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Mrs. Virginia Bottomley : The Department obtains its advice and information on hormone replacement therapy (HRT) and osteoporosis from experts and advisers working in the field and from published work in the scientific press. It also receives advice from working groups set up by professional or other bodies such as the Royal College of Physicians working group on fractured neck of femur. Recently the Royal College of Obstetricians and Gynaecologists was given funds by the Department towards the funding of a study group of experts on HRT and osteoporosis.
HRT has a role to play in the prevention of osteoporosis and the treatment of menopausal symptoms ; it is also possible that HRT may lead to a reduction in heart disease and strokes. However, since there may be risks, such as a possible increased risk of developing breast cancer, as well as benefits associated with its use, the individual patient's suitability for HRT is a matter for the clinical judgment of her doctor.
In the past HRT has been associated with an increased risk of cancer of the womb ; however, it is believed that HRT containing combined oestrogen- progestogen substantially reduces this risk.
Mr. Ashley : To ask the Secretary of State for Health (1) what is the current cost to the National Health Service of hormone replacement therapy ; and what the cost would be if all women aged between 50 and 60 years took the treatment ;
(2) what is the estimated number of women having hormone replacement therapy ; and what percentage this is of the women at risk of osteoporosis.
Mrs. Virginia Bottomley : Information is not available in the form requested. Hormone replacement therapy (HRT) can be administered in a variety of forms. The current cost to the NHS in England and Wales of oral HRT prescriptions is around £4 million per annum. This figure does not include women using implants or stick-on patches or who receive HRT on private prescriptions.
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The Department has recently agreed to fund an economic evaluation of HRT, which will look at its costs and benefits in relation to osteoporosis, cardiovascular disease and breast cancer.Mr. Ashley : To ask the Secretary of State for Health what research has been undertaken into a possible link between hormone replacement therapy and increased cancers.
Mrs. Virginia Bottomley : I refer the right hon. Member to the reply that my hon. Friend the Parliamentary Under-Secretary of State gave to the hon. Member for Antrim, East (Mr. Beggs) on 12 December 1989 at column 627 .
The Department of Health is about to commission a review of osteoporosis and related problems which will investigate the statistical association between hormone replacement therapy and cancer risk.
Clinical Research
Mr. Ashley : To ask the Secretary of State for Health what discussions he has had with medical research charities about the effect of the National Health Service reorganisation on clinical research carried out in National Health Service hospitals.
Mrs. Virginia Bottomley : Officials have met representatives of the Association of Medical Research Charities and some individual charities and have explained the measures that we are taking to ensure the continuation of high quality research in the NHS.
Imperial Cancer Research Fund
Mr. Ashley : To ask the Secretary of State for Health if he has had discussions with the Imperial Cancer Research Fund regarding subsidies from the fund to National Health Service hospitals to pay for patient care ; and if he will make a statement.
Mrs. Virginia Bottomley : Officials have discussed this issue with representatives of the Imperial Cancer Research Fund.
Hospital Trusts
Mr. Ashley : To ask the Secretary of State for Health (1) if he will prepare guidance and provide funds for the new National Health Service hospital trusts to ensure that their participation in clinical research is not diminished by their new status ; (2) what steps he is taking to ensure that the necessary facilities for teaching and research will continue to be provided on a long-term basis for medical and scientific professors and readers holding honorary appointments in the hospitals which are interested in becoming National Health Service hospital trusts.
Mrs. Virginia Bottomley : Guidance on applications for NHS trust status make it clear that plans for involvement in research should be clearly set out. Orders establishing trusts will specify research as a function of individual trusts where it already plays a major part. The National Health Service and Community Care Bill provides explicit powers for NHS trusts to engage in research and support research by others and for the existence of reserve powers to ensure continued involvement in research.
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In addition to money provided through contracts between purchasers and providers, funds will be available through SIFT : a similar scheme is being developed for non-teaching locations to meet the excess service costs to the NHS of research by universities and others. These should provide that hospitals will not become uncompetitive as a result of their involvement in research.Mr. Ashley : To ask the Secretary of State for Health what discussions he has had with university authorities regarding the provision of research and teaching facilities for academic staff in the National Health Service hospitals that have expressed an interest in becoming National Health Service hospital trusts.
Mrs. Virginia Bottomley : University authorities have been represented at meetings with officials at which these issues have been discussed, notably in the steering group on undergraduate medical and dental education.
Mr. Ashley : To ask the Secretary of State for Health which of the teaching hospitals that have expressed an interest in becoming a National Health Service hospital trust currently have medical and scientific professors and readers holding honorary appointments ; and what is the total number of such professors and readers.
Mrs. Virginia Bottomley : All teaching hospitals might be expected to have medical and scientific professors and readers holding honorary appointments working in them. Medical teaching and research now takes place in many locations outside the main university hospitals. Details of honorary appointments are not held centrally.
Patient Care
Mr. Ashley : To ask the Secretary of State for Health if the National Health Service retains its customary obligation to fund patient care when patients in National Health Service hospitals are participating in charitably funded research studies.
Mr. Freeman : There is a presumption that health authorities should meet the costs of care where the treatment involved forms part of the service which an authority would normally be expected to provide. The district health authority must, however, retain the final decision on how its funds can best be spent in the interests of its patients.
Bronchitis and Emphysema
Mr. Blunkett : To ask the Secretary of State for Health at what cost and by which research institutions work has been undertaken into distinguishing between the contribution of tobacco smoke and exposure to substances arising from steel production to the development of chronic bronchitis and emphysema.
Mr. Freeman : The Department of Health has not commissioned any research into the specific areas mentioned by the hon. Member. The Medical Research Council (MRC) is the main agency through which the Government fund bio-medical and clinical research in the United Kingdom. The MRC receives its grant in aid from the Department of Education and Science. I understand that the MRC has in the past conducted research into these diseases. The MRC is always willing to consider scientifically sound proposals for research which will be considered in competition with other applications.
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Nursing Homes (Prescriptions)
Mr. Morley : To ask the Secretary of State for Health (1) what steps he has taken to check prescriptions taken to dispensing chemists on behalf of elderly residents in private nursing homes are not misused ;
(2) what steps he has taken to ensure surplus prescribed drugs in private nursing homes are not stockpiled for unauthorised use.
Mrs. Virginia Bottomley : The Registered Homes Act 1984 requires the registering district health authority to inspect private nursing homes at least twice each year to ensure that adequate arrangements exist for the recording, safekeeping, handling and disposal of drugs held. Prescribed medicines may be obtained only on the authorisation of a qualified and experienced pharmacist employed by the nursing home and countersigned by a doctor or dentist. It is for the dispensing chemist to satisfy himself as to the appropriateness of each prescription for drugs. Medicines dispensed to individual patients must be given to the patient on discharge or otherwise destroyed in the presence of a patient or relation.
NHS Price Indices
Mr. Robin Cook : To ask the Secretary of State for Health if he will publish in the Official Report tables 13.3 and 13.21 of Cm. 1013 adjusted by the appropriate National Health Service price indices.
Mr. Freeman [holding answer 5 February 1990] : It is not possible to reproduce tables 13.3 and 13.21 of Cm. 1013 adjusted in the manner requested, for the following reasons :
i. no price indices exist for the NHS in the United Kingdom as a whole ;
ii. no specific price indices are available for the following categories of expenditure in England :
--central health and miscellaneous services ;
--departmental administration ;
--family practitioner services administration ;
--family practitioner services capital ;
iii. as no estimate is made of NHS pay and price inflation before the end of the current financial year it is not possible to adjust figures for 1989 -90 to 1992-93.
Details of the relevant pay and price deflators for HCHS current and capital and FPS current expenditure in England between 1984-85 and 1988-89 are shown in the table, together with an index for the NHS in England based on a weighted average of these indices :
General Medical Practitioner as at 1 October each year
England
|1979 |1980 |1981 |1982 |1983 |1984 |1985 |1986 |1987 |1988
------------------------------------------------------------------------------------------------------------------------------------------------------------
All staff |23,062 |23,674 |24,359 |24,835 |25,341 |25,788 |26,190 |26,529, |27,023 |27,420
Footnote:
Any staff holding appointments in these grades and additionally working as general medical practitioner (GMP) will also appear in the GMP table.
NHS Doctors
Mr. Robin Cook : To ask the Secretary of State for Health if he will list, by grade, the numbers of doctors working for the National Health Service, including consultants with part-time contracts, for each year since 1979.
Mrs. Virginia Bottomley [holding answer 8 February 1990] : The information is given in the table :
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General Medical Practitioner as at 1 October each year
England
|1979 |1980 |1981 |1982 |1983 |1984 |1985 |1986 |1987 |1988
------------------------------------------------------------------------------------------------------------------------------------------------------------
All staff |23,062 |23,674 |24,359 |24,835 |25,341 |25,788 |26,190 |26,529, |27,023 |27,420
Footnote:
Any staff holding appointments in these grades and additionally working as general medical practitioner (GMP) will also appear in the GMP table.
General Medical Practitioner as at 1 October each year
England
|1979 |1980 |1981 |1982 |1983 |1984 |1985 |1986 |1987 |1988
------------------------------------------------------------------------------------------------------------------------------------------------------------
All staff |23,062 |23,674 |24,359 |24,835 |25,341 |25,788 |26,190 |26,529, |27,023 |27,420
Footnote:
Any staff holding appointments in these grades and additionally working as general medical practitioner (GMP) will also appear in the GMP table.
General Medical Practitioner as at 1 October each year
England
|1979 |1980 |1981 |1982 |1983 |1984 |1985 |1986 |1987 |1988
------------------------------------------------------------------------------------------------------------------------------------------------------------
All staff |23,062 |23,674 |24,359 |24,835 |25,341 |25,788 |26,190 |26,529, |27,023 |27,420
Footnote:
Any staff holding appointments in these grades and additionally working as general medical practitioner (GMP) will also appear in the GMP table.
WALES
Community Health Councils
Mr. Barry Jones : To ask the Secretary of State for Wales if he will address an all-Wales conference of community health councils concerning his plans to reduce the number of community health councils in Wales ; and if he will make a statement.
Mr. Grist : We are always prepared to consider requests to attend conferences, subject to parliamentary and other commitments. I have in fact agreed to address the annual conference of the Association of Community Health Councils for England and Wales in Swansea in July.
Mr. Barry Jones : To ask the Secretary of State for Wales if he will meet (a) Clwyd South CHC and (b) Clwyd North community health council to discuss his Department's plans to merge Clwyd South and Clwyd North community health councils.
Mr. Grist : The consultation period on the Government's proposals for CHCs in Wales runs until the end of February 1990. Most CHCs have yet to respond and I have no plans to meet CHCs on an individual basis at present.
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Football Grounds (Safety)
Mr. Wigley : To ask the Secretary of State for Wales if he has assessed the implications for international soccer matches played in Wales arising from the Government's policy for the safety of football grounds in the wake of the Taylor report.
Mr. Grist : I refer the hon. Gentleman to the statement made by my right hon. and learned Friend the Secretary of State for the Home Department to the House on 29 January and to the schedule placed in the Library.
The Government accept, in principle, the recommendations of Lord Justice Taylor's final report. Consultations will take place with the appropriate representative bodies on the implementation, as necessary, of the recommen- dations.
Historic Monuments
Mr. Ron Davies : To ask the Secretary of State for Wales what has been the total annual income and the income from grant in aid of Cadw : Welsh Historic Monuments from 1984-85 to 1990-91.
Mr. Wyn Roberts : The table shows actual income received by Cadw for 1984-85 to 1988-89, provisional estimates 1989-90 and planned income for 1990-91 :
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£000
|1984-85 |1985-86 |1986-87 |1987-88 |1988-89 |1989-90
|outturn |outturn |outturn |outturn |outturn |forecast
----------------------------------------------------------------------------------------------------------
RCAHM(W) |538 |550 |608 |711 |655 |715
Archaeological trusts |413 |398 |450 |522 |605 |635
CTW |- |- |- |- |25 |25
Mr. Ron Davies : To ask the Secretary of State for Wales what was the amount paid by Cadw : Welsh Historic Monuments by category of grant in each year since 1984-85 ; what is the budget for 1989-90 ; and what is the estimate for 1990-91.
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Mr. Wyn Roberts : The information requested is to be found in the table :
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£000
|1984-85 |1985-86 |1986-87 |1987-88 |1988-89 |1989-90
|outturn |outturn |outturn |outturn |outturn |forecast
----------------------------------------------------------------------------------------------------------
RCAHM(W) |538 |550 |608 |711 |655 |715
Archaeological trusts |413 |398 |450 |522 |605 |635
CTW |- |- |- |- |25 |25
Mr. Ron Davies : To ask the Secretary of State for Wales which bodies received grant aid from Cadw : Welsh Historic Monuments annually from 1984- 85 to 1989-90 ; and what were the amounts involved.
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Mr. Wyn Roberts : The only bodies Cadw specifically grant-aided are : Royal Commission on Ancient and Historical Monuments in Wales (RCAHM (W)), the four archaeological trusts and the Civic Trust for Wales (CTW). The grant figures for each of the years requested are as follows :
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£000
|1984-85 |1985-86 |1986-87 |1987-88 |1988-89 |1989-90
|outturn |outturn |outturn |outturn |outturn |forecast
----------------------------------------------------------------------------------------------------------
RCAHM(W) |538 |550 |608 |711 |655 |715
Archaeological trusts |413 |398 |450 |522 |605 |635
CTW |- |- |- |- |25 |25
Severn Crossing and Barrage
Mr. Barry Jones : To ask the Secretary of State for Wales if he will meet the South Wales standing conference on regional policy to discuss (a) the second Severn crossing and (b) outline plans for a Severn barrage ; and if he will make a statement.
Mr. Wyn Roberts : My right hon. Friend the Secretary of State has already agreed to meet the South Wales standing conference on regional policy to discuss the proposals for a second Severn crossing. This meeting will be arranged once the successful tenderer is known. It is open to the standing conference to request that the agenda be extended to include the Severn barrage. c
River Dee Crossing
Mr. Barry Jones : To ask the Secretary of State for Wales if he will meet Clwyd county council to discuss plans for the proposed new River Dee crossing ; and if he will make a statement.
Mr. Wyn Roberts : The scheme has been conditionally accepted in the transport grant settlement for 1990-91. Its progress is a matter for the county council.
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Coal Mines (Applications)
Dr. Kim Howells : To ask the Secretary of State for Wales how many applications for (a) private opencast coal mines and (b) private underground coal mines have been received via British Coal or otherwise by the Welsh Office since 1 February 1989.
Mr. Peter Walker : None. The responsibility for the issuing of licenses for the extraction of coal either by opencast or deep mining methods, by private companies, rests solely with British Coal.
Landfill Sites
Dr. Kim Howells : To ask the Secretary of State for Wales what is the estimated average cost, per site, of remedial work required to safeguard landfill sites in Wales, including the costs associated with the investigation of geology and hydrogeology necessary as a precursor to such remedial work.
Mr. Grist : The estimation of costs is a matter for the operator of the site. As an approximate indicator Her Majesty's inspectorate of pollution has adopted an average sum of £250,000 when assessing the likely resource implications of landfill gas control.
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Clwyd Language Centre
Dr. Kim Howells : To ask the Secretary of State for Wales what is the level of financial support earmarked by the Welsh Office for the Clwyd language centre, Canolfan Laith Clwyd, in the coming financial year.
Mr. Wyn Roberts : Canolfan Laith Clwyd is one of many organisations that have applied for grant support next year. Whether they have been successful will be announced in due course.
Teachers' Pay
Dr. Kim Howells : To ask the Secretary of State for Wales what provision has been made for increases in school teachers' pay in the standard spending assessments for 1990-91 ; what percentage increase this represents ; how this provision has been calculated ; how this provision is related to the remit given to the interim advisory committee ; and if he will make a statement.
Mr. Peter Walker : Under the local authority revenue settlement for 1990-91 provision for total standard spending (TSS) is 9.4 per cent. over the equivalent figure for 1989-90 and 7.1 per cent. over local authorities' 1989-90 budgets. The remit given to the IAC was allowed for in full and the effect of the IAC's proposals on the community charge for standard spending is thus minimal. Standard spending assessments for individual local authorities are based on TSS but are not hypothecated to particular services. Further information about the settlement is provided in the reports approved by the House on 24 January 1990.
Community Care
Mr. Michael : To ask the Secretary of State for Wales what financial contribution he intends to make available to housing associations in Wales in order to enable them to make the contribution he expects from them towards implementation of the community care White Paper in respect of (a) elderly and very elderly people and (b) disabled people.
Mr. Grist : The Department makes funding available to Housing for Wales in support of housing associations within the Principality : for this purpose gross provision for 1990-91 will be raised by 40 per cent. over that for 1989-90. As to the future we have made it clear in draft planning guidance recently issued for consultation, that as a first step we expect housing associations to be consulted closely in the development of social care plans and to maintain and develop their crucial role--working within supporting guidance set out by Housing for Wales.
Mr. Michael : To ask the Secretary of State for Wales what financial contribution he intends to make available to local authorities in Wales in order to enable them to make the contribution he expects from them towards implementation of the community care White Paper in respect of (a) elderly and very elderly people and (b) disabled people.
Mr. Grist : The position in respect of funding the new framework for community care in Wales is fully set out in paragraphs 11.34 to 11.41 of the White Paper "Caring for People" Cm. 849. In addition, we are to make available in
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each of the financial years 1990-91 and 1991 -92 some £330,000 which will be used towards the costs of demonstration projects in each of the Welsh counties the aim of which will be to help authorities establish effective assessment and case management arrangements.Mr. Michael : To ask the Secretary of State for Wales whether he will make it his policy that Government contributions to support people living in homes for the elderly in Wales shall be calculated on the same basis, irrespective of whether the home is run by a local authority, a voluntary or charitable body, or on a private commercial basis.
Mr. Grist : Our policies for the future funding of care in the community are fully set out in the White Paper "Caring for People : Community Care in the Next Decade and Beyond" Cm. 849.
Mr. Michael : To ask the Secretary of State for Wales what guidance he has offered to housing associations in Wales on the contribution he expects them to make towards the provision of suitable homes for (a) disabled people and (b) elderly and very elderly people as part of the implementation of community care policies outlined in his recent White Paper.
Mr. Grist : I refer the hon. Gentleman to the reply given to him on 8 February.
Inspector of Schools Report
Mr. Barry Jones : To ask the Secretary of State for Wales when he expects to receive Her Majesty's inspector of schools Wales annual report ; and if he will make a statement.
Mr. Wyn Roberts : We have received the report and propose to publish it next week.
Mr. Barry Jones : To ask the Secretary of State for Wales (1) if he will make it his policy to convene a conference in Wales of local education authorities, parent-teachers associations and teacher unions to discuss Her Majesty's inspectorate of schools report of 5 February ;
(2) what initiatives he will take consequent upon the publication on 5 February of Her Majesty's inspectorate of schools report.
Mr. Wyn Roberts : The report of Her Majesty's inspectorate of schools which was published on 5 February related to England only.
Queensferry High School, Clwyd
Mr. Barry Jones : To ask the Secretary of State for Wales if he will meet the Clwyd local education authority to discuss the future of Queensferry high school.
Mr. Wyn Roberts : Should the LEA publish a statutory notice affecting the future of the school and there are statutory objections, the matter falls to my right hon. Friend for determination.
Mr. Barry Jones : To ask the Secretary of State for Wales if he will visit Queensferry high school to meet (a) staff members and (b) the parent- teachers association.
Mr. Wyn Roberts : I refer the hon. Gentleman to the answer that I gave him on 7 February 1990.
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Dyslexic Children
Mr. Roy Hughes : To ask the Secretary of State for Wales (1) if he has issued any guidance to local education authorities concerning early diagnosis of dyslexic children ;
(2) what arrangements have been made for the diagnosis of pre-school children who suffer from dyslexia ;
(3) what steps he is taking to support the role of local health and local education authorities in the teaching of dyslexic children.
Mr. Wyn Roberts : The Education Act 1981 imposes duties on local education authorities to identify, assess and make appropriate provisions for children with special educational needs, including dyslexics. For children under five, the Act places a duty on health authorities to inform parents when they are of the view that a child has, or is likely to have, special educational needs and, after discussion, to bring that view to the attention of the LEA. Welsh Office circular 54/89 gives guidance to LEAs on special educational needs and stresses the importance of early identification of any difficulties. The national curriculum will apply to all children, including dyslexics, as far as is practicable.
Mr. Roy Hughes : To ask the Secretary of State for Wales (1) what advice he is issuing to local education authorities concerning the training of teachers of dyslexic children ;
(2) what proposals he has to increase the number of teachers trained to teach dyslexic children.
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