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Written Answers to Questions
Friday 27 October 1989
HEALTH
GP Referrals
Mr. Redmond : To ask the Secretary of State for Health what research projects are being carried out in the Trent regional health authority into the pattern of general
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practitioner referrals ; where they are taking place ; if he will give details of the research ; and how much of this is in connection with hospitals considering opting out.Mr. Mellor : We do not hold this information centrally. The hon. Member may wish to contact the chairman of Trent regional health authority for the information he requires.
Occupational and Speech Therapists
Mr. Simon Coombs : To ask the Secretary of State for Health if he will list for each regional health authority the numbers of occupational and speech therapists in 1979, 1984 and 1988.
Mr. Freeman : The information is shown in the table.
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National Health Service staff in post in England
Qualified staff-by regional health authority
Occupational therapists and speech therapists at 30 September of each year
<1>Whole-time equivalent
Region 1979 1984 1988
|Occupational therapists|Speech therapists |Occupational therapists|Speech therapists |Occupational therapists|Speech therapists
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Northern |100 |80 |130 |120 |230 |160
Yorkshire |160 |110 |240 |130 |340 |170
Trent |200 |120 |370 |200 |550 |250
East Anglia |130 |70 |200 |100 |250 |110
North West Thames |230 |140 |290 |180 |340 |270
North East Thames |200 |100 |300 |200 |370 |250
South East Thames |200 |140 |260 |180 |320 |250
South West Thames |200 |120 |250 |150 |320 |190
Wessex |170 |70 |240 |100 |320 |130
Oxford |190 |90 |240 |110 |300 |140
South Western |200 |100 |300 |150 |410 |200
West Midlands |220 |150 |290 |210 |420 |260
Mersey |130 |60 |180 |90 |250 |110
North Western |160 |130 |270 |210 |400 |230
London post-graduate special health authorities |50 |30 |50 |20 |50 |20
|------- |------- |------- |------- |------- |-------
England |2,530 |1,510 |3,610 |2,150 |4,870 |2,730
Source: Department of Health (SMI3) Annual Census of NHS Non-Medical Manpower.
<1> All figures are indpendently rounded to the nearest ten (10) whole-time equivalent.
DRG plc
Mr. William Powell : To ask the Secretary of State for Health in the light of the work of DRG plc in the distribution of medical packaging products to the National Health Service, what consideration his Department has given to the effect of the bid for DRG plc by Pembridge Investments of Bermuda and any resulting sale of DRG Hospital Supplies on competition within the supply of such products to the National Health Service ; whether his Department has made a submission to the Office of Fair Trading ; and if he will make a statement.
Mr. Freeman : Officials have received representations concerning the bid both from DRG and Pembridge Investments Ltd. At the request of the Office of Fair Trading written comments have been passed to them which will be taken into account with other advice received. I am not aware that the bid will necessarily result in the sale of DRG Hospital Supplies and it would be my intention to ensure as far as possible that effective competition and security of supply was maintained for the NHS in this area of medical packaging.
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Practice Budgets
Mr. John Marshall : To ask the Secretary of State for Health what will be the effect on patient care of the proposals to allow large general practitioners practices to hold their own budgets.
Mr. Mellor : I refer my hon. Friend to the reply I gave to my hon. Friend, the Member for Rochford (Dr. Clark) on 27 June at column 417 .
Private Ambulance Companies
Mr. Spearing : To ask the Secretary of State for Health (1) what requirements in respect of experience, competence, or probity he lays down or recommends to the regional or district health authorities in respect of proprietors or managers of private ambulance companies whose vehicles are hired to them at public expense ;
(2) what requirements in respect of qualifications, experience or health he lays down or recommends to regional or district health authorities in respect of personnel employed by private ambulance companies whose services they use at public expense ;
(3) what requirements, standards or specifications he lays down or recommends to regional or district health
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authorities in respect of the minimum standards of private ambulances hired or contracted to them and paid out of public funds.Mr. Freeman : Health authorities are responsible for the day-to-day management of National Health Service ambulance services. It is for these authorities to arrange the most appropriate, efficient and cost effective means of transport for each of the patients the ambulance service is asked to convey. This may involve the use of private services. Requirements in respect of qualifications and experience are not set centrally : health authorities are responsible for negotiating contracts locally and for setting standards of service, patient care, and safety.
Cash Limits
Mr. Knox : To ask the Secretary of State for Health whether any changes will be made in the cash limits of his Department for 1989-90.
Mr. Kenneth Clarke : Subject to parliamentary approval of the necessary supplementary estimates, the following changes will be made.
The cash limit for class XIV vote 1 (Hospital and community health and other services, England) will be increased by £47,879,000 (from £11,861,947,000 to £11,909,826,000). This increase provides an additional £32,000,000 for expenditure in connection with the implementation of the NHS review ; £17,340,000 for the carry forward of underspends under the end year flexibility arrangements as announced by my right hon. Friend and Chief Secretary to the Treasury on 20 July 1989 ; and £539,000 in respect of a transfer from class XIV, vote 3 (subhead G2) for a management communications programme to inform NHS staff about the NHS review proposals. These increases are partly offset by a reduction of £2,000,000 in respect of a transfer to class XIV, vote 3 (subhead G3) for AIDS publicity.
The cash limit for class XIV, vote 3 (Department of Health, administration, miscellaneous health services and personal social services, England) will be increased by £8,891,000 (from £688,170,000 to £677,061,000). This increase provides an additional £7,400,000 for expenditure on Departmental administration in connection with the NHS review ; £2,000,000 for a transfer from class XIV, vote 1 for AIDS publicity ; and £30,000 for a transfer from class XV, vote 7 to adjust the apportionment of resources following the split of the former Department of Health and Social Security. These increases are partly offset by £539,000 in respect of a transfer to class XIV, vote 1 for a management communications programme to inform NHS staff about the NHS review proposals. As a result of the changes on this vote, the Department's running costs limit is increased by £7,341,000 from £238,815,000 to £246,156,000.
The net effect of these changes will be charged to the Reserve and will not therefore add to the planned total of public expenditure.
OPCS
Mr. Robert G. Hughes : To ask the Secretary of State for Health if he has made any changes to both the cash and gross running costs limits for the Office of Population Censuses and Surveys for 1989-90.
Mr. Freeman : Subject to parliamentary approval of the necessary supplementary estimate, the cash limit for class
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XX, vote 15 will be increased by £1,515,000 from £30,253,000 to £31,768,.000. This increase reflects the carry forward of £192,000 underspend on running costs in 1988-89 under the end-year flexibility scheme and increased provision of £485,000 for work to correct NHS statistics held on the family practitioner committee systems ; the carry forward of £323,000 underspend on capital in 1988-89 under the end-year flexibility scheme ; an additional £1,000,000 to allow for greater computer capacity for system development work on the 1991 census (this represents a timing change within the overall 1991 census expenditure) ; increased capital provision of £200,000 for processing the 1991 census of Scotland. The costs to correct the NHS statistics and for processing the 1991 census of Scotland will be met from within the respective existing resources of the Department of Health and the General Register Office (Scotland). Both of these costs will be balanced by an equivalent increase inappropriations-in-aid. The balance of the increase will be charged to the Reserve and will not therefore add to the planned total of public expenditure.
The OPCS gross running cost limit for class XX, vote 15 will be increased by £677,000 from £35,377,000 to £36,054,000 as a result of these changes.
Insulin
Mr. Ashley : To ask the Secretary of State for Health how many deaths and adverse reactions have been reported since the introduction of human insulin ; and if he will make a statement.
Mr. Freeman : Since December 1982 the Committee on Safety of Medicines has received just over 100 reports of adverse reactions which may be associated with human insulin. In four of these cases the patient died. A report of a suspected adverse reaction does not necessarily mean there is a causal relationship with the drug so it does not follow, that human insulin was responsible for the reported deaths.
Mr. Ashley : To ask the Secretary of State for Health which companies manufacture human insulin ; what warnings they gave to those taking the insulin ; whether these were approved by the Committee on Safety of Medicines ; and whether the warnings have been changed.
Mr. Mellor : Product licences for human insulin are held by : The Wellcome Foundation
Lilly Industries
Fisons Ltd.
Nordisk UK Ltd.
Novo Laboratories Ltd.
Novo Industries
Patient information leaflets for human insulin give a range of warnings covering such subjects as pregnancy, illness, taking other medicines, taking physical exercise and drinking alcohol. All patient information leaflets are approved by the licensing authority. All manufacturers of human insulin agreed to include an additional warning that a few patients who experienced hypoglycaemic reactions after transfer to human insulin have reported that the early warning symptoms were less pronounced or different from those experienced with their previous insulin.
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Whooping Cough Vaccine
Mr. Ashley : To ask the Secretary of State for Health in what circumstances his Department recommends that whooping cough vaccine should not be given ; and what are the recommendations of the manufacturers.
Mr. Freeman : The recommendations of the joint committee on vaccination and immunisation, which the Department has accepted and which are published in the memorandum "Immunisation Against Infectious Disease", advise that if a child is suffering from any acute illness, vaccination against whooping cough should be postponed until the child has fully recovered ; and that vaccination should not be given to children who have a history of severe local or general reaction to a preceding dose. "Local" and "general" are defined in the memorandum.
The JCVI also advises in the memorandum that there are certain groups of children for whom the advisability of whooping cough vaccination requires special consideration because of their own or their families histories. In such children the risk from vaccine may be higher, but the effects of the disease could be more severe. If the doctor is in doubt, he should seek advice from a consultant paediatrician or specialist in community medicine. These groups are :
(1) children with a documented history of cerebral damage in the neonatal period ;
(2) children with a personal history of convulsions ;
(3) children whose parents or siblings have a history of idiopathic epilepsy--in such children there may be a risk of developing a similar condition irrespective of vaccination.
The manufacturer of whooping couch vaccine is bound by the terms of the product licences granted to the company for its manufacture, sale and supply as a prescription-only medicine.
Cancer Screening and Immunisation
Mr. Haselhurst : To ask the Secretary of State for Health what is the typical level of coverage achieved within district health authority areas for cancer screening and immunisation ; and what information he has on preventive health performance in other European Community countries.
Mr. Mellor : For cervical cancer screening, the information is not available in the form requested. Following the introduction of a new statistical return from April 1988, it is hoped to be able to give details of levels of coverage for 1988-89 towards the end of this year. Similarly, following the introduction of a new statistical return for breast cancer screening from April 1989, it is hoped to be able to give details of levels of coverage achieved in 1989-90 towards the end of 1990.
The United Kingdom is the first country in the European Community to implement nationwide cervical cancer screening based on computerised call and recall. The United Kingdom and the Netherlands are currently implementing similar programmes for breast cancer screening.
On immunisation, the coverage for England in 1987-88 (the latest year available) averaged 87 per cent. for diphtheria, tetanus and polio, 76 per cent. for measles and 73 per cent. for whooping cough. In that year nearly 100
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of the English health authorities exceeded 90 per cent. for diphtheria, tetanus and polio, and eight also exceeded that figure for measles.Although European Community countries make immunisation uptake data available to the World Health Organisation, only the United Kingdom and the Netherlands use similar calculations to derive uptake. It is not therefore possible to make accurate comparisons.
Grading
Mr. Campbell-Savours : To ask the Secretary of State for Health (1) what administrative costs have so far been incurred at district health authority level in dealing with appeals made in accordance with section 32 of the General Whitley Council handbook against the imposition of particular grades under the new clinical grading structure ;
(2) what are the projected costs of dealing with appeals made in accordance with section 32 of the General Whitley Council handbook against the imposition of particular grades under the new clinical grading structure made at district, regional and national levels ; (3) what extra funds have been set aside to meet the administrative costs of appeals made in accordance with section 32 of the General Whitley Council handbook against the imposition of particular grades under the new clinical grading structure at district, regional and national levels.
Mr. Mellor : Detailed information about health authorities' particular administrative expenditure is not held centrally and to obtain it would incur disproportionate cost.
Mr. Campbell-Savours : To ask the Secretary of State for Health whether, in view of the number of clinical grading appeals from nurses, he will instruct Health Service managers to return to the negotiating table to resolve the dispute over the interpretation of the clinical grading criteria of continuing responsibility and supervision.
Mr. Mellor : I understand that these issues were discussed at length in the nursing and midwifery staffs negotiating council last year without agreement being reached between the staff and management sides. We share the vew of the management side that further discussions would not now be a helpful way forward, since the prospect of reaching agreement has not improved.
Mr. Tony Lloyd : To ask the Secretary of State for Health what additional funding has been made available by the Government to date in respect of successful nurse grading appeals.
Mr. Mellor : In 1988-89 the Government made available to health authorities in England additional funding of £731 million to meet the cost of the nurses pay and regrading exercise. This figure, which was based on health authorities' own estimates, includes the further £98 million announced in October 1988 to meet in full the final cost of the clinical regrading exercise. The total sum has been rolled forward to 1989-90 and this together with the substantial real terms increase in resources announced in the 1988 Autumn Statement provides authorities with sufficient resources to plan flexibly to meet the cost of successful appeals.
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Ambulance Services (Privatisation)
Mr. Spearing : To ask the Secretary of State for Health pursuant to his reply to the hon. Member for Newham, South of 20 October, Official Report, column 270, what authority, option, or instruction has been given by him relating to the privatisation, or sub-contracting, of any non- emergency ambulance service in England and Wales.
Mr. Freeman : There are no plans to privatise the ambulance service.
Health authorities are responsible for the operational management of the ambulance service. In 1984 the Department published a scrutiny report on the non-emergency sector of the ambulance service when we said that it was open to district health authorities to buy-in part of the ambulance service from the private sector if that is more cost effective and provided the quality of service was maintained. Many NHS ambulance authorities already use private contractors, the hospital car service and voluntary aid societies to transport appropriate NHS patients. This has been the case for many years and helps to ensure that skilled ambulance crews and specialist vehicles are used for those who need the special care and attention which they can provide.
Tobacco Advertising
Mr. Amos : To ask the Secretary of State for Health if he will place in the Library a full copy of the research commissioned by the committee for monitoring agreements on tobacco advertising and sponsorship into compliance with the agreements on advertising and sponsorship between the Government and the tobacco industry.
Mr. Freeman [holding answer 28 July 1989] : My right hon. and learned Friend the Minister for Health wrote to the hon. Member on 27 September to explain that the independent Committee for Monitoring Agreements on Advertising and Sponsorship (COMATAS) had been consulted about this matter, and that the tobacco industry had objected to the release of this material on various grounds. This matter has been pursued with the industry's representatives with the aim of securing the release of this material but they remain of the view that the research reports should not be made public. They argue that the business of COMATAS is private and confidential to the committee and that the research in question was not intended to be free-standing. They insist also that the reports contain commercially sensitive information.
This matter was discussed at a COMATAS meeting on Thursday 5 October. The independent chairman, Sir Peter Lazarus, concluded that since COMATAS is a joint committee consisting of equal representation from the industry and from Government, if one party insisted that the research reports should not be released, this view should prevail. The committee accepted this position.
The results of the research projects commissioned by COMATAS are reported in the first and second annual reports of the committee, published by Her Majesty's Stationery Office (ISBNs 0 11 321138 4 and 0 11 321225 9), both of which are in the Library.
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GPs (Contracts)
Mr. Maxwell-Hyslop : To ask the Secretary of State for Health whether, in the 1990 contract (a) "The Public Service" includes schools which have opted out from local education authority control, local education authority schools and further education colleges, (b) in paragraph 13(a) the £400,000 fund is annually refreshed by that amount and for post-graduate teaching only, (c) the definition of sparsely populated areas in paragraph 13(b) is altered ; and (d) to qualify under paragraph 26 a general practitioner must be qualified to perform all operations on the list of surgical procedures.
Mr. Mellor [holding answer 19 October 1989] : The National Health Service (General Medical and Pharmaceutical Services) Amendment (No. 2) Regulations 1989, laid on 16 October, set out the criteria by which FPCs should determine applications from GPs to work over four instead of five days a week. It will therefore be for the FPC to decide whether the provision of health care services to local education authority schools and further education colleges, whether opted out or not, may justify a GP providing general medical services over four rather than five days. The fund of up to £400,000 a year is recurrent, and will mainly be directed at undergraduate teaching. As regards "sparsely populated areas", no change is being made to the inducement practice scheme. To qualify for inclusion on the minor surgery list, a doctor must demonstrate competence to undertake all the procedures listed in schedule 1B of the amending regulations.
Mr. Maxwell-Hyslop : To ask the Secretary of State for Health whether, in the 1990 contract (a) the paragraph 51 general practitioner age limits apply to locums and assistant doctors, (b) time spent by general practitioners on representational work on official bodies can be subtracted from the 26 hours, referred to in paragraph A2, (c) the substantial extra resources referred to in paragraph 58 means resources new to the National Health Service, or resources reallocated within it and (d) proof of posting an offer, paragraph A7 will constitute offering the required services to a post-75 patient ; and who bears the cost of paragraph A13 reports.
Mr. Mellor [holding answer 19 October 1989] : Locums and assistant doctors who are not included in an FPC medical list are not affected by the introduction of a compulsory retirement age. Under the revised terms of service, a doctor will be required to be available to his patients for at least 26 hours over five days a week at times convenient to patients. Provision is made for an FPC to agree that a GP may fulfil this requirement over four instead of five days, provided the GP satisfies the criteria set out in the National Health Service (General Medical and Pharmaceutical Services) Amendment (No. 2) Regulations 1989.
Because a number of fees and allowances will be abolished, it will be necessary to redistribute a considerable proportion of the funds currently expended on general medical services to meet the costs of new payments. The reference to "substantial extra resources" in paragraph 2.6 of the White Paper "Promoting Better Health" and quoted in paragraph 58 of "The 1990 Contracts" referred to extra investments additional to current expenditure. Where a GP makes an offer in writing
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to a patient aged 75 or over under paragraph 13D of the revised terms of service, proof of posting the written offer will be accepted as discharging the responsibility to make such an offer. Should the patient accept the offer, the GP will be required to carry out the check-up as laid down in those terms of service.The production of annual reports by practices will not be a significant expense and, as with other expenses related to the provision of general medical services, will be reimbursed to the profession indirectly through fees and allowances.
NATIONAL FINANCE
Marriage Allowance
Miss Emma Nicholson : To ask the Chancellor of the Exchequer what arrangements he has made for the allocation of the marriage allowance following the introduction of separate taxation ; and what measures he will take to ensure that the marriage allowance is shared equally between husband and wife.
Mr. Lilley : The married couple's allowance which will be introduced under independent taxation in April 1990 will be given in the first instance to the husband. If he has insufficient income to use part or all of the allowance himself he will be able to transfer the surplus to his wife. Allowing married couples generally to share the married couple's allowance between them would add considerably to the complexity of independent taxation and would delay its introduction. Fewer than one in 300 couples would gain any financial advantage from this additional complexity.
DRG plc
Mr. William Powell : To ask the Chancellor of the Exchequer what representations he has received about the use by Pembridge Investments of Bermuda of that off-shore tax haven to launch a takeover bid for the Bristol-based company DRG plc and the fact that the tax status of Pembridge Investments would allow it to break up the constituent parts of DRG and sell them free of tax at the corporate level ; whether he will be considering legislation to bring the United Kingdom into line with the tax regime as it operates in this respect elsewhere in Europe ; and whether he will make a statement.
Mr. Lilley : I cannot comment on the tax aspects of individual takeover bids, but I have noted my hon. Friend's suggestion.
Central Statistical Office
Mr. Harry Greenway : To ask the Chancellor of the Exchequer whether he is proposing any change to the Central Statistical Office's cash limits for 1989-90.
Mr. Lilley : Subject to parliamentary approval of the necessary supplementary estimate, the cash limit for class XIX, vote 18 will be increased by £1,615,000, from £13,727,000 to £15,342,000 and the running cost limit by £1,163,000, from £10,804,000 to £11,967,000. Part of the increase reflects further transfers of provision from other Departments following the establishment of the Central Statistical Office as a separate Department : corresponding reductions will be included in supplementary estimates for the Cabinet Office : other services (class XX, vote 2), the
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Department of Trade and Industry (class V, vote 3) and the Department of Employment (class VII, vote 2). The remainder reflects provision to meet some of the additional administrative and other expenditure which arises for the Central Statistical Office as a separate Department, and to meet expenditure on a share register survey in connection with the Department's work to improve the quality of the national accounts' statistics. These elements (totalling £695,000) will be charged to the Reserve and will not therefore add to the planned total of public expenditure.HOME DEPARTMENT
Police (Supermarket Sites)
Mr. Redmond : To ask the Secretary of State for the Home Department if he will make a statement on the proposed deals with supermarket chains to build on sites owned by the Metropolitan police in return for providing a free police station ; and what other police forces in England and Wales are considering these proposals.
Mr. Peter Lloyd : We are prepared to consider proposals for new police stations submitted by police authorities in collaboration with the private sector, provided these offer better value for money than schemes which are totally publicly funded.
I understand from the Commissioner of Police of the Metropolis that the Metropolitan police are not at present considering any such scheme. I understand, however, that South Yorkshire police authority is doing so ; we are not aware that any other police authority in England and Wales is in a similar position.
Prison Sentences
Mr. Chris Smith : To ask the Secretary of State for the Home Department what sentence, with full remission ; results in (a) post- sentence or (b) a total period of imprisonment of four years ; and if he will make a statement.
Mr. Peter Lloyd : A sentence of six years imprisonment (with maximum remission but without parole) will result in a total period of four years being served in custody. The total period spent in custody, whether before or after sentence, earns remission. Thus, the length of sentence requiring four years to be served after sentence depends on the amount of pre- sentence detention.
Leicester (Visits)
Mr. Vaz : To ask the Secretary of State for the Home Department (1) if he will list the numbers and names of organisations invited to meet Mr. Colin Harnett and Mr. Satish Malik when they visited Leicester in October ;
(2) if he will place in the Library a copy of the notes taken by his officials during the visit of Mr. Colin Harnett and Mr. Satish Malik to Leicester in October ;
(3) what was the cost to the taxpayer of the visit to Leicester in October of Mr. Colin Harnett and Mr. Satish Malik ; what was the purpose of the visit ; what was the number of organisations attending the meetings ; and on what date hon. Members for Leicester were informed of the visit ;
(4) whether Mr. Colin Harnett and Mr. Satish Malik during their visit to Leicester in October 1989, sought the
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views of the public concerning (a) the Salman Rushdie affair (b) the effectiveness of hon. Members for Leicester in representing their constituents and (c) the police ;(5) which officials from his Department visited Leicester during October ; and on what date.
Mr. John Patten : As part of their normal duties (which include visits to all parts of the country), officials from the equal opportunities and general department make occasional visits to regional areas of the Commission for Racial Equality in order to improve their awareness of local community relations. On 17 and 18 October 1989, Mr. Colin Harnett, Mr. Satish Malik and Miss Pamela Johnson made such a visit to the commission's Leicester office. They were joined for the first day only by Mr. Stephen Rimmer of the police department.
At the request of the Home Office, the arrangements for the visit were made locally by the commission for Racial Equality and comprised meetings with the commission's staff, the officers and members of the Leicester Council for Racial Justice, officers of Nottingham and Wellingborough community relations councils, and separately with individual members of the Muslim communities. In additon the police arranged a meeting with the deputy chief constable of the Leicestershire constabulary and some of his officers, also attended by officers of the commission and Leicester Council for Racial Equality.
Discussions at these meetings covered a broad range of community relations issues at both national and local level. These included the impact of the issue surrounding the publication of the book "The Satanic Verses" and the relations between the police and the ethnic minority communities. I am informed that views about the effectiveness of hon. Members for Leicester were not sought at any time.
It would be neither necessary nor appropriate to inform hon. Members in advance of visits by officials in pursuance of their duties and this was not done in this instance. There will be no official report of the visit, which cost £360.80 in officials' expenses. Information on visits made by other officials from this Department to Leicester during October is not readily available and could be obtained only at disproportionate cost.
Citizenship
Mr. Vaz : To ask the Secretary of State for the Home Department what is the current backlog of naturalisation cases.
Mr. Renton : The number of applications for naturalisation outstanding at 16 October 1989 was 69,139.
Mr. Vaz : To ask the Secretary of State for the Home Department what is the current number of outstanding applications for registration for citizenship.
Mr. Renton : The number of applications for registration of all types outstanding at the end of September 1989 was 70,858.
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