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Mrs. Virginia Bottomley : By far the biggest increase has been in the number of prescriptions dispensed for people of pensionable age. The second largest increase has been in prescriptions dispensed for people on a low income.

GP Lists

Mr. Sims : To ask the Secretary of State for Health in which circumstances a general practitioner may at present ask for and receive a premium before accepting a patient or a group of patients on to the practice list.

Mrs. Virginia Bottomley : I will write to my hon. Friend as soon as possible.

Speech Therapy

Mrs. Ray Michie : To ask the Secretary of State for Health how many people on average are covered by a single speech therapist ; and what is the recommended number of people which one speech therapist should cover.

Mr. Freeman : In England in 1988, approximately 17,000 people were on average covered by a single (whole-time equivalent) NHS speech therapist. The Quirk committee report of 1972 recommended that there should be six whole-time equivalent speech therapists per 100,000 population.


Column 427

Mrs. Ray Michie : To ask the Secretary of State for Health if any study is currently underway into national target levels of speech therapy service in relation to patient groups ; and if he will make a statement.

Mr. Freeman : The Department has sponsored a research study by Dr. Philip Davies of Oxford university which will provide estimates of the level of speech therapy service required by various groups of speech and language impaired people. The study is expected to be published shortly and we would expect health authorities to take account of the results of the study in planning speech therapy services. There are no plans to establish national target levels for the speech therapy service.

Mrs. Ray Michie : To ask the Secretary of State for Health if he will give a breakdown of the percentages of speech therapy referrals which come from doctors and consultants, and from clinical medical officers, health visitors, community nursing, educational services, social services, speech therapists in other districts, from self-referrals and other sources.

Mr. Freeman : An estimate of the percentage breakdown of initial contacts in the year is given in the table.


Speech Therapy Services:                     

Percentage of initial contacts by Source of  

Referral: 1988-89                            

England                                      

---------------------------------------------

Consultants                          |25     

General Practice                     |5      

Other Medical                        |12     

Health Visitor                       |19     

Community Nursing                    |2      

Education Service                    |12     

Social Services                      |3      

Self Referral                        |9      

Speech Therapists in other Districts |2      

Other Sources                        |11     

Total all locations                  |100    

Mrs. Ray Michie : To ask the Secretary of State for Health if he will provide a percentage breakdown of the communication--handicapped population who receive speech therapy in (a) the hospital site, (b) National Health Service premises, (c) local authority premises, (d) patients' homes and (e) other locations.

Mr. Freeman : The figures are not available in exactly the form requested. An estimate of the percentage breakdown of face to face contacts in the year is given in the table.


Speech Therapy Services:                                                            

Percentage of face to face contacts by site: 1988-89 England                        

Type of Location                        |Percentage of face to                      

                                        |contacts                                   

------------------------------------------------------------------------------------

Hospital site                           |24                                         

NHS premises other than a hospital site |30                                         

Local Authority premises                |37                                         

Patient home                            |4                                          

Other locations                         |5                                          

Total all locations                     |100                                        

Mrs. Ray Michie : To ask the Secretary of State for Health if he will provide statistics on the levels of speech therapy service currently available in each district in the


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United Kingdom, if work is currently in progress to analyse the levels of service required for districts ; and if he will make a statement.

Mr. Freeman : The number of speech therapy staff (including helpers) in English district health authorities and the London postgraduate special health authorities at 30 September 1987, (the latest year for which information is available in the form requested) is given in the tables. It is for individual health authorities to assess the level of service required in their area.


Speech therapy (includes helpers)                         

Whole-time equivalents September 1987                     

                                            |Number       

----------------------------------------------------------

TOTAL                                       |2,657        

                                                          

Northern                                                  

Hartlepool                                  |5            

North Tees                                  |10           

South Tees                                  |15           

East Cumbria                                |9            

South Cumbria                               |9            

West Cumbria                                |7            

Darlington                                  |7            

Durham                                      |12           

North West Durham                           |5            

South West Durham                           |8            

Northumberland                              |16           

Gateshead                                   |8            

Newcastle                                   |22           

North Tyneside                              |10           

South Tyneside                              |6            

Sunderland                                  |12           

                                                          

Yorkshire                                                 

Hull                                        |12           

East Yorkshire                              |10           

Grimsby                                     |8            

Scunthorpe                                  |6            

Northallerton                               |5            

York                                        |10           

Scarborough                                 |7            

Harrogate                                   |8            

Bradford                                    |13           

Airedale                                    |10           

Calderdale                                  |10           

Huddersfield                                |14           

Dewsbury                                    |11           

Leeds Western                               |12           

Leeds Eastern                               |14           

Wakefield                                   |8            

Pontefract                                  |6            

                                                          

Trent                                                     

North Derbyshire                            |21           

South Derbyshire                            |30           

Leicestershire                              |39           

North Lincolnshire                          |12           

South Lincolnshire                          |13           

Bassetlaw                                   |5            

Central Nottingham                          |19           

Nottingham                                  |45           

Barnsley                                    |13           

Doncaster                                   |14           

Rotherham                                   |8            

Sheffield                                   |38           

                                                          

East Anglian                                              

Cambridge                                   |22           

Peterborough                                |15           

West Suffolk                                |11           

East Suffolk                                |16           

Norwich                                     |26           

Great Yarmouth and Waveney                  |10           

West Norfolk and Wisbech                    |8            

Huntingdon                                  |9            

                                                          

North West Thames                                         

North Bedfordshire                          |13           

South Bedfordshire                          |15           

North Hertfordshire                         |10           

East Hertfordshire                          |12           

North West Hertfordshire                    |15           

South West Hertfordshire                    |10           

Barnet                                      |17           

Harrow                                      |11           

Hillingdon                                  |7            

Hounslow and Spelthorne                     |15           

Ealing                                      |18           

Brent                                       |20           

Paddington and North Kensington             |11           

Riverside                                   |40           

                                                          

North East Thames                                         

Basildon and Thurrock                       |11           

Mid-Essex                                   |18           

North East Essex                            |16           

West Essex                                  |9            

Southend                                    |14           

Barking, Havering and Brentwood             |20           

Hampstead                                   |22           

Bloomsbury                                  |29           

Islington                                   |9            

City and Hackney                            |18           

Newham                                      |22           

Tower Hamlets                               |14           

Enfield                                     |8            

Haringey                                    |12           

Redbridge                                   |9            

Waltham Forest                              |13           

                                                          

South East Thames                                         

Brighton                                    |18           

Eastbourne                                  |11           

Hastings                                    |7            

South East Kent                             |9            

Canterbury and Thanet                       |17           

Dartford and Gravesend                      |6            

Maidstone                                   |9            

Medway                                      |12           

Tunbridge Wells                             |15           

Bexley                                      |13           

Greenwich                                   |25           

Bromley                                     |15           

West Lambeth                                |17           

Camberwell                                  |19           

Lewisham and North Southwark                |27           

                                                          

South West Thames                                         

North West Surrey                           |14           

West Surrey and North East Hampshire        |11           

South West Surrey                           |11           

Mid-Surrey                                  |12           

East Surrey                                 |9            

Chichester                                  |8            

Mid-Downs                                   |12           

Worthing                                    |12           

Croydon                                     |20           

Kingston and Esher                          |13           

Richmond, Twickenham and Roehampton         |14           

Wandsworth                                  |19           

Merton and Sutton                           |16           

                                                          

Wessex                                                    

East Dorset                                 |13           

West Dorset                                 |9            

Portsmouth and South East                   |28           

Southampton and South West                  |22           

Winchester                                  |10           

Basingstoke and North Hampshire             |9            

Salisbury                                   |8            

Swindon                                     |15           

Bath                                        |16           

Isle of Wight                               |7            

                                                          

Oxford                                                    

East Berkshire                              |17           

West Berkshire                              |33           

Aylesbury Vale                              |0            

Wycombe                                     |11           

Milton Keynes                               |22           

Kettering                                   |15           

Northampton                                 |18           

Oxfordshire                                 |29           

                                                          

South Western                                             

Bristol and Weston                          |29           

Frenchay                                    |26           

Southmead                                   |18           

Cornwall and Isles of Scilly                |10           

Exeter                                      |16           

North Devon                                 |6            

Plymouth                                    |15           

Torbay                                      |11           

Cheltenham                                  |10           

Gloucester                                  |19           

Somerset                                    |24           

                                                          

West Midlands                                             

Bromsgrove and Redditch                     |8            

Herefordshire                               |3            

Kidderminster                               |6            

Worcester                                   |10           

Shropshire                                  |15           

Mid-Staffordshire                           |11           

North-Staffordshire                         |19           

South-Staffordshire                         |12           

Rugby                                       |0            

North Warwickshire                          |11           

South Warwickshire                          |19           

Central Birmingham                          |16           

East Birmingham                             |11           

North Birmingham                            |9            

South Birmingham                            |13           

West Birmingham                             |12           

Coventry                                    |13           

Dudley                                      |18           

Sandwell                                    |18           

Solihull                                    |10           

Walsall                                     |16           

Wolverhampton                               |9            

                                                          

Mersey                                                    

Chester                                     |9            

Crewe                                       |14           

Halton                                      |7            

Macclesfield                                |11           

Warrington                                  |11           

Liverpool                                   |24           

St. Helens and Knowsley                     |14           

Southport and Formby                        |6            

South Sefton                                |6            

Wirral                                      |13           

                                                          

North Western                                             

Lancaster                                   |6            

Blackpool Wyre and Fylde                    |17           

Preston                                     |14           

Blackburn Hymburn and Ribb                  |14           

Burnley Pendle and Rossend                  |18           

West Lancaster                              |7            

Chorley and South Ribble                    |4            

Bolton                                      |12           

Bury                                        |11           

North Manchester                            |14           

Central Manchester                          |15           

South Manchester                            |16           

Oldham                                      |10           

Rochdale                                    |0            

Salford                                     |15           

Stockport                                   |20           

Tameside and Glossop                        |16           

Trafford                                    |13           

Wigan                                       |19           

The Hospital for Sick Children              |9            

The National Hospital for Nervous Diseases  |17           

Moorfields Eye Hospital                     |0            

The Royal Marsden Hospital                  |2            

Hammersmith and Queen Charlotte's           |6            

Mrs. Ray Michie : To ask the Secretary of State for Health if he will provide statistics relating to the percentages of people receiving speech therapy services who have associated mobility problems or a level of social-economic difficulty.

Mr. Freeman : Statistics are not collected in the form requested.

Mrs. Ray Michie : To ask the Secretary of State for Health when the joint Department of Health-National Health Service manpower advisory group intends to publish its recommendations aimed at improving recruitment and retention patterns in speech therapy ; and whether information or statistics on current patterns are at present available.

Mrs. Virginia Bottomley : It is intended to publish the DOH-MPAG report concerning recruitment and retention in speech therapy by the middle of next year.

Statistics are currently being analysed. When this is complete a clearer picture of current patterns of recruitment and retention will be available.

Mrs. Ray Michie : To ask the Secretary of State for Health when the results of the study currently under way into the use of speech therapy assistants will be published ; and whether his Department intends to issue guidelines following completion of the study.

Mr. Freeman : The research study into the use of speech therapy assistants commissioned by the Department is in its early stages. It is expected to be completed by September 1991, with publication following a few months later. We will consider the results of the study when they become available.

Management Consultants

Ms. Harman : To ask the Secretary of State for Health how much has been spent on management consultants by (a) his Department and (b) National Health Service regions and districts in England in each of the years 1979 to 1989 ; and what quality controls are used by (i) his Department and (ii) the National Health Service to ensure that these expenditures provide good value for money.

Mr. Freeman : We cannot apportion expenditure between the Departments of Health and of Social Security prior to 1985-86. The estimated expenditure for each succeeding financial year from 1985-86 on fees and expenses for management consultants on health matters is as follows :


          |£ million          

------------------------------

1985-86   |0.479              

1986-87   |2.103              

1987-88   |1.244              

1988-89   |1.584              

The figures are approximate since expenditure up to and including the 1988- 89 year was from a joint health and


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social security budget. In some cases expenditure has been apportioned where consultants have been engaged on both health and social security matters. The figures also include social services consultancy and some computer consultancy where these cannot be identified separately.

The Department of Health controls and monitors the use of management consultants in line with the requirements laid down from time to time by the Treasury.

The employment of management consultants is a matter for individual health authorities and their accounts do not separately identify any expenditure consequently incurred.

Breast Cancer Screening

Ms. Harman : To ask the Secretary of State for Health in the light of clinical and economic evidence produced since the publication of the Forrest report on breast cancer screening, what is the current cost/quality adjusted life year estimate for this procedure.

Mrs. Virginia Bottomley : We understand that work is being carried out, as part of the follow-up to the United Kingdom trial of early detection of breast cancer, on economic evaluation of the early detection of breast cancer. A model is being developed which would provide information on costs and quality adjusted life years.

Old People (Monitoring)

Ms. Harman : To ask the Secretary of State for Health what evidence he has of the cost-effectiveness of annual monitoring of the over 75-year- olds.

Mr. Freeman : We do not have any precise evidence linking the annual monitoring of people aged over 75 years to outcome costs. We have been happy to accept the advice we have received from a large number of doctors, and other health workers, that a better service can be offered to elderly people, not least in terms of the early identification of health or social problems, through a system of regular monitoring organised by their general practitioner. This proposal builds on a large number of local initiatives of this kind.

Diethylstilbestrol

Ms. Harman : To ask the Secretary of State for Health what is being done to support women who have been exposed to the synthetic hormone diethylstilbestrol.

Mrs. Virginia Bottomley : I will write to the hon. Member as soon as possible.

Resource Management

Mr. Robin Cook : To ask the Secretary of State for Health if he will publish the results of his Department's evaluation of the resource management initiative.

Mr. Freeman : The management executive is still discussing certain details of the evaluation with the joint consultants committee.

Dentistry

Mr. Teddy Taylor : To ask the Secretary of State for Health if the Dental Practice Board has completed its survey of full dental provision ; if the results will be published ; and why his Department commissioned the study.


Column 433

Mr. Freeman : I will write to my hon. Friend.

Irish Patients

Mr. Marlow : To ask the Secretary of State for Health if he will make a statement on his assessment of the reasons for patients from the Irish Republic seeking treatment in the United Kingdom.

Mrs. Virginia Bottomley [holding answer 28 July 1989] : Under the relevant EC regulations residents of the Republic of Ireland may seek immediately necessary treatment under the NHS on the same basis as residents of the United Kingdom and may be referred by the Irish health authorities for treatment for specific conditions. Information on the reasons for patients seeking treatment is not available centrally and could be collected only at disproportionate cost.

Generic Medicines

Mr. Michael Morris : To ask the Secretary of State for Health how many manufacturing sites for generic medicines supplied to the National Health Service are outside the European Community ; and how many of these sites have been inspected within the last five years, last two years and last year, respectively.

Mrs. Virginia Bottomley [holding answer 23 October 1989] : Manufacturing sites are not differentiated as generic or proprietary. Products currently licensed in the United Kingdom include those produced at 685 manufacturing sites outside the European Community (EC) : some of these sites are within signatory countries of the pharmaceutical inspection convention (PIC).

In the last five years the United Kingdom medicines inspectorate has inspected all manufacturing sites which are actively exporting medicinal products to the United Kingdom for use in the NHS and which are located outside the EC but are not within PIC signatory countries.

Mr. Michael Morris : To ask the Secretary of State for Health how many product licences for generic medicines were granted in the years (a) 1985, (b) 1986, (c) 1987 and (d) 1988 ; and how many of the licence applications that received approval were referred to the Committee on Safety of Medicines.

Mrs. Virginia Bottomley [holding answer 23 October 1989] : The information is not available in the form requested. Licences granted for medicinal products are recorded statistically by the Medicines Control Agency according to whether they are new active substances or established drug substances. Product licences granted for established drug substances, including those for products which may subsequently be prescribed generically, are given in the table according to whether or not they were approved by the Committee on Safety of Medicines (CSM).


Licences granted for established drug substances                                                    

Year                |Approved by the CSM|Others             |Total                                  

----------------------------------------------------------------------------------------------------

1985                |78                 |565                |643                                    

1986                |85                 |570                |655                                    

1987                |60                 |564                |624                                    

1988                |52                 |487                |539                                    

Mr. Michael Morris : To ask the Secretary of State for Health (1) what discussions his Department has had with


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the Food and Drug Administration in the United States of America with specific reference to the licensing of generic medicines ; (2) whether his Department has any intention of categorising generic medicines, licenced by the Medicines Control Agency, into grade A and grade B products similar to the classifications in the orange guide to generics compiled by the Food and Drug Administration of the United States of America ;

(3) whether, in view of the corrupt and fraudulent practices related to the submission of falsified data on some generic medicines to the Food and Drug Administration in the United States of America, he has any plans for tightening the procedures for the licensing of generic products by his Department.

Mrs. Virginia Bottomley [holding answer 23 October 1989] : We are aware of the allegations made in the United States of America that fraudulent data had been submitted as part of generic licence applications and officials have been in touch with the Food and Drug Administration. There is no evidence to suggest that the alleged malpractice in the United States of America has affected any of the generic products currently licensed in the United Kingdom but the matter will be kept under close review.

All licence applications, including generic products, must satisfy the strict requirements of the licensing authority as to safety, quality and efficacy of the product concerned before a licence is granted. We therefore have no plans for tightening the licensing procedures or for categorising generic drugs as in the United States of America.

Mr. Michael Morris : To ask the Secretary of State for Health (1) what steps he is taking to ensure that National Health Service patients receiving generic medicines are informed of the name of the manufacturer ;

(2) whether he intends to ensure that National Health Service patients will receive generic medicines in the manufacturers' original packs and with patient information leaflets in accordance with the proposed European Community Directive.

Mrs. Virginia Bottomley [holding answer 23 October 1989] : The question of original pack dispensing is under study. A recent European Community Commission consultative paper discussed the question of information for patients about medicines and made specific suggestions about labels and leaflets. However, this document was described as in no way engaging the Commission whom we understood currently to be considering the responses by Governments and outside organisations. It would be premature to make piecemeal commitments on detailed labelling or leaflet requirements before the Commission submits firm proposals for directives on these matters to the Council of Ministers.

Mr. Michael Morris : To ask the Secretary of State for Health whether he has any plans to ask the public health laboratories to provide laboratory disintegration, dissolution and analytical data in respect of generic medicines that are the subject of product licence applications based purely on data submitted by the manufacturing company.

Mrs. Virginia Bottomley [holding answer 23 October 1989] : The licensing authority has access to the results of tests carried out by the National Health Service quality control laboratories on products purchased by the NHS.


Column 435

In addition, the licensing authority operates a sampling and testing scheme for licensed products, usually at the medicines testing laboratory. Where relevant, such tests would include disintegration, dissolution and analysis. We have no plans to extend these arrangements.

Northern RHA

Mr. Amos : To ask the Secretary of State for Health how many (a) doctors, (b) nurses and (c) administrative staff were employed in the Northern regional health authority for each year since 1979 ; what are the projections for future years ; and if he will make a statement.

Mrs. Virginia Bottomley [holding answer 14 November 1989] : The information requested is given in the table. Since 1979 the numbers of doctors, nurses and administrative staff employed in the northern region have all increased, at the same time as the workload undertaken has increased significantly. The Government's manpower plan "Hospital medical staffing : Achieving a Balance" aims to bring about a future expansion to the consultant grade at a rate of approximately 2 per cent. per annum. In addition the introduction of "Project 2000" will have a significant impact on the recruitment and skill-mix of staff employed in nursing in the future. Details of manpower projections in the northern region are a matter for the regional health authority.


National Health Service staff in post                                                                                        

Northern regional health authority at 30 September each year                                                                 

                          Whole time                                                                                         

                          equivalent<1>                                                                                      

Year                     |Medical and dental<2>   |Nursing and midwifery<3>|Administrative and                               

                                                                           |clerical<4>                                      

-----------------------------------------------------------------------------------------------------------------------------

1979                     |2,530                   |23,940                  |5,940                                            

1980                     |2,610                   |25,170                  |6,100                                            

1981                     |2,670                   |26,210                  |6,160                                            

1982                     |2,690                   |26,380                  |6,090                                            

1983                     |2,770                   |26,840                  |6,220                                            

1984                     |2,780                   |26,740                  |6,310                                            

1985                     |2,820                   |27,110                  |6,120                                            

1986                     |2,820                   |27,390                  |6,260                                            

1987                     |2,810                   |27,640                  |6,490                                            

1988                     |2,820                   |27,770                  |6,710                                            

Source: Department of Health (SM13) annual census of NHS medical and non-medical manpower.                                   

<1> Figures are independently rounded to nearest ten (10) whole-time equivalents.                                            

<2> Includes permanent paid, honorary and locum staff. From 1987 figures also include agency locums.                         

<3> Includes agency staff.                                                                                                   

<4> Includes General Managers.                                                                                               


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Parliamentary Questions

Mr. Fisher : To ask the Secretary of State for Health how many written parliamentary questions to him in Session 1988-89 received answers that the information (a) was not available, (b) was not separately recorded, (c) was not centrally recorded, (d) was not recorded in Government statistics or (e) could be provided only at disproportionate cost.

Mr. Freeman [holding answer 14 November 1989] : I regret that the information requested is not readily available for the Session as a whole. However for the first quarter of the Session, during which a total of 1,395 written answers were given, the information requested is as follows :


                                                  |Number       

----------------------------------------------------------------

Information not available                         |23           

Information not separately recorded               |3            

Information not centrally recorded                |113          

Information not recorded in Government statistics |1            

Disproportionate cost                             |3            

There is no reason to suppose that this is not a representative quarter. For the Session as a whole, some 5,600 written answers have been given.

Non-emergency Ambulance Service

Mr. Spearing : To ask the Secretary of State for Health if, pursuant to his statement of 9 November, Official Report, column 1219, he will list those areas of the United Kingdom where the non-emergency ambulance service has been adequately replaced by other forms of transport ; and what is the policy of Her Majesty's Government for the non-emergency ambulance service in London.

Mrs. Virginia Bottomley [holding answer 14 November 1989] : Health authorities were advised in 1984 that it was open to them to buy in part of the ambulance service if that is more cost-effective and provided that the quality of service is maintained. A number of NHS ambulance authorities are using private contractors, the hospital car service and the voluntary aid societies to transport appropriate NHS patients. The table shows by ambulance authority the number of patient journeys carried out in England in 1987-88 (the last year for which we have figures).


Column 435


Ambulance authority    |Directly provided  |Agency services    |Hospital car       |Rail               |Air                |Other              |All services                           

                       |services                                                                                                                                                       

                                                                                                                                               |England                                

---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

England                |13,276,465         |306,836            |3,415,560          |6,454              |266                |221,179            |17,226,760                             

Cleveland              |197,764            |0                  |0                  |131                |0                  |313                |198,208                                

Cumbria                |210,812            |52                 |36,407             |341                |3                  |0                  |247,615                                

Durham                 |256,721            |0                  |2,033              |22                 |0                  |6,703              |265,479                                

Northumbria                                                                                                                                                                            

  Metropolitan         |625,171            |0                  |22,258             |90                 |2                  |32,088             |679,609                                

Humberside             |439,221            |0                  |10,129             |118                |0                  |0                  |449,468                                

North Yorkshire        |212,123            |0                  |25,818             |132                |2                  |0                  |238,075                                

West Yorkshire                                                                                                                                                                         

  Metropolitan         |814,428            |0                  |80,265             |87                 |0                  |0                  |894,780                                

Derbyshire             |287,975            |0                  |2,506              |112                |1                  |2,393              |292,987                                

Leicestershire         |320,949            |0                  |606                |111                |0                  |0                  |321,666                                

Lincolnshire           |169,487            |0                  |31,136             |0                  |0                  |0                  |200,623                                

Nottinghamshire        |378,283            |1,926              |69,743             |0                  |0                  |0                  |449,952                                

South Yorkshire                                                                                                                                                                        

  Metropolitan         |493,910            |0                  |9,514              |61                 |0                  |0                  |503,485                                

Cambridgeshire         |80,617             |0                  |111,376            |0                  |0                  |0                  |191,993                                

Norfolk                |182,564            |0                  |140,731            |325                |0                  |0                  |323,620                                

Suffolk                |197,491            |0                  |75,938             |189                |2                  |0                  |273,620                                

Bedfordshire           |119,159            |0                  |36,451             |0                  |0                  |0                  |155,610                                

Hertfordshire          |260,539            |0                  |21914              |0                  |0                  |0                  |282,453                                

Essex                  |265,011            |0                  |218,641            |3                  |0                  |0                  |483,655                                

East Sussex            |255,920            |0                  |199,465            |43                 |8                  |0                  |455,436                                

Kent                   |421,259            |0                  |31,758             |3                  |1                  |0                  |453,021                                

Surrey                 |253,530            |0                  |209,700            |6                  |15                 |0                  |463,251                                

West Sussex            |141,262            |0                  |136,953            |145                |3                  |0                  |278,363                                

London Ambulance                                                                                                                                                                       

  Service              |1,435,423          |120,971            |186,686            |1,764              |21                 |19,396             |1,764,261                              

Dorset                 |114,527            |0                  |260,314            |51                 |0                  |0                  |374,892                                

Hampshire              |227,881            |20,035             |232,812            |104                |3                  |0                  |480,835                                

Wiltshire              |45,086             |1,061              |120,908            |12                 |0                  |80,133             |247,200                                

Isle of Wight          |20,146             |876                |0                  |0                  |0                  |0                  |21,022                                 

Berkshire              |131,884            |0                  |55,080             |15                 |0                  |0                  |186,979                                

Buckinghamshire        |142,373            |3,570              |36,603             |1                  |0                  |0                  |182,547                                

Northamptonshire       |170,596            |0                  |14,398             |239                |0                  |0                  |185,233                                

Oxfordshire            |110,681            |0                  |64,940             |7                  |0                  |0                  |175,628                                

Avon                   |6,461              |0                  |56,665             |39                 |1                  |1,243              |64,409                                 

Cornwall and Isles of                                                                                                                                                                  

  Scilly               |49,577             |373                |76,376             |449                |180                |0                  |126,955                                

Devon                  |220,340            |0                  |460,472            |346                |10                 |9                  |681,177                                

Gloucestershire        |147,477            |0                  |74,388             |136                |0                  |0                  |222,001                                

Somerset               |99,934             |0                  |67,748             |106                |0                  |0                  |167,788                                

Hereford and Worcester |169,849            |181                |117,260            |9                  |0                  |0                  |287,299                                

Shropshire             |101,201            |0                  |35,491             |37                 |0                  |0                  |136,729                                

Staffordshire          |262,271            |0                  |11,689             |92                 |0                  |0                  |274,052                                

Warwickshire           |96,529             |0                  |4,573              |52                 |0                  |0                  |101,154                                

West Midlands                                                                                                                                                                          

  Metropolitan         |786,469            |125,410            |0                  |440                |6                  |26                 |912,351                                

Cheshire               |406,997            |0                  |16,186             |84                 |0                  |0                  |423,267                                

Mersey Metropolitan    |648,240            |0                  |0                  |260                |4                  |120                |648,624                                

Lancashire             |403,608            |0                  |17,144             |122                |0                  |78,392             |499,266                                

Greater Manchester                                                                                                                                                                     

  Metropolitan         |894,719            |32,381             |32,485             |170                |4                  |363                |960,122                                

The management of the London ambulance service is the responsibility of South West Thames RHA. The arrangements under which it provides a non- emergency service are a matter for that authority in discussion with the other three Thames regions and their district health authorities.

Teaching Hospitals

Mr. Cox : To ask the Secretary of State for Health what review funding allocation is taking place within his Department as to the cost of research and training by teaching hospital within the National Health Service ; and if he will make a statement.

Mr. Freeman : The service increment for teaching (SIFT) will be payable to teaching hospitals to cover the excess costs they incur as a result of supporting undergraduate medical education and research. The level of SIFT was last reviewed in 1988 by the then NHS management board as part of its review of the resource allocation working party formula. We intend to implement in 1990-91 the recommendation, arising from that review, that SIFT should be increased to meet, on average, 100 per cent. of the excess costs of teaching hospitals. The scope and distribution of SIFT will be reviewed again within three years.


Column 438

SOCIAL SECURITY

Community Charge Rebate

Mr. Pawsey : To ask the Secretary of State for Social Security how many community charge rebates it is anticipated will be made at the rates of (a) 80 per cent., (b) 50 per cent. and (c) 20 per cent. ; and how these figures have been calculated.

Mrs. Gillian Shephard : I will write to my hon. Friend about part (a) of his question. The information required to answer parts (b) and (c) of this question is not available and can be obtained only at disproportionate cost.

Civil Service Dispersal

Mr. Thurnham : To ask the Secretary of State for Social Security whether he has any plans to relocate his Department's offices to the north- west of England ; and if he will make a statement.

Mrs. Gillian Shephard : I refer my hon. Friend to the reply given on 14 November at c. 170 to my hon. Friend the Member for Colne Valley (Mr. Riddick). We decided on Leeds after the most careful consideration of its advantages and those of other possible locations, including several in the north-west.


Column 439

Spending Power

Mr. Battle : To ask the Secretary of State for Social Security if he will publish tables using the assumptions in his answer to the hon Member for Bradford, West (Mr. Madden) on 22 June 1988, Official Report, columns 571-76 but using expenditure and benefit figures appropriate for families in (a) Leeds, West, (b) Leeds metropolitan district and (c) nationally together with a column showing the extent of the differences resulting from the April 1988 changes.

Mr. Scott : I will write to the hon. Member.

Hardship Payments

Mr. Wigley : To ask the Secretary of State for Social Security how many people aged under 25 years have received discretionary hardship payments from his Department's local offices in Wales since October 1988.

Mr. Scott : Regulation 8(3) of the Income Support (General) Regulations was introduced in April 1988. Under it a person normally required to be available for work in order to receive income support may be excused that requirement, and therefore receive benefit, if he or his family would suffer hardship. Information on the number of people awarded benefit under this provision since October 1988 is not available. Details are being recorded from the start of October 1989 and the first figures will be available at the end of November. Section 20(4) of the Social Security Act 1986 gives the Secretary of State power to direct that a person aged 16 or 17 may receive income support, when he or she would not ordinarily be entitled, if payment of benefit is the only means of preventing severe hardship. In the period 12 September 1988 to 10 November 1989 a total of 533 applications from the Department's offices in Wales were considered under this provision. In 341 cases (64 per cent.) a direction was given to enable income support to be paid.

Attendance Allowance Board (Chairman)

Mr. Frank Field : To ask the Secretary of State for Social Security when the term of office for the current chairman of the Attendance Allowance Board comes to an end.

Mr. Scott : On 18 October 1992.

Christmas Bonus

Mr. Madden : To ask the Secretary of State for Social Security when he intends to announce the pensioners' Christmas bonus for 1989 ; if he will increase the bonus in line with inflation, since the bonus was first introduced ; and if he will make a statement.

Mr. Kirkwood : To ask the Secretary of State for Social Security if he has any plans to increase the Christmas bonus for pensioners.

Mrs. Gillian Shephard : We have no plans to do so.

Social Fund

Mr. Flynn : To ask the Secretary of State for Social Security if he will publish a table of numbers of applications for grants and loans under the social fund that have been rejected in the current financial year at each Department of Social Security office.


Column 440

Mr. Scott : Information on the numbers of applications processed and awards made is available in the Library. Numbers of applications that have been rejected can be obtained from this information.

Ms. Harman : To ask the Secretary of State for Social Security if he will specify the level of the social fund budget for offices covering Peckham in 1990-91.

Mr. Scott : We will make an announcement in due course.

Income Support

Mr. Flynn : To ask the Secretary of State for Social Security what steps were taken to ensure that income support was paid from 9 October to pensioners who claimed before that date and whose income at the date of claim exceeded the qualifying limit by less than the amount by which the pensioner premium was to be increased.

Mrs. Gillian Shephard : An extensive publicity campaign mounted from 9 July invited pensioners to claim income support. All claims made on or after that date by pensioners whose income exceeded the qualifying limit at the date of claim were automatically reconsidered from 9 October. Where appropriate, income support was payable from the payday in that week.

Ms. Short : To ask the Secretary of State for Social Security how many persons aged 16 and 17 years had made applications for income support on grounds of extreme hardship, how many had been granted at 3 November by region ; and how many at the same dates had been granted income support on grounds of being within exempted categories, by category.

Mr. Scott : The number of applications from 16 and 17-year-olds on grounds of severe hardship and the number of directions given to enable benefit to be paid in the period 12 September 1988 to 3 November 1989 are in the following table :


                                                                                                                                                                          |Applications received                                                                                                                                                    |Directions given                                                                                                                                                                                                                                                                                                                                   

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

London North                                                                                                                                                              |1,269                                                                                                                                                                    |785                                                                                                                                                                                                                                                                                                                                                

London South                                                                                                                                                              |1,227                                                                                                                                                                    |779                                                                                                                                                                                                                                                                                                                                                

Midlands                                                                                                                                                                  |1,827                                                                                                                                                                    |1,227                                                                                                                                                                                                                                                                                                                                              

North East                                                                                                                                                                |3,794                                                                                                                                                                    |2,534                                                                                                                                                                                                                                                                                                                                              

North West                                                                                                                                                                |2,428                                                                                                                                                                    |1,540                                                                                                                                                                                                                                                                                                                                              

Wales and South West                                                                                                                                                      |1,317                                                                                                                                                                    |840                                                                                                                                                                                                                                                                                                                                                

Scotland                                                                                                                                                                  |6,134                                                                                                                                                                    |4,197                                                                                                                                                                                                                                                                                                                                              

Great Britain                                                                                                                                                             |17,996                                                                                                                                                                   |11,902                                                                                                                                                                                                                                                                                                                                             

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        

As indicated in the reply to the hon. Member on 26 October at columns 539- 40, the number of 16 and 17-year-olds granted income support because they fall within one of the exempt categories ceased to be collected after October 1988 and could now be obtained only at disproportionate cost. However, our monitoring of the changes introduced in July 1989 indicates that between July and September some 2,600 awards of benefit were made to those who qualified under the exempt categories.


Column 441

Pension Schemes

Mr. Higgins : To ask the Secretary of State for Social Security what information he has on the existence of any occupational pension scheme in the private sector not covered by contributions.

Mrs. Gillian Shephard : The rules of an occupational pension scheme specify whether, in addition to the employer, employee members of the scheme are required to contribute to the scheme. It is not a condition for an occupational scheme to be used for contracting-out of the state earnings -related pension scheme (SERPS) that employees pay contributions. There are about 1 million members of non-contributory private sector occupational pensions schemes.

Job Search

Mr. Loyden : To ask the Secretary of State for Social Security (1) if he will estimate the additional costs of job search that unemployed people now have to bear in actively seeking work under the Social Security Act 1989 ;

(2) whether he intends to increase unemployment benefit and income support to cover extra costs incurred by those actively seeking work by introducing a special job search allowance.

Mr. Scott : Unemployed claimants have always been expected to look for work. For the majority of people who have done this, the new condition makes no difference. The cost of job search varies according to circumstances. Some activities cost nothing ; many other ways of finding work have a modest cost, for example use of telephones, stationery and postage stamps. The travel-to-interview scheme administered by the employment service is a matter for my right hon. Friend the Secretary of State for Employment.

We have no plans to increase benefit rates as suggested.


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