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39. Mr. David Young : To ask the Secretary of State for Health which organisations concerned with community care he has met since the publication of the National Health Service and Community Care Bill.

60. Mr. Ieuan Wyn Jones : To ask the Secretary of State for Health what representations he has received from voluntary organisations on the community care proposals set out in the White Paper "Caring for People".

83. Mr. Meale : To ask the Secretary of State for Health what further representations he has received regarding the Government's proposals on community care.

89. Mr. Clelland : To ask the Secretary of State for Health what further representations he has received regarding the Government's proposals on community care.

91. Mr. Morley : To ask the Secretary of State for Health what further representations he has received regarding the Government's proposals on community care.

104. Mr. Tony Lloyd : To ask the Secretary of State for Health which organisations concerned with community care he has met since the publication of the National Health Service and Community Care Bill.

Mrs. Virginia Bottomley : I refer my hon. Friend and the hon. Members to my replies on 12 December 1989 at columns 845-47. We have received further representations on the Government's proposals for community care. These representations have been from local authority associations, from individual directors of social services, from voluntary organisations, from carers' organisations and from independent providers of services. Most continue to express a general welcome for our proposals ; detailed issues are being discussed with these and other organisations as part of our preparations for implementation of the main proposals in the White Paper, "Caring for People" in April 1991.

107. Mr. Alexander : To ask the Secretary of State for Health what steps he is taking to ensure the involvement of qualified nurses in the move to care in the community for mental patients.

Mrs. Virginia Bottomley : As our recent published White Paper on community care, "Caring for People",


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reaffirms, nurses represent an important skilled resource. It will be essential that health and social services authorities and voluntary bodies make best use of both their time and skills. We propose to build on nurses' existing contributions to the health and social care needs of mentally ill and handicapped patients discharged from hospital and living in the community.

62. Mr. Arbuthnot : To ask the Secretary of State for Health what is the Government's policy on the role of the private residential nursing home in the field of community care.

Mrs. Virginia Bottomley : Our White Paper "Caring for People" makes it clear that we are firmly committed to a policy of community care which provides dignity and choice to frail and vulnerable people. While for most people this will be achieved by continuing to live in their own home, others would benefit from care in a more supportive environment. We believe that, along with other providers, independent sector nursing homes will continue to play an important part in meeting people's care needs.

Resource Management

Mr. Boswell : To ask the Secretary of State for Health what progress is being made on the implementation of resource management.

33. Mr. Anthony Coombs : To ask the Secretary of State for Health what further progress will be made with the resource management initiative in the coming financial year.

Mr. Freeman : The resource management initiative was launched in November 1986.

In March 1989 I announced the names of 50 hospitals starting resource management in 1989-90. I announced in December 1989 that 20 of those hospitals would invest in IT. The remaining 30 will invest substantially in IT in 1990-91. On 18 January I announced the names of 50 more hospitals which will implement the main resource management in 1990-91.

Computerised training packages on diagnostic related groups (DRGs) and DRG group software have been issued to all acute hospitals and a cost allocation model to the 50 acute hospitals which started resource management this year. This model will be issued to all acute hospitals shortly.

Breast Screening

37. Dr. Twinn : To ask the Secretary of State for Health what progress is being made in implementing a national breast screening service ; and if he will make a statement.

Mrs. Virginia Bottomley : The table lists those breast screening centres in England which had become operational by the end of 1989. Under the programme, all women aged between 50 and 64 years will be invited to be screened by mammography every three years ; older women will be screened on request. The purpose of screening is to detect changes in breast tissue which might be cancerous at an early stage when treatment can be simple and most likely to be effective. Plans for extending the breast screening programme to cover all district health authorities in England are well advanced ; a full nationwide service comprising about 80 centres (including mobile units) is expected to become operational during 1990.


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The breast screening programmes in the other parts of the United Kingdom are the responsibilities of my right hon. Friends the Secretaries of State for Wales and for Northern Ireland and my right hon. and learned Friend the Secretary of State for Scotland.


Screening centres operational as at December 1989                             

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

Northern                  |Gateshead                                          

                          |Newcastle                                          

                                                                              

Yorkshire                 |Huddersfield                                       

                                                                              

                          |York                                               

                                                                              

Trent                     |Nottingham                                         

                          |Leicester                                          

                          |Lincoln                                            

                          |South Yorkshire                                    

                                                                              

East Anglian              |King's Lynn                                        

                          |Suffolk                                            

                          |Peterborough                                       

                          |Norwich                                            

                                                                              

North West Thames         |Barnet                                             

                          |Charing Cross                                      

                                                                              

North East Thames         |Epping                                             

                          |Bloomsbury                                         

                          |East London                                        

                          |Chelmsford and Colchester                          

                          |Whipps Cross                                       

                                                                              

South East Thames         |Camberwell                                         

                          |Canterbury                                         

                          |East Sussex                                        

                                                                              

South West Thames         |Guildford                                          

                          |Worthing                                           

                                                                              

Wessex                    |Southampton                                        

                          |Isle of Wight                                      

                          |Portsmouth                                         

                                                                              

Oxford                    |Aylesbury                                          

                          |Northampton                                        

                          |Wycombe                                            

                          |Milton Keynes                                      

                          |Reading                                            

                                                                              

South Western             |Cornwall                                           

                          |Avon                                               

                          |West Devon                                         

                                                                              

West Midlands             |Stoke on Trent                                     

                          |Coventry                                           

                          |Dudley                                             

                          |Walsall                                            

                          |Birmingham                                         

                                                                              

Mersey                    |Liverpool                                          

                                                                              

North Western             |Manchester                                         

                          |Bolton                                             

                          |Wigan                                              

Family Planning

41. Mrs. Mahon : To ask the Secretary of State for Health if he will make a statement about the family planning service.

55. Mr. Steinberg : To ask the Secretary of State for Health if he will make a statement about the family planning services.


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76. Mrs. Wise : To ask the Secretary of State for Health if he will make a statement about the family planning services.

113. Ms. Gordon : To ask the Secretary of State for Health if he will make a statement about the family planning services.

Mrs. Virginia Bottomley : The Government regard family planning as an important preventive service that contributes to maternal and child health and to the stability of family life. The emphasis of family planning services is on enabling people to plan and space their families as they would wish, with the consequent beneficial effects on health and the quality of life.

The day-to-day management of family planning services is a matter for individual health authorities since they can best judge local circumstances and priorities. Planning guidelines for 1989-91, issued in July 1988, asked authorities to ensure that full use is made of family planning services as a resource in combating AIDS and to strike a balance between services provided by specialist clinics and those provided by GPs.

Disabled Persons

42. Mr. Illsley : To ask the Secretary of State for Health if he will make a statement on the implementation of the Disabled Persons (Services, Consultation and Representation) Act 1986.

57. Mr. John Hughes : To ask the Secretary of State for Health if he will make a statement on the implementation of the Disabled Persons (Services, Consultation and Representation) Act 1986.

Mr. Freeman : I refer the hon. Members to the reply that I gave the hon. Members for Knowsley, North (Mr. Howarth) and for Liverpool, Garston (Mr. Loyden) earlier today.

Medical Audit

43. Mr. David Davis : To ask the Secretary of State for Health what progress is being made on the proposals for medical audit.

Mrs. Virginia Bottomley : Encouraging progress is being made. Officials are working with members of the medical profession to develop and implement systems of medical audit. Across the country the Department has contributed £926,000 in direct funding to 43 projects which began in 1989. Regions and districts have also been funding projects of their own. Considerable further expansion is expected soon both in the hospital and community health service and in general practice. To enable this, my right hon. and learned Friend the Secretary of State announced the provision of £31 million in 1990-91.

72. Mr. Leigh : To ask the Secretary of State for Health if he will make a further statement on the recently announced £31 million for medical audit.

Mrs. Virginia Bottomley : A total of £24 million is being divided among the regional health authorities in their proportion to their consultant numbers, subject to their submitting satisfactory medical audit implementation plans to the NHS management executive. A total of £5 million will be used in general practice. The remaining £2 million will be retained centrally for training and for projects which have national application.


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General Practice (Computers)

45. Mr. Andrew Mitchell : To ask the Secretary of State for Health how many general practitioners are likely to be affected by the recently announced scheme to provide reimbursement for computers in general practice.

Mrs. Virginia Bottomley : Potentially all medical practitioners could benefit to some extent, depending upon the circumstances of their practices. Details will be published shortly in the statement of fees and allowances.

Drugs

47. Mr. Sumberg : To ask the Secretary of State for Health if he will make a statement on his proposals for the future supply of drugs to National Health Service patients.

Mrs. Virginia Bottomley : The proposed introduction of indicative prescribing budgets will not affect the supply of necessary drugs to NHS patients. GPs will remain free to prescribe all medicines which are clinically necessary for their patients. Where there is a choice of equally effective drugs, GPs will be expected to take the relative costs into account. Indicative prescribing budgets will encourage more effective and economic prescribing and help to eliminate unnecessary expenditure in drugs, thus releasing money for other aspects of patient care in the NHS.

West Midlands RHA

50. Mr. Pawsey : To ask the Secretary of State for Health how many patients were treated in the West Midlands regional health authority area in 1988 ; and what the comparable figure was in 1979.

Mr. Freeman : The information requested is given in the table.


Patients treated, NHS hospitals, West Midlands Regional Health                                           

Authority, 1979 and 1988-89                                                                              

                         |1979               |1988-89            |Percentage increase                    

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

In-patient cases treated |547,773            |689,457            |25.9                                   

Day cases                |51,769             |99,349             |91.9                                   

New out-patients         |731,764            |813,067            |11.1                                   

Total out-patient                                                                                        

  attendance             |3,315,153          |3,757,255          |13.3                                   

Source: Returns SH3 (1978 data), SH3a, KP70, KH09 and KH18 (1988-89 data).                               

114. Mrs. Maureen Hicks : To ask the Secretary of State for Health what is the allocation of funds to the West Midlands regional health authority for 1990-91.

Mr. Freeman : Regional health authorities' initial cash limits for 1990-91 will be announced shortly. But, as my hon. Friend may be aware, we have already announced that the West Midlands regional health authority will receive a cash increase of 6.76 per cent. on its general revenue allocation for next year.

NHS Indemnity Scheme

51. Sir Michael McNair-Wilson : To ask the Secretary of State for Health whether the National Health Service indemnity scheme for doctors in National Health Service hospitals is now in place.

Mrs. Virginia Bottomley : Yes. With effect from 1 January 1990, health authorities are taking direct financial


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responsibility in claims of negligence against their medical staff. In December the Department of Health issued a circular to health authorities and a leaflet for all doctors and dentists in the hospital and community health services. A copy of the circular, HC(89)34, and of the leaflet, "Medical Negligence" are available in the Library.

Tuberculosis

52. Dr. Michael Clark : To ask the Secretary of State for Health how many cases of tuberculosis were reported in the last year for which figures are available ; and what were the comparable figures for the previous five and 10 years.

Mr. Freeman : The information is shown in the table :


Notifications of tuberculosis in England  

and Wales for the years                   

1988, 1983 and 1978                       

Year          |Notifications              

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

1988          |5,164                      

1983          |6,803                      

1978          |9,688                      

NHS Reforms

53. Mr. Simon Coombs : To ask the Secretary of State for Health whether there are any experiments being undertaken to assess how the proposed National Health Service reforms would work.

Mr. Kenneth Clarke : The Health Service is undertaking a wide range of projects designed to inform the implementation of the Government's proposals to improve services.

111. Mr. Paice : To ask the Secretary of State for Health what progress is being made on plans for the implementation of the proposed reforms of the National Health Service.

Mrs. Virginia Bottomley : We are making good progress in putting into action the changes outlined in the White Paper "Working for Patients". We are 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. By 1990-91 the total expenditure on the implementation of the Government's proposals to improve the Health Service will exceed £300 million.

We have issued detailed guidance on many subjects, including the education and training of non-medical staff. Guidance on the principles of the new contracting system was issued in September, and further guidance on additional aspects of the contracting system will be issued shortly.

We have recently published a GP fundholder programme, which gives more details about the operation of a GP practice fund.

A new working paper, the 11th in the series, has been published, called, "Framework for Information Systems : Overview". This working paper covers two documents issued for consultation, looking at the way ahead for information and information technology and concentrating on action in preparation for April 1991.

We have launched a project to support district health authorities in detailed work in developing the key role


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which DHAs 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 over 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. Subject to progress in Parliament, we 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 financial year, and a further £26 million has been allocated to hospital and community health services for the development of medical audit in 1990-91. 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 outpatient 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 my right hon. and learned Friend the Secretary of State explained in a speech on 10 July 1989, since sent to all hospital doctors, we intend to take powers to ensure, for instance, the continuation of high standards of undergraduate, postgraduate and continuing education and research in all NHS hospitals.

We 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 training (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.

Health Authorities (Maintenance Backlog)

Mr. Flannery : To ask the Secretary of State for Health what is the total figure for the estimated maintenance backlog for health authorities.

54. Mr. Fatchett : To ask the Secretary of State for Health what is the total figure for the estimated maintenance backlog for health authorities.

Mr. Freeman : I refer the hon. Members to the reply that I gave the hon. Member for Peckham (Ms. Harman) on 10 January at columns 666-69.

Patient Services

56. Mr. John Greenway : To ask the Secretary of State for Health if he will make a statement on the use of contracts for patient services within the National Health Service.

Mr. Freeman : I refer my hon. Friend to the reply that I gave my hon. Friends the Members for Taunton (Mr. Nicholson) and for Hexham (Mr. Amos) on 12 December 1989 at columns 843-44.


Column 668

Health Promotion

58. Mr. David Evans : To ask the Secretary of State for Health what recent initiatives have been taken by his Department to assist with health promotion and disease prevention.

Mr. Freeman : We recognise the essential role of health promotion and disease prevention in sustaining and improving people's health. Recent major initiatives include :

(a) changes to the system of paying family doctors, which will be introduced from 1 April to encourage them to provide a wide range of health promotion and preventive activities. Examples include incentive payments for achieving specified levels of vaccination and immunisation and screening for cancer of the cervix ; new payments for approved health promotion clinics ; and a requirement on general practitioners to give advice on matters such as diet, exercise, alcohol, smoking and drugs ;

(b) the holding of an expert symposium, jointly organised with the Health Education Authority (HEA), to assess the current and future spread of HIV and AIDS in the United Kingdom and to inform future development of the AIDS public education campaign. The proceedings of this symposium will be published shortly ;

(c) the launch in December of the teenage smoking campaign, costing £2 million a year over the next five years and intended to dissuade young people from starting to smoke. National advertising is currently aimed at 11-15-year-olds ;

(d) also in December, the making of a regulation under the Consumer Protection Act 1987 banning the manufacture and supply of oral snuff. The ban takes effect from 13 March 1990 ;

(e) further "Look After Your Heart" campaign national television and press advertising as part of LAYH's endeavours to encourage the adoption of healthier lifestyles ;

(f) the preparation, with the HEA, of a further phase of a major information and education campaign on vaccination and immunisation for later this year.

112. Mr. Menzies Campbell : 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 : I refer the hon. and learned Member to the reply that I gave the hon. Member for Brecon and Radnor (Mr. Livsey) on 12 December at column 600.

Expenditure

Mr. Stott : To ask the Secretary of State for Health how many district health authorities project a deficit for the end of the current financial year.

59. Mr. O'Brien : To ask the Secretary of State for Health how many district health authorities project a deficit for the end of the current financial year.

61. Mr. Clay : To ask the Secretary of State for Health how many district health authorities project a deficit for the end of the current financial year.

90. Mr. Turner : To ask the Secretary of State for Health how many district health authorities project a deficit for the end of the current financial year.

Mr. Kenneth Clarke : Health authority cash limit spending is monitored by my Department on a regional basis and we do not expect any region to exceed its cash limit for the year. Information about the financial position


Column 669

of district health authorities is not collected centrally. The NHS is spending more money this year than last in real terms and is treating more patients.

Junior Hospital Doctors

63. Mr. Wallace : 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 : I shall be meeting the profession for talks shortly to discuss what further action might now be appropriate to reduce the number of junior doctors on onerous rota commitments and how best to take this issue forward. Reports have now been received from all regional health authorities on the results of our June 1988 initiative. They show encouraging progress, but more needs to be done to achieve further reductions.

National Health Service Funding

64. Mr. David Shaw : To ask the Secretary of State for Health if he will make a statement on funding for the National Health Service for 1990- 91.

Mr. Freeman : In 1990-91 gross expenditure on the National Health Service in England is planned to increase to over £23.3 billion. In addition, if health authorities do no more than they have achieved in recent years, they will have a further £150 million from their cost improvement programmes. Taken together, this means that the resources available to the NHS next year will increase by the equivalent of nearly 11 per cent. in cash or about 5.5 per cent. in real terms.

British Medical Association

66. Mr. Matthew Taylor : To ask the Secretary of State for Health when he last met representatives of the British Medical Association ; and what matters were discussed.

80. Mr. Lambie : To ask the Secretary of State for Health when he last met the British Medical Association and what subjects were discussed.

100. Mr. Hood : To ask the Secretary of State for Health when he last met the British Medical Association ; and what subjects were discussed.

119. Mr. McKelvey : To ask the Secretary of State for Health when he last met the British Medical Association ; and what subjects were discussed.

Mrs. Virginia Bottomley : I refer the hon. Members to the reply that my right hon. and learned Friend the Secretary of State gave the hon. Member for Glasgow, Central (Mr. Watson) earlier today.

Eye Hospital (Hampshire)

67. Sir David Price : To ask the Secretary of State for Health when he will give his approval for a new eye hospital for the Southampton and South West Hampshire health district, the details of which have been submitted to his Department.

Mr. Freeman : The Department is responsible for giving approval in principle, within delegated limits, to any scheme which starts a cycle of project development with a


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total works cost of over £10 million. The total cost of the proposed relocation plan for the Southampton eye hospital is, I understand, around £4 million and therefore not subject to departmental approval.

Wandsworth Health Authority

70. Mr. Cox : To ask the Secretary of State for Health what has been the overspending by the Wandsworth health authority in the current financial year ; and if he will make a statement.

Mr. Freeman : Wandsworth district health authority reports an overspend at the end of November of £2.197 million. This is projected to rise by the end of the financial year to a figure between £2.5 and £3.1 million. South West Thames region has been discussing with the district a package of economy measures to reduce the overspend in 1989-90 and to produce a balanced budget for 1990-91. The district is still considering what action to take.

Inpatients

73. Mr. Barry Field : To ask the Secretary of State for Health what figure he has for the average number of inpatients treated each week by the National Health Service : and what was the figure in 1979.

Mr. Freeman : The information requested is given in the table :


Patients treated, per week, NHS hospitals,      

England,                                        

1979 and 1988-89                                

                        |1979   |1988-89        

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

Inpatient cases treated |103,848|126,654        

Source: Returns SH3 (1978 data), SH3a (1988-89  

data).                                          


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