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Mr. David Alton : To ask the Secretary of State for Health when he now intends to implement the terms of the Griffiths report "An Agenda for Action."
Mr. Mellor : I refer the hon. Member and the right hon. Member to my reply to the hon. Member for Livingston (Mr. Cook) on 6 April 1989 at column 291.
Eye and Dental Examinations
Mr. Allen : To ask the Secretary of State for Health what information his Department has on the numbers of people who currently have eye tests and dental examinations (a) in England and (b) in the appropriate area covering Nottingham.
Mr. Mellor : I refer the hon. Member to my reply to him on 24 November at column 261. I regret that the local information requested is not available.
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Air Conditioning
Mr. Redmond : To ask the Secretary of State for Health which Trent regional health authority buildings have wet-air cooling air conditioning systems fitted ; what action is being carried out to have them replaced by a different type of air conditioning system ; and if he will make a statement.
Mr. Freeman : Information available centrally shows that the following buildings in the Trent region had wet-spray cooling towers in July 1986 :
Leicester Royal Infirmary
Leicester General Hospital
Glenfield General Hospital
Groby Road Hospital
Derby Royal Infirmary
Derby City Hospital
Bassetlaw District General Hospital
Doncaster Royal Infirmary
Nottingham City Hospital
Queens Medical Centre
Q M C University Hospital
Grantham Hospital
Pilgrim Hospital
Lincoln County Hospital
Balderton Hospital
Barnsley District General Hospital
Northern General Hospital
Royal Hallamshire Hospital
Rotherham District General Hospital
Chesterfield and North Derbyshire Royal Hospital
Scarsdale Hospital
The Department issued preliminary guidance in May 1987 and a detailed code of practice on the control of legionellae in health care premises in July 1988. Both the preliminary guidance and the code of practice recommended against premature replacement of wet-spray systems, unless these cannot be operated safely in accordance with specified technical criteria.
Chiropody
Mr. Allen : To ask the Secretary of State for Health, further to his reply to the hon. Member for Nottingham, North, of Tuesday 29 November, Official Report, column 187-88, whether all patients on the home treatment list for chiropody have received written confirmation of continuing home treatment ; and if he will make a statement.
Mr. Freeman : Responsibility for the management of local health services rests with the district health authority concerned (in this case Nottingham health authority). I suggest that the hon. Member contacts the chairman of Nottingham health authority for the information he seeks.
Birth Statistics
Mr. Redmond : To ask the Secretary of State for Health if he will list by year from 1979 the estimated percentage of women delivering in the Trent regional health authority whose deliveries were (a) spontaneous, including abnormal presentation of head and breech spontaneous, (b) instrumental, including forceps, vacuum and for breech extraction, (c) caesarean section and (d) other unspecified means.
Mr. Freeman : The information is not available in precisely the form requested. The table shows the mode of delivery for women normally resident in Trent RHA.
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The estimates are derived from the hospital in-patient enquiry (HIPE) data collection which closed 1985. Data from 1981 is unreliable and has been excluded from the table.|c|Mode of delivery for women normally resident in Trent RHA|c| Percentages Year |Spontaneous<1> |Instrumental<2> |Caesarean |Other and unspecified ------------------------------------------------------------------------------------------------------------------------------------ 1979 |77.0 |14.8 |7.8 |0.4 1980 |75.1 |15.7 |9.1 |0.1 1981 |n/a |n/a |n/a |n/a 1982 |75.5 |14.3 |10.2 |0.0 1983 |75.7 |14.3 |10.0 |0.0 1984 |76.0 |13.8 |10.2 |0.0 1985 |78.6 |12.6 |8.7 |0.0 <1> Includes abnormal presentation of head and breech spontaneous. <2> Includes forceps, vacuum and breech extraction. n/a=Data not available.
Mr. Redmond : To ask the Secretary of State for Health if he will list by year from 1979 to date the estimated percentage of women delivering in the Trent regional health authority (a) whose labours were induced, (b) whose labours were of spontaneous onset and (c) who had elective caesarean section.
Mr. Freeman : The information is not available in precisely the form requested. The table shows the mode of delivery for women normally resident in Trent RHA.
The estimates are derived from the hospital in-patient enquiry (HIPE) data, collection around in 1985. Data from 1981 is unreliable and has been excluded from the table.
|c|Induction of labour (with mode of delivery)|c|
|c|for women normally resident in Trent RHA|c|
Percentages
Year |Induced labours |Labours of spontaneous|Elective caesarean
|onset |sections
-------------------------------------------------------------------------------------------------------------------
1979 |25.1 |70.5 |4.4
1980 |23.4 |72.9 |3.7
1981 |n/a |n/a |n/a
1982 |20.5 |75.0 |4.5
1983 |21.6 |74.2 |4.2
1984 |18.3 |77.1 |4.6
1985 |18.1 |78.4 |3.5
n/a=Data not available.
Disabled Persons
Mr. Hannam : To ask the Secretary of State for Health what progress has been made in implementing section 5 of the Disabled Persons (Services, Consultation and Representation) Act 1986 in respect of its obligation to place duties upon educational authorities and social services authorities to identify, assess and provide for the needs of people with mental handicaps at the time that they move out of full-time education ; and what arrangements have been made to ensure that these facilities are being monitored in respect of their implementation in terms of quality of life.
Mr. Mellor : Section 5 of the Act, which came into force on 1 February 1988, requires local authorities to identify all disabled school leavers, including those with mental handicaps, and assess their needs for welfare services. Although children leaving school in 1990 will be the first
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group to fall within these provisions, we have asked local authorities to undertake similar functions for as many disabled children leaving school before that date as possible. The Department's social services inspectorate is undertaking two inspections of the implementation of sections 5 and 6 of the Act.Mr. Hannam : To ask the Secretary of State for Health what plans he has to implement sections 1 and 2 of the Disabled Persons (Services, Consultation and Representation) Act 1986 ; and whether he will meet the cost implications required to appoint authorised representatives for all people with mental handicaps in connection with the provision of services and the right to obtain relevant information to facilitate an informed choice of a selection of appropriate support services.
Mr. Mellor : We have accepted the view of the local authority associations that detailed work, including costings, on sections 1, 2 and 3 of the Act should follow implementation of section 7.
Immunopathology
Mr. Redmond : To ask the Secretary of State for Health if he will give for the Trent regional health authority (a) the number and (b) the locations of consultants in immunopathology ; and if he will make a statement.
Mr. Mellor : The total number of consultants in post for immunopathology in the Trent region as at 30 September 1987 is five (3.3 whole-time equivalent). This includes permanent paid, honorary and locum staff.
Consultant contracts are held by the employing regional health authority and teaching districts, so information is not available centrally on locations of those working in one or more districts.
Mental Health Act 1983
Dr. Twinn : To ask the Secretary of State for Health when the code of practice required under section 118 of the Mental Health Act 1983 will be laid before the House.
Mr. Freeman : There has been extensive consultation on two drafts of the code. I have established a small working group of people with wide experience of mental health matters to consider the comments received and produce a final draft, which we expect to lay before the House this autumn. The composition of the working group is as follows :
Chairman :
Mr. A. J. Collier, CB--formerly deputy secretary, Department of Health and Social Security ;
Members :
Mr. M. Brown--Director of nursing (mental health) west Lambeth health authority ;
Mrs. J. Miles--General manager, priority care services unit, Aylesbury Vale health authority ;
Professor E. Murphy--Consultant psychiatrist and deputy chairman, mental health act commission ;
Mr. N. Welch--Principal social worker, Oxfordshire county council social services department ;
Secretary :
Mr. W. Bingley--Legal director of MIND, on secondment to the Department of Health while acting as secretary ;
Assistant secretary :
Mrs. M. Houston--Department of Health.
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Census Information
Mr. Brandon-Bravo : To ask the Secretary of State for Health whether he will authorise any extension to the release of information from censuses more recent than 1881.
Mr. Freeman : Public access to individual census returns less than 100 years old is not generally permissible. However, I am prepared to extend the existing special arrangements which apply to the censuses of 1891 and 1901 and allow, subject to the consent of the person concerned or of direct descendant, for the release to researchers of the information recorded about that person's age and place of birth. This information may now be released also in respect of persons who die childless, provided the consent of the next of kin is given, and it will be available additionally to public trustee administrators seeking to trace possible beneficiaries to the estate of a deceased person. A charge for this service, approximating to the cost of providing it, will be made by the registrar general.
Working for Patients"
Mr. Ashley : To ask the Secretary of State for Health what representations he has had from disability organisations on the National Health Service White Paper "Working for Patients."
Mr. Mellor : We have received representations so far from three different organisations in the disability field. We are taking the opportunity of the response to emphasise to them that the continued provision of services for disabled and chronically sick people will be ensured by the White Paper proposals.
Rheumatologists
Mr. Ashley : To ask the Secretary of State for Health what percentage of health districts do not have a rheumatologist in post.
Mr. Mellor : Figures for September 1987 show than 34 per cent. of the 191 health districts in England did not have a rheumatologist in post.
Systemic Lupus Erythematosus
Mr. Ashley : To ask the Secretary of State for Health what steps his Department is taking to publicise the effects of systematic lupus erythematosus.
Mr. Freeman : The Department is not involved directly in publicising the effects of this disease, but welcomes the important work done by organisations such as Arthritis Care.
Artificial Limbs and Appliances
Mr. Alfred Morris : To ask the Secretary of State for Health if he will list all the bodies which have a statutory duty or powers to provide orthoses, prostheses or special equipment to people with disabilities ; if he will specify in each case the particular circumstances in which such equipment can be provided and any restrictions on its use ; if he has any plans to rationalise the provision of these services ; and if he will make a statement.
Mr. Mellor : A wide range of bodies provide equipment to disabled people for purposes including education and
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employment. Detailed responsibility in fields of health and social services with regard to equipment for disabled are as follows. The duty to provide the facilities in question for people with disabilities arises from the duty of the Secretary of State under the National Health Service Act 1977 to promote the establishment in England and Wales of a comprehensive health service. This duty is discharged through various bodies.District health authorities may provide orthotic appliances, footwear and certain types of prosthesis, when the patient has been examined and the appliance etc. prescribed by or under the direction of a consultant, either at a hospital, or at a clinic or on the occasion of a domiciliary visit.
Where provision or renewal of such appliances is recommended, the consultant may, if satisfied that the condition has reached stability, decide that supply be continued for a stated period of up to five years. In the case of breast prostheses and wigs, there is no such limit.
Following referral from a general practitioner to a consultant ophthalmologist, low vision aids may be prescribed through the hospital eye service's low vision clinic.
Hearing aids may be prescribed by a hospital consultant following referral from a general practitioner they are supplied and fitted on free loan by NHS hearing centres.
Communication aids may be prescribed by a hospital consultant to help with speech and language impairment.
Equipment to enable people to be nursed in their own home may be supplied free to out-patients being actively treated or to discharged in-patients, for as long as it is required. This equipment may be on loan and returnable ; or consumable.
General practitioners may prescribe certain equipment as items on the drug tariff. This includes some incontinence equipment (but not pads and garments which are obtainable, if necessary, through the community nursing services). People with stomas requiring ostomy equipment are permanently exempt from the usual charges.
The Disablement Services Authority supplies artificial limb prostheses. Its doctors assess people who are referred by their surgeon or general practitioner.
The Disablement Services Authority supplies on loan a range of wheelchairs on the recommendation of any NHS doctor. It will also meet the cost of repair to wheelchairs except in the case of misuse or neglect. Such equipment should be returned when no longer needed. The Disablement Services Authority also has powers to provide a range of services to war pensioners, including orthopaedic footwear, surgical appliances, hearing aids, wigs and home nursing equipment. (War pensioners may also obtain these services through their local district health authority.)
The Department of Health provides certain services directly. The Artificial Eye Service provides artificial eyes, cosmetic shells and orbital facial prostheses through its clinics. Environmental control equipment for severely disabled people may be provided on free loan to people meeting specific criteria as assessed by certain doctors acting on the authority of regional medical Officers (this authority is devolved to district medical officers in some regions).
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Where they are satisfied of need, local authority social services departments have a duty which includes the provision of facilities to meet the needs of a disabled person. Local authorities may make a charge for such services and, where appropriate, equipment should be returned when no longer required. This equipment includes wheelchairs for temporary use.The services of the Disablement Services Authority will pass to district health authorities on 1 April 1991 and negotiations are well in hand on the best way of carrying these services forward in future, in the light of local circumstances in each region and district.
Ambulance Services
Mr. Evennett : To ask the Secretary of State for Health what information he has regarding the arrangements which exist for the interchange of information between ambulance services in England ; and if he will make a statement.
Mr. Freeman : Regional ambulance officers are responsible for ensuring co-operation and co-ordination of ambulance services within their region and they hold regular meetings for that purpose with the chief ambulance officers of these services. Regional ambulance officers themselves form a group which meets regularly with departmental officials to facilitate the exchange of information between services. In addition, ad hoc seminars and conferences are held when necessary to discuss matters of national import.
Mr. Evennett : To ask the Secretary of State for Health if he will make a statement on the current standards of training provided for ambulance crews in England.
Mr. Freeman : The National Health Service Training Authority is the body responsible for devising the programme of training and syllabi for ambulance staff and in addition it also monitors extended training in the skills of advanced resuscitation. Training is carried out by regional ambulance training schools.
All grades of employees must attend appropriate courses as determined by their employing authority. To attain the grade of qualified ambulanceman, an employee must undertake a six-week approved course in ambulance aid ; a two-week driver course ; complete at least 12 months on operational duties and be assessed by the employing authority as competent over the whole range of duties. Qualified and leading ambulancemen must attend a two-week post-proficiency course in ambulance aid at intervals of no more than five years.
NHS Finance
Ms. Harman : To ask the Secretary of State for Health when he expects district health authorities and any National Health Service self- governing hospitals to be paying market rates of interest under the proposals on his capital charges working paper on the National Health Service on their land building and equipment ; and if he will make a statement.
Mr. Mellor : The rate of interest used in the calculation of capital charges will be set in line with the discount rate for the non-trading part of the public sector. The Chief Secretary recently announced that this rate will be 6 per cent. The capital charges scheme will not apply to
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self-governing hospitals. Self-governing hospitals will have an intitial debt equal to the value of the capital assets transferred ; the total arrangements for servicing the capital of self-governing hospitals will be consistent with the capital charging scheme.Benzodiazepine
Ms. Primarolo : To ask the Secretary of State for Health if he will commission the Institute of Psychiatry to carry out research into (a) the number of children in the United Kingdom addicted to benzodiazepines, (b) the number of adults in the United Kingdom addicted to benzodiaze-pines, (c) the number of people placed in psychiatric hospitals in the United Kingdom in order to withdraw from benzodiazepines and (d) the number of people on sick or invalidity benefit in the United Kingdom following benzodiazepine withdrawal ; and if he will make a statement.
Mr. Mellor [holding answer 11 April 1989] : There are no plans at present for the Department to commission research in the specific areas referred to by the hon. Member. However, the Department has sponsored a significant body of research relevant to benzodiazepines, mainly through the Institute of Psychiatry. In addition, the Medical Research Council, which is the main agency through which the Government support medical research in the United Kingdom and which receives its grant from the Department of Education and Science, is supporting a team at the Institute of Psychiatry which is examining the effects of benzodiazepines on mental function.
Ms. Primarolo : To ask the Secretary of State for Health what figures are available showing the trend of benzodiazepine prescriptions in 1988.
Mr. Mellor [holding answer 11 April 1989] : The number of prescriptions for benzodiazepines dispensed by community pharmacists in Great Britain in the period January to June 1988 compared with 1987 was as follows :
|Number of prescriptions
|millions
------------------------------------------------------------------------
January to June 1987 |12.7
July to December 1987 |12.8
January to June 1988 |11.9
July to December 1988 |n/a
n/a-Not available.
Ms. Primarolo : To ask the Secretary of State for Health if he will introduce legislation to prevent the prescription of benzodiazepines to children under the age of 16 years.
Mr. Mellor [holding answer 11 April 1989] : No. The benzodiazepines are clinically useful in treating children. Some of the drugs are essential for the treatment of epilepsy and they are valuable for short-term use to relieve acute anxiety. Occasional use of the drugs to treat night terrors and somnambulism may also be justified. It is up to doctors to prescribe the drugs properly in accordance with the guidance available to them.
Ms. Primarolo : To ask the Secretary of State for Health (1) whether he will request the Committee on Safety of Medicines to issue further advice to doctors in the light of the increase in prescriptions for benzodiazepines in 1987 ;
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(2) what advice the Committee on Safety of Medicines is issuing to doctors about the prescription of benzodiazepines to children ; (3) whether he will meet the Committee on Safety of Medicines to discuss the increase in benzodiazepine prescriptions in 1987.Mr. Mellor [holding answer 11 April 1989] : The Committee on Safety of Medicines published advice on the prescribing of benzodiazepines in Current Problems No. 21, issued to all doctors in January 1988 ; a copy is in the Library. Its advice, which is still valid, is directed towards the treatment of all patients and is also summarised in the latest edition of the British National Formulary (BNF) which the Department issues to all doctors. The BNF also warns that hypnotics, the most common of which are benzodiazepines, should rarely be prescribed for children. I have no present plans to meet the Committee or to ask it to issue further advice on this subject.
Ms. Primarolo : To ask the Secretary of State for Health what steps he intends to take following the increase in the number of prescriptions for benzodiazepines dispensed by community pharmacists in 1987.
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