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Ms. Primarolo : To ask the Secretary of State for Health if he will review the advice given to doctors in the Committee on Safety of Medicines bulletin "Current Problems, No. 21", January 1988, in the light of the findings of the Association of Community Health Councils of England and Wales.
Mrs. Virginia Bottomley : The advice on benzodiazepines, dependence and withdrawal symptoms published in "Current Problems No. 21" remains valid and is summarised in the latest edition of the "British National Formulary" which the Department issues free to all doctors.
Miss Emma Nicholson : To ask the Secretary of State for Health (1) if he will give consideration to legislation to provide dependent adults with legal status, basic rights and social protection should their carer be unable to provide for them ;
(2) what powers exist for the appropriate authorities to ensure that the rights and health of dependent adults are safeguarded in the event of their carer being unable to provide for them ;
(3) what protection exists to safeguard the care of dependent adults in the event of their carer being unable to provide for them ;
(4) what steps he plans to take to ensure that dependent adults' personal and medical welfare is properly protected by effective liaison between all interested professional parties in the event of their carer being unable to provide for them.
Mr. Freeman : Section 47 of the National Assistance Act 1948 and sections 115 and 135 of the Mental Health Act 1983 empower local authorities to take action to safeguard the welfare of dependent people who are not receiving proper care. The exercise of these powers is a matter for the local authority concerned which will need to keep in touch with the appropriate health authority. When failures of care come to light we ask the authorities for reports which are carefully studied to see whether any action is called for.
Mrs. Virginia Bottomley : There are no plans for Government intervention in relation to this matter of litigation in the United States courts. For the initial claims deadline, the court itself directed, and approved, publicity by the Dalkon shield manufacturers. Further extensions of the deadline have received independent media publicity. It is for individual health authorities to decide whether they wish to direct their resources to specific activity on this matter. Our longstanding advice has been that they should be as helpful as possible with regard to the release of information.
Mr. Freeman : The information in the form requested is not available centrally and the cost of obtaining it would be disproportionate. All regional and district health authorities in England are implementing a lead -free policy and are converting their vehicles at the earliest opportunity.
Ms. Harman : To ask the Secretary of State for Health if he plans to issue guidelines to health authorities requiring them to carry out an energy audit for health authority buildings, identify priority areas for energy saving and segregate fuel bills for each building.
Mr. Freeman : The Department has issued comprehensive guidance, the national energy code (ENCODE), on all aspects of energy efficiency for health care buildings including the need for energy audit and prioritising energy saving measures. Recommendations for separate metering where applicable will be issued shortly.
We have no plans to require health authorities to undertake a formal energy audit.
Ms. Harman : To ask the Secretary of State for Health if he will require health authorities to establish an energy management unit and allocate responsibility for energy efficiency to one member of staff for each building.
Mr. Freeman : The comprehensive guidance, the national energy code (ENCODE), on energy efficiency published by the Department recommends a level of energy management and responsibility appropriate to the size of the estate and potential for energy savings.
Ms. Harman : To ask the Secretary of State for Health if he plans to require health authorities to carry out an environmental audit on (a) energy consumption, (b) purchasing policy, (c) waste arising and disposal methods, (d) pollution from health authority premises and (e) environmental training.
Mr. Freeman : Health authorities are expected to comply with all relevant statutory legislation. We have no plans to require them to carry out environmental audits on energy consumption, purchasing policy, waste arising and disposal methods, pollution from health authority premises or environmental training.
(2) if he will draw up an environment policy for the National Health Service.
Ms. Harman : To ask the Secretary of State for Health if he will include as items for the regional review by Ministers (a) any adverse impact of health authority practices on the environment and (b) any adverse impact of environmental factors on public health within the region.
Mr. Freeman : This year public health issues were discussed with each region in preparation for regional reviews, which are now normally conducted by the chief executive of the management executive. Where there are serious concerns about these or other specific areas, they are raised at the review itself. Management action is taken in relation to the impact of health authority practices on the environment as they arise.
Ms. Harman : To ask the Secretary of State for Health if he will issue guidance banning the use by health authorities of products proven to be environmentally damaging where an alternative is available.
Mr. Freeman : No. We consider that, as responsible public bodies, health authorities should be able to take account of all relevant factors, including environmental factors and statutory requirements, in securing best value for money in their purchasing policies.
Ms. Harman : To ask the Secretary of State for Health if he will list those health authorities which have regular planning and consultative meetings with local authority environmental health officers ; and what exchange of information there is between them.
Ms. Harman : To ask the Secretary of State for Health whether there is an environmental component in the training and qualification of (a) nurses, (b) doctors, (c) radiographers, (d) hospital administrators and (e) health visitors.
(a) Nurses and health visitors : The standard and content of training for nurses and health visitors is determined by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting. (b) Doctors : The General Medical Council recommend the curriculum for undergraduate medical students.
(c) Radiographers : The Council for the Professions Supplementary to Medicine through its Radiography Board, is responsible for regulating the professional education of radiographers.
Column 688(d) Hospital Administrators : Health authorities and the National Health Service Training Authority are responsible for the standard and content of training for hospital administrators.
Mr. Freeman : Information on health authority premises where boiler and incinerator are known to give rise to air pollution problems is not available centrally but all installations are expected to comply with current legislation.
Mr. Freeman : The information requested is not available centrally. It is for health authorities to determine responsibilities for waste management. As far as clinical waste is concerned, the Department has issued guidance to health authorities which recommends that it should be the responsibility of a designated officer within each authority.
Mr. Freeman : National contracts for copy paper and listing paper for computer use do make provision for the use of recycled paper. No figures are yet available to show the percentage of recycled paper used. However, it is unlikely that the use of 100 per cent. recycled stationery will be significant. Large quantities of chemicals are necessary to achieve a desirable standard of whiteness in the paper. This calls into question the level of benefit to the environment, and can involve higher costs of production than ordinary paper.
Mr. Freeman : Regional supplies directors were advised at a meeting of the national procurement group in September 1988 that the small-scale use of chlorofluorocarbons in sterilisers as a carrier gas for ethylene oxide should be avoided, if possible, since pure ethylene oxide and ethylene oxide/carbondioxide mixtures were available as satisfactory alternatives.
(2) what is the current average waiting list for an enrolled nurse conversion course.
Mrs. Virginia Bottomley : This information is not collected centrally. Information provided by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting about the numbers in the United Kingdom who have paid the periodic fee and were therefore on the effective register shows that on 31 March 1989 there were 158,500 people who held an enrolled nurse qualification.
Mr. Corbyn : To ask the Secretary of State for Health if he will list by health district (a) the current nursing staff establishment, (b) the number in post at the latest available date and (c) the number who had left the National Health Service in the preceding year.
Mrs. Virginia Bottomley [holding answer 3 November 1989] : Information on the number of nursing and midwifery staff employed in each district health authority in England at 30 September 1988 is given in the table.
We do not collect information on nursing staff establishments centrally. Reliable information on the numbers leaving the National Health Service last year is not yet available.
Mr. Kenneth Clarke : I have frequent formal and informal meetings with doctors and dentists, mostly very amicable, constructive and supportive of our objectives. I met the British Dental Association on 27 September when I reached full agreement with it on the terms of its new contract. I met the British Medical Association on 18 October to discuss the implementation of our proposals in the White Paper "Working for Patients" and had a friendly and constructive discussion.
Mr. Malins : To ask the Secretary of State for Health what progress has been made on the Government's initiative announced in February for improving life for people in residential homes ; whether he proposes to take
Column 690any further action on the recommendations of the committee on residential care chaired by Lady Wagner ; and if he will make a statement.
Mrs. Virginia Bottomley : In February we announced our intention to launch a development programme aimed at improving life for people in residential homes, based on recommendations of the committee chaired by Lady Wagner.
We have appointed five agencies to carry forward important recommendations from the committee's report "Residential Care : A Positive Choice". Work has now begun and will continue for the next three years at a total cost of around £2.2 million. This initiative aims at better training for staff in homes, better information for the public in making choices, effective, accessible and widely known arrangements for making suggestions and complaints, a closer relationship between homes and their local communities and better management of homes. Cost-effective ways of achieving these objectives will be explored through a wide range of development projects. The results of these activities will be made widely and regularly available to national and local agencies concerned and will be independently assessed.
The thrust of many of the committee's recommendations, for example on the organisation and funding of community care, has been taken into account in the wider context of community care development and will be reflected in the forthcoming White Paper.
The committee's recommendations on setting and maintaining standards have been incorporated in our proposals to achieve even-handedness in inspection of residential care homes, as between independent and local authority homes, through the setting up of inspection units in social services departments at arms length from the management of local authorities' own homes. Issues concerning children and young people, on which the Wagner committee made recommendations, are covered in the Children Bill, including education and health needs of children in care, keeping siblings together wherever practicable and appropriate, the needs of ethnic minority groups and accommodation for young people leaving care. And we are considering issuing guidance on encouraging and enabling people in residential care homes to manage their own finances where they are capable of doing so.
The Wagner committee has done a valuable service in pointing the way to better standards. The Government are playing their part in responding to its report. We also look to local authorities and private and voluntary agencies, to whom much of the report was primarily addressed, to take those messages to heart and act on them.
The selected agencies and their fields of activity are as follows :
Basic training programmes for care staff : the National Institute for Social Work ;
Ways of increasing contacts between homes and their local communities and a wider role for volunteers : the Social Care Association (Education) ;
Methods of self-assessment and performance evaluation by managers : the Polytechnic of North London ;
Ways of providing information to help people in choosing a home or alternative to residential care : the Policy Studies Institute. The department of government, Brunel university will co-ordinate this activity, provide an information service and publish an independent assessment of the programmes.
Column 691In addition the Department's social services inspectorate will develop procedures for dealing with suggestions and complaints.
National Health Service staff in post in England nursing and midwifery by district health authority<1> at 30 September 1988 |Whole time equivalent<2> --------------------------------------------------------------------------------------- Total England |403,880 Northern RHA HQ |70 Hartlepool |860 North Tees |1,280 South Tees |2,650 East Cumbria |1,600 South Cumbria |1,120 West Cumbria |1,160 Darlington |1,170 Durham |1,180 North West Durham |730 South West Durham |1,620 Northumberland |3,170 Gateshead |1,400 Newcastle |5,200 North Tyneside |970 South Tyneside |970 Sunderland |2,600 Yorkshire RHA HQ |120 Hull |2,660 East Yorkshire |1,610 Grimsby |1,300 Scunthorpe |1,240 Northallerton |530 York |2,300 Scarborough |890 Harrogate |1,170 Bradford |2,740 Airedale |1,440 Calderdale |1,570 Huddersfield |1,990 Dewsbury |970 Leeds Western |3,420 Leeds Eastern |3,310 Wakefield |2,000 Pontefract |1,070 Trent RHA HQ |100 North Derbyshire |2,270 South Derbyshire |3,980 Leicestershire |6,570 North Lincolnshire |2,230 South Lincolnshire |2,110 Bassetlaw |680 Central Nottingham |2,250 Nottingham |5,670 Barnsley |1,700 Doncaster |2,560 Rotherham |1,850 Sheffield |6,310 East Anglian RHA HQ |50 Cambridge |2,600 Peterborough |1,780 West Suffolk |1,660 East Suffolk |2,640 Norwich |3,950 Great Yarmouth and Waveney |1,410 West Norfolk and Wisbech |1,300 Huntingdon |770 North West Thames RHA HQ |<3>- North Bedfordshire |1,380 South Bedfordshire |1,900 North Hertfordshire |1,020 East Hertfordshire |1,050 North West Hertfordshire |3,060 South West Hertfordshire |1,240 Barnet |2,870 Harrow |1,430 Hillingdon |2,050 Hounslow and Spelthorne |2,030 Ealing |1,760 Brent |2,000 Paddington and North Kensington |2,050 Riverside |3,910 North East Thames RHA HQ |110 Basildon and Thurrock |2,180 Mid-Essex |1,910 North East Essex |2,980 West Essex |1,670 Southend |2,000 Barking, Havering and Brent |3,350 Hampstead |2,120 Bloomsbury |3,210 Islington |1,510 City and Hackney |2,620 Newham |1,410 Tower Hamlets |2,390 Enfield |1,500 Harringey |1,350 Redbridge |1,520 Waltham Forest |2,660 South East Thames RHA HQ |10 Brighton |2,250 Eastbourne |1,700 Hastings |1,280 South East Kent |1,610 Canterbury and Thanet |2,590 Dartford & Gravesend |1,880 Maidstone |1,580 Medway |1,640 Tunbridge Wells |1,890 Bexley |1,580 Greenwich |2,050 Bromley |2,180 West Lambeth |2,370 Camberwell |2,310 Lewisham and North Southwark |3,550 South West Thames RHA HQ |120 North West Surrey |1,640 West Surrey and North East Hampshire |1,340 South West Surrey |1,750 Mid-Surrey |1,820 East Surrey |1,740 Chichester |1,370 Mid-Downs |1,780 Worthing |1,570 Croydon |2,300 Kingston and Esher |1,550 Richmond, Twickenham and R. |1,260 Wandsworth |2,940 Merton and Sutton |2,590 Wessex RHA HQ |10 East Dorset |3,210 West Dorset |1,820 Portsmouth and South East |3,930 Southampton and South West |4,180 Winchester |1,310 Basingstoke and North Hampshire |1,780 Salisbury |1,440 Swindon |1,860 Bath |3,120 Isle of Wight |1,030 Oxford RHA HQ |70 East Berkshire |2,310 West Berkshire |2,870 Aylesbury Vale |1,710 Wycombe |1,250 Milton Keynes |730 Kettering |1,510 Northampton |2,410 Oxfordshire |4,150 South Western RHA HQ |80 Bristol and Weston |3,470 Frenchay |2,690 Southmead |2,160 Cornwall and Isles of Scilly |2,900 Exeter |3,300 North Devon |1,000 Plymouth |2,890 Torbay |1,850 Cheltenham |1,350 Gloucester |2,490 Somerset |3,130 West Midlands RHA HQ |130 Bromsgrove and Redditch |1,150 Herefordshire |1,200 Kidderminster |1,280 Worcester |1,700 Shropshire |2,740 Mid-Staffordshire |1,760 North-Staffordshire |4,190 South-Staffordshire |1,900 Rugby |460 North Warwickshire |1,490 South Warwickshire |1,910 Central Birmingham |2,860 East Birmingham |1,400 North Birmingham |1,380 South Birmingham |2,610 West Birmingham |2,540 Coventry |2,600 Dudley |2,070 Sandwell |1,490 Solihull |1,150 Walsall |1,960 Wolverhampton |2,210 Mersey RHA HQ |70 Chester |1,730 Crewe |1,790 Halton |630 Macclesfield |1,580 Warrington |2,350 Liverpool |5,160 St. Helens and Knowsley |2,580 Southport and Formby |1,230 South Sefton |2,290 Wirral |2,770 North Western RHA HQ |120 Lancaster |2,120 Blackpool Wyre and Fylde |2,540 Preston |2,490 Blackburn Hymburn and Ribb |1,930 Burnley Pendle and Rossend |3,240 West Lancaster |920 Chorley and South Ribble |610 Bolton |1,900 Bury |1,100 North Manchester |2,450 Central Manchester |2,070 South Manchester |3,120 Oldham |1,480 Rochdale |1,170 Salford |3,320 Stockport |2,160 Tameside and Glossop |1,420 Trafford |1,230 Wigan |2,110 London Post Graduate SHA's The Hospital for Sick Children |1,240 The National Hospital |410 Moorfields Eye Hospital |190 The Bethlem Royal Hospital |720 The National Heart and Chest |640 The Royal Marsden Hospital |460 Hammersmith and Queen Charlottes |1,230 Eastman Dental Hospital |10 LAS |<3>- BTS |70 PHLS |10 Other |10 <1> Including unqualified nursing and midwifery staff and agency staff. <2> Figures independently rounded to nearest ten (10) whole time equivalents. <3> Indicates less than five (5) whole time equivalents. Source: Department of Health (SM13) annual census of NHS non-medical manpower.
Numbers of deaths attributable to certain drugs, United Kingdom 1986-88 |1986|1987|1988 -------------------------------------------------------- Drug dependence or addiction<1> |63 |65 |56 Other drug abuse or intoxication<2> |16 |14 |21 Other poisoning by drugs<3> |105 |129 |128 <1>Morphine type. Heroin, Methadone, Opium, Opium alkaloids and other derivatives, Synthetics with morphine-like effects. Cocaine. Coca leaves and derivatives. Combinations of morphine type drugs with any other. <2>Morphine type. Cocaine type. <3>Opiates and related narcotics. Codeine (methylamorphine), Heroin (diacetylmorphine), Pethidine (mepiridine), Methadone, Morphine, Opium ( alkaloids). Surface and infiltration anaesthetics. Cocaine, Lignocaine, Procaine, Tetracaine.
8. Mr. Patrick Thompson : To ask the Secretary of State for the Environment what comments he has received on his proposal to drop the special prescription in favour of development from the draft PPG3 planning guidance note.
Column 695law on waste disposal. This will include a duty of care on waste producers and improved controls over the disposal or treatment of waste. I shall also be issuing a consultation paper on the review of the special waste regulations shortly.
19. Mr. Evennett : To ask the Secretary of State for the Environment whether he intends to introduce legislation to provide local authorities with powers to abate odour nuisance from sewage treatment works.
20. Mr. Matthew Taylor : To ask the Secretary of State for the Environment when he last discussed United Kingdom compliance with European Community water directives with the Community environment commissioner ; and if he will make a statement.
76. Mr. Win Griffiths : To ask the Secretary of State for the Environment if he will make a statement on progress towards reaching agreement with the Commission of the European Communities on plans for the implementation of the drinking water directive, 80/778/EEC, and the bathing water directive, 76/160/EEC.
42. Mr. Livsey : To ask the Secretary of State for the Environment by what date the United Kingdom will meet the requirements of European Council directives on water quality ; and if he will make a statement.
Mr. Howard : In the majority of cases the United Kingdom already meets the requirements of the various European Community directives concerning water quality. For the remainder of cases measures are in hand to achieve these, notably in the case of the directives on the quality of drinking water and bathing waters, where timetabled improvement programmes have been submitted to the Commission of the European Communities.
Mr. Heathcoat-Amory : It is impractical at present to set specific limits for emissions of dioxins, as the monitoring and analysis of these compounds is complex, slow and expensive. Emissions of dioxins are therefore controlled in the United Kingdom, as in the European directives on municipal waste incineration plants, through effective control of combustion conditions and the fitting and use of suitable abatement equipment.
Mr. Chope : Estimates of the number and percentage of dwellings in owner-occupation in the South West region are given in table 9.4 of "Housing and Construction Statistics 1978-1988", a copy of which is available in the Library.
Mr. Moynihan : The sixth conference of European Ministers responsible for sport which I attended in Reykjavik from 30 May to 1 June 1989 agreed a resolution concerning apartheid in sport and discouraging sporting contact with South Africa. The resolution has been adopted by the Committee of Ministers and I have asked the Sports Council to circulate a copy of it to the governing bodies of sport.
In August I wrote to the chairman of the Test and County Cricket Board and the president of the Rugby Football Union about the proposed tours to South Africa restating the Government's commitment to the Gleneagles agreement and our policy of seeking to discourage sporting contact with South Africa. I asked for copies of my letters to be passed on to individual players who had accepted invitations to visit South Africa.