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Mr. Allen : To ask the Secretary of State for Health what guidelines his Department has issued for the purposes of the Local Government Finance Act 1988 which cover the right of mentally handicapped people to demand services.
Mr. Freeman : The issuing of guidelines relating to the implementation of the Local Government Act 1988 is for my right hon. Friend the Secretary of State for the Environment. Severely mentally impaired people are exempt from liability to pay the personal community charge under the Act. Their right to local services is, however, no different from those who will be liable to pay the community charge, including those people with a less severe mental impairment.
Mr. Freeman : The information that my hon. Friend requires is available in the reports "The prevalence of disability among adults" and "The prevalence of disability among children" which were produced at the request of the Department by the Office of Population Censuses and Surveys. Copies have been placed in the Library.
Mr. Rooker : To ask the Secretary of State for Health if the proposal to classify all nursing assistants to grades B and C in 1992 will involve payment of arrears of wages to those currently on grade A.
Mrs. Virginia Bottomley : For several years the staphylococcal reference laboratory of the public health laboratory service has gathered information about the occurrence of toxic shock syndrome, a condition which is associated, very rarely, with the use of internal sanitary protection.
Mr. Freeman : I regret that pressure of other work has delayed completion of the analysis of the results of this survey, but it remains our intention to review present provision for counselling and genetic diagnosis and screening--including that for sickle cell disease and thalassaemia--and consider the need for further central guidance. I hope that this work can commence early in the new year.
Column 219Nottinghamshire health authority in 1989, stating their qualifications and the basis on and by whom they were appointed.
Mrs. Virginia Bottomley : The appointment of members of NHS Health Advisory Service visiting teams is a matter for the director, Professor Philip Seager. My hon. Friend may wish to write to him for the information.
(2) when he expects the new hospital in Kendal to receive its first patients.
Mr. Freeman : I understand that development of the new Westmorland General hospital, Kendal is proceeding to time and cost and the latest estimate of the works cost of the project (excluding fees and equipment) is £15.6 million. The first patient use is expected to be in April 1991.
Mr. Freeman : Regional health authorities decide their own priorities for capital projects within overall limitations on their spending. Health authorities' plans for development of services in their area may involve the relocation of services from existing sites, with the eventual potential for sale of surplus sites, but it is not generally possible to link particular hospital developments with site sales. The Department does not provide capital support against specific future site sales.
Mrs. Dunwoody : To ask the Secretary of State for Health if he will instigate a national campaign against child abuse which is aimed specifically toward general education for citizens and all their children.
Mrs. Virginia Bottomley : The Department has long recognised the need to raise public awareness of child abuse. The Department has funded production of a training package by the Open University which was launched earlier this year. This aims to provide greater awareness and recognition skills to people who have had little or no knowledge of the subject, as well as professionals and voluntary workers. The Department also provides core funding for several child care organisations such as the NSPCC, Childline and the National Children's Bureau which, as part of their day-to -day activities, raise public awareness of child abuse.
Mr. Vaz : To ask the Secretary of State for Health how many people in each of the last 10 years have (a) consulted a counsellor, (b) taken the test, (c) had a positive result and (d) had a negative result for the genetic tests to discover if they are carrying the hereditary disease Huntington's Chorea, by area health authority ; and if he will make a statement.
Mr. Freeman : This information is not held centrally, although we recognise the need to safeguard, by proper counselling, those at risk of developing or transmitting a hereditary disease such as Huntington's Chorea. Therefore, in the light of rapid advances in clinical genetics and the growth of interest in screening, we have initiated a review of the genetic services currently available in the NHS to see if central guidance on the scope and organisation of these services is required.
Mrs. Virginia Bottomley : Since the publication of "The 1990 Contract" on 3 August 1989, the Department has received over 800 letters on the subject, mostly from general practitioners. The regulations necessary to introduce the new contract were laid on 16 October and have been approved by Parliament. All GPs will shortly be receiving their new terms of service and the revised statement of their NHS fees and allowances. The new arrangements will come into operation from 1 April 1990.
Mr. Vaz : To ask the Secretary of State for Health if he will make a statement regarding budgeting levels for regional health authorities and family practitioner committees in relation to the Government White Paper.
Mrs. Virginia Bottomley : We have announced that, following this year's public expenditure survey, an additional £257 million will be made available in the NHS as a whole in England in 1990-91 for initiatives arising from the White Paper "Working for Patients". This brings the total available for regional health authorities and family practitioner committees in England next year for implementing the White Paper to £300 million. This is part of the extra £2.6 billion resources that the NHS in the United Kingdom will have available next year, £2.2 billion of which will be for England.
Mr. Latham : To ask the Secretary of State for Health to what extent he intends that general practitioners who are not budget holders will be permitted to choose the hospital to which they send their patients for (a) non-emergency treatment on an inpatient basis and (b) maternity care, including delivery of the baby ; and whether he will make a statement.
Mrs. Virginia Bottomley : For all services, including non-emergency and maternity services, GPs should usually be able to choose the hospital that they consider most appropriate, taking account of their patients' needs and wishes. GPs who are not fund-holders will normally refer patients to hospitals with which the district health authority (DHA) has placed contracts. In placing those contracts the DHA will be expected to secure the referral patterns which local GPs wish to see put in place, unless there are compelling reasons for not doing so. In addition, the DHA will maintain a financial reserve to cover those occasions when GPs need to refer patients to hospitals with which their DHA has not contracted.
Column 221assessment of the unit costs of small local community hospitals in the event of budget-holding general practitioners seeking to place their patients in larger hospitals with lower unit costs ; and whether he will make a statement.
Mr. Latham : To ask the Secretary of State for Health what is the average length of time spent by mothers who have given birth to their first babies in district general hospitals between the birth and their discharge ; what is the average lying-in period in maternity units in small local community hospitals ; and what advice he has given to regional health authorities about the provision of lying-in time, especially for those mothers having their first babies.
Mrs. Virginia Bottomley : Information is not held centrally on length of stay in maternity units which distinguishes between district general hospitals and smaller local hospitals, nor are we able to identify first babies. In 1985, the last year for which data are available, the average length of stay post-delivery for all births was 4.1 days.
It is for health authorities to determine their own policies on post-natal care including the timing of hospital discharge which, in addition to a clinical assessment of the health of mothers and their babies, takes into account the family's social and economic circumstances, the location of the maternity unit in relation to the centres of population and the scope of the community health services.
Mr Wigley : To ask the Secretary of State for Health at what age local authorities remove children from the child protection register ; and if he will bring forward legislation to ensure that all children can be kept on such registers until the age of 18 years.
Mrs. Virginia Bottomley : Local authorities will normally remove children from the child protection register when it is decided in a case conference that formal inter-agency working is no longer necessary to protect the child. The age of the child may be one consideration in such a decision. Provided the criteria for continuing registration are met, there is nothing to prevent a young person remaining on the child protection register until the age of 18 years. The "Survey of Children and Young Persons on Child Protection Registers Year Ending 31 March 1988", copies of which are available in the Library, shows that there were an estimated 1,700 young persons aged 16 and over on child protection registers in England at 31 March 1988.
Mr Wigley : To ask the Secretary of State for Health how many local authorities in England and Wales currently insist that owners of small homes for residential care inform them of their presence ; how many local authorities have a register for such information ; if he will make it compulsory for all residential home owners serving the vulnerable in society to inform their respective local authorities ; and if he will make it compulsory for all local authorities to keep a register of these homes.
Mr. Ieuan Wyn Jones : To ask the Secretary of State for Health if he will bring forward legislation making it compulsory for local authorities to assess all intending providers of residential care and, if approved, place them on a register.
Mrs. Virginia Bottomley : Under part 1 of the Registered Homes Act 1984 the owners of private and voluntary residential care homes catering for four or more residents are required to register with the local social services authority. There are no plans at present to extend this requirement to cover homes with fewer than four places. Information on any records held by local authorities of such homes is not held centrally.
Mr. Wigley : To ask the Secretary of State for Health if he will introduce safeguards to protect individual disabled people over the age of 17 years, who live at home with a family member convicted of a sexual abuse offence who is likely to re-offend.
Mrs. Virginia Bottomley : At present, there is a specific statutory provision reflecting the needs of people with a severe mental handicap who are the subject of sexual abuse. Under the Sexual Offences Act 1957 is is an offence for a man to have sexual intercourse with a woman whom he knows or suspects to be mentally handicapped. Under the Sexual Offences Act 1967 homosexual acts with a man whom is known to be suffering severe abnormality within the meaning of the Mental Health Act 1959 are also unlawful unless the offender can prove he was not aware of the fact. We have no plans for further additional statutory provisions.
Mrs. Virginia Bottomley : Training is available from a variety of sources. We have asked local authorities, in using the training support grant for the elderly, to have regard to the training needs of independent agencies. As part of the follow-up by the Department to the Wagner report on residential care, the National Institute for Social Work has been commissioned to undertake a programme to promote the training of staff in homes of all types.
The Registered Homes Act 1984 requires people running residential care homes to be fit persons and the Residential Care Homes Regulations 1984 require home owners to employ suitably qualified and competent staff. Guidance on the qualifications and experience the person running the home should normally have is contained in "Home Life", a code of practice for residential care.
Column 223Mr. Wigley : To ask the Secretary of State for Health what legal sanctions are enforced if cases of malpractice among residential carers are found ; and if he will make a statement.
Mrs. Virginia Bottomley : Local authorities have powers under the Registered Homes Act 1984 to cancel an existing registration where the person registered or any other person concerned with the running of a residential care home is found to be unfit to do so. They may also cancel a registration where the person registered fails to provide adequate services or facilities in the home or otherwise fails to comply with the provisions of the Act or regulations made under it. Where a criminal offence is alleged to have been committed, action is a matter for the police.
Mr. Latham : To ask the Secretary of State for Health whether he will make a statement on the role and extent of services which he intends to be delivered in local community hospitals ; and how he intends these services to be made available to non-budget holding partnerships of general practitioners.
Mrs. Virginia Bottomley : Under the proposals in the National Health Service and Community Care Bill, district health authorities (and those GPs with practice budgets) will take into account the services offered by community hospitals when they place contracts to ensure the provision of a comprehensive range of services for their patients. Where DHAs have placed contracts with community hospitals the services offered will be available as now to those general practitioners who do not hold a practice budget.
Mr. John Evans : To ask the Secretary of State for Health if he will make a statement on capital investment funding for St. Helens and Knowsley health authority in relation to capital investment funding in other health authorities in the Mersey region since 1974.
Mr. Freeman : We do not hold this information centrally. It is for regional health authorities to decide how they allocate funding, both capital and revenue, among the districts. The hon. Member may wish to contact the chairman of Mersey regional health authority.
Patients treated in National Health Service hospitals St. Helens and Knowsley district health authority |1982 |1986 |1987-88 |<1>1988-89 -------------------------------------------------------------------------------------- In-patient cases treated |32,965 |34,045 |35,140 |35,346 Day cases |6,271 |8,034 |7,875 |9,549 New out-patients |34,181 |38,433 |37,381 |40,533 Total out-patients attendances |166,574 |169,750 |163,726 |164,773 <1>Provisional Source:1982, 1986: SH3 return. 1987-88, 1988-89: SH3A, KH09, KP70 returns.
In-patient waiting lists St. Helens and Knowsley district health authority at at 31 March ----------------------- 1982 |3,405 1986 |3,868 1987-88<1> |3,775 1988-89<1> |3,586 <1>Total less self-deferred.
Mr. John Evans : To ask the Secretary of State for Health if he will make a statement on ward closures in the St. Helens and Knowsley health authority.
Mrs. Virginia Bottomley : The management of health services locally is a matter for the health authority concerned. The hon. Member may wish to contact the chairman of the St. Helens and Knowsley health authority.
Mr. William Ross : To ask the Secretary of State for Health if he will insert in the new general practitioner contracts guidelines on the frequency with which anti-tetanus booster injections should be offered.
Column 225Mr. Freeman : Guidelines on anti-tetanus and other vaccinations are set out in the memorandum "Immunisation Against Infectious Disease" which is prepared for the health departments by the joint committee on vaccination and immunisation, and issued to all doctors, a copy of which has been placed in the Library. A new edition of the memorandum is due to be published early next year.
Mr. Sims : To ask the Secretary of State for Health in the light of scientific developments indicating the possibility of medical treatment involving genetic modification, what guidance is available to doctors contemplating such treatment ; and what steps he is taking to inform himself of progress in this area and of the implications of such developments.
Mrs. Virginia Bottomley : Developments are taking place in this field. Following primary research in animals there is within the next two to three years the prospect of treating adults and children with certain serious conditions of genetic origin by gene modification. Such modification would be confined to the individual patient and not transmissible to offspring. The Government consider that it is important that the introduction of such treatments should be carefully studied in advance. I have therefore decided to set up a committee on the ethics of gene therapy with the following terms of reference :
"To draw up ethical guidance for the medical profession on treatment of genetic disorders in adults and children by genetic modification of human body cells ; to invite and give ethical consideration to proposals from doctors wishing to use such treatment on individual patients and to provide advice to the United Kingdom health Ministers on scientific and medical developments which have a bearing on the safety and efficacy of human gene modifications." The committee will report to the Secretaries of State for Health, for Scotland, for Wales and for Northern Ireland. It will be chaired by Sir Cecil Clothier KCB, QC (formerly Parliamentary Commissioner for Administration and Health Service Commissioner for England, Scotland and Wales and Chairman of the Police Complaints Authority). Its members are :
Miss Margaret Auld (formerly Chief Nursing Officer Scottish Home and Health Department), Professor Martin Bobrow (Prince Philip Professor of Paediatric Research, United Medical Schools of Guy's and St. Thomas'), Mrs. Jane Davies (Member, North West Thames RHA), Professor the Rev. Canon Gordon Dunstan, DD, LLD, FSA (Emeritus Professor of Moral and Social Theology, University of London), Dr. Alison Hill (general medical practitioner, Oxfordshire), Professor June Lloyd (President, British Paediatric Association, Nuffield Professor of Child Health, Institute of Child Health, London), Mr. Nick Ross (Broadcaster), Professor Sir David Weatherall FRS (Nuffield Professor of Clinical Medicine, Oxford University), Professor R. Weiss (Director, Chester-Beattie Laboratories).
Although no such treatment is at present being carried out in the United Kingdom it seems likely that it will be available within a few years. The Government consider it important that the introduction of such treatments should be carefully studied in advance.
Mr. Warren : To ask the Secretary of State for Health what plans he has to support information and information technology requirements arising out of "Working for Patients" and "Promoting Better Heath" ; and if he will make a statement.
Mr. Roger Freeman : The reforms outlined in "Working for Patients" will assist in integrating the NHS. There will, for example, be better links between primary and secondary care. District health authorities will need to work closely with GPs to take account of GPs' views when agreeing patterns of provision. GPs holding their own funds for elective and diagnostic services will be involved in direct transactions with hospitals.
These changes come into effect in April 1991, and health authorities, hospitals and GP practice fund holders will need to be ready for them. In the first instance, block contracts will predominate, but with experience contracts will become increasingly sophisticated. To reap all the considerable benefits of these changes, the NHS will need to make major progress in such matters as the letting and management of contracts, the definition and measurement of quality of care and costing and resource management. To do all this they will need improved information systems and investment in technology to support them.
We can, however, build upon present information systems for the task ahead. Implementation of the Ko"rner recommendations put in place a range of minimum data sets that provide an excellent foundation for the post-review NHS. Some changes in the data sets will be necessary, of course, and one of the review implementation projects is considering what these should be.
Spending on computing in health authorities has risen from £36 million in 1983-84 to around £130 million in 1988-89. This very considerable resource indicates the priority which we--and health authorities themselves --have given to information and IT in managing the delivery of health care. Computerisation is not, of course, an end in itself. District health authorities and the family practitioner services need to base IT developments on careful assessment of their information needs and the best means, clerical or IT, of meeting them. That is why the information requirements of the proposals in "Working for Patients" are being considered by working groups involving both the NHS and the Department. We expect the development of IT to be an evolutionary process. The past developments in IT already complement the general direction of the proposals in "Working for Patients" and the IT systems now in use in the NHS provide a firm base on which to build. For example, the new arrangements for contracting for services in the NHS, which will be introduced in April 1991, will initially be able largely to operate on the basis of existing information systems. In the longer term, as more sophisticated forms of contracting develop, we would expect changes in the information which is needed and the way it is provided. We believe that IT will have an important role in supporting such developments.
Starting with the hospital and community health services, we propose to make available the following resources for 1990-91 :
£ million |Capital|Revenue|Total --------------------------------------------------------- Resource management |39 |39 |78 Hospital information and support systems |21 |4 |25
"Working for Patients" set out our plans to extend the introduction of resource management to 260 acute hospitals by April 1992. The £78 million now available for resource management in 1990-91 will enable progress to be made in many sites. I expect to announce very soon the names of the 20 sites which will move into full resource management this year, following a period of preparation and the commencement of training, and the details of the programme for the remaining sites will follow. The management executive have evaluated the progress made at the six pilot sites and are still discussing some details of the evaluation with the joint consultants committee.
It is important to emphasise that resource management is important in its own right in involving clinicians in hospital management and in giving both clinicians and managers the information they need. A major part of the funds available will be directed at these aspects. The proposed system of contracts will be supported at the outset by existing information systems. In due course, resource management systems will provide much information which will allow contracts to become more precisely specified. But the pace of implementation of resource management set out in the White Paper and now matched by the funds which will achieve it will not be rushed for this reason. We believe strongly that IT systems can benefit patients, not only by making NHS administration more efficient and by helping healthcare professionals to manage their resources better, but in more direct ways, such as the Eurodiabeta project at St. Thomas' hospital, which is developing better management of care for diabetics.
We have made funds available to enable the two HISS projects in Darlington and Greenwich to move ahead towards completion and for work to continue on the Nottingham HISS project--which is using new methods of specifying and designing hospital computer systems. We shall also fund other projects in this field in 1990-91 to broaden our experience both in achieving integrated systems and in obtaining the maximum benefit from them.
District health authorities, too, will need information systems to help them carry out their new functions such as placing and monitoring contracts and, most importantly, assessing the health needs of the population they serve. A study is under way to assess how best to meet districts' information needs. We will make a further statement next year on support for such systems.
Although we are intending to fund a number of different initiatives at sites throughout the country, we will take steps to ensure that the money is spent in a co-ordinated way, irrespective of the level at which the initiative takes place. We also believe that the NHS could make more use of its considerable purchasing power to get even better value for money in IT and we will be taking steps to encourage this, in concert with the NHS procurement directorate and the centre of responsibility for computer procurement based at South Western RHA.
We are well aware that information systems require expertise--people to design, build and operate them, as
Column 228well as to use the information they produce. These people need training and we have established a number of centrally financed projects--some £4 million will be spent over the next two years--to build up a training infrastructure for information management and technology in the NHS. As the need for exchange of information between different parts of the service grows, there will be increasing need for an electronic network which facilitates this exchange. The Department has therefore recently entered into negotiation for a private network for the NHS under the umbrella agreement between the Central Computer and Telecommunications Agency and Racal Data Networks Ltd. for the Government data network. The first links to the network will be between family practitioner committees (FPCs) and the newly computerised NHS central register, starting in mid-1990. Thereafter, it is planned to link other FPS administrative bodies and those FPS practitioners with computer systems meeting the required communications standards. We expect this FPS network to evolve over time to be capable of handling most of the needs of the wider NHS.
FPCs are already working to improve the quality of the data they hold--data which will assume an increasing importance in a contractual environment. The management information requirements for FPCs arising from "Promoting Better Health" have been examined and work has begun to develop some of the information systems required.
As far as IT in GPs' practices is concerned, the Government have already made it clear that we are fully behind the movement towards more and better computerisation. Quite apart from the importance of IT to link family doctors to family practitioner committees and hospitals, we are keen to encourage them to use computers to secure clinical benefits for their patients, to provide a wider range of services and to manage their practices more effectively.
To encourage that, we announced earlier this year that, from 1 April 1990, GPs will be able to claim 50 per cent. direct reimbursement of their computer maintenance costs, the balance to be reimbursed indirectly through the setting of general fees and allowances. I am now able to announce that in 1990-91 additional resources amounting to £24 million will be made available for computerisation in general practice. From 1 April 1990, all GPs will be able to claim 50 per cent. direct reimbursement of the costs of purchasing, leasing, upgrading and maintenance of their computer systems, together with 70 per cent. of the initial staff costs of setting up the systems. The balance of these costs will be reimbursed indirectly. These allowances will be subject to upper limits based on a sliding scale according to practice list sizes and will take account of systems obtained in 1989-90. We shall be discussing the details with representatives of the medial profession and in due course will publish them in the statement of fees and allowances. These revised arrangements will be reviewed after three years. Additional assistance will be announced shortly for GPs who choose to be funded through practice budgets to reflect their special computer needs.
We are also making available additional sums from 1991-92 to set up a central GP computer development and research fund to examine and evaluate developments in this field.
We have also set aside funds to develop and pilot systems to provide GPs with information on waiting times for hospital treatment. This, together with other
Column 229information relating to availability, cost and quality of service, will enable them to refer their patients to hospitals which provide a good quality service in a reasonable time.
As well as information about their patients and practices and the contracts held by their DHAs, GPs will also require information about their prescribing costs. This will help them to monitor expenditure against their indicative prescribing budgets. We are funding the changes necessary to provide them from the enhanced prescription analyses and cost (PACT) system being developed at the prescription pricing authority. All GPs will be able to monitor such information without computer assistance but, over time, information technology will be of growing assistance in this field.
A more detailed document setting out our strategy for the information needs and use of information technology in the NHS will be launched for consultation on 17 January 1990.
13. Mr. Benn : To ask the Secretary of State for Defence whether any reassessment has been made of the need to replace short-range nuclear forces in the light of the recent political changes in eastern Europe.
32. Mr. Buchan : To ask the Secretary of State for Defence whether any reassessment has been made of the need to replace short-range nuclear forces in the light of the recent political changes in eastern Europe.
33. Mr. James Lamond : To ask the Secretary of State for Defence whether any reassessment has been made of the need to replace short-range nuclear forces in the light of the recent political changes in eastern Europe.
37. Dr. Reid : To ask the Secretary of State for Defence whether any reassessment has been made of the need to replace short-range nuclear forces in the light of the recent political changes in eastern Europe.