approval has been given since May 1979.
Mr. Freeman : Since 1979 the Department has approved in principle three phases of development at Hemel Hempstead general hospital. The capital cost of each phase at approval in principle stage was for phase 1 : £5.9 million ; for phase 2 : £3.9 million ; and for phase 3 : £12.4 million.
29. Mr. Michael : To ask the Secretary of State for Health if he will make a statement on his policy regarding the balance to be sought between treatment and prevention at all levels of the Health Service.
Mr. Mellor : We are as much concerned to prevent ill-health and promote good health as we are to ensure that treatment is available to all who fall ill. Not all illness is preventable. Where it is, however, we seek to ensure that the appropriate preventive services are provided (vaccination and immunisation, for example) or that steps are taken to give people the best possible advice on how to look after their health. It is not possible, or indeed appropriate, to try to quantify the balance between preventive and curative activity. Nor is it always possible to differentiate between them. A doctor treating a patient, for example, might well take the opportunity to offer advice about changing to a healthier lifestyle and I would expect any patient recovering from a heart attack to be given advice about steps to try to prevent a recurrence. Nevertheless, it must always be better to try to prevent ill health in the first place than to have to cure, or care for it later. Prevention of ill health and promotion of good health are therefore major priorities for the Government and the Health Service.
Norwich is one of 22 districts with particular waiting problems which have been selected for special targeted help in 1989-90. Its waiting lists are to be investigated by a management team, and if the team identifies the need for an injection of funds the district will be able to apply for a special allocation from the £6 million reserved from the waiting list fund. Norwich has already received over
Column 567£500,000 from the fund in 1987-88 and 1988-89, and the East Anglian regional health authority plans to make further allocations to the district next year.
Mr. Kenneth Clarke : Regional health authorities have been asked, as part of the waiting list initiative, to agree with their districts targets for the reduction of waiting time. They are also developing with districts local statements of policy on out-patient and in-patient waiting times. These will eventually include specific targets, for example maximum wait, for specific medical conditions, including the most common waiting list conditions.
The White Paper "Working for Patients" includes a number of proposals designed to reduce waiting time for treatment. We do not, however, propose to set targets from the centre. These are best developed locally, to reflect local needs, demands and resources.
Mr. Mellor : We have asked district health authorities to ensure that laboratories report the results of cervical smears to the smear-taker within one month. We are informed on a quarterly basis of districts not meeting this target. In December 1988, 43 districts reported backlogs exceeding one month's work, compared with 54 in September. Among these districts the average length of backlog in December was 6.93 weeks, as against seven weeks in September. We do not have information on processing times in districts which do meet the one-month target.
Mr. Mellor : The Government recognise the essential role of preventive medicine in sustaining and improving people's health and have recently given priority to major initiatives such as the introduction and promotion of the MMR vaccine, the implementation of screening programmes for breast and cervical cancer and important health education campaigns on AIDS, drug abuse and coronary heart disease. We intend to develop these areas of work further and have just announced major new initiatives to combat alcohol misuse and teenage smoking, which we hope to halve by 1993, and on prevention of cancer in conjunction with the European Year of Information on Cancer.
Column 568the Royal College of Physicians and the Royal College of Psychiatrists that old age psychiatry should be officially recognised as a specialty within psychiatry, and that every health district should include a specialised service for the psychiatry of old age.
Mr. Freeman : I am pleased to be able to report that the Department has accepted the Royal College of Psychiatrist's formal request for recognition of the psychiatry of old age as a specialty. An important benefit will be that more specific information relating to the new specialty can be collected and arrangements for this are well in hand. The development of specialised services in each district is a key priority in our policy to provide a comprehensive range of services for the elderly mentally ill.
Mr. Freeman : The principles advanced in the report "Public Health in England" of a greater commitment to improving public health, have been accepted. Last December, guidance was issued to health authorities about their responsibilities to improve the health of their populations, including prevention, surveillance and control of communicable disease. The Government seek to maintain the general improvements in the health of the nation and resources available next year will be equivalent to a cash increase of £2 billion which is 5 per cent. in real terms.
Mr. Kenneth Clarke : My proposals for changes to the family doctors' remuneration system are set out in the report "General Practice in the National Health Service--A New Contract". These proposals include a rural areas supplement to the basic practice allowance designed to recognise the particular nature of practice in sparsely populated rural areas and to ensure that GPs practising in these areas are not unduly disadvantaged by the nature of the area in which they work.
51. Mr. Kennedy : To ask the Secretary of State for Health if he will assess the likely implications for general practitioners in rural areas of his proposed changes to general practitioners' contracts ; and if he will make a statement.
Mr. Kenneth Clarke : The Government's proposals for linking family doctors' pay more closely to the range and quality of their services to patients are set out in the report "General Practice in the National Health Service--A New Contract", which I have sent to all GPs. The implications for rural practice are fully considered in that report. My proposals include a rural areas supplement to the basic practice allowance which is designed to recognise the particular nature of practice in sparsely populated rural areas and to ensure that GPs practising in such areas are not unduly disadvantaged by the nature of the area in which they work.
Mr. Mellor : Following publication of "Primary Health Care--An Agenda for Discussion" in April 1986, Health Ministers chaired 12 public consultation meetings in different parts of the country. Health Authorities were represented at a number of meetings. Full account was taken of the views expressed during the consultation process in the White Paper "Promoting Better Health" which was published in November 1987. Ministers also discussed their proposals with the chairmen of all 90 family practitioner committees in England at a series of meetings in April and May 1988. In addition officials have held regular meetings with individual family practitioner committees and with representatives of the Society of Family Practitioner Committees and the Society of Administrators, Family Practitioner Services.
Mr. Freeman : In 1976-77 gross spending on the NHS in England rose by £638 million ; an increase of about 1 per cent. in real terms. In 1989-90 gross spending is planned to increase by £1,685 million compared with estimated outturn in 1988-89. In addition health authorities will retain savings of nearly £300 million from a reduction in the employers' superannuation contributions. New cost improvements are expected to provide around a further £150 million. Taken together the additional resources available to the NHS in 1989-90 will be equivalent to a real terms increase of more than 5 per cent. over 1988-89.
Mr. Mellor : The number of nursing and midwifery staff (including agency staff) employed in the NHS in England at 30 September 1979 and 1987 were 358,400 and 404,000 whole-time equivalents respectively.
Mr. Mellor : No. Each regional and district health authority in England is required by the Act to publish reports annually. For information on action being taken in particular regions or districts, hon. Members may like to consult the authorities concerned.
Mr. McLoughlin : To ask the Secretary of State for Health how much Government funding has been allocated to research on AIDS in 1986 and each year since ; how much he expects to allocate in the next two years ; and if he will make a statement.
|£ million ------------------------------ 1986-87 |2.46 1987-88 |10.36 1988-89 |13.98
So far £14.5 million has been made available for AIDS research for 1989-90, but not all Government Departments and agencies involved in the AIDS research effort have finalised their contributions. Comparable estimates for 1990-91 are not yet available.
Mr. Kenneth Clarke : The Government have introduced a range of measures designed to reduce the risk of food contamination and, with industry, is continuing to consider what further action is necessary.
Both primary and secondary legislation have been under review. I recently announced my intention to consult shortly on changes in the food hygiene regulations, and the Government are presently considering the results of consultation on a wide-ranging review of the Food Act.
We have recently announced the establishment of a committee on food safety, under the chairmanship of Sir Mark Richmond, to advise Ministers on matters relating to the microbiological safety of food. We have also taken steps, where appropriate, to reassure the public.
52. Mr. McCrindle : To ask the Secretary of State for Health what steps he is taking to ensure that the proposals contained in the White Paper "Putting Patients First" are understood by members of the public.
Mr. Kenneth Clarke : My ministerial colleagues and I are taking every opportunity to publicise the review and to ensure that the public fully understands its proposals. We plan to undertake a series of visits and speaking engagements, throughout the country. In addition, a leaflet setting out our main proposals is readily available in post offices, doctors' surgeries, pharmacies and similar outlets.
53. Mr. Hinchliffe : To ask the Secretary of State for Health how many National Health Service establishments have been closed on grounds of unsuitability for residential care for the elderly or handicapped ; and what information he has on their subsequent disposal.
54. Mr. Ralph Howell : To ask the Secretary of State for Health what is the latest estimate of the value of (a) total National Health Service estate and (b) the land and property owned by the National Health Service that is surplus to requirements.
Mr. Freeman : The latest estimates of the value of the NHS estate, as at June 1987, have been placed in the Library. The document is a summary of the valuation of all property including that which is surplus. The realisable value of a specific site is obtained when a sale is in prospect.
Mr. Freeman : We are still considering legislation to prohibit the sale of organs for transplantation. The Polkinghorme committee is currently reviewing the existing code of practice about the use of foetuses and foetal tissue for research in the light of recent developments to the field of human tissue transplantation and other relevant research.
Mr. Freeman : The cash expenditure by health authorities in England on capital programmes rose from £331.71 million in 1975-76 to £367.35 million in 1978-79, an increase of 10.7 per cent. over the period. The corresponding figures for 1984-85 to 1987-88 show a rise of 25.9 per cent. from £795.40 million (1984-85) to £1,001.44 million (1987-88).
Mr. Teddy Taylor : To ask the Secretary of State for Health if he will take steps to ensure that the flexibility proposed in pay negotiations for hospital trusts will be limited to supplementary payments in excess of agreed national salary levels within the health service ; and if he will make a statement.
Mr. Teddy Taylor : To ask the Secretary of State for Health what procedures he will provide to ensure that the standards of medical and clinical care are maintained in hospitals following the new flexibilities and opportunities provided by the creation of hospital trusts and the creation of practice budgets for some general practitioners' practices ; and if he will make a statement.
Mr. Kenneth Clarke : The Government have proposed in its White Paper "Working for Patients" that a framework of quality control known as medical audit should be established in all hospitals and GP practices in the NHS. Medical audit means that doctors keep careful
Column 572records of how patients are diagnosed and treated and how successful the treatment is. The results can then be considered by other doctors to see if satisfactory clinical standards are being maintained and to advise on possible improvements.
The Government's proposals for medical audit as set out in working paper No. 6 are therefore designed precisely to ensure that the standards of medical and clinical care are maintained. They apply to all hospitals, both self-governing and health authority managed, and to all general practices including those managing practice budgets.
Mr. Mellor : The Government's principal objective in maternity and neonatal care is to improve the services, and in consequence ensure the safety of mothers and their babies. The second report of the maternity services advisory committee (MSAC), which we have commended to health authorities, although recognising that a woman should have a choice of where her baby is to be born, encourages delivery in a maternity unit where emergency facilities are readily available. It is for health authorities to determine the level and pattern of services, taking into account their detailed knowledge of the needs of local communities.
(i) an additional £5.5 million for health authorities towards the extra cost of the nurses' pay award as it affects their contractual and other longstanding arrangements with independent and mainly charitable hospitals and hospices ; about a quarter of this sum was for hospices ;
(ii) a grant of £400,000 to "Help the Hospices" for disbursement to individual hospice projects ;
(iii) grants of £170,000 to the London Lighthouse and of £256,000 to the Mildmay Mission Hospital, which provide in-patient hospice units for the care of people with AIDS.
64. Dame Jill Knight : To ask the Secretary of State for Health whether he envisages any early change in the procedure to deal with alleged disciplinary misdemeanours by hospital doctors or consultants ; and if he will make a statement.
Mr. Kenneth Clarke : NHS review working paper 7 "NHS Consultants : Appointments, Contracts and Distinction Awards" states the Government's intention to start negotiations with the profession on the basis of proposals contained in the report of the joint working party which examined hospital and community doctors' and dentists' disciplinary procedures. The report, which was completed last year, contains a number of useful recommendations including a new procedure for dealing with cases of professional misconduct and incompetence
Column 573which warrant disciplinary action short of dismissal and improvements both to existing disciplinary procedures and the system of appeals to me against dismissal. The working paper makes it clear that our aim is to introduce new arrangements by the end of the year at the latest.
66. Mr. Alton : To ask the Secretary of State for Health what has been the incidence of Down's syndrome in newborn infants in (a) the latest year for which figures are available, (b) 10 years previously and (c) 20 years previously.
Figures are derived from a voluntary system of notification which collects information on cases reported at birth or up to seven days therafter. It is, therefore, likely to be an incomplete measure of the total number of babies affected.
* |c|Number of babies born with Down's syndrome and rate per 10,000|c| |c|total and live births in England and Wales for 1967, 1977 and 1987|c| All births Live births Year |Number|Rate |Number|Rate ------------------------------------------ 1967 |613 |7.3 |594 |7.1 1977 |425 |7.4 |413 |7.3 1987 |450 |6.6 |443 |6.5
Mr. Nicholas Winterton : To ask the Secretary of State for Health (1) if he will list those hospitals which provide specialist services for the therapeutic and remedial treatment of Down's syndrome ; (2) what recent steps have been taken by his Department to ensure that therapeutic as well as remedial treatment is available for Down's syndrome.
Mr. Freeman : No information is available centrally about hospitals providing such specialist services and no action has been taken by the Department to make treatment available specifically for Down's syndrome. Health care and treatment for people with a mental handicap and associated physical conditions caused by Down's syndrome is provided by the mental handicap and generic services in hospitals and in the community, including primary care services. When specialist care or treatment is required for an acute or chronic condition referral is arranged in the usual way. The Department has been funding research on Down's syndrome, and other departmentally-funded research in the field of mental handicap is also relevant to people with Down's syndrome.
Mr. Kenneth Clarke : The proposals in our White Paper "Working for Patients" will help reduce the variations in waiting times between health authorities. 100 extra consultants will be appointed over the next three years, and these will be targeted at the districts and specialities where waiting times are the longest. We will also change the funding system used by the health service to enable patients to receive treatment in hospitals where the wait is shortest if they wish.
We have made £86 million available over three years through our waiting list fund to enable hundreds of thousands of extra patients to be treated from the waiting lists. Next year some £6 million of the fund will be used to give special targeted help to districts with particular waiting problems.
Mr. Freeman : Medical ethics are a matter for the professions concerned. Some medical bodies have established medical ethical committees to advise their members--these are outside the remit of the Department of Health.
Within the National Health Service each health authority is required to have a research ethics committee to supervise the ethics of clinical research investigations. The work of these committees is explained in health circular HSC (IS) 153, which is available in the Library.
72. Mr. Matthew Taylor : To ask the Secretary of State for Health how many representations he has received opposing his proposals to remove local government representatives from health authority membership.
Mr. Mellor : I refer the hon. Member to my reply of 27 January at columns 795-98. Within the Department's research programme child protection was made a priority theme in 1988-89. This reflects the need for research into
Column 575child abuse and child sexual abuse. The Department, in collaboration with other Government Departments, is putting together a full and effective programme of child protection research. Government-funded research on child abuse including child sexual abuse has been commissioned and is being planned by the Scottish Office, the Department of Health and Social Services (Northern Ireland), the Economic and Social Research Council and is under consideration by the Home Office.
Mr. Frank Field : To ask the Secretary of State for Health if he has received a copy of the Children's Society publication entitled "Working with Sexually Abused Children ;" and if he will make a statement.
Ms. Walley : To ask the Secretary of State for Health, pursuant to his answer of 10 February to the hon. Member for Stoke on Trent North, Official Report, column 851, why members of angling organisations are not issued with warning leaflets alerting them to be vigilant about Weil's disease.