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Alcohol and Drug Addicts

Mr. Wheeler : To ask the Secretary of State for Health if he will take steps to ensure the continuance of the services for alcohol and drug addicts provided by Accept.

Mr. Freeman : The funding of local services is a matter for the local statutory authorities concerned. However, I understand that funding to ensure the continuance of Accept's activities is being provided by the London regional health authorities who have such services within their regions.

Secure Units

Mrs. Gillian Shephard : To ask the Secretary of State for Health which regional health authorities provide secure units for people with mental illness or psychiatric disorder and with mental handicap ; how many beds are now open in each unit ; and how many further units or beds are firmly planned.

Mr. Freeman : I refer my hon. Friend to my reply to the hon. Member for Leyton (Mr. Cohen) on 16 March at columns 327-30. The only regional secure unit specifically for mentally handicapped people is the Sycamores unit at Borocourt hospital, Reading.

Pharmaceutical Imports

Mr. David Nicholson : To ask the Secretary of State for Health whether he has any plans to require the inspection of pharmaceutical wholesaling establishments supplying the National Health Service with parallel imports, in those countries which are not a party to the pharmaceutical inspection convention.

Column 576

Mr. Mellor : No. Arrangements for inspection of pharmaceutical wholesalers in other member states are a matter for the competent authorities in such states.

Mr. David Nicholson : To ask the Secretary of State for Health what steps he is taking to seek concerted action by the United Kingdom's European Community partners in relation to recent problems associated with an unlicensed counterfeit medicine imported into the United Kingdom from Greece.

Mr. Mellor : The representatives of the drug regulatory agencies in the European Community last week affirmed their commitment to inform each other without delay of any incident involving counterfeit materials. The United Kingdom has requested a meeting of Community experts to discuss aspects of the EC parallel importing scheme and this will include counterfeiting


Miss Emma Nicholson : To ask the Secretary of State for Health when he proposes to set up a national screening service for pregnant women for congenital toxoplasmosis.

Mr. Mellor : As with other maternal infections the question of toxoplasmosis in pregnancy, including the possibility of screening, is kept under regular review. We are currently seeking the views of experts in this field in order to consider what action may be necessary.

Miss Emma Nicholson : To ask the Secretary of State for Health if he will give national figures by district health authority area of cases of congenital toxoplasmosis ; and if he will make a statement.

Mr. Freeman : Congenital toxoplasmosis is not a legally notifiable condition ; data on incidence are not therefore available. However, data on deaths occurring where congenital toxoplasmosis has been assigned as the underlying cause of death are available. During the years 1983-87 there were six such deaths registered in England and Wales.

International Classification of Diseases, (ninth revision) 271.2 (part).

Ages 28 days and over from 1986 onwards.

Miss Emma Nicholson : To ask the Secretary of State for Health if he will give figures, by district health authority area, of recorded screenings for congenital toxoplasmosis ; and if he will make a statement.

Mr. Mellor : We do not collect this information centrally. A recent survey of toxoplasmosis in pregnancy in west Glamorgan found an overall incidence of maternal infection with toxoplasma of two in 1, 000.

Miss Emma Nicholson : To ask the Secretary of State for Health if he will make a statement concerning his Department's policy on health education in the prevention of toxoplasmosis with special regard to prevention of the infection of pregnant women.

Mr. Mellor : Hygiene measures can help to prevent infection with toxoplasmosis and are especially important for pregnant women. They include washing hands after working with raw meat and handling cat litter, and cooking all meat thoroughly. Pregnant women should also avoid contact with young kittens. The health education authority's leaflet "You and Your Pet" contains advice on toxoplasmosis and on general hygiene in relation to pets.

Column 577

Miss Emma Nicholson : To ask the Secretary of State for Health if he will make a statement on his Department's research into a vaccine for toxoplasmosis.

Mr. Mellor : The Department does not itself conduct research into vaccines or other medicines, but is always prepared to consider well- founded proposals. Research in the United States of America into a possible vaccine against toxoplasmosis indicates that its development is a long way off.


Mr. Lawrence : To ask the Secretary of State for Health in which regional health authority areas there has been a reduction in the proportion of children suffering from dental caries over the past five years ; and which of these areas officially has fluoridated drinking water.

Mr. Freeman : Surveys of dental caries levels in children were carried out in England in 1983 and in 1985-86. The results, given in the table , showed that there was little change between 1983 and 1985-86. In none of the regions is drinking water wholly fluoridated.

Recent studies have shown that fluoridation of water has continued to produce important benefits in those areas where schemes operate over and above the general decline in caries over the last 15 years. Downer MC "Time trends in dental decay in young children" Health Trends 1989 ; 21 : 7-9.

|c|Table: Dental caries experience of 5-year-old children in England|c|     

Survey region(s)   |1983              |1985-86                              

                   |decayed and filled|decayed and filled                   

                   |primary teeth     |primary teeth                        


Northern      }                                                             

              }    |1.3               |1.6                                  

Yorkshire     }                                                             


Mersey	       }                                                             

              }2.1 |2.1                                                     

North Western }                                                             


West Midlands      |1.9               |1.6                                  


Trent	       }                                                              

              }    |1.5               |1.6                                  

East Anglia   }                                                             


South Western }                                                             

Wessex	       }    |1.2               |1.4                                  

Oxford	       }                                                             


North East    }                                                             

 Thames       }                                                             

              }1.7 |1.1                                                     

North West    }                                                             

 Thames       }                                                             


South East    }                                                             

 Thames       }                                                             

              }    |1.4               |1.1                                  

South West    }                                                             

 Thames       }                                                             

                   |----              |----                                 

England            |1.6               |1.5                                  

Operating Department Assistants

Mr. Hoyle : To ask the Secretary of State for Health how many operating department assistants are trained each year ; and how many operating department assistants leave the National Health Service each year.

Mr. Mellor : We do not hold this information centrally.

Whitley Councils

Mr. Hoyle : To ask the Secretary of State for Health what proposals he has for the replacement of the Whitley councils.

Mr. Mellor : None.

Column 578

General Practitioners (Contracts)

Mr. Kirkwood : To ask the Secretary of State for Health if he will publish a table similar to those contained in the new contract for general practitioners document, for the income of a general practitioner with a list size of 1,000 using the average number of new referrals, night visits and the age of patients for a list size of 1,000.

Mr. Kenneth Clarke : I refer the hon. Member to the first example in appendix F of "A New Contract" which fits his specification. Copies of this document are available in the Vote Office and the Library.

Mr. Kirkwood : To ask the Secretary of State for Health whether he has made any assessment of the consequences which would result from a large number of general practitioners resigning from the National Health Service ; and if he will make a statement.

Mr. Kenneth Clarke : Obviously, the consequences could be serious but I have no reason to believe that anything of the kind will happen.

Mr. Wigley : To ask the Secretary of State for Health if he will publish a table showing for each of the regions of England how many general practitioners are men and how many are women.

Mr. Mellor : The information requested is as follows :

|c|Unrestricted principals England as at 1    

October 1987|c|                               

                  |Total |Male  |Female       


England           |24,922|19,718|5,204        

Northern          |1,584 |1,309 |275          

Yorkshire         |1,883 |1,534 |349          

Trent             |2,335 |1,892 |443          

East Anglia       |1,043 |876   |167          

North West Thames |1,971 |1,395 |576          

North East Thames |1,992 |1,522 |470          

South East Thames |1,933 |1,518 |415          

South West Thames |1,537 |1,146 |391          

Wessex            |1,534 |1,211 |323          

Oxford            |1,301 |1,020 |281          

South Western     |1,869 |1,541 |328          

West Midlands     |2,694 |2,183 |511          

Mersey            |1,259 |982   |277          

North Western     |1,987 |1,589 |398          

Voluntary Sector (Grants)

Mr. Frank Field : To ask the Secretary of State for Health when voluntary organisations will know the level of section 64 grants for the next financial year.

Mr. Freeman : We have received a large number of applications for new and renewal section 64 grants in 1989-90, the total of which far exceed the resources available. I am currently considering with my ministerial colleagues how resources are to be allocated and I expect to be able to notify organisations of their awards shortly.

Medical Students

Mr. Rogers : To ask the Secretary of State for Health if there are any projected increases in medical student numbers by universities and hospitals in the United Kingdom over the next 10 years.

Mr. Mellor : The report of the second advisory committee for medical manpower planning was published

Column 579

in January 1989. In the light of its conclusions, based on projections for the supply and demand of doctors over the next 20 years, we do not consider immediate action is indicated to alter the current medical school intake in the United Kingdom. The report also recommended that the manpower situation should be kept under review and this we intend to do.

Practice Nurses

Sir David Price : To ask the Secretary of State for Health (1) if he will make it his policy to provide the same opportunity for practice nurses to attend locally-based courses as are available for other branches of nursing ;

(2) what are the criteria for reimbursing practice nurses for training, and what is his policy on practice nurses receiving the same funding for training as other branches of nursing ;

(3) what guidance his Department has given to family practitioner committees regarding the apportioning of funding for courses and the restrictions on eligibility for family practice nurses to obtain training and grants for courses.

Mr. Mellor : Health authorities and family practitioner committees should collaborate locally in making arrangements for meeting the continuing education and training needs of nurses, midwives and health visitors. Under a central initiative in 1988-89, more than 500 places were provided in educational establishments, free of charge to practice nurses, based on the curriculum approved by the four United Kingdom national boards for nursing, midwifery and health visiting. We hope to repeat the arrangements in 1989-90. Depending on the outcome of discussions with the representatives of the medical profession on the changes set out in the White Paper "Promoting Better Health", we propose to permit family practitioner committees to take account of the cost of training practice nurses when allocating resources to GPs for staff and premises from 1 April 1990.

Mentally Handicapped People

Mr. Tom Clarke : To ask the Secretary of State for Health, pursuant to his reply to the hon. Member for Monklands, West of 9 February, Official Report, column 802, what plans he has to improve public awareness in respect of the integration of mentally handicapped people into local communities.

Mr. Mellor : We are discussing with the voluntary organisation CMH completion of the project that we have funded it to undertake to assess ways of improving public acceptance of people with a mental handicap moving into the community. We shall be considering other steps in the light of this project.

Mentally Ill Patients

Mr. Tom Clarke : To ask the Secretary of State for Health, what was the outcome of the recent meeting between his Department and the campaigning group, SANE, in relation to the possibility of setting up a study to monitor mentally ill patients discharged from hospital care.

Mr. Freeman : The proposals made by SANE are under active consideration and we expect to reach a decision shortly.

Column 580

London Ambulance Service

Mr. Corbyn : To ask the Secretary of State for Health if he will list the number of staff on duty attached to emergency vehicles for each shift for December 1988 and January 1989 of the London ambulance service.

Mr. Freeman : The figures are as follows :

                 |Early |Late  |Night        


 1 December 1988 |330   |290   |182          

 2 December 1988 |324   |272   |170          

 3 December 1988 |282   |260   |158          

 4 December 1988 |250   |240   |158          

 5 December 1988 |322   |284   |172          

 6 December 1988 |338   |284   |178          

 7 December 1988 |324   |278   |166          

 8 December 1988 |318   |280   |164          

 9 December 1988 |318   |282   |154          

10 December 1988 |290   |256   |150          

11 December 1988 |254   |224   |162          

12 December 1988 |328   |286   |164          

13 December 1988 |326   |280   |164          

14 December 1988 |320   |274   |172          

15 December 1988 |316   |286   |156          

16 December 1988 |326   |266   |156          

17 December 1988 |274   |246   |148          

18 December 1988 |244   |234   |158          

19 December 1988 |330   |272   |166          

20 December 1988 |328   |278   |174          

21 December 1988 |322   |282   |164          

22 December 1988 |318   |266   |174          

23 December 1988 |316   |262   |164          

24 December 1988 |280   |244   |152          

25 December 1988 |232   |186   |172          

26 December 1988 |306   |254   |168          

27 December 1988 |312   |272   |164          

28 December 1988 |316   |276   |156          

29 December 1988 |318   |276   |162          

30 December 1988 |314   |286   |156          

31 December 1988 |284   |248   |<1>140       

 1 January 1989  |238   |256   |164          

 2 January 1989  |324   |296   |168          

 3 January 1989  |322   |296   |168          

 4 January 1989  |322   |286   |170          

 5 January 1989  |322   |294   |160          

 6 January 1989  |324   |292   |166          

 7 January 1989  |294   |286   |146          

 8 January 1989  |262   |252   |160          

 9 January 1989  |338   |284   |162          

10 January 1989  |336   |290   |166          

11 January 1989  |334   |292   |168          

12 January 1989  |332   |294   |170          

13 January 1989  |324   |282   |164          

14 January 1989  |288   |270   |154          

15 January 1989  |262   |242   |174          

16 January 1989  |328   |292   |174          

17 January 1989  |334   |294   |176          

18 January 1989  |334   |290   |172          

19 January 1989  |332   |296   |174          

20 January 1989  |334   |290   |172          

21 January 1989  |298   |278   |164          

22 January 1989  |256   |254   |164          

23 January 1989  |328   |304   |174          

24 January 1989  |334   |302   |170          

25 January 1989  |324   |296   |174          

26 January 1989  |330   |294   |172          

27 January 1989  |326   |288   |164          

28 January 1989  |302   |276   |156          

29 January 1989  |258   |256   |166          

30 January 1989  |320   |298   |170          

31 January 1989  |334   |296   |166          

<1>Service augmented by 50 St. John          

Ambulance Staff manning their own vehicles   

in the vicinity of Trafalgar Square from     

20.00 hrs until no longer required.          

Column 581

Artificial Limbs

Mr. Ashley : To ask the Secretary of State for Health if he will ask the disablement services authority to reconsider its directive which limits the supply of spare artificial limbs to certain categories of people ; and if he will seek an assessment from the authority of how much money it hopes to save by this new ruling.

Mr. Mellor : These are matters for the Disablement Services Authority, to which the right hon. Member should address this question.

Mr. Ashley : To ask the Secretary of State for Health, before the disablement services authority was established (a) what was the policy regarding the provision of spare artificial limbs, (b) which people were entitled to them and (c) what proportion of those entitled had them provided.

Mr. Mellor : Spare artificial limbs were issued only where an artificial limb and appliance centre medical officer could see that there were clinical grounds for the issue.


Mr. Fearn : To ask the Secretary of State for Health if he has discussed the question of benzodiazepine addiction with his counterparts with other European Community member states.

Mr. Freeman : We have had no such discussions.

Mr. Fearn : To ask the Secretary of State for Health when he expects to see a reduction in the number estimated to be addicted to benzodiazepines.

Mr. Freeman : There are no precise figures to show the level of benzodiazepine dependence, although recent years have seen a reduction in the number of prescriptions dispensed for these drugs. A number of measures have been taken to tackle the problem of benzodiazepine dependence, including the issue of advice to doctors on the careful use of these drugs, the promotion of alternatives to their use, and the development of services to help those dependent on them.

Dr. Owen : To ask the Secretary of State for Health what research is being undertaken into the best methods of coping with the side-effects and withdrawal symptoms caused by benzodiazepines.

Mr. Freeman [holding answer 16 March 1989] : The main agency through which the Government support medical and related biological research is the Medical Research Council (MRC), which receives its grant-in -aid from the Department of Education and Science. I understand that the MRC is supporting a team at the Institute of Psychiatry, London, which is examining the effects of benzodiazepines on mental function, and exploring ways of helping patients to discontinue this medication.


Mr. Fearn : To ask the Secretary of State for Health whether any limits are placed on the inducements given to doctors by drug companies to persuade them to prescribe particular drugs for their patients.

Column 582

Mr. Mellor : The pharmaceutical price regulation scheme explicitly excludes gifts and hospitality other than that provided for medical symposia from the costs accepted in the price of NHS medicines.


Mr. Blunkett : To ask the Secretary of State for Health (1) if he will publish his best estimates of the total number of people suffering from Alzheimer's disease ;

(2) if he will publish his best estimates of the total number of people suffering from dementia.

Mr. Freeman : The information available centrally relates only to admissions to National Health Service mental illness hospitals or units with a main diagnosis of dementia (International Classification of Diseases 290.0, 290.1, 290.2, 290.3, 290.4, 290.8, 290.9). Dementia in Alzheimer's disease is included under these diagnoses. In 1986, the most recent year for which information is available, there were 20,848 admissions with a diagnosis of dementia in its various forms. It is not known what proportion of these admissions are in fact dementia in Alzheimer's disease. The total figure above is not the number of patients suffering from dementia as a patient can be discharged and re-admitted more than once during a year. We do not hold information on the number of patients as opposed to admissions. Also not all sufferers are admitted to a NHS mental illness hospital or unit and so do not appear in official statistics.

Ancillary Workers

Mr. Campbell-Savours : To ask the Secretary of State for Health what representations he has received on the National Health Service ancillary workers' pay claim.

Mr. Mellor : Since the last time this matter was raised during questions on 1 November 1988 we have received two letters from hon. Members and one from a member of the public.

Psychiatric Patients

Mr. Harry Greenway : To ask the Secretary of State for Health how many patients have been moved into the community from psychiatric institutions in each of the past five years ; and if he will make a statement.

Mr. Freeman : The table shows the number of discharges to the community from NHS mental illness hospitals and units in England after a duration of stay of one year or more for the last five years for which information is currently available.

Year                 |Number of Discharges                     


1982                 |3,465                                    

1983                 |3,563                                    

1984                 |3,928                                    

1985                 |3,441                                    

1986                 |3,751                                    


Mr. Hinchliffe : To ask the Secretary of State for Health if, pursuant to his answer 20 February, Official Report, column 528, he will provide reference to any information concerning listeria considered during his Department's expert group's appraisal.

Column 583

Mr. Kenneth Clarke [holding answer 27 February 1989] : As I said in my answer of 20 February 1989 at column 529 the group considered a wide range of information on the scientific basis of the cook-chill system from a variety of sources. To identify any particular material considered by the group would tend to give that aspect of the group's work undue prominence and would not properly reflect the broad information base available to the members of the group.

Dr. David Clark : To ask the Secretary of State for Health whether a safe level of listeria monocytogenes in pre-cooked chilled food has been established.

Mr. Kenneth Clarke [holding answer 9 March 1989] : The 1988 World Health Organisation working group indicated that virtually nothing is known about the infectious dose of listeria monocythogenes, although it may be related to host susceptibility. This is why we have given advice to pregnant women and other vulnerable groups to avoid certain soft cheeses, and to reheat thoroughly cook-chilled meals and ready-to-eat poultry. We are also working with the food industry to consider optimal production methods which will reduce the levels of listeria in foods as far as is practicable.

NHS (Agency Staff)

Mr. Patchett : To ask the Secretary of State for Health if he will provide a breakdown of agency staff employed in the National Health Service ; intemising (a) what jobs they do, (b) what the agencies are paid for their work and (c) what comparable payments are made to those same grades employed by the National Health Service.

Mr. Mellor [holding answer 3 March 1989] : A breakdown of agency nursing and midwifery staff and medical and dental staff employed in the National Health Service is shown in the table.

We do not collect figures for other agency staff or information on health authorities' expenditure specifically for agency staff centrally.

Column 584

It is for authorities at local level to determine with agencies rates of pay. However, the Department has set the following guidelines for nursing and midwifery staff and medical and dental staff respectively :

That authorities pay nurse agencies a maximum calculated on the mean of the appropriate NHS nursing staffs pay scale for the grade plus the agency commission and the employer's national insurance contribution.

Payments to locum medical agencies are currently to be restricted to no more than was being charged at 31 March 1988. Future arrangements are under consideration.

|c|NHS staff in post in England|c|           

|c|Agency staff in nursing and midwifery and 

medical and dental|c|                        

|c|at 30 September 1987|c|                   

|c|Whole time equivalents<1>|c|              



Nursing                        |5,900        

Midwifery                      |300          

Nursing and midwifery          |6,100        

Medical and dental<2>          |600          


Nursing and miwifery<2>                      

 Medical and dental<2> (Total) |6,700        

Source: Department of Health (SR7) annual    

censuses of medical and non-medical          


<1> Figures independently rounded to nearest 

100 whole-time equivalents.                  

<2> In previous years medical and dental     

agency locums were not separately            


Directly employed locums are now included in 

medical and dental staff data.               

Electronic Tagging

Mr. Hinchliffe : To ask the Secretary of State for Health if it is his policy to allow electronic tagging of residents or patients in residential homes and nursing homes or hospitals.

Mr. Mellor [holding answer 9 March 1989] : The management of a resident or patient is a matter for the local judgment of those professionally concerned with his or her care.


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