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Tobacco Products

Mr. Aspinwall : To ask the Secretary of State for Health what information his Department has received about the amounts spent by the tobacco industry as part of its campaign to encourage retailers to support the law prohibiting the sale of cigarettes to children under 16 years ; and if he will give the amounts spent for the years 1986-87, 1987-88 and 1988- 89.

Mr. Freeman : Information on this campaign is contained in the first and second reports of the Committee for Monitoring Agreements on Tobacco Advertising and Sponsorship.

These reports, copies of which are held in the Library, show that approximately £1 million was spent in each of the years, 1986-87 and 1987-88.

Details of expenditure in 1988-89 are not yet available but will be included in the committee's third report.

West Midlands RHA

Mr. Archer : To ask the Secretary of State for Health whether he has any plans to meet the chairman of the West Midlands regional health authority to discuss the budget for the forthcoming year.

Mr. Freeman : No.

Sir James Ackers

Mr. Rooker : To ask the Secretary of State for Health if he will dismiss Sir James Ackers from his position as chair of the West Midlands regional health authority.


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Mr. Freeman : No.

Income Support Exemptions

Mr. Ashley : To ask the Secretary of State for Health if he will issue guidance to local authorities that people on income support or an equivalent level of income should be exempt from charges for services such as home help.

Mrs. Virginia Bottomley : We have no plans to do so.

Anyone who feels unable to afford local authority charges for domiciliary care can make representations to the authority which may reduce the charge to the amount it considers reasonable for him or her to pay.

Community Care

Mr. Ashley : To ask the Secretary of State for Health what steps he is taking to ensure that standards of community care are of a national minimum quality.

Mrs. Virginia Bottomley : The need to secure and safeguard the necessary quality of community care is integral to the proposals set out in the White Paper "Caring for People". A wide range of measures will be taken. Some are provided for in the National Health Service and Community Care Bill. In particular we are seeking powers to require local authorities to draw up and publish plans for community care services, and to assess the needs of people requiring social care.

In drawing up contracts for service provision from independent suppliers, local authorities will need to specify the quality and standards expected. Authorities will also be required to set up independent inspection units charged with inspecting and reporting on local authority residential care homes, as well as registering and inspecting independent residential care homes.

The Department proposes to issue guidance on the establishment of these units and the assessment of quality of provision.

These arrangements will be monitored by the Department's social services inspectorate whose advisory and supervisory functions will be strengthened.

Disabled Persons

Mr. Ashley : To ask the Secretary of State for Health what steps he is taking to promote and encourage independent advocacy schemes for disabled people.

Mr. Freeman : The Department has approved a grant under section 64 of the Health and Public Services Act 1968 in 1989-90 towards the administrative costs of national citizen advocacy, which aims to promote the development of high quality citizen advocacy for mentally handicapped people in the United Kingdom. We are also contributing towards the cost of a project run by "one to one", an organisation which recruits and trains volunteers to act as friends, enablers and advocates of mentally handicapped people. We have no plans for formal independent advocacy schemes for other groups of disabled people.

Mr. Ashley : To ask the Secretary of State for Health whether he will take steps to ensure that local authorities are authorised to make payments to disabled people for the purchase of care or personal assistance services.

Mr. Freeman : Local authorities are not authorised to make such payments and we have no plans further to do


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so. Nevertheless the White Paper "Caring for People" proposes that local authorities should set up systems for assessing the care needs of disabled people and arranging packages of care to meet them. Disabled people and their carers should be fully involved in this process.

My right hon. Friend the Secretary of State for Social Security has just published a Command Paper, "The Way Ahead : Benefits for Disabled People" containing proposals for improvements in the structure of social security help for disabled people. These improvements, which will increase social security spending in 1993-94 by some £300 million as announced last week, reflect the Government's aim of ensuring a better life for Britain's disabled people.

Mr. Ashley : To ask the Secretary of State for Health whether his Department is funding any independent case management schemes for disabled people.

Mr. Freeman : I refer the right hon. Member to the reply that I gave to my hon. Friend the Member for Exeter (Mr. Hannam) on 20 December at column 339.

Mr. Alfred Morris : To ask the Secretary of State for Health on what date he now intends to implement section 3 of the Disabled Persons (Services, Consultation and Representation) Act 1986.

Mr. Freeman : I refer the right hon. Member to my reply to my hon. Friend the Member for Exeter on 19 December 1989 at column 170.

NHS Staff

Mr. Kirkwood : To ask the Secretary of State for Health (1) how many health authorities have now decided to take local action to fund increases for NHS clerical and administrative staff who were previously paid above the maximum of their former grade and who have assimilated to the minimum of their new grade ;

(2) how many health authorities must now decide to take local action to fund increases for NHS clerical and administrative staff who were formerly paid on the maximum point of their salary scale and who have assimilated to the penultimate point of their new salary scale ;

(3) if he will now consider issuing a variation order to the regrading structure national agreement relating to NHS clerical and administrative staff ;

(4) what representations he has received from local health authorities regarding the need to issue a variation order to the regrading structure national agreement relating to NHS clerical administrative staff.

Mrs. Virginia Bottomley : Such information is not held centrally. We have received no representations from health authorities about the need to issue orders varying the agreement reached last year in the administrative and clerical staffs Whitley council and have no plans to do so.

Sight Tests

Mr. Kirkwood : To ask the Secretary of State for Health if he will estimate the change in the number of sight tests carried out after the introduction of charges for the latest period for which figures are available ; and if he will make a statement.

Mrs. Virginia Bottomley : Figures on the number of NHS sight tests carried out between 1 April and 30


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September 1989 will shortly be available. The results of a survey on the total number of sight tests in the first quarter of 1990 compared with earlier periods should be available after Easter.

Births

Mr. Wigley : To ask the Secretary of State for Health if he will list for the years 1987 and 1988 the estimated percentage of women delivering in (a) England and (b) England and Wales whose deliveries were (i) spontaneous, including abnormal presentation of head and breech spontaneous, (ii) instrumental, including forceps vacuum and breech extractions, (iii) caesarean section and (iv) other and unspecified means.

Mrs. Virginia Bottomley : Information is not available for the years requested nor for England and Wales. The information for the latest year available, 1985, is given in the following table :


Deliveries                                                                                    

Percentage of deliveries by method of delivery: 1985                                          

England                                                                                       

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

Spontaneous delivery                                                                          

   (including breech spontaneous and abnormal                                                 

                                              |  presentation of head)                        

Instrumental delivery                                                                         

   (including forceps, vacuum and breech                                                      

    extraction)                               |10.7                                           

Caesarean section                             |10.5                                           

Other and unspecified means                   |0.1                                            

Note: Percentages do not total 100 because of rounding.                                       

Source: Hospital In-Patient Enquiry 1985.                                                     

Mr. Wigley : To ask the Secretary of State for Health if he will list for the years 1987 and 1988 the estimated percentages of women delivering in (a) England and (b) England and Wales (i) whose labours were induced, (ii) whose labours were of spontaneous onset and (iii) who had elective caesarean sections.

Mrs. Virginia Bottomley : Information is not available for the years requested nor for England and Wales. The information for the latest year available, 1985, is given in the following table :


Deliveries                                                   

Percentage of deliveries by method of delivery: 1985         

England                                                      

Mode of delivery           |Percentage of                    

                           | all deliveries                  

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

Induced labour             |17.5                             

Spontaneous onset          |65.5                             

Elective caesarean section |4.9                              

Accelerated labour         |12.1                             

Source: Hospital In-Patient Enquiry 1985.                    

NHS Working Party

Mr. Cousins : To ask the Secretary of State for Health if he will state (a) the members of the working party on National Health Service costing and their expertise, (b) the terms of reference of this working party, (c) when the working party expects to report and (d) whether he will place its conclusions in the Library.


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Mr. Freeman : The working party is made up of a number of health authority directors of finance and departmental officers, including accountants and an economist.

Its remit is :

(i) to assist the NHS Management Executive in developing the principles for costing and pricing hospital services ; and (ii) to provide guidance to the NHS on the application of these principles.

The NHSME will shortly issue a discussion draft on the cost allocation principles for contract pricing. More detailed guidance will follow later in the year.

When the guidance exists in final form it will be placed in the Library.

Working for Patients

Mr. Cousins : To ask the Secretary of State for Health what assistance (a) for computerisation and information technology and (b) otherwise, he proposes to offer to general practitioners of medicine to carry out additional duties arising from the implementation of his White Paper, "Working for Patients" ; and, in each case, what is his estimate of the cost of such assistance.

Mr. Freeman : I refer the hon. Member to my reply to my hon. Friend the Member for Hastings and Rye (Mr. Warren) on 28 November 1989 at columns 228-231. Subject to parliamentary approval of the necessary legislation, in recognition of the additional work which practices will need to undertake in 1990-91 to prepare for fund-holding, costs incurred on these tasks will be reimbursed up to a maximum of £16, 000. Practices which join the fund-holding scheme will be eligible for an annual management allowance of up to £32,000. The cost will depend on the number of fund-holders.

Prescription Pricing Authority

Mr. Cousins : To ask the Secretary of State for Health what additional capital and revenue provision he has made in 1989-90 and succeeding years in the budget of the Prescription Pricing Authority for England ; and what proportion of this is accounted for by the additional work for the authority arising from the White Paper "Working for Patients".

Mr. Freeman : The revenue allocation for the Prescription Pricing Authority for 1989-90 is £2.64 million higher than for 1988-89. The capital allocation is £0.9 million lower. Allocations for future years, including sums for work which the Prescription Pricing Authority is undertaking in respect of White Paper initiatives, have not yet been finalised.

Mr. Cousins : To ask the Secretary of State for Health what steps he and his predecessors have taken since 1984 to identify alleged false prescriptions or overprescriptions ; and what action has been taken as a result.

Mrs. Virginia Bottomley : Arrangements exist for the Prescription Pricing Authority to forward to family practitioner committees, for their consideration, investigation and appropriate action, prescriptions where some irregularity is suspected. No central record is kept of the action taken by family practitioner committees in these cases, or in others which may come to their attention. Since 1984 doctors of the Department's regional medical


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service have visited over 2,800 practices whose prescribing costs overall were significantly above the local average. This has led to an estimated saving of around £15,000 per practice in a full year in 1989-90.

Census

Mr. Cohen : To ask the Secretary of State for Health what plans he has to amend procedures relating to the disclosure of information from the next census to take into account access to (i) the electoral register, (ii) the extract of the poll tax register and (iii) anonymous poll tax data ; whether access to any of these could undermine the confidentiality of the census ; and whether he will make a statement.

Mr. Freeman : As in past censuses, no information on identified individual people or households will be passed to anyone other than employees of the registrars general. Thus current procedures already prevent such information being passed to electoral registration officers or community charge registration officers. Furthermore, stringent measures already exist to guard against possible indirect disclosure of information on individual people or households through the published statistics and no incidents of such disclosure have been reported from the 1981 census. It is planned to strengthen these measures further for the 1991 census by doubling the minimum thresholds, below which no statistics, other than a simple total of people and households will be released for any area, to 16 households and 50 people.

Mr. Cohen : To ask the Secretary of State for Health what plans he has to reassure individuals who complete the census that they will not be identified from the information subsequently disclosed by his Department ; and whether he will make a statement.

Mr. Freeman : Reassurance on confidentiality will be given on the front page of the census forms in the message addressed to heads of households and others responsible for completing the forms. It will also be reinforced in publicity material issued before the census.

Mr. Cohen : To ask the Secretary of State for Health whether he will describe the uses of census data that specifically require the collection of the date of birth rather than the age of a person ; and whether he will make a statement.

Mr. Freeman : The question on date of birth is asked primarily because it has been found to give more accurate statistics than can be obtained by a question simply on age. As the census is taken in April the information on date of birth is used to produce the mid-year population estimates by age as at 30 June. Also, four dates of birth have been used to select the OPCS longitudinal study sample from the 1971 and 1981 censuses. OPCS plans to include in this study the appropriate sample of records from the 1991 census.

Birmingham Health Resources

Mr. Terry Davis : To ask the Secretary of State for Health what assurances have been given to the West Midlands regional health authority about the availability of the resources which will be required to implement the latest proposals entitled "Building a Healthy Birmingham."


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Mr. Freeman : The overall level of resources available for the Health Service is determined each year in the public expenditure round. All RHAs are then told what resources they will be allocated in the next financial year. No Secretary of State could give any RHA assurances beyond this period because this is dependent upon the outcome of subsequent expenditure surveys.

999 Calls

Mr. Caborn : To ask the Secretary of State for Health what has been the average response time for the 999 calls for December 1989 in each of the health authorities covering south Yorkshire.

Mrs. Virginia Bottomley : Details for activation and response times are not held centrally for December 1989. I suggest the hon. Member contacts the chairman of Trent regional health authority for the information he seeks.

Eye Tests

Mr. Simon Hughes : To ask the Secretary of State for Health what research has been carried out on the impact on the number of people seeking eye tests of the introduction of a charge.

Mrs. Virginia Bottomley : We have recently commissioned a survey of the volume of sight tests. The survey will collect information on the numbers carried out during the first quarter of 1990 and the results compared with demand in earlier periods.

The findings should be available after Easter when we would expect to provide a summary for the Library.

Mentally Ill

Mr. Fearn : To ask the Secretary of State for Health if he will make a further statement on the provision of community care for the mentally ill.

Mr. Freeman : In addition to the initiatives referred to in "Caring for People" (Cm 849), we have recently announced the establishment of a National Health Service loans fund, which we hope will enable the early provision of community facilities for people with a mental illness or handicap.

Hospital Capital Spending

Mr. Ian Bruce : To ask the Secretary of State for Health if he will make a statement on future hospital capital spending.

Mr. Freeman : Exchequer provision for health authority capital spending for the next three years was announced in the Chancellor's Autumn Statement. Government spending on capital in the NHS will amount to some £1,086 million next year, a real terms increase of 12.4 per cent. over 1989-90. In addition health authorities will continue to benefit from receipts from land and property sales. The Government attach the highest priority to improving and modernising health buildings and throughout England over 500 schemes each costing over £1 million with a total value of over £5 billion are at various stages of planning, design and construction.


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Family Practitioner Committees

Mr. Speller : To ask the Secretary of State for Health what is the estimated cost of printing stationery changes involved in changing the name of family practitioner committees in the first year of implementation.

Mr. Freeman : It is not possible to make a reliable estimate of the cost of this proposal. The amount involved is likely to be very small as FPCs will be able to run down existing stocks in advance of the change and, where appropriate, use existing stocks until they are exhausted.

Perinatal Deaths

Mr. Pike : To ask the Secretary of State for Health what action his Department proposes to take to reduce the perinatal death rate in those health authority areas where that death rate is higher than the national average.

Mrs. Virginia Bottomley : I refer the hon. Member to the Government reply to the First Report from the Social Services Committee, Session 1988- 89 on Perinatal, Neonatal and Infant Mortality (CM 741), a copy of which is available in the Library.

Air Ambulances

Mr. Matthew Taylor : To ask the Secretary of State for Health for how long he has committed Government resources to the London Air Ambulance.

Mr. Freeman : The Department has committed resources for three years from January 1989.

Mr. Matthew Taylor : To ask the Secretary of State for Health how much the Government are contributing to the financing of (a) the Cornwall First Air Ambulance and (b) the London Air Ambulance.

Mr. Freeman : The Department is contributing from central funds £673,000 (revenue) and £1,349,000 (capital) to the London Air Ambulance.

Mr. Matthew Taylor : To ask the Secretary of State for Health on how many occasions (a) the London Air Ambulance and (b) the Cornwall First Air Ambulance have been called out.

Mr. Freeman : This information is not held centrally by the Department.

Mr. Matthew Taylor : To ask the Secretary of State for Health what provision there is for carrying journalists or photographers on (a) the London Air Ambulance and (b) the Cornwall First Air Ambulance.

Mr. Freeman : There is no provision for carrying journalists or photographers on either of these services.

Mr. Matthew Taylor : To ask the Secretary of State for Health whether he, or one of his Ministers, has met representatives from (a) the Cornwall First Air Ambulance and (b) the London Air Ambulance, or has plans to do so.

Mr. Freeman : I have met representatives of the Cornwall First Air Ambulance Service operating company. I have no plans at present to meet other representatives.


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Mr. Matthew Taylor : To ask the Secretary of State for Health whether he, or one of his Ministers, has visited or plans to visit (a) London Air Ambulance and (b) the Cornwall First Air Ambulance.

Mr. Freeman : Neither I nor my colleagues have visited either of these services and there are currently no arrangements to do so.

Personal Stereos

Mr. Maclennan : To ask the Secretary of State for Health whether he has any evidence to suggest that the use of personal stereos causes a hearing loss ; and if he will make a statement.

Mr. Freeman : We are aware of the recent report by the National Deaf Children's Society which warns that personal stereos may be causing damage to the hearing of children and young people. However, we have not yet seen a copy of this report. There is evidence that prolonged exposure to loud noise may constitute a risk to hearing.

Unregistered Homes

Ms. Harman : To ask the Secretary of State for Health how many people currently live in unregistered homes, with fewer than four occupants.

Mr. Freeman : This information is not collected centrally.

Registered Homes Tribunals

Ms. Harman : To ask the Secretary of State for Health how many tribunal cases there have been where it has come to light that the proprietor of a registered home has previous criminal convictions which would have made him unsuitable or ineligible to run a home.

Mr. Freeman : As at 31 December 1989 there have been six tribunal decisions confirming an authority's decision either to cancel or to refuse an application for registration because the appellant is not considered to be a fit person to be running a home in the light of a previous criminal conviction.

Ms. Harman : To ask the Secretary of State for Health what consideration he gives to the decisions of the registered homes tribunals and whether he has accepted any of their recommendations.

Mr. Freeman : The registered homes tribunals are independent statutory bodies. They are mainly concerned with appeals against the decisions of district health authorities and local authorities which are the registering authorities for nursing homes and most independent residential care homes respectively.

The Secretary of State is the registering authority only for voluntary children's homes and no appeal against his decisions has been made to the registered homes tribunal.

Ms. Harman : To ask the Secretary of State for Health where the decisions of the registered homes tribunal are circulated.

Mr. Freeman : Distribution of decisions of the registered homes tribunal includes the following :

Directors of Social Services Local Authorities England General Managers District Health Authorities England


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Association of County Councils

Association of Metropolitan Authorities

British Federation of Care Home Proprietors

Council on Tribunals

MIND (National Association for Mental Health)

National Care Homes Association

National Council for Voluntary Organisations

Social Care Association

Welsh Office

Libraries of the Houses of Parliament


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