House of Commons Hansard Debates for 20 Feb 1990

Resource Management Initiative

19. Mr. Jack : To ask the Secretary of State for Health whether further progress will be made with the resource management initiative in the coming financial year.

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Mr. Freeman : The National Health Service Management Executive has been discussing with the National Health Service details of the programme for the coming financial year for which the Government have made available an additional £78 million. Fifty more hospitals in England have been chosen to prepare and implement the main resource management programme in 1990-91. Since my announcement last March about the extension of the programme a total of 100 hospitals have been selected to implement the main resource management process. We are proceeding at a pace that the service can sustain in setting up project management teams and purchasing computer equipment. This is backed-up with guidance from the Management Executive on the best way to proceed.

Medical Audit

20. Mr. Cash : To ask the Secretary of State for Health if he will give further details of the recently announced£31 million allocation for medical audit.

Mr. Kenneth Clarke : Most of this money--£24 million--is being allocated to regional health authorities to help doctors in hospital and community health services set up new systems of quality control of clinical services known as medical audit. In addition, about £5 million will be used by family practitioner committees to further the development of medical audit in general practice and£2 million will be used to fund audit initiatives proposed by the medical royal colleges and other professional bodies.

Drug Budgets

21. Mr. Sumberg : To ask the Secretary of State for Health when he last met the Health Reform Group to discuss the proposals relating to the management of indicative drug budgets.

Mr. Kenneth Clarke : I last met the Health Reform Group formally on 9 January 1990 and had a wide-ranging discussion on our proposed National Health Service reforms which it warmly supports.

106. Mr. Stevens : To ask the Secretary of State for Health what representations he has received concerning the proposed indicative drug budgets.

Mrs. Virginia Bottomley : We have received 766 representations specifically referring to the proposals on indicative prescribing budgets. In addition we have received some 14,000 representations about the White Paper proposals in general, many of which have raised questions about, amongst other things, indicative prescribing budgets. Many of the letters concern the availability of medicines under the new system. As representations of the profession accept general practitioners will be able to continue to prescribe all the medicines which individual patients might need.

Stone House Hospital

22. Mr. Gill : To ask the Secretary of State for Health what representations he has received regarding proposals to change the status of the Stone House hospital at Bishop's Castle.

Mr. Freeman : I am aware of only five inquiries, in the form of letters received direct from members of the public.

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British Medical Association

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

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

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

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

Mr. Kenneth Clarke : I met members of the general medical services committee on 14 February when the report of the doctors and dentists review body and the pay of doctors and dentists were discussed.

Carers

24. Mr. Hoyle : To ask the Secretary of State for Health what consideration he has given to the need for carers to be able to request an assessment under the proposals in the National Health Service and Community Care Bill.

Mrs. Virginia Bottomley : In practice requests for local authority services will often, as at present, come from carers rather than from people who are being cared for. We want carers to play an active part in the assessment process and have already made clear that assessments should take account of their own needs, their preferences and their ability to go on providing care.

Primary Health Care

25. Mrs. Maureen Hicks : To ask the Secretary of State for Health what assessment he has made of the report on primary health care in Wolverhampton.

Mrs. Virginia Bottomley : The report on primary health care in Wolverhampton contains, for the most part recommendations which are for the local FPC and DHA, in collaboration, to implement. I have asked both authorities to proceed with implementing them and I have now written in more detail to my hon. Friend. We are most grateful to Sir Michael Drury, professor of general practice at Birmingham university, for his report.

Community Care

26. Mr. Cunliffe : To ask the Secretary of State for Health what steps his Department is taking to encourage the development within the community of alternatives to the use of institutional care for elderly and disabled people.

79. Mr. Dunnachie : To ask the Secretary of State for Health what steps his Department is taking to encourage the development within the community of alternatives to the use of institutional care for elderly and disabled people.

85. Mr. Hinchliffe : To ask the Secretary of State for Health what steps his Department is taking to encourage the development within the community of alternatives to the use of institutional care for elderly and disabled people.

Mr. Ron Davies : To ask the Secretary of State for Health what steps his Department is taking to encourage the development within the community of alternatives to the use of institutional care for elderly and disabled people.

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Mrs. Virginia Bottomley : The Government's White Paper "Caring For People" published in November 1989 included as a key proposal that domiciliary, day and respite services should be developed to enable people to live in their own homes for as long as possible. Existing funding structures have worked against the development of home based services. The Government seek to establish the right financial and managerial framework to help local authorities to provide the services that are needed. That objective is central to the new community care arrangements in the National Health Service and Community Care Bill currently before the House.

Mr. Harry Greenway : To ask the Secretary of State for Health what provision he is making to take back into psychiatric hospitals those patients released into the community who have not succeeded in establishing themselves there ; and if he will make a statement.

Mr. Freeman : Where it seems likely to a consultation psychiatrist that a patient discharged from hospital would benefit therapeutically from readmission, it is open to the consultant to propose, and if the patient agrees, seek to arrange, readmission.

87. Mr. Roger King : To ask the Secretary of State for Health if he has any plans to visit Birmingham to discuss community care.

97. Mr. Sims : To ask the Secretary of State for Health if he plans to make an official visit to Bromley to discuss community care.

Mrs. Virginia Bottomley : I recently visited both Bromley and Birmingham as part of a series of visits planned to see how community care services are being developed and improved at a local level. The visits are proving highly informative and have provided valuable insights into how the Government's proposals for the future organisation and management of community care can be implemented successfully.

Mr. Win Griffiths : To ask the Secretary of State for Health what recent representations he has received regarding the Government's proposals for community care.

60. Mr. Graham : To ask the Secretary of State for Health what recent representations he has received regarding the Government's proposals for community care.

110. Ms. Gordon : To ask the Secretary of State for Health what recent representations he has received regarding the Government's proposals for community care.

118. Mrs. Fyfe : To ask the Secretary of State for Health what recent representations he has received regarding the Government's proposals for community care.

Mrs. Virginia Bottomley : I refer the hon. Members to my replies on 23 January at column 663. We have received further representations from voluntary organisations and others on the Government's proposals for community care and will be taking careful note of them as part of our preparations for implementation of the main proposals in the White Paper "Caring for People".

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42. Mr. Day : To ask the Secretary of State for Health what provision is being made to provide community facilities for the mentally ill and handicapped.

Mr. Freeman : It has long been policy for health and social services to collaborate to provide such facilities as resources allow. As a consequence there has been substantial growth in places in local authority, voluntary and private homes ; day centres, day hospitals ; mental health centres and in the number of community psychiatric nurses.

I refer my hon. Friend, for statistics on the growth of community facilities, to statistical bulletin 3(2)90 "Personal Social Services Provision for Mentally Handicapped People in England 1978-88" and statistical bulletin 3(4)89 "Personal Social Services Provision for Mentally Ill People in England 1977-87". Copies are available in the Library.

Family Planning

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

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

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

Mrs. Virginia Bottomley : I refer the hon. Members to the reply I gave the hon. Member for Mansfield (Mr. Meale) earlier today.

52. Mr. Watts : To ask the Secretary of State for Health what the current number of patients is who annually seek doctors' advice on family planning matters.

Mrs. Virginia Bottomley : Information is not available in precisely the form requested.

Figures are recorded on the number of patients in respect of whom a fee is payable to a general practitioner for providing contraceptive services, and the number of people attending family planning clinics. For 1987-88, the latest year available, the information is shown in the table.


Family Planning Services (1987-88-England)                    

                                          |Thousands          

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

Patients seen by GPs                      |2,554.9            

Persons attending Family Planning Clinics |1,352.0

Hospices

28. Mr. Kirkhope : To ask the Secretary of State for Health if he will make a further statement on funding for the hospice movement.

96. Mr. Irvine : To ask the Secretary of State for Health whether he will give more details of the £8 million funding for the voluntary hospice movement.

Mrs. Virginia Bottomley : We shall shortly be notifying health authorities of the allocation they will receive for this purpose, and giving guidance on its distribution.

125. Mr. Ian Taylor : To ask the Secretary of State for Health how many hospice projects have now been assisted directly with resources provided by his Department.

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Mrs. Virginia Bottomley : Two projects for people with AIDS, the London Lighthouse and the Mildmay Mission, currently receive direct assistance from the Department, and from health authorities. The funding of individual projects is otherwise a matter for discussion between the health authorities and the organisations concerned. Authorities will receive an additional allocation of £8 million for 1990-91 to enable them to increase their existing contributions to the voluntary hospice movement.

NHS (Patient Involvement)

30. Mr. Patchett : To ask the Secretary of State for Health if he will take steps to increase the involvement of patients in the running of the National Health Service.

Mrs. Virginia Bottomley : I refer the hon. Member to the reply I gave the hon. Members for Glasgow, Pollock (Mr. Dunnachie), for Leeds, West (Mr. Battle), for Renfrew, West and Inverclyde (Mr. Graham) and for Wigan (Mr. Stott) on 23 January at column 662.

NHS Trusts

31. Dr. Michael Clark : To ask the Secretary of State for Health what plans he has to specify the core services provided by National Health Service trusts.

Mrs. Virginia Bottomley : There are no plans for the core or "designated services" provided by an NHS trust to be specified routinely by my right hon. and learned Friend the Secretary of State. Designated services are simply those which need to be provided locally and can be provided only to a defined population by a particular hospital, which has become an NHS trust. Designation becomes relevant if the trust does not wish to provide those services. The NHS and Community Care Bill provides for powers of direction by my right hon. and learned Friend the Secretary of State to achieve provision of designated services by NHS trusts as a last resort. The responsibility for identifying services which need to be designated for a particular population will rest with the DHA concerned.

Mr. Wareing : To ask the Secretary of State for Health what representations he has received about feasibility studies being carried out by hospitals considering opting out of health authority control.

Mrs. Virginia Bottomley : I refer the hon. Member to the reply I gave him on 18 January at column 402.

Mr. Robin Cook : To ask the Secretary of State for Health what was his Department's total expenditure on the meetings on National Health Service trusts held on 23 and 24 October 1989, 14 and 15 December 1989 and 22 and 23 January.

Mrs. Virginia Bottomley : These were internal management meetings with senior NHS managers. It is not our practice to disclose such costs.

Mr. Austin Mitchell : To ask the Secretary of State for Health up until what stage a potential self-governing trust's application for self- governing hospital status may be withdrawn ; up to what date new applications may be submitted ; and if he will list those which have been withdrawn to date.

Mrs. Virginia Bottomley : Formal application for NHS trust status may be made only after Parliament has

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approved the necessary legislation. Applications may, thereafter, be submitted at any time. They may be withdrawn at any time before the order establishing a particular trust is laid.

84. Mr. Livsey : To ask the Secretary of State for Health what recent representations he has received on the need for a ballot to take place before hospitals opt out of the existing National Health Service management structure.

Mrs. Virginia Bottomley : One letter has been received since the beginning of the year.

59. Mr. Flannery : To ask the Secretary of State for Health how many hospitals have now shown an interest in self-government ; and what is the precise method for doing this.

Mrs. Virginia Bottomley : A total of 191 units have, to date, expressed an interest in NHS trust status, including a number with more than one hospital. For the precedure for registering an interest in NHS trust status, I refer the hon. Member to the reply I gave him on 17 January at column 277.

56. Mr. McAllion : To ask the Secretary of State for Health what representations he has had from district health authorities on his proposals for self-governing hospitals.

Mrs. Virginia Bottomley : We have received representations from a wide range of individuals and representative bodies, including district health authorities, on the NHS review proposals over the past year. These have included representations on our proposals for NHS trusts.

Regional Health Authorities

32. Mr. Paice : To ask the Secretary of State for Health if he will make a further statement on the new system of distributing resources to regional health authorities.

Mr. Freeman : I refer my hon. Friend to the reply I gave my hon. Friend the Member for Hereford (Mr. Shepherd) on 23 January at columns 673- 74.

Nurses and Midwives

33. Mr. Andrew Mitchell : To ask the Secretary of State for Health whether any changes have been made in the provision of training for nurses and midwives since 1978-79.

Mrs. Virginia Bottomley : Yes. There have been important and far- reaching changes over this period.

The Nurses, Midwives and Health Visitors Act 1979, in setting up the United Kingdom Central Council and four national boards, one for each country in the United Kingdom, introduced a unified statutory structure for the nursing, midwifery and health professions. Under this Act, the council is responsible for establishing and improving standards of training for the nursing professions.

In January 1987 the council presented to the four Health Departments proposals, known as Project 2000, for a major reform of nurse education and training. These proposals, designed to secure a more appropriately prepared profession better able to meet future health

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needs, have been largely accepted by the Government. By April 1990, a total of 13 Project 2000 schemes will have started in England. We hope to announce further sites shortly.

The past decade has also seen the development of a variety of links between schools and colleges of nursing and further/higher education establishments. There has been a growth in the number of degree courses in nursing and associated degree courses combined with registered nurse training. Several chairs of nursing have been established within universities, to enhance developments in nurse education and practice.

Curricula for pre-registration nurse education have developed to ensure that all nursing staff are able to meet changing demands in health care. In particular there has been a growth in

post-registration courses in high technology areas to meet advances in medical technology.

Waiting Lists

34. Mr. Pike : To ask the Secretary of State for Health whether he proposes to make any additional resources available to reduce hospital waiting lists in the current year.

Mrs. Virginia Bottomley : We have made £31 million available through the waiting list fund in 1989-90. This will enable health authorities to treat over 100,000 additional in-patients and day cases and 90,000 out-patients from the waiting lists. A further £33 million is being allocated in 1990-91. I refer the hon. Member to the reply I gave my hon. Friend the Member for Sutton and Cheam (Sir N. Macfarlane) on 6 December 1989 at columns 280-81.

Ambulance Dispute

35. Mr. Rogers : To ask the Secretary of State for Health if he will now meet representatives of ambulance staff.

38. Ms. Primarolo : To ask the Secretary of State for Health if he will now meet representatives of ambulance staff.

83. Mr. Mullin : To ask the Secretary of State for Health if he will now meet representatives of ambulance staff.

100. Mr. Nellist : To ask the Secretary of State for Health if he will now meet representatives of ambulance staff.

Mrs. Virginia Bottomley : I refer the hon. Members to the reply my right hon. and learned Friend gave the hon. Member for Bolsover (Mr. Skinner) on 23 January at columns 655-56.

140. Mrs. Rosie Barnes : To ask the Secretary of State for Health whether the National Health Service management board has any plans to meet representatives of the Association of Professional Ambulance Personnel to discuss the current ambulance dispute.

Mr. Kenneth Clarke : No. The board would not expect to have meetings with any trades union on disputes about pay and conditions for any group of staff. Negotiations of pay of Whitley council groups is for the relevant Whitley council.

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132. Mr. Tony Banks : To ask the Secretary of State for Health what is his current estimate of the costs arising out of the ambulance dispute.

Mr. Kenneth Clarke : It is too soon to form a clear estimate of the costs arising out of the dispute. The cost of military involvement to the end of December 1989 was £1.8 million, although there will of course be offsetting savings on salaries and fuel costs from the normal service. Figures for assistance provided by the police have not yet been assessed by all the authorities concerned.

98. Mr. Janner : To ask the Secretary of State for Health what recent representations he has received concerning the ambulance workers' dispute.

Mrs. Virginia Bottomley : We have received numerous recent representations concerning the ambulance workers' dispute.

57. Mr. Parry : To ask the Secretary of State for Health if he will make a statement on the ambulance workers' dispute.

114. Mr. Roy Hughes : To ask the Secretary of State for Health what is the present situation concerning the ambulance dispute ; and if he will make a statement.

123. Mr. Harry Ewing : To ask the Secretary of State for Health if he will make a statement on the dispute in the ambulance service.

Mr. Kenneth Clarke : NHS management has always wanted to have further talks with the unions on the basis of its final offer, provided the unions changed their position and did not simply repeat their demands for a high pay increase and a pay formula. I am pleased that the two sides are meeting this afternoon at ACAS. I hope that today's talks will bring about a swift resolution of this dispute.

NHS Administrators

36. Mr. Cryer : To ask the Secretary of State for Health what restrictions are placed on administrators in the National Health Service from working part time for any form of private trust to facilitate opting out by National Health Service hospitals ; and if he will make a statement.

Mrs. Virginia Bottomley : Health authorities are responsible for determining the detailed terms and conditions of employment of NHS administrators. Any decision to place restrictions on outside activities by administrators would be a matter for the health authority concerned.

Drug Misusers

37. Mr. Strang : To ask the Secretary of State for Health how many injecting drug misusers are known to have been infected by HIV ; and how many of them are known to be still alive.

Mrs. Virginia Bottomley : The table shows the cumulative totals of HIV anti-body positive reports, up to the end of December 1989, and AIDS cases, up to the end of January 1990.

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