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Patients treated, NHS hospitals, Bury district health authority, 1979 and 1987-88 |1979 |1987-88 |Percentage increase --------------------------------------------------------------------------------------------------------- In-patient cases treated |17,768 |23,130 |30.2 Day cases |1,621 |2,421 |49.4 New out-patients |22,474 |24,589 |9.4 Total out-patient attendances 99,889 109,596 9.7 Source: Returns: SH3 (1979 data), SH3a, KH09 and KH18.
Mr. Mellor : The booklet "Comparing Health Authorities" published by the Department in April 1988, copies of which are in the Library, gave examples of some of the conclusions drawn from work on analysing performance indicators. These include :
Cost per case for acute in-patient care : Even when standardised for specialty mix and the costs of teaching hospitals and London, this Indicator in 1986-87 showed that costs in some districts are more than 15 per cent. higher or lower than might be expected. Length of stay : The Indicator for average length of stay in general surgery in 1986-87, standardised for age, sex and clinical condition, showed figures in some districts over 40 per cent. more than the national figure and in others more than 30 per cent. less. There are similar variations for other specialties.
Throughput : Throughput for general surgery in 1986-87 standardised for age, sex and diagnosis was in some districts over 40 per cent. higher than the national average and in others over 30 per cent. lower than the national average. There are similar variations in other specialties.
These show marked scope for improvements in performance by significant parts of the service.
Column 667important in review cycles establishing a key role in addressing variations in performance. Last year districts were asked to carry out an analysis of the four-year trend in their indicators and to report to their authority members. This underlined the role of indicators in the monitoring and management of services at the local level. Research completed in 1987 showed widespread acceptance and use of the indicators by all levels of Health Service management.
Mr. Amess : To ask the Secretary of State for Health how many conceptions in 1986, 1987 and 1988 (a) led to maternities, (b) were terminated under the terms of the Abortion Act 1967 among residents of England and Wales aged 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21 years, 22 to 24 years, 25 to 29 years, 30 to 34 years, 35 to 39 years and 40 years and over ; and what percentage (a) represents of (b) .
Mr. Freeman : Some conceptions occurring in 1988 would lead to maternities in 1989 and this information is not yet available. Data for 1986 and provisional data for 1987 are as follows. All pregnancies of women usually resident in England and Wales which led to a maternity or termination by abortion under the 1967 Act are included (and those which led to a spontaneous abortion are excluded).
Age of woman at Number of conceptions Maternities per 100 conception abortions |Leading to maternities |Terminated by abortion<1> ---------------------------------------------------------------------------------------------------------------------------------- 1986 All ages |671,259 |147,658 |455 Under 11 |2 |0 11 |1 |0 |70 12 |10 |14 13 |107 |158 14 |809 |1,171 |69 15 |3,293 |3,629 |91 16 |8,933 |6,492 |138 17 |16,101 |8,675 |186 18 |22,456 |9,721 |231 19 |27,419 |9,786 |280 20 |32,348 |10,028 |323 21 |37,767 |9,882 |382 22-24 |138,241 |24,865 |556 25-29 |225,557 |28,242 |799 30-34 |115,352 |17,672 |653 35-39 |37,503 |12,763 |294 40 and over |5,360 |4,560 |118 1987 All ages |689,452 |160,948 |428 Under 11 |1 |1 11 |2 |2 |72 12 |16 |13 13 |126 |185 14 |736 |1,163 |63 15 |3,304 |3,586 |92 16 |9,415 |7,097 |133 17 |15,915 |8,894 |179 18 |23,114 |10,534 |219 19 |27,911 |11,137 |251 20 |32,808 |10,904 |301 21 |38,046 |10,778 |353 22-24 |140,590 |28,750 |489 25-29 |233,178 |31,468 |741 30-34 |120,131 |18,910 |635 35-39 |38,186 |12,601 |303 40 and over |5,973 |4,925 |121 <1> Legal terminations under 1967 Abortion Act. Note: 1987 data are provisional.
Mr. Mellor : We have received a large number of representations in respect of the NHS White Paper plans for indicative drug budgets. These have come from a wide range of members of the community including GPs, community health councils, pharmaceutical companies, bodies representing patients suffering from chronic illness and members of the public. In response we have been able to provide unequivocal reassurances that indicative drug budgets will enable patients to receive all the drugs they require, that there will be no disincentive to GPs to accept patients requiring expensive courses of drug treatment and that there will be no change to the range or quality of appliances available to patients nor to the existing arrangements for certain categories of patients to receive free prescriptions.
66. Mr. Roger King : To ask the Secretary of State for Health what was the percentage reduction in the number of patients waiting longer than 12 months for an operation in the South Birmingham health authority area in the last year for which figures are available.
Mr. Mellor : Between September 1987 and September 1988 there was a 48 per cent. reduction in the number of patients waiting more than a year for treatment in the surgical specialties in the South Birmingham health authority.
Mr. Freeman : I refer the hon. Member to the statement that my right hon. and learned Friend the Secretary of State for Health made to the House on community care on 12 July 1989, and to the written answer that I gave to my hon. Friend the Member for Eddisbury (Mr. Goodlad) on 13 July at columns 620-25.
Mr. Mellor : On 28 June the NHS management executive and the NHS training authority launched a strategy for training Health Service staff in information management and technology. As part of this launch, we announced a programme of 20 centrally funded projects worth £4 million to develop training courses and material in support of health authorities' implementation of the strategy.
The importance of training cannot be overemphasised. The NHS is becoming increasingly dependent upon accurate and timely information for the effective and efficient management of health services, both in the acute sector and in the community. This will inevitably mean larger numbers of more powerful computer-based information systems. The people who design and run the systems, those who put the data in and those who interpret and use the information they provide must all be trained if they are to do their jobs properly. The strategy will provide a very useful framework within which Health Authorities can make the arrangements that best suit their local needs.
Mr. Jack : To ask the Secretary of State for Health how many general practitioners were under contract to the National Health Service in 1979 ; how much this cost ; and what were the comparable figures in 1988.
f Year on 31 October |1979 |1987 |<1>1988 ------------------------------------------------------------------------------------------------------ Number of unrestricted principals<2> |21,357 |24,992 |25,322 Cost of general medical services<3> (£ million) |468 |125 |1,402 <1>Provisional. <2>Doctors in contract with FPCs in England to provide unrestricted services. <3>Cost of the general medical services in England, excluding the cost of drugs and appliances prescribed by GPs and the administrative costs, for years 1979-80, 1987-88 and (provisional) 1988-89.
Mr. Freeman : An expert group which recently reviewed the cook-chill guidelines concluded that, provided the guidelines are followed, food produced by the cook-chill method is as nutritious as food produced by conventional catering. Regional and district health authorities are responsible for monitoring hospital catering services.
Mr. Mellor : Appointment to consultant posts is made on the advice of advisory appointments committees. Appointments are normally made from the senior registrar grade. In 1987 there were 3,215 senior registrars in the hospital service in England, of whom 500 had been in the grade for four years or more.
Column 671number of topics discussed when my right hon. and learned Friend the Secretary of State met the TUC health services committee on 1 March 1989.
91. Mr. Hardy : To ask the Secretary of State for Health if he is satisfied that the resources available to the Trent regional health authority are sufficient to meet the needs of areas like that served by the Rotherham health authority.
Mr. Freeman : This year Trent regional health authority received a real terms increase in funding of 2.9 per cent.--higher than the national average increase of 2.7 per cent. The region subsequently received additional moneys to help meet the cost of the review body awards (£9.6 million) and NHS review implementation (£2.5 million). Allocation of funds to individual district health authorities is a matter for the regional health authority.
Mr. Freeman : The provision and funding of direct client services for drug misusers is the responsibility of the local statutory authorities and the Government have also provided them with special earmarked funds for drug services. However, under the central funding initiative set up by the Department in 1983 to pump-prime community-based services for drug misusers, Phoenix House received grants totalling over £1.1 million. Each grant was for a period of three years. In each of the years referred to by the hon. Member Phoenix House received the following amounts in support of its local residential rehabilitation facilities :--
|£ ------------------------ 1985-86 |135,055 1986-87 |404,276 1987-88 |309,234 1988-89 |59,000
I understand that Phoenix House has also received support from Home Office funds.
Mr. Cohen : To ask the Secretary of State for Health what is the cash limit for the disablement services centre for 1989-90 ; what number of artificial limbs this was estimated to cover ; how many have been produced since the beginning of the financial year to the latest available date ; what contingency plans exist for continued production in the event of demand for these limbs outstripping expected quotas ; and if he will make a statement.
Mr. Mellor : The cash limit for the Disablement Services Authority for 1989-90 is £94.231 million. The authority is required to keep its total spending, of which expenditure on artificial limbs is a part, within this figure. Questions about the detail of its spending should be addressed to the authority.
Mr. Mellor : The Single European Act (SEA) commits the European Community to the aim of progressively establishing a single market by the end of 1992. The provision of health care is not directly affected by the SEA and remains a domestic matter. There are however a number of proposals concerned with the free movement of goods, services and people throughout the Community, which may have an indirect effect on health. The main areas affected by European Community legislation and legislative processes are pharmaceuticals, medical equipment, tobacco products and the mutual recognition of professional qualifications.
Mr. Fearn : To ask the Secretary of State for Health whether he has requested an evaluation of the performance of the cyclotron machine at Clatterbridge hospital, the Wirral ; and if he will make a statement.
Sir David Price : To ask the Secretary of State for Health what is his latest estimate of the number of people in England and Wales infected by dog-related toxocariasis ; and how serious he estimates the threat of this disease to be to human beings.
Mr. Freeman : The provisional number of laboratory reports in 1988 from England, Wales and (all) Ireland to the Public Health Laboratory Service's communicable disease surveillance centre is 54. The seriousness of toxocariasis varies from mild pulmonary symptoms and fever to permanent loss of vision.
Mr. Ieuan Wyn Jones : To ask the Secretary of State for Health what guidelines his Department has given to regional and district health authorities about risk-taking policies becoming part of the format for developing community services for people with a mental handicap.
Mr. Freeman : None. However, in respect of general provision for those with a mental handicap, "Needs and Responses" published in June 1989 draws attention to the need for all agencies participating in the provision of care for those with special needs to have jointly agreed guidelines on risk taking. A copy is in the Library.
Mr. Allen : To ask the Secretary of State for Health how many National Health Service patients have been identified to have died because of delays in receiving radiotherapy doses due to (a) shortages of hospital physicists and (b) other causes.
Mr. Mellor : At 30 September 1987 there were 790 (whole-time equivalents) physicists employed in the NHS in England ; the role of the medical physicist is very varied and the specific duties will depend on an individual's contract with his/her employing authority ; the salary scales are as follows :
Pay scales as at 1 April 1988 1988-89 £ ---------------------------------------------- Probationer-lower qualification 7,378 7,949 8,255 8,548 8,866 9,158 9,452 9,770 Probationer-higher qualification 8,255 8,548 8,866 9,158 9,452 9,770 10,063 10,369 Basic 8,548 8,866 9,158 9,452 9,770 10,063 10,568 11,073 Senior 11,778 12,163 12,814 13,440 14,091 14,742 15,394 Principal 15,180 15,899 16,630 17,347 18,078 18,810 19,527 20,258 20,989 Top grade 21,136 21,893 23,090 24,193 25,297 Top grade-with greater responsibility 23,914 24,672 25,869 26,971 28,088
Negotiations on a pay increase from 1 April 1989 are still continuing and an interim offer of 5 per cent. has been made.
Bound volumes will shortly be placed in the Libraries containing the 1988 reports of the Medicines Commission, the Committee on Safety of Medicines, the Veterinary Products Committee, the British Pharmacopoeia Commission, the Commitee on the Review of Medicines and the Committee on Dental and Surgical Materials. The bound volumes include a record of the personal and non-personal interests in the pharmaceutical industry of members of these advisory bodies, with the exception of the Veterinary Products Committee for whom only personal interests are recorded.
I am glad to pay tribute to the valuable work done in the public interest by the distinguished members of the Medicines Act advisory bodies.
Mr. O'Brien : To ask the Secretary of State for Health what consideration has been given to the provision of housing alterations and adaptations for elderly and mentally disabled people being discharged into the community from long-stay hospitals ; and if he will make a statement.
Mr. Freeman : Elderly and mentally disabled people are eligible for assistance for house alterations under the provisions of the Chronically Sick and Disabled Persons Act 1970, and are also eligible for help under the home improvement grant schemes run by local authorities. We would expect health authorities and local authorities to liaise as necessary over any adaptation needed for an eligible patient who is to be discharged.
Mr. Mellor : The Health Service Commissioner has, as in previous years, made a report on the performance of his functions in England, Scotland and Wales. My right hon. and learned Friend the Secretary of State for Scotland and my right hon. Friend the Secretary of State for Wales presented the report to the House on Thursday 13 July. It was published on 13 July (House of Commons Paper No. 457) and copies are available from the Vote Office.
Mr. McLoughlin : To ask the Secretary of State for Health by what percentage the number of midwives working in the National Health Service has increased over the last 10 years ; and by what percentage midwives' pay rates have increased since last year.
Mr. Mellor : There has been a 28 per cent. increase in the number of midwives working in the NHS in England in the 10 years up to September 1987. Midwives' pay rates have increased on average by over 28 per cent. since March last year.
Mr. Sumberg : To ask the Secretary of State for Health if he is now in a position to publish the report of the committee set up last year to review the report of the advisory group on the use of foetal material and foetuses for research ; and if he will make a statement.
Mr. Kenneth Clarke : Together with my right hon. and learned Friend the Secretary of State for Scotland and my right hon. Friend the Secretary of State for Wales I am arranging for the report of the committee to review the guidance on the use of foetal material and foetuses for research (Cm. 762) to be published today. A copy has been placed in the Library. We are most grateful to the Rev. Dr. John Polkinghorne, FRS and his committee for producing their report on this complex and sensitive matter in just over a year.
The Government accept the Committee's main recommendations which are that :
The use in research of foetuses showing signs of life is no longer in general to be permitted (the Peel code permitted this in certain circumstances);
The mother's consent to the use of foetal tissue for research of therapy is required;
The mother's consent for such purposes should not be sought until she has given her consent to the termination of pregnancy. She should not be informed of the specific use which may be made of foetal tissue, lest this may influence her decision to have her pregnancy terminated;
The Government should begin negotiations with the Medical Research Council and relevant professional bodies with a view to setting up an intermediary body which would receive tissue for research or therapy from centres willing to provide it. Those wishing to undertake research or therapy involving foetal tissue would obtain it from this intermediary. The committee's recommendation is founded on the principle of keeping the practice of abortion separate from the use to which any tissue might be put.
Column 676The principal change proposed by the committee is a substantial revision of the guidance on the use of foetuses for research in the Peel report published in 1972 in the light of subsequent developments including the use of foetal tissue in transplants involving patients suffering from Parkinson's disease. Letters are being sent to all health authorities in Great Britain commending the use of the revised code in the NHS and to all proprietors of private sector facilities approved under section 2 of the Abortion Act 1967.
The Government will actively pursue the other recommendations in the report and in particular will shortly begin discussions with the Medical Research Council and the relevant professional bodies with a view to setting up the intermediary body which the committee recommends should become the sole agency in this country from which those wishing to carry out research or treatment involving the use of foetal tissue should obtain it. The committee recommended that its report should be kept under regular review with the professional bodies concerned. I will arrange for this to be done on a five-yearly basis.
Mr. Jack : To ask the Secretary of State for Health if, pursuant to the reply to the hon. Member for Wyre Forest (Mr. Coombs) on 3 July, Official Report, column 48, he is now able to provide details of the membership of the new Special Hospitals Service Authority.
Mr. Freeman : With the agreement of my right hon. Friend the Secretary of State for the Home Department, we have decided that the authority's membership should reflect the Government's proposals for health authority membership in the White Paper, "Working for Patients". Accordingly, there will be five non-executive members, including the chairman, and four executive members--the chief executive, medical and nursing advisers and a finance director. I am pleased to announce that Dr. Donald Dick, a consultant psychiatrist, a vice-president of the Royal College of Psychiatrists, and former director of the Health Advisory Service, and Mr. James Collier, a business consultant and former deputy secretary in my Department, have accepted my invitation to serve as members of the authority. The names of the two remaining non-executive members will be announced shortly, following further consultation with my right hon. Friend.
The executive members are to be appointed following open competition for the posts in question. The first of these appointments has now been made : Mr. Charles Kaye, currently district general manager, Basingstoke and North Hampshire health authority, will be joining the authority as its chief executive. Arrangements for the selection of the authority's other senior managers have been put in hand, and the outcome will be announced in due course. I am also pleased to announce that, as a result of a selection process based on open competition, Dr. Diana Dickens has been appointed general manager, Rampton hospital and Mr. Alan Franey, general manager at Broadmoor hospital. The selection process for the appointment of general manager, Moss Side and Park Lane hospitals, is continuing and, until its completion, interim arrangements are being made for management of those hospitals.