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HEALTH
National Health Service (Staff Training)
Mr. Gordon Brown : To ask the Secretary of State for Health if he will provide an estimate of the annual expenditure of the National Health Service in England on training of staff, differentiating between medical and non-medical staff.
Mr. Mellor : We do not have centrally comprehensive information on the total expenditure incurred. However, in 1987-88 relevant revenue expenditure amounted to at least £360 million, which includes the total Revenue expenditure of the National Health Service training authority (£5.5 million) and the English national board for nursing, midwifery and health visiting (£90.5 million). Most of the remainder was incurred by regional and district health authorities. While the expenditure of the English national board for nursing, midwifery and health visiting can be attributed to nurse education and training and the summarised accounts of regional and district health authorities identify some £10 million for postgraduate medical and dental education, in general the information available does not differentiate between expenditure incurred on training medical and non-medical staff.
The National Health Service training authority is piloting a set of training activity indicators in a number of health authorities which, among other measures, are designed to identify more precisely expenditure on training on different staff groups.
Overseas Patients
Mr. Galbraith : To ask the Secretary of State for Health what consideration he is giving to the number of overseas patients that can be treated in the self-managing hospitals proposed in the White Paper "Working for Patients".
Mr. Kenneth Clarke : We are considering how treatment of overseas patients in National Health Service hospitals, including self-governing hospitals, might best be administered in the context of the White Paper and associated working papers.
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Clinical Grading
Mr. Campbell-Savours : To ask the Secretary of State for Health how many nursing, midwifery and health visiting staff from each of the old grades have been assimiliated to each of the new grades in the recent clinical grading structure for each of the specialty branches of nursing, midwifery and health visiting.
Mr. Mellor : The information requested cannot be derived from the data which are held centrally. The information which is available has already been placed in the Library.
Mr. Hinchliffe : To ask the Secretary of State for Health if he will require health authorities to provide figures on the number of nurse regrading appeals currently outstanding in district health authorities within the Yorkshire region, and the stage in the appeal processes in each district health authority.
Mr. Mellor : No. The processing of appeals under the national agreement is a matter for individual health authorities.
Mr. Hinchliffe : To ask the Secretary of State for Health what arrangements have been made to process nurse re-grading appeals in each of the district health authorities within the Yorkshire region.
Mr. Mellor : Appeals are being dealt with under a long-standing agreement between the management and trades union sides of the General Whitley Council on procedures for settling differences over NHS employees' conditions of service. Detailed arrangements for operating this agreement are for local decision, and we collect no information centrally.
Toxic Waste (Doncaster)
Mr. Redmond : To ask the Secretary of State for Health how many representations to date he has received from residents living in or near Doncaster metropolitan borough council concerning the proposed toxic waste site at Kirk Sandell by Leigh Environmental and the environmental implications for this populated area ; and if he will make a statement.
Mr. Freeman : One representation has been received to date. Responsibility for the licensing of toxic waste disposal sites lies with the local authority, under powers granted by my right hon. Friend the Secretary of State for the Environment. Sites must be registered with Her Majesty's inspectorate of pollution, which is responsible for subsequent monitoring and advice on discharges from the site. The Department of Health will advise the Department of the Environment on possible health effects of discharged chemicals if they are asked to do so.
Male Circumcision
Mr. Andrew F. Bennett : To ask the Secretary of State for Health what was the cost to the National Health Service of male circumcision operations in the last 10 years for which figures are available ; and what was the cost of comparable operations in the private sector.
Mr. Mellor : We do not collect this information centrally.
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GOS Forms
Mrs. Wise : To ask the Secretary of State for Health (1) what quantity of form GOS 2 (R), National Health Service repair and replacement of spectacles voucher application, was printed with (a) words indicating or implying that full-time students under 19 years would be eligible for free repairs without family practitioner committee approval and (b) prescription details requiring left eye before right ; and if he will make a statement outlining what advice he has given to opticians and ophthalmic medical practitioners regarding these errors ;
(2) what quantity of form GOS (V), National Health Service spectacle voucher applications, has been printed requiring left eye to be entered before right ; and what advice he has given to opticians and ophthalmic medical practitioners as to how to deal with this error ;
(3) what quantity of form GOS (P), patient's prescription/statement, was printed showing left eye first, right eye second, if he will make a statement as to what advice he has given to opticians and ophthalmic medical practitioners as to how to deal with this error ; and how the advice has been conveyed ;
(4) what was the cost of the new forms relating to eye examinations which were printed with errors, GOS(P), GOS2(R) and GOS(V) ; and who will bear the cost of any mistakes or confusion which arise as a consequence of these printing errors ;
(5) on what date family practitioner committees received the forms which were needed by opticians for use on 1 April ;
(6) whether he intends to continue to use forms GOS(ST)A and GOS(P) in their present design which makes it impossible to use carbon paper for information required to be duplicated on each form.
Mr. Mellor : The revised GOS forms were delivered to family practitioner committees on Monday 19 March.
A total of 150,000 copies of forms GOS(P), GOS(V) and GOS2(R) were printed transposing left and right eye prescription details. FPCs were advised of this on 31 March in a letter which asked them to inform contractors to amend the forms manually until reprinted versions were available. Two million forms GOS2(R) were printed stating that students could have repairs made without reference to the FPC. A health circular and family practitioner notice has been issued advising health authorities and FPCs of this error. The design of forms GOS(ST) A and GOS(P) will be revised as soon as possible.
Information on the cost of printing forms GOS(P), GOS2(R) and GOS(V) is not currently available. The cost of reprinting will be met by the Department.
Optometrists
Mrs. Wise : To ask the Secretary of State for Health what representations he has had as a result of his two week consultation on his proposed exemption of optometrists from the requirement to examine for disease as well as refraction ; and which bodies supported his proposal and which opposed it.
Mr. Mellor : The Department has received comments to date from 17 bodies and individuals. The great majority are opposed to the proposal.
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Air Ionisers
Mr. Allen : To ask the Secretary of State for Health how his Department studied the health effects of domestic air ionisers ; and if he will make a statement.
Mr. Freeman : The Department's expert independent advisory committee on the medical aspects of contamination of air and soil reviewed the research into the effects of air ionisers. This includes a presentation to the committee by researchers. The committee advised the Department that the evidence presented did not satisfy them that the use of domestic air ionisers had demonstrable health effects. Results of studies on the health effects of ionised air published subsequently in the scientific literature supports that opinion.
Schizophrenia
Mr. Goodlad : To ask the Secretary of State for Health how much his Department spent on research into schizophrenia in each of the last two years ; and what proportion each figure was of expenditure on the National Health Service research programme.
Mr. Freeman : In 1988-89, £1,307,900 was made available from the Department of Health and Social Security for directly commissioned health, personal social services and social security research programmes for research into mental illness, much of which will be relevant to sufferers from schizophrenia. In 1987-88 the comparable sum was £1,267,000. Expressed as a percentage of the health, personal social services and social security research budget the figures are 8.2 per cent. and 9.3 per cent. respectively.
In 1986 a specific research initiative on schizophrenia was started consisting of seven new research studies. It is hoped that the results of these projects will provide valuable information on the pattern of care of schizophrenia patients.
Mr. Goodlad : To ask the Secretary of State for Health (1) what is the current annual cost per patient to the National Health Service in the Mersey health region of the care and treatment of patients with a main diagnosis of schizophrenia psychoses ;
(2) how much was spent in the Mersey health region in the last year on the care and treatment of patients suffering from schizophrenia psychoses ; and what percentage that figure represented of total expenditure on (a) mental and (b) all health services.
Mr. Freeman : Information relating specifically to the cost of treating patients suffering from schizophrenia psychoses in the Mersey region is not collected centrally.
Anti-psychotic Drugs
Mr. Vaz : To ask the Secretary of State for Health how many prescriptions were written for anti-psychotic drugs in each year since 1985 ; and how many were written for (a) prochlorperazine, (b) thioridazine, (c) chlorpromazine hydrochloride and (d) trifluoperazine.
Mr. Mellor : We have no information centrally about the number of prescriptions written by doctors. Official statistics are based on the prescriptions dispensed by community pharmacists. The information about the drugs requested is therefore as follows :
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(,000) England |1985 |1986 |1987 --------------------------------------------------------- All anti-psychotic drugs |4,430 |4,436 |4,409 Prochlorperazine |2,288 |2,214 |2,147 Thioridazine |597 |623 |657 Chlorpromazine HC1 |542 |532 |513 Trifluoperazine |486 |471 |479
Tardive Dyskinesia
Mr. Vaz : To ask the Secretary of State for Health if he will take steps to provide the public with information on the causes and dangers of tardive dyskinesia.
Mr. Freeman : No. It is for doctors to provide information to their patients about possible adverse reactions associated with prescribed medicines.
Paddington Chest Clinic
Mr. Wheeler : To ask the Secretary of State for Health what is the present ownership of property known as the Paddington chest clinic, Newton road, London, W2 ; when the property was sold and to whom ; and whether the property was placed on the open market for sale by tender upon the advice of a professional valuer.
Mr. Freeman : The sale of property in the Paddington area is the responsibility of Parkside health authority.
Midwives
Mr. Redmond : To ask the Secretary of State for Health if he will list by country the percentage of home delivery training that is given to trainee midwives in the European Economic Community member states : and if he will make a statement.
Mr. Mellor : We do not hold information centrally on the percentage of home delivery training given to student midwives either in this country or in the European Community. The aim of midwifery education in England is to encompass antenatal, perinatal and postnatal care, as well as delivery, in both hospital and community setting in an integrated fashion.
Mr. Redmond : To ask the Secretary of State for Health when he last had consultations with the Association of Radical Midwives ; what subjects were discussed ; and if he will make a statement.
Mr. Mellor : We have had no consultations with the Association of Radical Midwives. Our usual contacts with the midwifery profession are with the Royal College of Midwives and the statutory bodies for nursing, midwifery and health visiting.
Prescription Charges
Mr. Gale : To ask the Secretary of State for Health if he has estimates for the extra revenue that would be generated through the extension of prescription charges to those reaching retirement age throughout the current year while exempting those on income support ; and if he has further estimates for the additional revenue that would be generated if such a policy was projected over the next five years.
Mr. Mellor : The information needed to make these estimates is not available.
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Mr. Gale : To ask the Secretary of State for Health what would be the extra annual revenue generated by the extension of prescription charges to all those over retirement age, exempting only those in receipt of income support.
Mr. Mellor : I estimate that the additional annual revenue would be in excess of £200 million.
Hospital Formularies
Mr. Gale : To ask the Secretary of State for Health what incentives are contained within the existing hospital formularies system for the development in the United Kingdom of new and improved drugs.
Mr. Mellor : The existence of hospital formularies is, in itself, an incentive for the development of safer and more effective medicines. Hospital formularies are subject to ongoing review. Drug companies, bearing this in mind, will therefore work towards the production of medicines which meet criteria for hospital use and demonstrate advantages over existing products, to warrant their inclusion in the formularies.
Mr. Gale : To ask the Secretary of State for Health what plans he has to make funds available for the compilation of local drug formularies.
Mr. Mellor : Extra funds have been made available to FPCs from 1989- 90 to enable them to carry out their increased responsibilities, as announced in the White Paper "Promoting Better Health". These responsibilities include encouraging the development of local drug formularies.
Mr. Gale : To ask the Secretary of State for Health what the effect of European Community directives will be upon the prospects for the introduction of a national United Kingdom formularly for drugs.
Mr. Mellor : We have no plans to introduce a national formulary. We do however wish to see the continued development of voluntary, local formularies as part of the effort by doctors to achieve more effective and economic prescribing. Such formularies will not be affected by the European Community directives.
Modern Drugs
Mr. Gale : To ask the Secretary of State for Health when his Department last carried out cost/benefit studies on the potential savings to be made through the greater use of modern drugs instead of expensive hospital care ; and what conclusions he has drawn from those studies.
Mr. Mellor : The Department has not itself commissioned any such research, but we are aware of some useful studies on this topic.
Generic Medicines
Mr. Gale : To ask the Secretary of State for Health what proposals he intends to make to increase the information available to general practitioners through improvements to the labelling of generic medicines.
Mr. Mellor : The information put on medicine labels is that essential to tell patients how to use their medicines.
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Since most GPs never see labels, they are not generally a practicable way to provide doctors with information about drugs.Kidney Donor Cards
Mr. Alfred Morris : To ask the Secretary of State for Health what is his current advice concerning the advisability of people in HIV high risk groups carrying kidney donor cards ; and if he will list any medical conditions which render carrying such cards inadvisable.
Mr. Mellor : On 2 March 1987 the Department's chief medical officer wrote to all doctors to remind them of the precautions needed to prevent the transmission of HIV through the transplant of infected tissue or organs. He made it clear that it was essential that blood from the donor is tested and found negative for HIV antibodies before the organ or tissue is transplanted and that inquiries should also be made to exclude donors most likely to have been exposed to the AIDS virus. I do not propose at present to issue a list of
contra-indications to organ donation because assessment of the medical suitability of a potential donor is a matter for the doctors concerned, and is undertaken at the time of donation.
Ethnic Minorities
Mr. Cohen : To ask the Secretary of State for Health when he intends to respond to the National Association of Health Authorities ' report entitled "Action Not Words : a Strategy to Improve Health Services for Black and Minority Ethnic Groups ;" if he plans to take any action to encourage implementation of its proposals and guiding principles and objectives by health authorities ; and if he will make a statement.
Mr. Mellor : I refer the hon. Member to my reply to the hon. Members for Brent, South (Mr. Boateng) and for Birmingham, Ladywood (Ms. Short) on 9 February 1989 at columns 800-1.
Hospitals (Site Value)
Ms. Harman : To ask the Secretary of State for Health what is the most recently calculated site value for each of the hospitals with over 250 beds.
Mr. Freeman : The valuation of the NHS estate does not provide site values in terms of bed numbers and to obtain the information by a special exercise would incur disproportionate cost.
Hormone Replacement Therapy
Mr. Michael Morris : To ask the Secretary of State for Health what advice he has received on the use of hormone replacement therapy for the prevention of stroke and fractures of the femur in elderly women National Health Service patients.
Mr. Freeman : I am advised that hormone replacement therapy (HRT) prevents bone loss in post-menopausal women and therefore reduces the risk of fractures. There is also evidence that HRT may provide additional protection against heart disease and strokes. Since there may be risks as well as benefits of such treatment for some people, the individual patient's suitability for HRT should be a matter for the clinical judgment of their doctor. The Medical Research Council has set up a specialist group to look at the further research required into HRT.
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Glaucoma
Mr. Michael Morris : To ask the Secretary of State for Health what advice he has received from his Department's consultant adviser on ophthalmology on screening programmes for the early detection of glaucoma in National Health Service patients.
Mr. Freeman : Any advice given to the consultant adviser to the chief medical officer is confidential.
Cancer Screening
Mr. Michael Morris : To ask the Secretary of State for Health what measures he proposes to introduce to encourage family doctors to screen National Health Service patients for cervical and breast cancers.
Mr. Freeman : Guidance to health authorities on cervical cancer screening was contained in HC(88)1 of January 1988. Breast cancer screening was covered by draft circular DA(87)14 of March 1987 and the letter EL(88)P/48 of April 1988. Copies of these are in the Library.
The cervical cancer screening service is provided largely through GPs, whereas breast cancer screening is available through static centres and mobile units provided by health authorities. In both programmes GPs are involved in the issuing of invitations to eligible women.
To encourage GPs to achieve higher levels of cover, the item of service payment for cervical cancer screening is to be replaced by target payments. Such payments will be made for achieving or helping to achieve (for example with the family planning clinic) cover of 80 per cent. of the relevant practice population. By this means we believe that a significant increase will be achieved in the numbers of women screened and therefore in the numbers of cases of early detection and successful treatment of conditions which otherwise might have developed into cervical cancer.
In the case of breast cancer screening we would expect GPs to be involved in discussions on arrangements for the follow-up and treatment of any of their patients who have screen-detected abnormalities. Resource material for primary care teams, including a practical guide for GPs, has been developed by the Cancer Research Campaign. These information packs are being distributed free of charge to every GP practice in the country three months prior to eligible women in the practice being invited for screening.
Health Screening
Mr. Michael Morris : To ask the Secretary of State for Health (1) what measures his Department proposes as a follow-up to the "Look After Your Heart!" campaign ; and if he proposes to ask all family doctors to undertake screening programmes among National Health Service patients to detect and treat risk factors for coronary artery disease ;
(2) what measures his Department is planning to encourage family doctors to undertake screening programmes to detect patients requiring treatment for mild to moderate hypertension.
Mr. Mellor : The "Look After Your Heart!" campaign is a continuing one with two main aims. First, to raise awareness of the risk factors associated with coronary
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heart disease. Secondly, to help people make the necessary lifestyle changes in key areas such as nutrition, smoking, alcohol consumption and exercise. Work continues on both fronts. Under changes to general practitioners' terms of service proposed in the document "A New Contract" which was sent to all GPs on 23 February, it will be a requirement that GPs offer patients regular check-ups. These check-ups will include measurement of blood pressure. We believe that this important development will provide an opportunity for GPs to advise patients, particularly those at risk, of measures to avoid developing high blood pressure. Whenever hypertension is identified they will be able at an early stage to take whatever action is appropriate to control the situation. We have also asked the standing medical advisory committee to advise on the cost-effectiveness of wider cholesterol testing in the prevention and treatment of heart disease.Mr. Michael Morris : To ask the Secretary of State for Health what measures his Department proposes to encourage special screening and treatment programmes to detect and treat National Health Service patients suffering from diabetes mellitus.
Mr. Freeman : Provisions of screening and treatment programmes for National Health Service patients suffering from diabetes mellitus is a matter for individual health authorities. Under changes to general practitioner terms of service proposed in the document "A New Contract", which was sent to all general practitioners on 23 February, it will be a requirement that general practitioners offer patients regular check ups. These check ups will include a urine test which, amongst other things, will provide an indication of whether further investigations are necessary to determine whether or not a patient is suffering from diabetes mellitus. The early identification of disease is an essential part of the package of changes to general practice set out in the White Paper "Promoting Better Health".
Cook-chill Food
Mr. Hinchliffe : To ask the Secretary of State for Health (1), pursuant to his answer to the hon. Member for Wakefield on 7 April, Official Report, columns 303-4, if he will give the reference for the press reports on cook-chill food which he refers to as biased and inaccurate ;
(2) if, pursuant to his answer to the hon. Member for Wakefield on 7 April, Official Report, columns 303-4, he will seek a report from the Wakefield district health authority as to when it received representations from the hon. Member for Wakefield and which representations did not relate to cook- chill food at Clayton hospital.
Mr. Kenneth Clarke : It is for the district health authority to follow up local complaints. But my hon. Friend the Parliamentary Under- Secretary of State for Health is writing to the hon. Member about his request for cook-chill to be suspended, and he will enclose with that letter a copy of the article referred to and a copy of the unit general manager's subsequent letter to the editor of the newspaper concerned setting out the true position.
Residential Care
Mr. Hinchliffe : To ask the Secretary of State for Health what is his policy on the installation of electronic monitoring equipment in residential homes for the elderly.
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Mr. Mellor : The installation of such equipment is a matter for the local authority concerned together with the proprietors of independent sector homes. We would hope that any equipment installed would be consistent with the human dignity of residents, a homely atmosphere and the necessary human contact betwen residents and staff.
Mr. Hinchliffe : To ask the Secretary of State for Health if it is his intention to introduce a system of care tests to ensure that elderly persons do not enter residential care unnecessarily.
Mr. Mellor : We are considering the case for introducing a system for assessment of need for residential care as part of our wider examination of community care following Sir Roy Griffiths' report. We hope to be able to bring forward our proposals on community care in the near future.
Foster Parents
Mr. Hinchliffe : To ask the Secretary of State for Health what guidance he has issued to local authorities and voluntary organisations regarding insurance procedures for foster parents.
Mr. Mellor : Regulation 3 of the Boarding Out of Children (Foster Placement) Regulations requires local authorities and voluntary organisations to include with notices of approval to foster parents information on the agency's arrangements for meeting any legal liabilities of a foster parent arising by reason of the placement. The regulations come into force on 1 June 1989. The accompanying handbook of guidance suggests a number of different arrangements for meeting claims by or against foster parents in respect of damage, loss or injury or legal defence costs.
Apnoea
Sir Michael McNair-Wilson : To ask the Secretary of State for Health how the condition known as apnoea is categorised.
Mr. Freeman : Apnoea simply means without breath. It can be normal, as with deglutition apnoea which occurs in swallowing, or abnormal, as a result of a number of medical conditions. It may occur on a temporary basis as a consequence of treatment, for example during the administration of an anaesthetic.
Birmingham Family Practitioner Committee
Mr. Terry Davis : To ask the Secretary of State for Health when he received a request from the Birmingham family practitioner committee to approve an out-of-time investigation into allegations involving one or more doctors in Birmingham, following an article in The Sunday Times on 22 November 1987 ; how many doctors are the subject of this request ; and what reply has been sent to the Birmingham family practitioner committee.
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