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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".
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.
Column 662reaffirms, 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.
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.
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.
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.
Column 663The 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
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.
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.
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.
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.
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.
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.
Column 666responsibility 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.
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.
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
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
Column 667which 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.
(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.
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 669of 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.
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.
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.
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.
Column 670total 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.
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.
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.
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).