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patients for their patients' lifetimes. After this, the records pass to the local family practitioner committee (FPC) where they are retained for a minimum of three further years. We are currently reviewing these arrangements. Any changes need to be considered carefully, not least because of the resource implications for FPCs of storing records for longer periods.Community Care
Mr. Goodlad : To ask the Secretary of State for Health (1) how many severely mentally ill patients he expects to be discharged from hospital into the community between now and 1991 ; what is the current cost of maintaining them in hospital ; and what is his estimate of the additional cost of looking after them in the community ;
(2) what is his estimate of the additional cost of caring for the severely mentally ill in the community over the cost of caring for them in hospital.
Mr. Freeman : Forecasts of future discharges from hospital of people with a mental illness are not made or collected centrally. The average inpatient cost per day in England for hospitals categorised "mental illness" in 1986-87, the latest year for which information is available, was £44.05 cash, equivalent to £308.35 per week. No comparable information is available centrally about the costs of caring for such patients outside hospital.
Elderly Patients (Collection of Information)
Mr. Kirkwood : To ask the Secretary of State for Health who will own the information collected by general practitioners on the lifestyle and relationships of elderly patients, as will be required by paragraph 11 of appendix B of the new contract document ; whether family practitioner committees or health authorities will be entitled to have access to this information ; and if he will make a statement.
Mr. Mellor : General practitioners collect and maintain information for the purpose of the treatment and care of their patients. Ownership of such information lies with the relevant family practitioner committee. FPCs will be entitled to have access to this information but, in accordance with the Department's policy on confidentiality of medical records, only in exceptional cases. A health circular and guidance for FPCs on the subject of ownership and confidentiality of data will be issued shortly.
Land Development
Mr. Campbell-Savours : To ask the Secretary of State for Health what extent in the proposed land transactions of health authorities with developers to upgrade, purchase and build community facilities for the mentally ill, capital receipts would be offset against regional health authority allocations to district health authorities.
Mr. Freeman : The policy is that district health authorities should benefit from the proceeds of sale of surplus property but the "Handbook on Land Transactions" makes it clear that the closure of hospitals for the mentally ill and mentally handicapped must be preceded by the build-up of comprehensive alternative services covering the whole of the hospital's catchment area. In these cases regional health authorities are required
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to use their discretion as to the districts which are to benefit from sale proceeds within the general requirement to ensure that the proceeds are specifically used for development of services for the client group concerned.Social Care
Mr. Campbell-Savours : To ask the Secretary of State for Health whether he will make a statement on the distinction between social care and health care as referred to in his statement of 12 July, Official Report, columns 975-79.
Mr. Mellor : In relation to community care, health care involves the investigation, diagnosis, treatment and rehabilitation undertaken by a doctor or by other professional staff to whom a doctor has referred the patient. In addition, it includes health promotion and the prevention of ill health.
Social care consists of non-health care and support provided through the supply of goods and services to maintain or establish people in their own homes, or by residential or non-acute nursing home care, as appropriate to individuals' needs.
Health and social care combined form the basis of community care.
Mental Illness (Services)
Mr. Campbell-Savours : To ask the Secretary of State for Health which bodies and individuals he intends to consult in constructing the substantive statement of good practice regarding the minimum acceptable professional standards for assessing patients prior to discharge, and for follow-up after discharge referred to in his answer of 13 July, to the hon. Member for Eddisbury (Mr. Goodlad), Official Report, columns 620-25.
Mr. Freeman : The Royal College of Psychiatrists has been invited to publish a document on good practice for discharge and after-care procedures, following a recommendation (17.24) by the Spokes report (committee of inquiry into the care and after-care of Miss Sharon Campbell), published in July 1988. The college is seeking the views of colleagues in other professions.
Mr. Campbell-Savours : To ask the Secretary of State for Health which bodies and individuals he will be consulting concerning his consideration of the possibility of proposing new legislation for compulsory treatment in the community referred to in his answer of 13 July to the hon. Member for Eddisbury (Mr. Goodlad), Official Report, columns 620-25.
Mr. Freeman : We are awaiting views of the Royal College of Psychiatrists on this issue. If, in the light of the college's views, we believe that it would be appropriate to consider new legislation, we will first consult representatives of health and social services authorities, and other relevant statutory services, appropriate professional associations and voluntary organisations.
Schizophrenia
Mr. Allen : To ask the Secretary of State for Health if he will consider urgently the case for specific grant for training social workers and other local authority staffs in the care of people with schizophrenia, in the light of the Spokes report and his statement to the House on 12 July, Official Report, columns 975-79.
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Mr. Mellor : Special training arrangements already exist for approved social workers working with mentally ill people under the Mental Health Act 1983. We shall keep under review the need for any further training initiatives for social services staff in the light of the future development of community care services.
Residential Homes
Mr. Allen : To ask the Secretary of State for Health whether the Government accept Sir Roy Griffiths recommendation that residential homes with less than four residents should be subject to regulation and inspection.
Mr. Mellor : As my right hon. and learned Friend the Secretary of State said in his statement in the House on 12 July, the Government have concluded that, for the present, existing statutory functions relating to registration and inspection of residential care and nursing homes should remain unaltered.
Performance Indicators
Mr. Amess : To ask the Secretary of State for Health what variations in the performance of health authorities the latest set of Health Service indicators shows.
Mr. Freeman : My hon. Friend will be aware that the booklet "Comparing Health Authorities" published by my Department in April 1988, copies of which are in the Library, illustrated wide variations in a number of aspects of performance. I will be placing in the Library tomorrow a copy of some key indicators for 1987-88. These show that variations remain substantial. For example, within England in 1987-88 for general surgery- urology and for all medical specialties, as in earlier years, the average expenditure per cash and average length of stay varied by a factor of about three. The indicators show wide variations in waiting time. For general surgery in some districts no patients had been waiting for more than a year on 31 March 1988 but in others over one third were in this position. Another indicator showing wide variations is the proportion of cases treated as day cases rather than admitted to hospital which ranges from less than 10 per cent. to over 30 per cent. for general surgery-urology and from less than 5 per cent. to over 20 per cent. for general medicine.
Where there is no apparent good clinical explanation for these variations, and in those places where a high cost per case prevails, local management will need to investigate, particularly where other indicators such as waiting times appear to be poor. This critical examination of performance, as a routine part of managing the service, will be particularly important for all those providing, and all authorities purchasing, services if the changes set out in the White Paper are to be fully effective.
Food Imports
51. Dr. Kim Howells : To ask the Secretary of State for Health what action his Department is taking to ensure the wholesomeness of imported food.
Mr. Mellor : I refer the hon. Member to my reply to the hon. Member for Caerphilly (Mr. Davies) on 18 July at columns 135-36.
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Food Businesses (Register)
52. Miss Emma Nicholson : To ask the Secretary of State for Health, whether he will consider the need for a register of food businesses.
Mr. Freeman : I refer my hon. Friend to the reply I gave to the hon. Member for Southport (Mr. Fearn) on 24 July 1989.
NHS Reform
Mr. Austin Mitchell : To ask the Secretary of State for Health what pricing policy he expects independent National Health Service hospitals to follow under his proposals in the case of operations for which there are long waiting lists everywhere ; and how this will effect the budgets of family doctors.
Mr. Mellor : We expect all hospitals, whether they are self- governing or directly managed by the district health authority, to follow pricing policies which enable them to compete with other hospitals while covering their costs. Length of waiting lists should not have any particular effect on prices, save that for elective treatments district health authorities and GPs with practice budgets will be able to choose from a far wider range of providers than in other cases. Far more significant will be the effect that waiting lists themselves will have on competition between hospitals, since district health authorities and GPs will be seeking to place contracts with those hospitals that offer the best service to patients.
Mr. Cohen : To ask the Secretary of State for Health how many different standard formats of computerised letters his Department has in response to those raising their concerns about Her Majesty's Government's proposals for the future of the Health Service ; and how many in total have been sent out to date.
Mr. Mellor : Many correspondents have raised similar concerns about the proposals and have received similar replies.
Mr. Robin Cook : To ask the Secretary of State for Health if he will place in the Library copies of those of the 8,000
representations on the White Paper, "Working for Patients" which do not come from individiuals.
Mr. Mellor [holding answer 26 July 1989] : By far the majority of the responses are from individuals who have questions or concerns about the White Paper. Many of the major organisations responding to the White Paper or the working papers have already made their responses public. For some the responses form the basis of further discussion, which is still continuing. I see no use in combing through the many responses to see which could be usefully placed in the Library and which are already there.
72. Mr. Robert G. Hughes : To ask the Secretary of State for Health what progress is being made on the quality initiative proposed in the White Paper, "Working for Patients".
Mr. Mellor [holding answer 25 July 1989] : The chief executive wrote to all health authorities last month to establish a programme for quality improvements. A copy of his letter has been placed in the Library. His letter asked
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all authorities to establish a framework for broad, unit-based, quality assurance programmes, including provision this year to cover appointment systems, information to patients, and public areas and reception arrangements. £2 million has also been allocated largely for hospital-related medical audit projects, and we hope to announce a number of national quality demonstration projects soon.AIDS
Mr. Cohen : To ask the Secretary of State for Health how much of the £129.5 million he made available in 1989-90 to the National Health Service for the prevention of HIV infection and the services related to HIV infection and AIDS has been made available to Waltham Forest district health authority ; whether any of the money has gone to substantial upgrading of genito-urinary medicine services in Waltham Forest ; and if he will make a statement.
Mr. Mellor : I am advised that Waltham Forest district health authority received £238,000 from North East Thames regional health authority's allocation of £16,655,000 for the prevention of HIV infection and the services related to HIV infection and AIDS. The district is reviewing the provision of genito-urinary medical services for its resident population which are currently provided by Tower Hamlets and Newham health authorities.
Mr. Cohen : To ask the Secretary of State for Health what response he has had from Waltham Forest district health authority to his February letter advising them to provide details of all completed and planned developments in genito-urinary medicine services ; when they published the relevant report ; if he will make a copy of it available to the hon. Member for Leyton ; whether the response is in accord with his comments prioritising such services during the debate on AIDS on 13 January ; and if he will make a statement.
Mr. Mellor : I understand that Waltham Forest district health authority has sent the requested AIDS control report to North East Thames RHA, which is due to submit reports from all districts in the region to the Department at the end of July. A copy of the report can be obtained from the local health authority.
Mr. Alfred Morris : To ask the Secretary of State for Health what information is available to him on the relative efficacy of medicines prescribed to people with AIDS or AIDS-related complex according to whether they are, or are not, able to afford the high protein and calorie diets recommended to them by their doctors ; and if he will make a statement.
Mr. Mellor [holding answer 25 July 1989] : We are not aware of any scientific information relating the efficacy of drug therapies for AIDS or AIDS-related complex to the consumption of high-protein and calorie diets.
Mr. Alfred Morris : To ask the Secretary of State for Health what information is available to him on the survival rate of people with AIDS or AIDS-related complex, analysed by level of income ; and if he will make a statement.
Mr. Mellor [holding answer 25 July 1989] : We do not hold this information.
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Mr. Alfred Morris : To ask the Secretary of State for Health what is his estimate of the average weekly cost of medicines prescribed to people with AIDS or AIDS-related complex.
Mr. Mellor [holding answer 25 July 1989] : People with HIV disease may be treated for a number of different illnesses with a number of different drugs. We do not have information in the Department on all the drugs administered to all people with AIDS or AIDS-related complex and cannot therefore provide an estimate of the average weekly cost per patient.
Mr. Marlow : To ask the Secretary of State for Health (1) to what extent foreign AIDS and drug dependency patients are treated by the Parkside health authority.
(2) why it took Parkside health authority over six weeks to reply to a letter from the hon. Member for Northampton, North, saying that no information was available.
Mr. Mellor : Parkside health authority regrets the delay in replying to my hon. Friend's letter of 25 May which was occasioned by the need to check a number of potential sources of information within the authority. Information of this kind on patients' nationalities is not held centrally and could be extracted clerically from individual records only at disproportionate expense.
Intra-uterine Device
Mr. Cohen : To ask the Secretary of State for Health what was the local research ethics committee, including its composition, which approved the trial of the copper intra-uterine contraceptive device on patients in the United Kingdom for experimental purposes ; what consideration it gave to the fact that the device had not been approved by the relevant authorities in the United States at that time and to notifying the patients that they were being used for experimental test purposes ; and what steps he has taken to avoid United Kingdom patients being unknowingly tested by foreign drug companies occurring again.
Mr. Mellor : Information about particular local research ethics committees is not held centrally.
With regard to the testing of medical products and the conditions under which they are administered to patients, I refer the hon. Member to my answer to the hon. Member for Lewisham, Deptford (Ms. Ruddock) at column 542 on 29 June.
Sir Michael McNair-Wilson : To ask the Secretary of State for Health how many complaints of infertility in women who have used the Copper 7 intra-uterine contraceptive device have been reported to his Department ; and when the device was approved by the Department for use.
Mr. Freeman : In 20 letters received by the Department, women have expressed the belief that they have been adversely affected by the device, known in this country as the Gravigard. However infertility is not specified either in these individual cases, or in reports received under the scheme whereby doctors are asked to notify suspected adverse reactions.
The Gravigard's product licence was granted on 17 December 1973 and took effect retrospectively from 7 November 1973.
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Audiology Students
Mr. Ieuan Wyn Jones : To ask the Secretary of State for Health if he will undertake an urgent review of the grading of audiology students.
Mr. Mellor : I presume that the hon. Member refers to student physiological measurement technicians specialising in audiology. This is a matter for the professional and technical staffs B Whitley Council. Negotiations are taking place on proposals to introduce a new pay and grade structure for this and other groups of technical staff.
Hearing Aids
Miss Emma Nicholson : To ask the Secretary of State for Health what action he has taken, or proposes to take, in relation to the proposals on the provision of hearing aids advanced by the hon. Member for Torridge and Devon, West on 23 March, Official Report , columns 1299-1303.
Mr. Ieuan Wyn Jones : To ask the Secretary of State for Health (1) what consideration he is giving to developing innovative pilot projects in community delivery of hearing aids ;
(2) what plans he has to reduce the time taken to obtain a National Health Service hearing aid ;
(3) what steps he is taking to improve the take-up and use of National Health Service hearing aids ;
(4) what steps he is taking to make hearing aid services more accessible, particularly to elderly people and to people living in residential homes ;
(5) when he intends to respond to the Royal National Institute for the Deaf's fair hearing campaign ; and if he will make a statement.
Mrs. Rosie Barnes : To ask the Secretary of State for Health (1) what guidance his Department has issued on the direct referral of patients needing hearing aids to hearing aid centres ; and if he will make a statement ;
(2) what plans he has for the improvement of National Health Service hearing aid services ; and if he will make a statement ; (3) what research his Department has conducted into the average waiting time for the testing and fitting of a hearing aid ; (4) what response his Department has made to the Royal National Institute for the Deaf document, "Hearing Aids--the Case for Change" ;
(5) whether he will take steps to increase the choice of hearing aids available on the National Health Service.
Mr. Freeman : I am very grateful to the Royal National Institute for the Deaf for bringing public attention to the difficulties which some people face in obtaining a hearing aid. There is a broad measure of agreement for the idea of making hearing tests and the supply of hearing aids more accessible to people in the community and I am pleased to be able to announce a number of measures towards this end.
First, Sir Donald Wilson, chairman of Mersey regional health authority, which acts as the centre of responsibility for the procurement and distribution of hearing aids in the National Health Service, is meeting representatives of hearing aid manufacturers today to discuss ways of increasing the number of commercial hearing aids and accessories which are supplied to patients by National Health Service audiology departments in addition to the
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standard National Health Service range of hearing aids. We will also be considering in the Department ways of enabling patients requiring hearing aids to obtain them more easily. We expect to begin consultations in the autumn.Secondly, I have asked my officials with the help of appropriate outside expert advice to draw up and consult interested bodies on a programme of action commencing in the new financial year to expand the number of direct referral schemes and set up a mechanism to evaluate them to ensure that they are operating with appropriate safeguards and are effective in reducing waiting times. Direct referral schemes would entail National Health Service patients being referred by their GPs direct to the audiology service for a hearing test and dispensing of hearing aids rather than going via hospital-based consultants.
Thirdly, my officials are currently involved in the development of a national vocational qualification in audiology. I have asked them to begin discussions in the autumn with professional bodies and other interested parties to examine the scope for a greater measure of integration between the service provided by National Health Service audiologists and that provided by private hearing aid dispensers. I expect that these measures, together with the impact of the new Hearing Aid Council Act, which received Royal Assent earlier this month, will result in a substantial measure of improvement in service and greater choice for people who have a hearing impairment.
Mr. Ieuan Wyn Jones : To ask the Secretary of State for Health what assessment has been made by his Department of the likely impact of the forthcoming demographic changes in demand for hearing aid services.
Mr. Freeman : The Institute for Hearing Research has produced figures which suggest that the prevalence of hearing loss is greater in people aged 60 and over. However, not all of these people require hearing aids.
King Edward VII Hospital, Windsor
Dr. Glyn : To ask the Secretary of State for Health, if he will ensure that the acute services available at King Edward VII hospital, Windsor, are not reduced to the extent that constituents will be deprived of any local hospital and compelled to rely on facilities for which adequate public transport is not available.
Mr. Freeman : I understand that East Berkshire health authority will soon be starting formal public consultation on its proposals to rationalise the provision of acute services within its district. The matter may in due course be referred to Ministers for a final decision and it is therefore inappropriate for me to make any comment at this stage.
Statutory Instruments
Dr. David Clark : To ask the Secretary of State for Health for each of the last five parliamentary Sessions, including the 1988-89 Session, if he will list the number of statutory instruments that were issued by his Department ; how many were negative and how many were affirmative ; and if he will make a statement.
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Mr. Freeman : The information is in the table. For Sessions earlier than 1988-89 the figures are only those statuory instruments issued by the Department of Health and Social Security which relate to health matters.
Session |Affirmative instruments|Negative instruments ------------------------------------------------------------------------------------------------ 1984-85 |2 |32 1985-86 |1 |47 1986-87 |0 |25 1987-88 |1 |42 1988-89 |3 |48
Rubella
Ms. Ruddock : To ask the Secretary of State for Health how many rubella-handicapped adults are estimated to live in England and Wales.
Mr. Freeman : This information is not collected centrally. SENSE, the National Deaf-Blind and Rubella Association, estimates that in 1965, during the last major rubella epidemic and, before rubella vaccine was introduced, about 1,000 babies were born in the United Kingdom with congenital rubella syndrome. Since the introduction of vaccine, numbers of such births have fallen to approximately 20 per year.
Ms. Ruddock : To ask the Secretary of State for Health what plans he has to increase funding made available to the National Rubella Council to encourage its work in preventing children being born handicapped by congenital rubella syndrome.
Mr. Freeman : Officials will be touch shortly with the council about its section 64 grant for 1989-90 and 1990-91. In addition, there will be further discussions with the council about support for the specific publicity proposals which it has put forward.
Vaccine (Ethnic Minorities)
Ms. Ruddock : To ask the Secretary of State for Health what plans he has to increase the uptake of the mumps, measles and rubella vaccine amongst ethnic minority groups.
Mr. Freeman : Leaflets in several ethnic languages were produced jointly by the Health Education Authority (HEA) and the Department of Health as part of the programme to launch MMR immunisation last October, and discussions between the HEA and the Department on future activity will include the need for information aimed at ethnic minority groups.
General Practitioners (Contract)
Mr. Bermingham : To ask the Secretary of State for Health when he next plans to meet the General Medical Services Committee to discuss changes to the new contract for general practitioners in the light of the completion of the general practitioners' referendum ; and if he will make a statement.
Mr. Kenneth Clarke : At their request I met the negotiators of the General Medical Services Committee on Monday 24 July. I made it clear that I would have preferred an agreed basis for the new contract and that I had all along made considerable efforts to achieve an
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agreed solution. The discussions satisfied me that there was no sensible basis on which anyone could now reasonably expect to reopen the issues agreed with them on 4 May. I believe the contract agreed on 4 May to be in the best interests of all patients, as it will improve the standard of care they can expect to receive. I did agree, at the negotiators' request, to extend the deadline for the formal response to the draft regulations to 15 August. I have no present plans for another meeting.Blood Donations
Mr. Harry Barnes : To ask the Secretary of State for Health how many donations of blood were (a) used in the National Health Service and (b) transferred to the private sector in each of the years 1978 to 1988.
Mr. Freeman : I shall write to the hon. Member with such information as is available as soon as possible.
Salmonella
Mr. Harry Barnes : To ask the Secretary of State for Health if he will give details of the illnesses, deaths, cause, source, locations and time period of the recent outbreak of salmonella poisoning in north Derbyshire ; and if he will make a statement.
Mr. Freeman : I understand that during May of this year 61 cases of salmonella typhimurium were recorded in
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north Derbyshire and neighbouring districts. Pork products were definitely implicated in at least 27 of the cases. The organism was identified in four people who died. Its contribution as a factor in their deaths forms part of the coroners' investigations, which are not yet complete. The outbreak has been fully investigated and appropriate action taken.Alzheimer's Disease
Mrs. Ann Taylor : To ask the Secretary of State for Health what was the number of cases of Alzheimer's disease in each health authority area in England in each of the last 10 years.
Mr. Freeman : The table shows admissions to NHS mental illness hospitals and units in each regional health authority in England for the years 1981 to 1986 with a main diagnosis of presenile or senile dementia (ICD 290.0, 290.1, 290.2, 290.3). Alzheimer's disease is included under these diagnosis. The admission figures may be greater than the number of patients treated, as a patient can be discharged and readmitted more than once during the year. Not all cases of Alzheimer's disease will be admitted to hospital. Additional information is not available centrally or could be provided only at disproportionate cost.
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