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Mr. Kenneth Clarke : When district health authorities place contracts, they will be expected to give effect to the referral patterns which local GPs want. They will need to consult closely with their GPs, therefore, in order to agree a range of contracts which make best use of their resources to secure the best services for their residents. As a result, local GPs will be much more closely involved in planning health care for their patients than at present. GPs will also have their freedom to refer increased, because for the first time they will be able to refer patients for NHS treatment in private hospitals. DHAs will be much better placed to take advantage of GPs' knowledge of their patients' needs.
GP practice budget holders will of course have their freedom to refer increased because they will be able to negotiate their own preferred pattern of referral with hospitals and units using the taxpayers money at their disposal.
31. Mr. Arbuthnot : To ask the Secretary of State for Health what progress is being made on the implementation of the proposals in the White Paper, "Working for Patients".
Mr. Mellor : We are pleased to be able to say that good progress is being made on the implementation of our proposals for the Health Service. Consultation is taking place with a great many interested parties, including those
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representing medical opinion, and we are working with NHS managers to ensure smooth implementation. Progress includes :receipt of 178 expressions of interest in self-governance from hospitals and other NHS services ;
publication of an initial guide on self-governing hospitals which has provided much more information about how self governing hospitals will operate ;
the establishment of the new NHS management executive and the NHS policy board ;
a major initiative to improve the quality of service is now under way ;
publication of a further working paper on the capital charging system ;
the first 56 hospitals are now in the process of installing new information systems ;
shortlisting for 90 FPC general manager posts is virtually complete and a number of appointments have already been made.
medical audit systems are being developed at a cost of £2 million this year ; and
bids for the 100 extra consultant posts promised in the White Paper are due at the end of July.
40. Mr. Stevens : To ask the Secretary of State for Health how education and training will be affected by the proposals in the White Paper, "Working for Patients".
54. Mr. Carrington : To ask the Secretary of State for Health what are the implications of the White Paper, "Working for Patients", for education and training.
Mr. Mellor : Since the White Paper "Working for Patients" was published, a number of working papers have been issued and these contain some further detail about training and education. The working paper, "Self- Governing Hospitals--An Initial Guide", advises that a consultation paper on training and education will be issued shortly, which will deal fully with these important issues.
65. Mr. Pawsey : To ask the Secretary of State for Health what representations he has received directly from members of the public about the reforms of the National Health Service.
Mr. Mellor : We have received more than 5,000 representations directly from members of the public in respect of our proposals for the Health Service.
Nurses
15. Mr. Andrew Mitchell : To ask the Secretary of State for Health what is the number of nurses in the National Health Service at present; and what it was in 1979.
Mr. Mellor : Provisional figures show that at 30 September 1988 there were 404,000 whole-time equivalent nursing and midwifery staff (including agency staff) in the National Health Service in England. The comparable figure for September 1979 is 358,000 whole-time equivalents.
27. Mr. Hood : To ask the Secretary of State for Health if he will make a statement on the progress of appeals by nurses with regard to regradings.
70. Mr. Meale : To ask the Secretary of State for Health if he will make a statement on the progress of appeals by nurses with regard to regradings.
83. Mr. Martyn Jones : To ask the Secretary of State for Health if he will make a statement on the progress of appeals by nurses with regard to regradings.
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Mr. Freeman : I refer the hon. Members to my reply to the hon. Member for Dundee, West (Mr. Ross) earlier today.
General Practitioners (Contract)
16. Mr. Fearn : To ask the Secretary of State for Health what recent representations he has received about the new contract for general practitioners.
17. Mr. Kirkwood : To ask the Secretary of State for Health if he will make a further statement on the proposed contract for general practitioners.
Mr. Kenneth Clarke : I met Mr. Michael Wilson and his negotiating team from the General Medical Services Committee yesterday. The Government are proceeding with the preparation of the necessary amendments to regulations and to the GPs' statement of fees and allowances. Subject to Parliament's approval, the reforms to the GPs' contract will be introduced on 1 April 1990.
33. Mr. Henderson : To ask the Secretary of State for Health when he will next be meeting the chairman of the British Medical Association to discuss progress on negotiations over the general practitioners' contract.
57. Mr. Redmond : To ask the Secretary of State for Health when he will next be meeting the chairman of the British Medical Association to discuss progress on negotiations over the general practitioners' contract.
85. Mr. John Hughes : To ask the Secretary of State for Health when he will next be meeting the chairman of the British Medical Association to discuss progress on negotiations over the general practitioners' contract.
88. Mr. Caborn : To ask the Secretary of State for Health when he will next be meeting the chairman of the British Medical Association to discuss progress on negotiations over the general practitioners' contract.
Mr. Kenneth Clarke : I have no plans at present to meet the chairman of the British Medical Association on this subject, but I met the chairman of the General Medical Services Committee and his negotiating team on 24 July.
34. Mr. Irvine : To ask the Secretary of State for Health how the new general practitioners' contract will affect health promotion clinics and regular check-ups.
Mr. Mellor : The new contract will for the first time introduce a fee for GPs providing health promotion clinics. It will also require GPs to offer health check-ups to patients newly registering with them, and patients who have not seen their GP for three years.
41. Mr. Janman : To ask the Secretary of State for Health how the new general practitioners' contract will affect the performance of minor surgery by general practitioners.
89. Mr. Jacques Arnold : To ask the Secretary of State for Health to what extent general practitioners will be able to carry out minor surgery under the terms of the new general practitioners' contract.
Mr. Mellor : The new contract will for the first time introduce a fee for suitably qualified GPs who provide
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minor surgery services to patients. This will encourage the provision of minor surgery by GPs and relieve the pressure on out-patient departments.45. Mr. Conway : To ask the Secretary of State for Health what are the implications in the new general practitioners' contract for the assessment of the health care of young children.
Mr. Mellor : The new contract will for the first time introduce a fee for GPs who provide child health surveillance services to children on their lists, according to programmes agreed by the district health authority. There will also be new incentives to encourage GPs to help achieve high levels of coverage for childhood immunisations. District health authorities will continue to be responsible for monitoring health care services for young children, and GPs will be required to keep them fully informed of the services they provide. DHAs will work in close co- operation with family practitioner committees.
47. Mr. Anthony Coombs : To ask the Secretary of State for Health what are the implications of the new general practitioners' contract for immunisation and screening policies.
Mr. Mellor : By introducing new payments linked to the achievement of specified levels of coverage for childhood immunisation and cervical cytology, the new contract will offer GPs a powerful incentive to help raise coverage among their patients.
48. Mr. Curry : To ask the Secretary of State for Health how health care in deprived areas will be affected by the new general practitioners' contract.
60. Mr. Maples : To ask the Secretary of State for Health what will be the implications of the new general practitioners' contract for services in deprived areas.
Mr. Mellor : The new contract will help improve services in deprived areas. Changes to their remuneration system will encourage GPs to practise in areas of deprivation by recognising the special circumstances involved. In future family practitioner committees will be able to target funds for premises improvements and practice team expansion to improve services in these areas. The greater emphasis in the new contract on preventive care will mean that patients in deprived areas will benefit as GPs seek to improve the levels of protection against childhood diseases and cancer of the cervix.
67. Mr. John Greenway : To ask the Secretary of State for Health what are the implications of the new general practitioners' contract for health care for elderly patients.
79. Mr. Hannam : To ask the Secretary of State for Health how the new general practitioners' contract will affect health care for elderly patients.
Mr. Mellor : The new contract will lead to improved services to elderly people. As a result of changes to their terms of service and remuneration system GPs will have a powerful incentive to strive to provide them with the best possible care. There will be a significantly increased capitation free for patients over the age of 75, and in return for this GPs will be expected to offer annually a thorough health assessment, including a home visit if the patient wishes.
68. Mr. McLoughlin : To ask the Secretary of State for Health how the new general practitioners' contract will affect preventive health care.
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71. Dr. Goodson-Wickes : To ask the Secretary of State for Health if he will give details of how the new general practitioners' contract will affect preventive health care.
Mr. Mellor : The new contract forms an important part of our policy of encouraging health promotion and the prevention of ill-health. General practitioners' terms of service will make clear their role in these areas, and there will be new payments encouraging the provision of health promotion clinics, check-ups for newly registered patients and the achievement of high levels of coverage for cervical cancer screening and childhood immunisations.
90. Mr. Nicholas Baker : To ask the Secretary of State for Health what are the implications of the new general practitioners' contract for night visits by doctors.
Mr. Mellor : The hours during which a night visit fee may be claimed will be extended and a higher fee introduced for GPs who make their own visits or who arrange visits in a small rota of no more than 10 doctors. This will reward those doctors who ensure continuity of care to their patients during out-of-hours periods.
Hospices
18. Mr. Ian Taylor : To ask the Secretary of State for Health how much was provided by the Government in 1988-89 in grant to Help the Hospices.
Mr. Mellor : The Department made a grant of £400,000 on 9 March 1989 to Help the Hospices for distribution to local projects in short-term financial difficulty.
92. Mr. Ashley : To ask the Secretary of State for Health what has been the cost and nature of the support given by his Department to the hospice movement.
Mr. Mellor : During 1988-89 the Government made an additional £1.3 million available to health authorities to distribute as a contribution to the costs incurred by voluntary hospices due to the nurses' pay award. It also made a grant of £400,000 to Help the Hospices for distribution to local projects in short-term financial difficulty. In addition, the Government provided separate funding for the AIDS hospices at the Mildmay hospital and London Lighthouse, £256,000 and £208,000 respectively. The bulk of NHS support for hospices comes from local health authorities, which are best placed to judge how the contribution of voluntary bodies can be integrated with the other services for which they are responsible.
Smoking
20. Mr. Adley : To ask the Secretary of State for Health what recent representations he has received about smoking.
Mr. Freeman : I receive a number of representations on this important subject, from a range of interested bodies.
Mr. Jack : To ask the Secretary of State for Health when he will publish the results of the 1988 Office of Population Censuses and Surveys survey of teenage smoking ; and if he will make a statement.
Mr. Mellor : The results of this survey were published yesterday in an Office of Population Censuses and Surveys report entitled "Smoking among secondary school children in England in 1988" [ISBN 0 11 691267 7]. Copies have been placed in the Library.
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The results of the survey show that the decline in teenage smoking revealed by the 1986 survey has been confirmed, and there is evidence of a further decline in 1988. The prevalence of regular smoking among teenagers aged 11-15 is estimated at 7 per cent. for boys and 9 per cent. for girls. This is well below the level of 13 per cent. for both boys and girls seen in 1984. The results of this survey will be of great value in helping to determine the precise strategy to be used in the new teenage smoking campaign announced by the Prime Minister in January. This should encourage health workers, teachers and parents to continue their worthwhile efforts to persuade young people not to take up this dangerous habit.Eye Tests
21. Mr. Robert Hughes : To ask the Secretary of State for Health if he will make a statement on monitoring of the take-up of eye tests.
24. Mr. Allen Adams : To ask the Secretary of State for Health if he will make a statement on monitoring of the take up of eye tests.
30. Mr. Callaghan : To ask the Secretary of State for Health if he will make a statement on monitoring of the take-up of eye tests.
35. Mr. Allen McKay : To ask the Secretary of State for Health if he will make a statement on the monitoring of the take-up of eye tests.
Mr. Mellor : We intend to carry out a survey into the number of private sight tests later this year when the market has had time to become more stable.
NHS (Scientists)
22. Mr. Wray : To ask the Secretary of State for Health what urgent measures he is taking in order to solve the problems of recruitment and retention of scientists in the National Health Service.
Mr. Mellor : We understand that the management side of the Scientific and Professional Staffs Council has set up a working party to investigate the recruitment and retention of scientists in the NHS and is currently considering its findings.
Hospital Doctors
23. Mr. David Martin : To ask the Secretary of State for Health what progress has been made on initiatives to reduce junior hospital doctors' hours.
39. Mr. Kirkhope : To ask the Secretary of State for Health if he will make a statement on initiatives to reduce the hours worked by junior hospital doctors.
51. Mr. Brandon-Bravo : To ask the Secretary of State for Health what steps have been taken to reduce the hours worked by junior hospital doctors.
Mr. Mellor : The Government are committed to reducing further the onerous hours of some junior hospital doctors. There are two current initiatives. That launched in June 1988 aims to minimise the number of doctors with average weekly hours of duty in excess of 84. Interim reports from health authorities in January showed
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progress had been made but more needed to be done. The second initiative was launched earlier this month and involves studies to see whether the Government's long-term aim of 72 hours duty a week can be achieved within existing constraints. Final reports on both initiatives are due in October.74. Mr. Riddick : To ask the Secretary of State for Health what is the number of hospital doctors in the National Health Service now ; and what it was in 1979.
Mr. Mellor : The information is in the table :
Figures, for England only, as at 30
September
|1979 |1987
--------------------------------------------
Hospital medical staff |41,736|46,394
No-fault Compensation
26. Mr. Cran : To ask the Secretary of State for Health what is his Department's policy on the introduction of a no-fault compensation system for high-risk medical practitioners.
Mr. Mellor : The Department has no plans to introduce any kind of no -fault compensation scheme for medical practitioners. We consider that the basis for seeking compensation for injuries alleged to have been suffered as a result of medical negligence should continue to be through litigation in the courts.
British Medical Association
28. Mr. Yeo : To ask the Secretary of State for Health when he last met the British Medical Association ; and what subjects were discussed.
38. Mr. Latham : To ask the Secretary of State for Health whether he will make a statement on his latest discussions with the British Medical Association regarding the White Paper, "Working for Patients."
Mr. Kenneth Clarke : I last met the British Medical Association on 15 June when we talked about the Government's proposals for the Health Service. Although the BMA expressed opposition to some of the proposals, they continued to support a number of our planned reforms including medical audit, the principle of money following the patient, the extension of resource management and the greater involvement of doctors in management. Both sides expressed their unconditional support to the underlying principles of the Health Service.
64. Mr. Dykes : To ask the Secretary of State for Health if he is now able to give an assessment of the current relations between his Department and the doctors within the British Medical Association membership.
Mr. Kenneth Clarke : Although I very much regret the hostile and unconstructive stance that the BMA as an association has taken towards our plans for the Health Service, I know that there is strong support for the principles on which our reforms for the Health Service are based and for many of our individual proposals among doctors in the hospital service and in general practice.
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Hospitals (Self-governing Status)
29. Mr. Madden : To ask the Secretary of State for Health how public opinion is to be tested in Bradford over proposals for local hospitals to become self-governing trusts ; and if he will make a statement.
84. Mr. Tony Lloyd : To ask the Secretary of State for Health what guidance he is issuing to health authority on arrangements for public consultation where groups have expressed an interest in pursuing the opting out of individual hospitals.
Mr. Mellor : I refer the hon. Members to the reply that my right hon. and learned Friend gave to the hon. Member for Halifax (Mrs. Mahon) earlier today.
Hospital Patients (Discharge)
32. Mr. Andrew Bowden : To ask the Secretary of State for Health what steps he is taking to ensure that health authorities adopt the hospital discharge practices outlined in circular HC (89) 5, "Discharge of Patients from Hospital".
Mr. Freeman : Circular HC(89)5 states that, in the light of the guidance held in the circular, district and special health authorities should report on action taken to their regional health authority or, in the case of special health authorities, to the Department by 31 March 1990.
Hospitals (West Midlands)
36. Ms. Short : To ask the Secretary of State for Health whether he has had any discussions with Sir James Ackers about his plans to redevelop the hospital system in the west midlands.
Mr Mellor : Yes, recent discussions have covered hospital services in Birmingham, for which the region has made proposals for reorganisation which are currently the subject of preliminary local consultation.
Wheelchairs (Leicestershire)
37. Mr. Vaz : To ask the Secretary of State for Health if he will make a statement on the provision of wheelchairs by the Leicestershire health authority.
Mr. Mellor : Provision of wheelchairs is a matter for the district health authority concerned and the hon. Member may care to contact the chairman of Leicestershire health authority for the information that he seeks.
Midwives (Grading)
42. Mr. Cox : To ask the Secretary of State for Health what has been the number of settlements in the midwives' regrading dispute ; and if he will make a statement.
Mr. Mellor : We do not collect this information centrally.
Doctors (Northern Region)
43. Mr. Devlin : To ask the Secretary of State for Health when he last met doctors in the northern region ; and what matters were discussed.
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