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Junior Hospital Doctors
13. Mr. Malcolm Bruce : To ask the Secretary of State for Health what steps he is taking to reduce the number of hours worked by junior hospital doctors.
Mrs. Virginia Bottomley : Reports have been received recently from regional health authorities on the results of our initiative launched in 1988 to reduce onerous rota commitments. These are being analysed but it is already clear that significant reductions have been achieved. I intend to invite representatives of the profession to discuss with me, early in the new year, what further action needs to be taken to tackle the remaining onerous rotas.
Abortion
14. Mrs. Maureen Hicks : To ask the Secretary of State for Health if he will give the most recent statistics on the numbers of abortions performed on girls aged 16 years and under.
Mrs. Virginia Bottomley : In England and Wales in 1988 a total of 10,081 abortions were carried out on resident girls aged 16 and under.
Mrs. Ann Winterton : To ask the Secretary of State for Health if he will give a breakdown by numbers of (a) previous children and (b) previous abortions of the total number of abortions performed in the latest year for which figures are available.
Column 595
Mr. Freeman [holding answer 29 November 1989] : The number of abortions performed under the Abortion Act 1967 upon usually resident women by numbers of (a) previous liveborn or stillborn children and (b) previous abortions in England and Wales 1988 are shown in the tables.
Table 2
Number of abortions performed under the Abortion Act 1967, upon
usual residents of England and Wales, 1988 by previous legal
terminations and spontaneous miscarriages.<1>
Previous number |Legal terminations|Spontaneous
|miscarriages
----------------------------------------------------------------------------
0 |133,103 |154,525
1 |29,206 |10,230
2 |4,078 |1,876
3 |719 |440
4 |170 |164
5+ |63 |104
Unknown |959 |959
<1> The notification form for abortions carried out under the Abortion Act
1967 requires information about previous abortions to the woman concerned
to be recorded, distinguishing between spontaneous miscarriages and legal
terminations.
The table shows the information requested for abortions performed in
England and Wales in 1988 for those women having had one or more previous
spontaneous miscarriage or legal termination.
Notifications having at least one previous spontaneous miscarriage and also
at least one previous legal termination, and women having more than one
abortion under the Act in 1988 will be counted more than once in the
statistics.
Table 2
Number of abortions performed under the Abortion Act 1967, upon
usual residents of England and Wales, 1988 by previous legal
terminations and spontaneous miscarriages.<1>
Previous number |Legal terminations|Spontaneous
|miscarriages
----------------------------------------------------------------------------
0 |133,103 |154,525
1 |29,206 |10,230
2 |4,078 |1,876
3 |719 |440
4 |170 |164
5+ |63 |104
Unknown |959 |959
<1> The notification form for abortions carried out under the Abortion Act
1967 requires information about previous abortions to the woman concerned
to be recorded, distinguishing between spontaneous miscarriages and legal
terminations.
The table shows the information requested for abortions performed in
England and Wales in 1988 for those women having had one or more previous
spontaneous miscarriage or legal termination.
Notifications having at least one previous spontaneous miscarriage and also
at least one previous legal termination, and women having more than one
abortion under the Act in 1988 will be counted more than once in the
statistics.
Mrs. Ann Winterton : To ask the Secretary of State for Health if he will give a breakdown of the numbers and percentages of abortions performed on pregnancies of 18 weeks or more gestation in England and Wales in the latest year for which figures are available by (a) age of mother, (b) residency of mother, (c) grounds for abortions, (d) marital status of mother, (e) numbers of previous children and (f) numbers of previous abortions ; and if he will indicate the numbers and percentages of those abortions which were performed in the public and private sectors.
Mr. Freeman [holding answer 29 November 1989] : Numbers and percentages of abortions performed under the Abortion Act 1967 at 18 weeks or more gestation on residents and non-residents of England and Wales in 1988 by age of mother, residency of mother, grounds of abortions, marital status of mother, number of previous children and numbers of previous abortions.
Number of previous legal terminations and spontaneous
miscarriages<1>
Previous nuLegal terminations Spontaneous miscarriages
|Number |Per cent.|Number |Per cent.
------------------------------------------------------------
0 |8,146 |5.6 |9,143 |5.4
1 |1,346 |4.3 |444 |4.1
2 |168 |3.9 |83 |4.2
3 |34 |4.4 |14 |3.1
4 |4 |2.2 |11 |6.5
5+ |2 |2.8 |5 |4.5
Unknown |23 |2.3 |23 |2.3
<1> The notification form for abortions carried out under
the Abortion Act 1967 requires information about previous
abortions to the women concerned to be recorded,
distinguishing between spontaneous miscarriages and legal
terminations.
Notifications having at least one previous spontaneous
miscarriage and also at least one previous legal
termination, and women having more than one abortion under
the Act in 1988 will be counted more than once in the
statistics.
Number of previous legal terminations and spontaneous
miscarriages<1>
Previous nuLegal terminations Spontaneous miscarriages
|Number |Per cent.|Number |Per cent.
------------------------------------------------------------
0 |8,146 |5.6 |9,143 |5.4
1 |1,346 |4.3 |444 |4.1
2 |168 |3.9 |83 |4.2
3 |34 |4.4 |14 |3.1
4 |4 |2.2 |11 |6.5
5+ |2 |2.8 |5 |4.5
Unknown |23 |2.3 |23 |2.3
<1> The notification form for abortions carried out under
the Abortion Act 1967 requires information about previous
abortions to the women concerned to be recorded,
distinguishing between spontaneous miscarriages and legal
terminations.
Notifications having at least one previous spontaneous
miscarriage and also at least one previous legal
termination, and women having more than one abortion under
the Act in 1988 will be counted more than once in the
statistics.
Column 597
Yorkshire Regional Health Authority
15. Mr. O'Brien : To ask the Secretary of State for health when he last met the chairman of the Yorkshire regional health authority ; and what was discussed.
Mr. Freeman : My right hon. and learned Friend the Secretary of State last met the chairman of the Yorkshire regional health authority on the 14 November 1989 to discuss matters relating to the management of the NHS.
52. Mr. Lofthouse : To ask the Secretary of State for Health when he expects to meet the chairman of the Yorkshire regional health authority ; and what matters he proposes to discuss.
Mrs. Virginia Bottomley : My right hon. and learned Friend the Secretary of State for Health will be meeting all regional chairmen on 17 January 1990 to discuss matters relating to National Health Service management.
NHS Reform
19. Mr. Ashton : To ask the Secretary of State for Health if he will make it his policy to hold a referendum in health authority areas which propose to opt out of their local hospitals.
Mr. Kenneth Clarke : The Government do not consider that it would be sensible for the proposed management changes in the NHS to be the subject of any ballot. There is no question of any hospital opting out of the NHS.
118. Mr. Dykes : To ask the Secretary of State for Health if he will give his latest assessment of the expert and lay public support for his National Health Service modernisation proposals.
Mr. Kenneth Clarke : I have been greatly encouraged by the constructive support that I have received for the proposed improvements to the Health Service. Many of the individual letters I have received from members of the public endorse some or all of the proposals. The proposals are being increasingly backed by members of the health professions. The Health Reform Group, recently formed under the chairmanship of Professor Richard Lilford, is a good example of medical support for the reforms. The long established Hospital and Consultants Association has publicly disassociated itself from and disapproved of the BMA's campaign against the reforms. The National Association of Health Authorities has always given general support to our proposals.
72. Mr. Shersby : To ask the Secretary of State for Health what representations he has received from the Health Reform group, under the chairmanship of Professor Richard Lilford, concerning the proposals contained in the White Paper on reform of the National Health Service.
Mr. Kenneth Clarke : I have received representations on the detail of the reform process by the Health Reform Group. A meeting between Ministers and the group is planned early in the new year when further contributions from members of the group will be received. I am pleased to welcome the formation of this and indeed any Group of those working within the health Service who wish to propose constructive dialogue on the detail of Health Service reforms.
Column 598
46. Mr. Maples : To ask the Secretary of State for Health if he will make a statement on progress on the implementation of National Health Service reforms.
73. Mr. Quentin Davies : To ask the Secretary of State for Health what progress is being made on the implementation of the proposed reforms of the National Health Service.
Mr. Kenneth Clarke : We are making good progress in putting into action the changes outlined in the White Paper "Working for Patients". I am confident that the NHS will be ready to implement the basic elements of the new and better systems of matching growth and resources with expansion of patient services by April 1991 once Parliament approves the necessary legislation. We have made £82 million available to finance progress towards implementation this year with a further £257 million available for initiatives in 1990-91.
We have issued detailed guidance on many subjects including the new contracting system for all district health authority hospitals and community units and on education and training for non-medical staff. We shall be publishing shortly a GP fund holder programme which will give more details about the operation of a GP practice fund. We have recently launched a project to support district health authorities in detailed work in developing the key role which DHA's will have under the new system of identifying and obtaining the best pattern of services which will most effectively meet all the health needs of the population they serve.
We have received more than 180 expressions of interest from potential NHS hospital trusts. Seventy nine of them are proceeding towards being the first wave of applicants for trust status within the NHS in April 1991 and I expect many more to be ready for later waves of applicants in future years.
We have made £2 million available for implementation of medical audit this year. A £4.5 million scheme has been launched to develop information technology skills. Demonstration projects, aimed at improving the quality of care and services to patients, have been announced for five out-patient departments. The principles of general management are being introduced into the family practitioner committee system.
Good progress is also being made in relation to medical education and research. As I explained in a speech on 10 July, since sent to all hospital doctors, I intend to take powers to ensure, for instance the continuation of high standards of undergraduate, postgraduate and continuing medical education and research in all NHS hospitals. I will also ensure that postgraduate training posts are provided in NHS hospital trusts in accordance with the national objectives set out in "Achieving a Balance". Medical education and research will be further enhanced by the proposed increase in the service increment for teaching (SIFT) to meet 100 per cent. of the median excess costs of teaching hospitals. This will be distributed by Regions in consultation with universities.
The National Health Service and Community Care Bill is now before the House.
41. Mr. Ian Taylor : To ask the Secretary of State for Health if he will make a statement about the units which have applied to become National Health Service hospital trusts.
Column 599
Mr. Kenneth Clarke : No units will apply for NHS trust status until Parliament has approved the necessary legislation.38. Mrs. Rosie Barnes : To ask the Secretary of State for Health what criteria he intends to use in assessing applications by district health authority units, hospitals and related services for self-governing status when such applications if successful would result in all of a district health authority services becoming self-governing.
Mr. Kenneth Clarke : No units will apply for NHS trust status until Parliament has approved the necessary legislation. The key criteria were set out in working paper No. 1, "Self-governing Hospitals" and the outline application document circulated under EL(89)MB/148, which has been placed in the Library, set out the criteria in more detail. Each application will be judged on its own merits taking into account local circumstances. It may be sensible for services in some relatively small, cohesive districts to apply for trust status as a single entity. In any such case I would need to consider the overall size and manageability of the proposed trust ; the extent to which services and management were integrated ; the implications for patient choice and competition ; and the views of staff and local people.
28. Mr. Baldry : To ask the Secretary of State for Health whether there are any experiments taking place to assess how the proposed National Health Service reforms would work.
Mrs. Virginia Bottomley : The Health Service is undertaking a wide range of projects designed to inform the implementation of the Government's proposals to improve services.
Column 600
Social Workers
20. Mr. Rowe : To ask the Secretary of State for Health if he will make a statement on the extent to which social worker qualifications will be recognised across the European Community after 1992.
Mrs. Virginia Bottomley : Under the first EC directive on the mutual recognition of qualifications, social workers holding a qualification awarded on completion of at least three years higher education and training preparing them for the profession will be entitled to have their qualification recognised by any member state which requires such a qualification. They may in some circumstances be required to have professional experience or to undergo an adaptation period. A second directive covering qualifications awarded upon completion of courses of less than three years has been proposed and is currently under consideration in Brussels.
Health Promotion and Education
21. Mr. Livsey : To ask the Secretary of State for Health whether he will increase the level of investment in health promotion and health education programmes.
Mr. Freeman : The importance that the Government attach to health education and health promotion is demonstrated by the increases to the Health Education Authority's budget. This stands at £28 million, nearly three times the 1986 budget of its predecessor the Health Education Council. The allocation for the coming financial year is still to be determined. In addition, health authorities spend an unquantifiable amount of their resources on a whole range of educative and promotional activity.
Column 601
Drugs
22. Mr. Robert B. Jones : To ask the Secretary of State for Health what is his latest estimate of the savings to the National Health Service drugs bill as a result of the limited list of drugs.
Mrs. Virginia Bottomley : In 1985-86 the selected list scheme saved £75 million on the drugs bill. It is not possible to make meaningful estimates for subsequent years but there is every reason to believe that significant savings continue to be made.
32. Mr. Flynn : To ask the Secretary of State for Health whether he intends making any new recommendations on the labelling of drugs available (a) on prescription and (b) over the counter to the general public.
Mrs. Virginia Bottomley : We have commented on a European Community (EC) Commission consultative document suggesting, amongst other things, revision of EC directive requirements on medicines labels. The EC Commission is expected to put a formal proposal for a directive to the Council of Ministers early in the New Year. It would be counterproductive and contrary to our EC obligations to revise the United Kingdom Medicines (Labelling) Regulations before the adoption of the new directive.
Ambulance Dispute
23. Mr. McAvoy : To ask the Secretary of State for Health if he will meet representatives of ambulance staff to discuss pay and conditions.
Mr. Kenneth Clarke : I refer the hon. Member to the reply that I gave earlier today.
75. Mr. Evennett : To ask the Secretary of State for Health what discussions have been held by his Department with the Association of Professional Ambulance Personnel concerning the present ambulance dispute.
Mr. Kenneth Clarke : Ministers and officials held several meetings with representatives of the Association of Professional Ambulance Personnel before I decided on 1 December to accept a body comprising the Association of Professional Ambulance Personnel and representatives of the employing authorities and health departments as a negotiating body for ambulancemen and women.
25. Mr. Battle : To ask the Secretary of State for Health if he will make a further statement on the ambulance dispute.
26. Mr. Canavan : To ask the Secretary of State for Health whether he will make a statement about the ambulance service dispute.
45. Mr. Nellist : To ask the Secretary of State for Health when he last met ambulance crews' union representatives about the pay dispute.
47. Mr. Barry Porter : To ask the Secretary of State for Health what representations he has received concerning the ambulance men's dispute ; and if he will make a statement.
96. Mr. Tim Smith : To ask the Secretary of State for Health if he will make a statement about the ambulance dispute.
Column 602
123. Mr. Buckley : To ask the Secretary of State for Health, if he will meet representatives of ambulance staff to discuss pay and conditions.
130. Ms. Walley : To ask the Secretary of State for Health if he will meet representatives of ambulance staff to discuss pay and conditions.
Mrs. Virginia Bottomley : I refer my hon. Friends and the hon. Members to the reply that my right hon. and learned Friend the Secretary of State gave to my hon. Friends the Members for Christchurch (Mr. Adley) and for Suffolk, South (Mr. Yeo) and the hon. Member for Barnsley, West and Penistone (Mr. McKay) earlier today.
Spastics Society
24. Mr. Hood : To ask the Secretary of State for Health what plans he has to meet the Spastics Society to discuss community care.
51. Mr. Jim Marshall : To ask the Secretary of State for Health when he next expects to meet the Spastics Society ; and what matters he hopes to discuss.
91. Mr. Frank Cook : To ask the Secretary of State for Health what plans he has to meet the Spastics Society to discuss community care.
95. Mr. Meale : To ask the Secretary of State for Health what plans he has to meet the Spastics Society to discuss community care.
127. Mr. Flannery : To ask the Secretary of State for Health what plans he has to meet the Spastics Society to discuss community care.
Mr. Freeman : My right hon. and learned Friend the Secretary of State has no plans to meet the Spastics Society in the immediate future. However, my right hon. Friend the Minister for Social Security and with responsibility for the disabled met representatives of the society on Monday 11 December to discuss conductive education.
Stockport Hospitals
27. Mr. Favell : To ask the Secretary of State for Health if he has any plans to visit Stockport to inspect its hospitals.
Mr. Freeman : My right hon. and learned Friend the Secretary of State has no plans to visit Stockport. However, I hope to visit Stockport sometime early next year.
Clegg Report
29. Mr. Holt : To ask the Secretary of State for Health if he will establish an independent tribunal to investigate any changes in ambulance men's duties since the Clegg report.
Mrs. Virginia Bottomley : One of the suggestions made in 1979 in the Clegg report for joint examination by the employers and unions was the possibility of introducing, at no overall increase in cost, an all-in salary for qualified ambulance men and women. Such a salary was introduced at substantial additional cost in 1986 and led to radical changes in working practices. The offer made to the trade unions includes a joint review of the 1986 agreement in the light of three years' experience.
Column 603
The Future of Medicine in Liverpool"
30. Mr. Wareing : To ask the Secretary of State for Health what representations he has received in respect of proposals contained in the report "The Future of Medicine in Liverpool", commissioned by the Mersey regional health authority ; and if he will make a statement.
Mrs. Virginia Bottomley : We have received various representations. These proposals are a matter for the health authorities concerned. I understand that the Liverpool and South Sefton health authorities are considering the report's recommendations.
Hip Replacements
31. Miss Widdecombe : To ask the Secretary of State for Health how many hip replacement operations per year are being carried out by the National Health Service now ; and what was the figure in 1979.
Mr. Freeman : The estimated number of total hip replacement and other arthroplasty of hip operations performed on in-patients discharged from NHS non-psychiatric hospitals in England in 1986 (the last year for which information is available centrally) and 1979 were 40,900 and 30,730 respectively.
115. Mr. Riddick : To ask the Secretary of State for Health how many hip replacement operations were carried out in the Yorkshire regional health authority area in the five years between 1974 and 1979 and between 1983 and 1988 ; and if he will make a statement.
Mr. Freeman : The information requested is given in the table. 1986 is the last year for which information is available centrally.
Estimated number of
total hip
replacement and
other arthroplasty
of
hip operations
performed on
in-patients
discharged from NHS
non-
psychiatric
hospitals, Yorkshire
regional health
authority
|Number
---------------------
1974 |1,550
1975 |1,700
1976 |1,790
1977 |1,630
1978 |1,740
1979 |1,870
1983 |2,620
1984 |2,540
1985 |2,470
1986 |2,700
Hospitals, Central Manchester
33. Mr. Tony Lloyd : To ask the Secretary of State for Health if he will make a statement on the proposals for opting out by hospitals in central Manchester.
Mrs. Virginia Bottomley : The decision on whether or not to prepare a formal application for National Health Service trust status, when Parliament has approved the necessary legislation, is a matter for the sponsors of the expression of interest in the unit concerned. There is no question of any hospital "opting out" of the National Health Service.
Column 604
Community Care
34. Mr. Janner : To ask the Secretary of State for Health what representations he has received concerning the impact of the community care White Paper on the mental health services.
Mr. Freeman : We have received two representations concerning the impact on mental health services of the Government's White Paper on community care, and are considering both carefully.
35. Mr. Redmond : To ask the Secretary of State for Health what plans he has to meet the Association of Metropolitan Authorities to discuss the role of local authorities in community care policy formulation.
70. Mr. Wall : To ask the Secretary of State for Health what plans he has to meet the Association of Metropolitan Authorities to discuss the role of local authorities in community care policy formulation.
80. Mr. Litherland : To ask the Secretary of State for Health what plans he has to meet the Association of Metropolitan Authorities to discuss the role of local authorities in community care policy formulation.
90. Mr. John Hughes : To ask the Secretary of State for Health when he next expects to meet the Association of Metropolitan Authorities ; and what matters he hopes to discuss.
110. Mr. Patchett : To ask the Secretary of State for Health what plans he has to meet the Association of Metropolitan Authorities to discuss the role of local authorities in community care policy formulation.
Mrs. Virginia Bottomley : I met representatives of the Association of metropolitan Authorities (AMA) on 2 November and again on 16 November to discuss community care. Officials have been meeting regularly with officers of the association over recent months to discuss a range of community care issues, including detailed financial matters. We shall continue to engage in regular consultation with the AMA and the other Local Authority Associations as we plan the implementation of our proposals for community care which were set out in our recent White Paper, "Caring for People" (Cm. 849).
36. Mr. Haynes : To ask the Secretary of State for Health what comments he has received on the White Paper on community care.
78. Mr. Adams : To ask the Secretary of State for Health what comments he has received on the White Paper on community care.
82. Mr. Cunliffe : To ask the Secretary of State for Health what comments he has received on the White Paper on community care.
108. Mr. Andrew Bowden : To ask the Secretary of State for Health what comments he has received in response to the community care White Paper.
119. Dr. Godman : To ask the Secretary of State for Health what comments he has received on the White Paper on community care.
120. Rev. Martin Smyth : To ask the Secretary of State for Health what representations he has received since the
Column 605
publication of the White Paper on Community care and the publication of the National Health Service and Community Care Bill.121. Mr. Ieuan Wyn Jones : To ask the Secretary of State for Health what representations he has received in the White Paper on community care ; and if he will make a statement.
Mrs. Virginia Bottomley : We have received several representations following publication of our White Paper "Caring for People : Community Care in the Next Decade and Beyond'. Most have expressed a general welcome for our proposals. Some have raised detailed concerns about a number of implementation issues which we shall be discussing with representatives of the local authority associations and other interested parties as part of our preparations for implementation in April 1991.
37. Mr. David Shaw : To ask the Secretary of State for Health if he will make a statement on services for disabled patients and the Government's proposals for community care.
94. Sir David Price : To ask the Secretary of State for Health if he will make a statement about care for the disabled and the elderly.
Mr. Freeman : The Government's policies for improving health services and community care for all are set out in our White Papers, "Working for Patients" (Cm 555) and "Caring for People" (Cm 849). Under the proposals for NHS services district health authorities will be responsible for seeing that the needs of all their resident population, including elderly people and those with disabilities, are met and that patients have access to a comprehensive range of high quality, value for money services. Paragraph 2.12 of "Caring for People" sets out our particular priorities for health and community care for elderly people and people with disabilities. They are to promote positive and healthy lifestyles, promote coherent networks of local services designed to assist people to live dignified and independent lives in their own homes, provide a full range of appropriate health care facilities for those who require it, avoid unnecessary institutional care by ensuring that decisions on the provisions of services are made on the basis of assessed need, and ensure improved access to information about local and national facilities including respite care, and a greater involvement of patients, clients and carers in the development of services. In addition under our new contract for general medical practitioners GPs will be expected to offer a visit to those aged 75 or over to see their home environment, find out whether carers and relatives are available and to assess social, physical and mental well- being.
Mr. Michael : To ask the Secretary of State for Health whether he will make it his policy to provide adequate financial resources to ensure that care in the community is matched to the needs of individuals in each community.
Mr. Freeman [holding answer 6 December 1989] : We recognise that local authorities will need adequate resources for their enhanced responsibilities under the community care proposals outlined in our White Paper "Caring for People : Community Care in the Next Decade and Beyond", published on 16 November. This will be achieved by transferring to the local authorities the
Column 606
resources that the Government would otherwise have provided to finance care through social security payments to people in residential and nursing homes. We also recognise that the numbers of people needing support are growing, so the transfer will take account of demographic factors. With funding coming principally through the revenue support grant, local authorities will be able to make their own decisions on individual community care needs based on local knowledge.
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