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Mrs. Dunwoody : To ask the Secretary of State for Health if he will instigate a research project to establish how many facilities to help child abusers overcome their problem are available, with their location.
Mrs. Virginia Bottomley : It is for individual local authorities to determine what resources to allocate to a particular service in the light of local needs and priorities. However, through the training support programme (child care) the Department has this year made available £7 million in support of total expenditure of £10 million for the training of local authority child care staff, with a particular emphasis on training in child protection.
Mrs. Virginia Bottomley : The General Medical Council in November 1987 expressed the view that, if a doctor has reason for believing that a child is being physically or sexually abused, not only is it permissible for the doctor to disclose information to a third party but it is a duty for the doctor to do so. That view was published in the council's annual report for 1987 and reproduced in "Working Together" (1988) and in "Diagnosis of Child Sexual Abuse : Guidance for Doctors" (1988), both of which were published by the Department and are available in the Library.
Mrs. Dunwoody : To ask the Secretary of State for Health if he will conduct a research project on the number of emotionally abused children that have been reported in the last two years ; and what type of help is provided for them.
Mrs. Virginia Bottomley : Statistics on the number of children placed on child protection registers by reason of emotional abuse are available in "Survey of Children Placed on Child Protection Registers Year Ending 31 March 1988 England", copies of which are available in the Library. The Department has identified the need for research into the relationship between emotional abuse and neglect ; and has included this issue in its strategy for possible research in 1990-91. There are a range of assessment, treatment and support services provided by local authority social services departments, health authorities and voluntary child care organisations available for abused children, including those who have been emotionally abused.
Mr. Alton : To ask the Secretary of State for Health what information he has about the minimal gestation age at which an aborted baby can show one or more of the following signs of life (a) brain activity, (b) pulse rate, (c) heart beat, (d) breathing and (e) movement.
Mrs. Virginia Bottomley : Breathing and brain activity are functions associated with viability. Although we know of no formal research on these points some doctors have noted transient heartbeat and movement from about 12 weeks' gestation.
Mr. John Marshall : To ask the Secretary of State for Health whether his Department now has a clearer idea regarding the proportion of people with haemophilia with HIV who are subsequently likely to contract full- blown AIDS.
Mr. Freeman : My right hon. and learned Friend the Secretary of State announced yesterday that the work of the whole of the National Health Service management executive is to be relocated from London to Leeds. We decided on Leeds after the most careful consideration of its advantages and those of other potential locations.
Mr. Cummings : To ask the Secretary of State for Health if he will list the number of hospital beds in (a) Sunderland area health authority, (b) Durham area health authority, and (c) Hartlepool area health authority, for each year from 1979 to 1989.
Average daily available beds, Hartlepool, Durham and Sunderland district health authorities, 1979 to 1987-88 District health authority |Hartlepool|Durham |Sunderland ------------------------------------------------------- 1979 |592 |1,192 |2,426 1980 |614 |1,188 |2,379 1981 |600 |1,181 |2,356 1982 |627 |1,156 |2,338 1983 |636 |1,165 |2,351 1984 |705 |1,107 |2,349 1985 |607 |1,103 |2,312 1986 |639 |1,107 |2,273 1987-88 |642 |1,075 |2,315
Mr. Cummings : To ask the Secretary of State for Health if he will list the number of people on hospital waiting lists within the Sunderland, Durham and Hartlepool health authorities at the beginning of October.
In-patient waiting list<1>, Hartlepool, Durham and Sunderland district health authorities, as at 31 March 1989 District health authority |Number waiting ------------------------------------------------------------------------------ Hartlepool |1,167 Durham |1,425 Sunderland |4,609 <1> Less self deferred.
Mr. Cummings : To ask the Secretary of State for Health what was the number of patients on hospital waiting lists in the Durham, Sunderland and Hartlepool health authority areas, waiting for (a) varicose veins ; (b) hip joint replacements ; and (c) cataracts at the beginning of October.
Mrs. Virginia Bottomley : Waiting list information is held centrally only by clinical specialty of the consultant and not by operation or diagnosis. The hon. Member may wish to write to the chairmen of the health authorities concerned for the information he seeks.
Mrs. Virginia Bottomley : Statistics on the number of children placed on child protection registers by reason of neglect are available in "Survey of Children Placed on Child Protection Registers Year Ending 31 March 1988 England", copies of which are available in the Library. We have no plans to instigate a report on how cases of child neglect are being dealt with. However, the social services inspectorate has a programme of inspections of child protection services within individual local authorities and these reports are published.
Mr. Freeman : The provisional number of reported cases of salmonella in humans reported in the period January to September 1989 is 21,843. This figure was published on 30 October in the "Update on salmonella infection" produced jointly by the public health laboratory service and the state veterinary service, a copy of which is in the Library.
Mr. Freeman : The information on inpatient and day cases treated as a result of attacks by animals should be available early next year when health authorities have overcome problems in introducing the additional codes on their patient records.
The information is not collected on outpatients because there are too many outpatient attendances for such coding to be practical.
Mrs. Margaret Ewing : To ask the Secretary of State for Health (1) what was the spending on the National Health Service in England and Wales in each year from 1959 until the present (a) in cash terms and (b) adjusted for retail price inflation ;
(2) what was the spending on the National Health Service in England and Wales each year from 1959 until the present, adjusted for inflation in the National Health Service costs in England and Wales.
Mr. Freeman : The information requested for the years from 1974-75 to 1989-90 is shown in the table. Comparable information for the period before 1974-75 cannot be provided without incurring disproportionate costs. The retail price index is a measure of increases in cost in a basket of consumer goods and as such has no particular relevance to NHS expenditure.
NHS Gross expenditure-England and Wales £ million |(a) |(b) |(c) |Cash<1> |RPI<2> |Adjusted for NHS pay and |price<3> ----------------------------------------------------------------------------------------------------------------------------- 1974-75 |3,636 |13,721 |16,846 1975-76 |4,793 |14,518 |17,309 1976-77 |5,466 |14,364 |17,484 1977-78 |6,048 |13,950 |17,667 1978-79 |6,936 |14,784 |18,253 1979-80 |8,237 |15,145 |18,124 1980-81 |10,723 |16,953 |18,578 1981-82 |12,035 |17,059 |19,130 1982-83 |13,131 |17,392 |19,416 1983-84 |13,939 |18,650 |19,629 1984-85 |14,965 |18,036 |19,881 1985-86 |15,838 |18,013 |20,001 1986-87 |17,043 |18,772 |20,247 1987-88 |18,730 |19,851 |20,622 1988-89 |20,833 |20,833 |20,833 1989-90<5> |22,575 |-<4> |-<4> <1>The gross expenditure figures shown have been produced by adding Department of Health figures for NHS expenditure in England to figures for Wales produced by the Welsh Office. <2>Figures have been adjusted to 1988-89 prices. The RPI is constructed on a United Kingdom basis, there is no specific England and Wales RPI. <3>No specific deflator is produced for NHS pay and price inflation in England and Wales. The cash figures have therefore been adjusted by a deflator produced by the Department of Health for England only. <4>Estimates of retail price inflation and pay and price rises in the NHS are not produced by the Department of Health until after the financial year has ended. <5>Estimated.
Mr. Freeman : Following is information derived from the annual accounts of regional and district health authorities in England. Information about expenditure in Wales is a matter for my right hon. Friend the Secretary of State for Wales.
Total revenue expenditure on blood transfusion services |£ (cash) --------------------------------- 1986-87 |59,849,163 1987-88 |63,787,839 <1>1988-89 |68,420,036 <1> Provisional figure (as yet subject to audit).
|£ million ------------------------------ 1986-87 |20.7 1987-88 |17.9 1988-89 |19.3
The information relating to the Welsh pricing committee is a matter for my right hon. Friend the Secretary of State for Wales.
Mr. Freeman : The public health laboratory service board, which is the statutory body with responsibility for running the public health laboratory service in England and Wales has received grants from the Department of Health and the Welsh Office in respect of that responsibility as follows.
£000s Financial year |Revenue |Capital |Total --------------------------------------------------------------------------- 1986-87 |31,083 |418 |31,501 1987-88 |34,898 |2,976 |37,874 1988-89 |37,629 |5,013 |42,642
The public health laboratory service board also receives funds from the sale of its services.
Information about expenditure in Wales is a matter for my right hon. Friend the Secretary of State for Wales.
Total expenditure (cash) 1986-87 1987-88 <1>1988-89 Region |Regional health|District health|Region total |Regional health|District health|Region total |Regional health|District health|Region total |authorities |authorities |authorities |authorities |authorities |authorities |£000 |£000 |£000 |£000 |£000 |£000 |£000 |£000 |£000 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Northern |49,249 |668,102 |717,351 |46,185 |732,671 |778,856 |55,691 |800,844 |856,535 Yorkshire |77,299 |740,791 |818,089 |70,463 |812,399 |882,862 |70,801 |905,679 |976,480 Trent |79,660 |912,306 |991,966 |73,401 |1,011,787 |1,085,188 |81,274 |1,133,256 |1,214,530 East Anglian |28,876 |393,076 |421,952 |27,606 |434,256 |461,862 |29,435 |491,172 |520,607 North West Thames |57,877 |786,447 |844,324 |50,360 |866,914 |917,274 |59,999 |1,003,195 |1,063,194 North East Thames |72,324 |979,681 |1,052,005 |55,687 |1,086,053 |1,141,740 |76,422 |1,223,109 |1,299,531 South East Thames |59,634 |873,972 |933,606 |63,769 |956,251 |1,020,020 |66,668 |1,064,886 |1,131,554 South West Thames |60,254 |643,969 |704,243 |103,166 |710,939 |814,105 |110,282 |800,097 |910,379 Wessex |62,790 |557,361 |620,151 |55,523 |609,274 |664,797 |56,683 |680,977 |737,660 Oxford |35,391 |431,957 |467,346 |33,377 |486,034 |519,411 |43,945 |545,075 |589,020 South Western |53,070 |665,359 |718,429 |41,357 |737,832 |779,189 |45,207 |818,652 |863,859 West Midlands |106,455 |1,058,538 |1,164,993 |106,307 |1,146,550 |1,252,857 |82,442 |1,266,708 |1,349,150 Mersey |49,370 |541,893 |591,264 |46,641 |593,950 |640,591 |26,245 |663,287 |689,532 North Western |84,994 |903,031 |988,025 |88,870 |989,569 |1,078,438 |88,340 |1,093,787 |1,182,127 |------- |------- |------- |------- |------- |------- |------- |------- |------- Total |877,243 |10,156,503 |11,033,746 |862,712 |11,174,480 |12,037,192 |893,435 |12,490,723 |13,384,158 <1> Provisional figures (as yet subject to audit).
1. The figures cover total revenue and capital expenditure on all Hospital and Community Health Services (HCHS)--including hospital, community health, patient transport (ie ambulance), blood transfusion and other services.
2. Expenditure on family practitioner services (FPS) which is accounted for by family practitioner committees and cannot strictly be assigned to particular regions, is excluded.
3. The figures for regional health authorities include expenditure on services within HCHS which are directly managed by those authorities and expenditure on major capital schemes at district levels within the respective regions.
4. The annual accounts of the special health authorities for the London postgraduate teaching hospitals, which do not form part of the regional structure, record total expenditure on HCHS as follows :
|£000 (cash) ------------------------------------ 1986-87 |219,711 1987-88 |240,964 <1>1988-89 |258,823 <1> Provisional figure.
Column 345agreement on tobacco products' advertising and promotion and health warnings. The Council has just responded on behalf of the industry that although it believes that meaningful discussions about a future voluntary agreement will be difficult until the outcome of discussions in Brussels on the draft EC directive on tobacco advertising is known, the industry is prepared to meet the Health Ministers to discuss possible renegotiations.
Mr. David Knox : To ask the Secretary of State for Health, when he expects to publish the Government's response to the Social Services Committee report on the National Health Service White Paper "Working for Patients."
Mr. Kenneth Clarke : The Government's response was published today. It notes the large degree of agreement between the Committee and the Government both on the need for reform of the NHS and on our specific proposals for change. The Committee's clear endorsement of the fundamental aims of the White Paper "Working for Patients", namely, that the NHS will continue to be a comprehensive service open to all regardless of means and financed largely out of taxation is welcomed. We also welcome the Committee's support for many of the key proposals in the White Paper. These include the proposals for devolving more management responsibilities to the local level, extending patient choice, resource management, medical audit of the quality of care, making more efficient use of capital, increasing the number of NHS consultants and removing the "efficiency trap" by ensuring that resources are linked to workload.
The Government's response fully addresses the Committee's concerns about funding. First, it reaffirms the assurance that the necessary funding to introduce the NHS reforms will not be at the expense of patient care. We have made available an additional £82 million this year to assist with implementation. Secondly, the Committee has not recognised that spending on the NHS in the United Kingdom has increased massively--from £8 billion in 1978 to £26 billion in 1989. This represents an increase in real terms of 40 per cent. As announced in the Chancellor's Autumn Statement, the Government's spending plans mean that gross expenditure on the NHS will increase to over £28 billion in 1990-91, an increase in resources over 1989-90 of £2.6 billion. The equivalent figure for England is £23.3 billion, an increase in resources of more than £2.2 billion or 5.5 per cent. in real terms. This increase is well in excess of the Committee's recommended increase of around 2 per cent. each year. The increase will also raise the overall increase since the Government came to power in 1979 to 45 per cent. in real terms.
The Committee's other concerns are largely about the pace and process of implementation of the proposals in "Working for Patients", rather than the overall direction of change. We believe that the Committee's concerns about the availability of information systems to cost treatments and about the need for pilot projects are misplaced. Implementation of the proposals in "Working for Patients" will be an evolutionary process. Subject to parliamentary approval, the Government intend to have in place the central elements of their reforms by April 1991. These include the reshaped health authorities and FPSAs. Their chairmen and members will need to lead the
Column 346implementation of the new arrangements for the NHS and their task will be very different from that of chairmen and members of the current authorities. The Government have decided therefore to follow the Committee's recommendation that non-executive members of health authorities and FPSAs should be remunerated. Other key elements will include, for example, the first NHS trusts, the first practice budgets for fund-holding GPs and the new system for contracting for services within the NHS. The subsequent development of these programmes will be informed by the experience gained from the first participating hospitals and practices.
The Government are supporting a number of projects throughout the country with the aim of developing information, financial and management systems by April 1991. The system for contracting for services will initially operate largely on the basis of existing information. At first many services are likely to be provided under "block" contracts with hospitals agreeing to provide a defined level and range of services in return for an agreed level of resources. More sophisticated forms of contracting and the associated supporting information and costing systems will develop as the experience of the NHS with contract funding grows.
Mr. Alfred Morris : To ask the Secretary of State for Health when he expects to have completed his assessment of the likely need for erythropoietin and its expenditure implications ; and if he will make a statement.
Mr. Ashley : To ask the Secretary of State for Health if he has considered whether the Association of Crossroads Care Attendant Schemes, may be able to assist local authorities to set up appropriate assessment procedures as proposed in "Community Care : Agenda for Action".
Mrs. Virginia Bottomley : Our proposals for assessment will be set out in our White Paper on community care which is to be published on Thursday 16 November. We plan to issue further detailed guidance to local authorities and health authorities in due course, following discussions with professional and representative bodies, including voluntary sector organisations.
Mr. Ashley : To ask the Secretary of State for Health if, in the preparation of the White Paper on community care, he has considered the need to increase section 64 funding to voluntary organisations providing community care services.
Mr. Freeman : The increased role of the voluntary sector envisaged in our White Paper proposals is likely to lead to increased funding, using the section 64 power, in coming years. Health authorities (using section 64) and local authorities (using section 65) will determine their arrangements for care provision involving voluntary organisations and hence the levels of funding.
Mr. Madden : To ask the Secretary of State for Health what changes, in terms of rights, occur when a mentally handicapped person is transferred from a National Health Service hospital to a private home, supervised by a consortium ; and if he will make a statement.
Mr. Freeman : Patients treated under contractual arrangements retain the same rights as those treated in the National Health Service and the health authority has a continuing responsibility for their medical and nursing care. The position of patients admitted to the private sector following discharge from a National Health Service hospital depends on the terms of the admission. Such patients retain the right to National Health Service general medical and dental services.
Mr. Dalyell : To ask the Secretary of State for Health what response he is making to the report by Dr. Sheila Gore of the Medical Research Council biostatistics unit in Cambridge relating to the shortage of organs for transplant.
Mr. Freeman : This report, which was commissioned by the Department of Health, analyses the results of an audit of deaths in intensive care units which was organised by the Department. The audit includes an examination of the number of deaths, how many were potential donors, in how many cases relatives were asked to consent to donation and how many refused.
Tomorrow I will be chairing a seminar to examine ways of improving the voluntary donation of organs to which I have invited a group of experts and interested parties. Our discussions will include the implications of the report to which the hon. Member refers.
Mr. Dobson : To ask the Secretary of State for Health (1) if he will give for each district health authority the percentage of cases on the gross demand waiting list at March waiting for 12 months or more, and the ranking for that percentage for (a) general surgery, (b) traumatic and orthopaedic, (c) ear or nose and throat, (d) cardiothoracic surgery, (e) paediatric surgery, (f) gynaecology and (g) the total waiting list ;
(2) if he will give for each district health authority the percentage change in the gross demand day-case total waiting list between March 1988 and March 1989 and the ranking of that percentage change ;
(3) if he will give for each district health authority the sum of the gross demand total waiting lists for in-patients and day cases in March 1988, the comparable figure for March 1989, the percentage change between the two dates and the ranking of that percentage change ;
(4) if he will give for each district health authority the percentage change in the in-patient waiting list between March 1988 and March 1989 and the ranking of that percentage change, using the gross demand figures for (a) general surgery, (b) traumatic and orthopaedic, (c) ear, nose and throat, (d) cardiothoracic surgery, (e) paediatric surgery, (f) gynaecology and (g) the total waiting list ;
(5) if he will give for March 1989 and for each district health authority the notional time to clear the waiting lists, and the ranking of that notional time to clear, for (a)
Column 348general surgery, (b) traumatic and orthopaedic, (c) ear, nose and throat, (d) cardiothoracic surgery, (e) paediatric surgery, (f) gynaecology and (g) the total waiting list ;
(6) if he will give for each district health authority the March gross demand day case waiting list, and the ranking of that waiting list for (a) general surgery, (b) traumatic and orthopaedic, (c) ear, nose and throat, (d) cardiothoracic surgery, (e) paediatric surgery, (f) gynaecology and (g) the total waiting list ; (7) if he will give the March gross demand figures for the number of cases on the in-patient waiting lists for each district health authority for (a) general surgery, (b) traumatic and orthopaedic, (c) ear, nose and throat, (d) cardiothoracic surgery, (e) paediatric surgery, (f) gynaecology and (g) the total waiting list ; and if he will give the ranking of each district health authority by each specialty.
Mr. Freeman [holding answer 30 October 1989] : The information requested has been placed in the Library. Reasons for the variations between districts in the number of cases on individual waiting lists include the size and age structure of the population and the extent of local development of specialised services. Not all health authorities provide each specialty.
Mrs. Virginia Bottomley [holding answer 3 November 1989] : I refer the hon. Member to my hon. and learned Friend's reply to the hon. Member for Holborn and St. Pancras (Mr. Dobson) on 18 July at column 131 concerning district manpower information for 1988. Similar information covering the previous two years has already been placed in the Library.
The present structure of NHS districts has existed only since 1982. Information to this level of detail from that time up to 1985 is not available without incurring disproportionate cost.
Mrs. Virginia Bottomley [holding answer 9 November 1989] : Any company wishing to set up clinical trails under the Medicines Act 1968 would need to apply to the Medicines Control Agency before such trials could commence. Details of any such applications are confidential to the licensing authority.
Column 349homelessness provisions of the Housing (Scotland) Act 1987 is estimated to have been 25,000 in 1988-89. Of these, about 9,500 were assessed by local authorities as homeless.
Lord James Douglas-Hamilton : The Government have taken a number of measures to ensure that housing needs in Scotland are more closely matched by housing provision. It is for local authorities to deal with cases of homelessness.
15. Mr. Maclennan : To ask the Secretary of State for Scotland when he next proposes to meet representatives of the Scottish fishing industry to discuss decommissioning of fishing vessels and future licensing arrangements of the industry.
decommissioning and licensing were among the issues discussed.
Mr. Lang : My right hon. and learned Friend and my noble Friend the Minister of State are urgently considering proposals to help align fishing opportunity and catching capacity. These raise many difficult issues, but we hope to announce our decisions very soon.
22. Mr. Kennedy : To ask the Secretary of State for Scotland if he will assess the need for a decommissioning scheme in the Scottish fishing industry in the light of current total allowable catches ; and if he will make a statement.
Mr. Lang : The Government are fully aware of both the present scarcity of white fish and the excess capacity which exists in the United Kingdom fishing fleet and are considering how fishing opportunity can be better aligned to catching capacity. This consideration includes the option of a decommissioning scheme. Before introducing any such scheme we would need to be satisfied that it addressed the problem appropriately and that it represented good value for taxpayers' money.