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Region |Scheme --------------------------------------------------------------------------------------------------------------------------------- Trent |Queen's Medical Centre Development, | Phase 2 North West Thames |St. Mary's W2, Phase 1B North East Thames |Homerton Hospital, Phase 1 South West Thames |St George's Block H, Phase 2A Wessex |Bournemouth District General Hospital, | Phase 1A West Midlands |Telford District General Hospital, Phase 1 West Midlands |Bromsgrove Redditch District General | Hospital, Phase 1, Contract 2 Mersey |North Sefton District General Hospital, | Southport, Phase 1
Information on Wales, Scotland and Northern Ireland is the responsibility of their respective Secretaries of State.
Column 193Mrs. Virginia Bottomley : No changes are planned at present to this unit. Since October 1988 it has provided women aged 50 to 64 from south-east London with a successful and popular screening and follow-up assessment service.
Mrs. Virginia Bottomley : The Government have accepted the need to improve training for social workers and other social care staff and we are implementing a balanced programme of improvements. This includes the provision of additional funding for phasing out one-year post-graduate social work courses in favour of a minimum of two years training, improvement to the quality and quantity of practice placements and improvements to course curricula. Additional funds are also being made available to the Central Council for Education and Training in Social Work to introduce a new qualifying course, the diploma in social work which will replace the existing qualifying courses in due course. We are also giving consideration to improving opportunities for social work post-qualifying training.
Mr. Barry Jones : To ask the Secretary of State for Health if he will take steps to introduce a scheme of financial assistance to voluntary hospices for Her Majesty's Government to match pound for pound, up to 50 per cent. of running costs, money raised by the voluntary sector.
Mr. Rooker : To ask the Secretary of State for Health what use the registrar general is making of information collected for the community charge in respect of improving the accuracy of population statistics.
Column 194a view to their use in making population estimates. If it becomes clear that use of community charge data would improve the accuracy of population estimates, this will begin as quickly as practicable.
Mr. Freeman : Agreement has recently been reached on a major new development, known as phase II, at Lewisham hospital, the cost of which will be around £27 million. This scheme should provide, from the mid- 1990s, a greatly improved range of health care to local people. The development complements the equally impressive phase III scheme at Guy's hospital in the north of Lewisham and North Southwark health authority costing around £75 million.
Mr. Cousins : To ask the Secretary of State for Health (1) in how many cases in each year since 1979 family practitioner committees deducted prescription costs from general medical practitioners, remuneration ; and in which National Health Service regions those cases occurred ;
(2) in how many cases in each year since 1979 local medical committees invoked their powers under section 20 of the National Health Service Regulations 1974 ; and in which National Health Service regions such cases occurred.
Mrs. Virginia Bottomley : Information for the period prior to August 1988 is no longer held in the Department. For the period since August 1988 the table shows for each region, on the basis of the information reported to the Department, the number of cases considered by local medical committees (LMCs) under regulation 20 of the NHS (Service Committees and Tribunal) Regulations 1974, the number of cases in which LMCs decided that the substances should not have been prescribed, and the total number of cases in which the cost of the prescription was recovered from the GP concerned.
Region |Cases considered |LMC decisions |All decisions to |by LMC's |against the GP |recover the cost |from the GP<2> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- East Anglia |5 |1 |7 Mersey |0 |0 |7 North East Thames |4 |3 |3 Northern |3 |1 |1 North Western |15 |3 |5 North West Thames |4 |3 |3 Oxford |1 |0 |12 South East Thames |2 |2 |11 South Western |3 |1 |19 South West Thames |10 |1 |3 Trent |7 |0 |1 Wessex |2 |1 |11 West Midlands |1 |0 |9 Yorkshire |12 |2 |2 <1>The figures are based on information provided by Family Practitioner Committees (FPCs) and Local Medical Committees (LMCs). <2>Includes cases determined by the Family Practitioner Committee without reference to the Local Medical Committee by agreement with the GP concerned.
Mr. Cousins : To ask the Secretary of State for Health in how many cases in each year since 1979 PD8 inquiries were undertaken into individual doctors' prescribing practices ; and in which National Health Service regions these inquiries were carried out.
Mrs. Virginia Bottomley : Inquiries into the prescribing of practices whose costs overall are significantly above the local average (previously known as PD8 inquiries) are undertaken by medical officers of the Department's regional medical service (RMS). RMS boundaries are not conterminous with NHS regional boundaries and it is therefore not possible to provide information in exactly the form requested. The RMS is organised in six divisions and covers the NHS regions as follows :
Column 196Eastern Division
North West Thames, North East Thames and East Anglian Regions. East Midlands Division
Trent and Oxford Regions.
North Eastern Division
Yorkshire and Northern Regions, excluding Cumbria.
North Western Division
North Western and Mersey Regions, plus Cumbria.
South East Thames, South West Thames and Wessex Regions. Western Division
West Midlands and South Western Regions.
The numbers and total of visits to high cost practices undertaken in England since 1979 in each of the RMS divisions is shown in the following table :
RMS Division |1979 |1980 |1981 |1982 |1983 |1984 |1985 |1986 |1987 |1988 |1989 -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Eastern |121 |104 |97 |87 |72 |24 |43 |87 |55 |143 |143 East Midland |90 |67 |35 |89 |110 |31 |34 |47 |92 |93 |129 North Eastern |92 |62 |49 |70 |62 |33 |14 |116 |114 |94 |128 North Western |161 |82 |50 |121 |96 |26 |53 |63 |143 |114 |99 Southern |121 |91 |35 |101 |59 |17 |36 |34 |105 |84 |168 Western |143 |94 |87 |144 |120 |46 |56 |48 |101 |143 |77 |--- |--- |--- |--- |--- |--- |--- |--- |--- |--- |--- Totals |728 |500 |353 |612 |519 |177 |236 |395 |610 |671 |744
(2) what help or advice has been given to the national tranquilliser advice centre by his Department towards preventing its closure through lack of funds.
Mr. Freeman : The Department awarded a grant of £10,000 to TRANX (UK) Ltd. in 1988-89 to enable the organisation to balance its books in that year. The organisation was advised that it should collaborate closely with local statutory authorities in order to secure adequate funds for the future. In the current financial year representatives of TRANX (UK) Ltd. met departmental officials who advised them that central funding was unlikely to be available in their existing circumstances. To assist TRANX, officials therefore suggested that it should provide details of its budget expectations and how it would set priorities for the services it offers in line with the
Column 196funding likely to be available. Following this reappraisal by TRANX, the Department would consider whether there was any advice or help which it could offer.
When the North West Thames regional health authority and the London borough grants unit decided not to continue to support TRANX the Department wrote in December explaining that because the local statutory authorities are no longer prepared to fund local elements of the service TRANX (UK) Ltd. provides and given the constraints on central funds the Department is unable to offer the organisation any further grant aid.
Mr. Ashley : To ask the Secretary of State for Health if he will summarise the nature of the new provision for drug misusers that has been made by the regional health authorities with the near £15 million provided by his Department ; and approximately what proportion of this provision is specifically aimed at those addicted to tranquillisers.
Mr. Freeman : Regions are due to report in detail on the use made of the £14.793 million allocated in 1989-90 specifically for the development of drug misuse services in July 1990. We will be asking regions for full details of developments funded from these earmarked allocations which will include information on services for people dependent on tranquillisers.
Column 197Mr. Ashley : To ask the Secretary of State for Health (1) what assessment he has made of the spread of the service provided by the national tranquilliser advice centre for tranquilliser addicts ; (2) what information he has been given by the national tranquilliser advice centre about the national service it provides ; and what information he has on the proportion of the inquiries it receives from people living in areas which are not part of the North West Thames region.
Mr. Freeman : Direct client services of the kind TRANX (UK) Ltd. offers are best provided locally rather than nationally. Local statutory authorities are best placed to decide which services are worthy of support and fit in with their overall plans. TRANX (UK) Ltd. has provided the Department with details of the national service it offers. This consists of telephone counselling, written information about tranquillisers and advice on how to withdraw from them, together with a newsletter.
Figures from TRANX (UK) Ltd's annual report for 1988 (the most recent available) show that 44 per cent. of inquiries in England were from areas not covered by the catchment areas of the four Thames regions. The breakdown of inquiries from the North West Thames area is not separately available.
Mr. Ashley : To ask the Secretary of State for Health what efforts his Department has made to establish the number of people at risk of addiction through taking benzodiazepine tranquillisers on a long term basis.
Mr. Freeman : It is unlikely that it would be possible to obtain accurate statistical data on those dependent on benzodiazepines. What is important is to encourage careful prescribing of benzodiazepines, to promote alternatives to their use and to provide services for those experiencing problems as a result of their dependence : the right hon. Member will be aware of the initiatives the Government are taking in this respect.
Mr. Ashley : To ask the Secretary of State for Health what information he has on the number of tranquilliser advice centres, similar to the national tranquilliser advice centre, operating throughout the United Kingdom and on their source of funding.
Mr. Freeman : We are aware of a number of centres in various parts of England which provide advice for those working with those dependent on tranquillisers. We are also aware of many local services for this group. The provision and funding of these local direct client services is the responsibility of the local statutory authorities. We are funding the National Association for Mental Health (MIND) to produce a national directory of services for this group. Up to £81,000 has been made available for the work which is spread over three financial years starting in 1988-89.
Mr. Ashley : To ask the Secretary of State for Health what investigation there has been of the type of support and advice that best enables those addicted to tranquillisers to overcome their addiction.
Mr. Freeman : Studies have shown that in other fields of dependence face-to-face counselling and contact with a local treatment service improve the likely prognosis compared with other treatment approaches. The available evidence is that this also applies to tranquillisers.
Mr. Freeman : Detailed information is not held centrally, but it is known that in recent years the increase in the number of local agencies which have been established partly as a result of Government initiatives, has resulted in a far greater number of people coming forward for help in withdrawing from their prescribed drugs.
Mr. Ashley : To ask the Secretary of State for Health what is the most recent figure for the annual rate of prescription of benzodiazepine tranquillisers ; and which pharmaceutical companies currently supply the National Health Service.
Mrs. Virginia Bottomley : The latest estimate of the number of prescriptions for benzodiazepines dispensed by community pharmacists in Great Britain is 23.2 million in 1988. Under the selected list scheme prescriptions for most benzodiazepine sedatives and tranquillisers must be written generically. It is not possible to produce a comprehensive list of pharmaceutical companies whose products are being supplied. However some benzodiazepines may be prescribed at NHS expense using the brand name for example for intravenous use. The manufacturers concerned are
C. P. Pharmaceuticals Ltd.
Farmitalia Carlo Erba Ltd.
Roche Products Ltd.
Mr. Ashley : To ask the Secretary of State for Health what response has been given to the pharmaceutical company Roche which has indicated that it would contribute towards the organisational costs of the national tranquilliser advice centre if his Department did likewise.
Mr. Freeman : My noble Friend Lady Hooper has written to Roche, informing it of the decision by North West Thames regional health authority and London borough grants unit and the Department of Health that no further funding can be awarded to TRANX (UK) Ltd.
Mr. Atkinson : To ask the Secretary of State for Health how many patients were admitted to mental illness and mental handicap hospitals under compulsory powers ; how many were resident in such hospitals when detained, excluding special hospitals ; and what percentage of total admissions and residents they constituted, at the latest available date.
Mr. Freeman : The most recent complete information is for 1986. During that year there were 237,311 admissions, of which 16,193 (6.8 per cent.) were formal admissions under compulsory powers, to National Health Service mental handicap and mental illness hospitals and units in England. It is estimated that 9,900 patients, already admitted as informal, were subsequently detained as formal patients and 7,600 formal patients had a change of legal status although remaining detained. On 31 December 1986 there was a total of 93,442 patients resident in these hospitals and units, of whom 4,602 (or 4.9 per cent.) were formally detained patients.
Mr. Bermingham : To ask the Secretary of State for Health if he will list the proportion of total redeemed token value in the welfare milk scheme submitted by roundsmen in each year since 1979 in England and Wales ; and if he will make a statement.
Mr. Bermingham : To ask the Secretary of State for Health what are his proposals for apportioning revenue loss costs between farmers, dairies and distributors with respect to his proposed welfare milk scheme discount ; and if he will make a statement.
Mr. Freeman : The regulations laid on 5 January enable the dairy trade, on a voluntary basis, to accept tokens for the supply of liquid welfare milk and pass them up through the trade so that the cost of the price reduction can be shared equitably. The dairy trade has well- established mechanisms and procedures for deciding prices and discounts between milk marketing boards and distributors.
Mr. Bermingham : To ask the Secretary of State for Health what negotiations have taken place with the milk trade and its constituent companies concerning proposals for changes to the welfare milk scheme ; and if he will make a statement.
Mr. Freeman : Before negotiations commenced we wrote to all suppliers explaining that as part of the Government's initiative to see whether better value for money could be obtained the cost of purchasing liquid welfare milk was to be examined. Detailed and extensive negotiations subsequently took place over a period of eight months involving over 40 separate companies and six major supermarket chains. Discussions were held with representatives from all sectors of the dairy trade including the dairy trade federations, the National Dairyman's Association and the milk marketing boards. Meetings were held with representatives of the British Retail Association, the National Farmers Union and the National Fedration of Self Employed and Small businesses. Following the decision to introduce a revised pricing structure, we have written to all suppliers explaining the decision together with details of the measures that we have introduced to enable the cost of the price reduction to be shared equitably throughout the trade.
Mr. Bermingham : To ask the Secretary of State for Health what representations have been received by his Department with respect to current proposals to change funding arrangements for the welfare milk scheme ; and if he will make a statement.
Mr. Freeman : Following the announcement of the decision to implement a revised price structure for the supply of liquid welfare milk we have received representations from the English Dairy Trade Federation and the National Dairyman's Association. In response my noble Friend Baroness Hooper met with officers and members of the English and Scottish dairy trade federations on 9 January to hear the trade's views and make arrangements to discuss implementation of the new structure.
Mr. Cousins : To ask the Secretary of State for Health whether imported blood products are tested for hepatitis C ; and what are the differences in testing procedures between imported blood products and fresh blood donations from British resident donors.
Mr. Freeman [holding answer 10 January 1990] : As far as we are aware, at present there is no routine testing for hepatitis C carried out by the home authorities in any country from which blood products are imported to the UK. Such tests as are available are still being developed and evaluated.
It is a matter for the authorities in each country to decide on appropriate screening procedures for blood. These may vary according to the prevalence of certain infectious agents in the country of origin. The Department keeps testing procedures under review and recommends the introduction of new tests in the light of scientific and other developments.
Blood or plasma collected overseas for processing into blood products which are to be imported into the United Kingdom under United Kingdom product licence is subjected to such screening tests as are laid down by the home authority, as well as any that are required by our licensing authority--the Medicines Control Agency.
Mr. Menzies Campbell : To ask the Secretary of State for Scotland how employment training and YTS will be administered after the Scottish Enterprise and the Highlands and Islands Enterprise proposals are implemented.
Mr. Wallace : To ask the Secretary of State for Scotland whether he intends to promote any measures to increase the take-up of YTS and employment training places in Scotland ; and if he will make a statement.
Mr. Lang : I have no present plans for further measures specifically designed to increase uptake of employment training and youth training. However, I fully expect that the creation of local enterprise companies and the opportunities that they will have for flexibility in the provision of training will lead to more attractive locally-oriented training arrangements for both adults and young people that are closely geared to their needs and those of local employers.
Mr. Worthington : To ask the Secretary of State for Scotland if he will publish in the Official Report an analysis of training expenditure in Scotland, consistent with page 40 of "Public Expenditure to 1991-92 : A Commentary on the Scotland Programme", indicating for the years 1983-84 to 1991-92 (a) public expenditure in Scotland on training, (b) the public expenditure programme in which it was included for that year, (c) the Vote on which it was taken for that year and (d) the impact of the definitional and classification changes upon the annual totals of public
Column 201expenditure on the Scotland programme, as shown in table 16.1 of Cm. 616 and in the table appended to the Secretary of State's statement to the House on 6 December, Official Report, columns 330-33.
Column 202Commission and the Training Agency cannot be broken down in sufficient detail to distinguish fully spending on training from spending by these bodies on other employment-related programmes such as the employment rehabilitation service and the enterprise allowance scheme. The figures given in the table therefore represent total expenditure in Scotland by these bodies, which were funded by the Secretary of State for Scotland :
-------------------------------------------------- 1983-84 1984-85 1985-86 1986-87 1987-88 1988-89 1989-90 1990-91 1991-92 (d) Since this expenditure has been in programme changes affecting it have had no impact on the Sco