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Mr. Freeman : From April 1991, health authorities will be expected to include the effects on capital charges of their proposals for hospital rationalisation schemes in the
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submissions they make to the Department of Health. This will enable better informed decisions to be taken, as full consideration will be given to the recurring costs of using assets over a future period, and not just to the capital outlay involved.Handicapped Children
90. Mr. Ashton : To ask the Secretary of State for Health what is the latest annual figure for the number of children in the United Kingdom who were born either mentally or physically handicapped.
Mr. Freeman : The information requested is not available centrally.
The third report from the OPCS on disability in Great Britain "The Prevalance of Disability Among Children", published last year following surveys in 1985 and 1988, estimated that there are some 360,000 children in Great Britain under 16 with one or more disability. The definition was wide enough to include most children usually considered to be physically or mentally handicapped. It is not possible to distinguish the number of children who were born either mentally or physically handicapped from those who acquired a disability later since the surveys did not publish information on whether disabilities existed at birth. A copy of this report is in the Library.
NHS (Service Quality)
93. Mr. Leigh : To ask the Secretary of State for Health if he will make a statement on action being taken to improve the quality of service being given by the National Health Service.
Mrs. Virginia Bottomley : The White Paper reforms aim to provide a better National Health Service with more attention to quality of care and customer service flowing from greater devolution, the separation of the purchaser and provider functions and introduction of contracts, wider choice and the extension of medical and clinical audit. These proposals are being reinforced by a series of initiatives to make the consumers' interest more central to the management and delivery of health care.
North West Thames RHA
95. Mr. David Evans : To ask the Secretary of State for Health what plans he has to meet the chairman of the North West Thames regional health authority to discuss the allocation of funds to the region's district health authorities.
Mr. Freeman : My right hon. and learned Friend the Secretary of State and I met the chairman of North West Thames regional health authority, together with a number of other colleagues, on 17 January to discuss allocations of districts. My right hon. and learned Friend meets the chairmen of all the regional health authorities regularly.
Orthopaedic Hospital, Stanmore
101. Mr. Dykes : To ask the Secretary of State for Health if he will consider the creation of a special health authority to supervise the management of the Royal National orthopaedic hospital, Stanmore, Middlesex.
Mr. Freeman : We do not consider the creation of a special health authority for the Royal National orthopaedic hospital is the best way forward.
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North East Thames and North West Thames regional health authorities issued proposals last August to transfer the management of the Royal National orthopaedic hospital (Stanmore) from Bloomsbury district health authority to Harrow district health authority as the most effective arrangement for securing the future of the hospital. No definitive proposal has yet been put to Ministers.I discussed options for the hospital's future management with my hon. Friend when he led a delegation from the hospital to see me last week. I plan to visit the hospital shortly.
Infertility Treatments
102. Mr. Bradley : To ask the Secretary of State for Health if he will bring forward proposals to improve the range and availability of infertility treatments.
128. Mr. Clay : To ask the Secretary of State for Health if he will bring forward proposals to improve the range and availability of infertility treatments.
Mrs. Virginia Bottomley : I refer the hon. Members to the reply I gave the hon. Members for Cardiff, West (Mr. Morgan), for Bristol, South (Ms. Primarolo), for Carmarthen (Mr. Williams) and for Newcastle-upon-Tyne, North (Mr. Henderson) on 23 January at columns 660-61.
Northumbria Ambulance Service
103. Mr. Jack Thompson : To ask the Secretary of State for Health what expenditure has been incurred in pursuing the opting-out proposals for the Northumbria ambulance service.
Mr. Freeman : Over £85 million has been made available this year for the implementation of the NHS review proposals. Of this, £35 million has been allocated to regional health authorities to enable them to develop the finance and personnel functions, to strengthen the public health function, to prepare for the introduction of capital charges and medical audit, and to create new consultant posts as promised in the White Paper, Northern RHA has been allocated £2, 478 million. No additional resources have been made available specifically for the preparation of NHS trusts. However, all authorities including those with units considering this option will benefit from the overall strengthening of key management functions.
NHS Reform
104. Mr. Tim Smith : To ask the Secretary of State for Health if he will make a statement on implementation of the National Health Service reforms.
113. Miss Widdecombe : To ask the Secretary of State for Health what progress is being made on 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. We have
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made £85 million available to finance progress towards implementation this financial year and more than £300 million will be available in 1990-91.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 published a GP fund holder programme which gives details about the operation of a GP practice fund. There has been an encouraging level of interest in the proposed scheme in all regions in England.
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 intend to publish a further working paper on indicative prescribing budgets within the next few weeks.
We have launched a project to support district health authorities in detailed work in developing the key role 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 190 expressions of interest from potential NHS hospital trusts, 80 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 out-patient departments. The principles of general management are being introduced into the family practitioner committee system.
My right hon. and learned Friend the Secretary of State has invited the medical and nursing royal colleges and the statutory bodies concerned with clinical issues to early talks on how, if necessary, clinical standards can be reinforced after the proposals in the National Health Service and Community Care Bill are implemented. Good progress is also being made in relation to medical education and research. As my right hon. and learned Friend explained in a speech on 10 July 1989, since sent to all hospital doctors, we intend to take powers to ensure, for example, the continuation of high standards of undergraduate, postgraduate and continuing education and research in all National Health Service hospitals. We will also ensure that postgraduate training posts are provided in National Health Service 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 teaching (SIFT) to meet 100 per cent. of the median excess costs of teaching hospitals. This will be distributed by regions in consultation with universities.
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The National Health Service and Community Care Bill is now before the House.Mr. Teddy Taylor : To ask the Secretary of State for Health if he will publish a pamphlet summarising the implications for patients of the Health Service reforms ; and if he will make a statement.
Mrs. Virginia Bottomley : A leaflet (reference HSR1) setting out the implications of the proposed reforms for patients was published together with the White Paper "Working for Patients". We will consider further the need for additional public information.
Operating Theatres
109. Mr. Patrick Thompson : To ask the Secretary of State for Health whether any steps are being taken to ensure that operating theatres are utilised effectively.
Mr. Freeman : In December 1989 a report by the Department's value for money unit on the management and utilisation of operating departments was issued to health authorities. This made a number of recommendations concerning the efficient utilisation of operating theatres, and suggested a target planned level of utilisation of 90 per cent. should be achievable. The Department is currently consulting health authorities and others about guidance following the recommendations made in the study report, copies of which are available in the Library.
Model Contracts
112. Mr. David Martin : To ask the Secretary of State for Health if he will indicate when guidance will be published on model contracts for use in 1991-92.
Mr. Freeman : We expect to publish this guidance shortly.
Hospital Services (Islington and Bloomsbury)
115. Mr. Corbyn : To ask the Secretary of State for Health what action he will take to ensure there are no further cuts in hospital services in Islington and Bloomsbury if the health authorities are required to merge.
Mrs. Virginia Bottomley : A consultation document on the proposal to merge Islington and Bloomsbury health authorities was issued at the end of last year. Comments have been requested by 12 April 1990. Until the outcome of the consultation is known it would be inappropriate for Ministers to comment on any aspects of the merger.
Eye Consultants
117. Mr. Wallace : To ask the Secretary of State for Health what information he has regarding the number of referrals by opticians to eye consultants in the periods 1 April to 31 December 1988 and in the same period in 1989.
Mrs. Virginia Bottomley : We do not collect this information. Opticians normally refer patients to their general practitioner if, as a result of an eye examination, they suspect disease, abnormality or injury. The general practitioner may then refer the patient on to the hospital eye service, if appropriate.
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Capital Expenditure (Bury)
119. Mr. Burt : To ask the Secretary of State for Health what are the figures for capital expenditure in the Bury health authority in the years 1979-80 and 1988-89 ; and if he will make a statement.
Mr. Freeman : The capital expenditure figure for Bury health authority is shown in the table :
|Total
|expenditure
|(in cash
|terms)
------------------------------------
1979-80 |1,539,000
1988-89 |1,484,000
These figures do not represent the trend, as expenditure has fluctuated during the intervening years.
Birmingham General Hospital
121. Mr. Rooker : To ask the Secretary of State for Health what representations he has received in respect of the proposed closure of the general hospital, Birmingham.
Mr. Freeman : Since the West Midlands regional health authority first published its preliminary proposals for the reorganisation of Birmingham's health services in April 1989 the Department has received a number of inquiries about the future of the general hospital from right hon. and hon. Members and direct from members of the public.
Voluntary Organisations (Consultations)
22. Mr. Alfred Morris : To ask the Secretary of State for Health what representations he has received from voluntary organisations on the need to ensure service users and providers are consulted as part of an ongoing process under the proposals in the National Health Service and Community Care Bill ; and if he will ensure local authorities establish an advisory body to do this.
Mrs. Virginia Bottomley : We have received representations on this from several voluntary organisations. Ministers and officials meet regularly with national organisations to discuss such matters of common concern. The White Paper makes it clear that local authorities, when drawing up plans for community care, should consult interested agencies. We believe that they should determine for themselves the most appropriate way of doing this.
Nurses (Regrading)
126. Mr. Devlin : To ask the Secretary of State for Health if the regrading of nurses has now been completed.
Mrs. Virginia Bottomley : The new clinical grading structure for nursing and midwifery staff was implemented during 1988, with staff concerned being informed of their new grades by the end of October that year.
Royal College of Nursing
129. Mr. Fearn : To ask the Secretary of State for Health when he last met the general secretary of the Royal College of Nursing ; and what matters were discussed.
Mrs. Virginia Bottomley : My right hon. and learned Friend the Secretary of State last met the general secretary
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of the Royal College of Nursing on 1 February when he informed representatives of nursing and midwifery staff and the professions allied to medicine of the Government's decision on the 1990 review body reports.Patient Services
131. Mr. Evennett : To ask the Secretary of State for Health what experience there has been within the National Health Service of using contracts for patient services.
Mr. Freeman : I refer my hon. Friend to the reply I gave my hon. Friends the Members for Taunton (Mr. Nicholson) and for Hexham (Mr. Amos) on 12 December at columns 843-44.
GP Lists
134. Dr. Goodson-Wickes : To ask the Secretary of State for Health how many patients are on the average general practitioner's list at present ; and what was the comparable figure in 1979.
Mr. Freeman : At 1 October 1988 (the latest year for which figures are available) the average list size in England was 1,999 compared to 2,286 at 1 October 1979--a decrease of about 12.5 per cent.
Rural GPs
135. Mr. Beith : To ask the Secretary of State for Health what assessment he has made of the future of general practice in rural areas under his proposed changes and under the new contract.
Mrs. Virginia Bottomley : Patients living in rural areas will benefit from the changes to the GPs' contract. In particular the new contract encourages more minor surgery and child health surveillance in general practice, extra services for elderly patients, greater cover for childhood immunisation and more screening for cancer of the cervix, more health promotion advice for all adults and more professional staff in the surgery such as nurses, counsellors and chiropodists.
GPs working in rural areas sometimes experience difficulties due to the scattered nature of their practices. In consultation with the BMA's general medical services committee, the Department of Health and the Welsh Office are reviewing the present arrangements (in England and Wales) for paying these GPs a rural practice payment. In doing so, full account will be taken of changes that are taking place in rural practice.
Cornwall Air Ambulance
137. Mr. Robert Hicks : To ask the Secretary of State for Health whether the 1990-91 financial allocation to the South West regional health authority includes an element for public funding of the Cornwall air ambulance ; and if he will make a statement.
Mr. Freeman : No. The Cornwall air ambulance is a local service and funding is a matter for the Cornwall and Isles of Scilly health authority.
Nurses
139. Mr. Favell : To ask the Secretary of State for Health what was the nurse in-patient ratio in 1979 and the latest date for which figures are available.
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Mrs. Virginia Bottomley : Manpower statistics cover staff working in hospitals and are collected at a particular point in time ; they do not show what activities within the hospital the staff are engaged upon--for example, whether they are providing treatment to in-patients, out-patients or accident and emergency patients. By contrast, activity statistics show the number of cases treated during the year in National Health Service hospitals. It is possible, however, to give a ratio in terms of the population being served. At 30 September 1979 the number of qualified nursing and midwifery staff, measured in whole-time equivalents, was 438.6 per 100,000 population for England. At 30 September 1988 the number of qualified nursing and midwifery staff, measured in whole-time equivalents, was 508.9 per 100,000 population. These ratios have been adjusted to take account of the change in nurses' working hours (from 40 to 37.5 hours per week) during 1980-81. The average number of in-patients treated in a week was 103,848 in 1979 and 126,654 in 1988.
Press and Publicity
Mr. Galbraith : To ask the Secretary of State for Health if he will give for each health authority the amount of money spent on press and publicity in each of the past three years.
Mr. Freeman : The information specifically requested is not collected centrally. However, the summarised accounts of health authorities in England record in total the following categories of revenue expenditure :
|Advertising |Public relations
|£000 (cash) |£000 (cash)
--------------------------------------------------------------------
1986-87 |14,089 |1,297
1987-88 |19,021 |2,174
1988-89 |22,363 |2,690
Notes:
1. Expenditure on advertising relates primarily to staff
recruitment while that on public relations includes all pay and
other costs incurred on public relations departments.
2. The annual figures for each category are not necessarily
mutually exclusive being derived from separate analyses of total
revenue expenditure within the accounts.
Preventive Health Care
Mr. Stern : To ask the Secretary of State for Health what proportion of general practitioners are currently meeting the targets for preventive health care to be brought into effect by the new contract.
Mrs. Virginia Bottomley : In 1987-88, over half of all district health authorities (DHAs) had exceeded 90 per cent. coverage levels for diphtheria, tetanus and poliomyelitis. The national average was 87 per cent. in the same year the average for measles was 76 per cent. and for whooping cough 73 per cent. This is above the lower target of 70 per cent. for childhood immunisation.
Data for individual general practitioners are not collected centrally.
St. Catherine's House
Mr. Austin Mitchell : To ask the Secretary of State for Health if he will take steps to enable applicants in person for copies of birth certificates and so on at St. Catherine's house to make only one visit both to record the intention and to collect the certificate.
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Mr. Freeman : I refer the hon. Member to the reply I gave my hon. Friend the Member for Basingstoke (Mr. Hunter) on 1 February at columns 354-55 about the publications of a White Paper "Registration proposals for change" (Cm. 939). This includes proposals for changes to the present arrangements for issuing birth, death and marriage certificates at St. Catherine's house, including the introduction of a one- day search and collections service.Abortion
Mr. Alton : To ask the Secretary of State for Health if he will give the figures by year and in total for the number of hospital posts notified to his Department in which the job description included a duty to advise, undertake or participate in abortions from 31 December 1983 to the latest date for which figures are available ; and what was the total number of such posts vacant in each year and in total for (a) psychiatry, (b) anaesthetics and (c) obstetrics and gynaecology.
Mrs. Virginia Bottomley : This information is not held centrally.
Shropshire Health Authority
Mr. Conway : To ask the Secretary of State for Health what is (a) the national average and (b) the sum for Shropshire of expenditure per patient for family practitioner committees.
Mr. Freeman : I refer my hon. Friend to the reply I gave to the hon. Member for Livingston (Mr. Cook) on 12 February, at columns 28-30.
Doctors (Training)
Mr. Steinberg : To ask the Secretary of State for Health what is the current cost of training a doctor ; how many doctors have left the National Health Service to join private health organisations ; and how many doctors have been trained by private health organisations at their own expenses.
Mrs. Virginia Bottomley : Undergraduate education is provided at universities with medical schools and, for the clinical part of the course, in association with the NHS. The public expenditure cost associated with that process is of the order of £130,000. The cost of subsequent postgraduate training varies according to the speciality and may take an additional four to nine years.
Although some data are held centrally on the number of National Health Service leavers, these are not complete, and it is not possible to identify those who have left to join private health organisations.
Postgraduate training of qualified doctors is carried out almost entirely in the NHS and universities.
Electoral Rolls
Mr. Hayward : To ask the Secretary of State for Health what is the total number of voters for each shire county and former metropolitan county on the electoral rolls effective from 16 February.
Mr. Freeman : The 1990 electorate statistics are still being collected from local authorities. Following the usual timetable, figures will be published in "OPCS Monitor" El 90/1 at the end of April. A copy will be placed in the Library.
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Mink
Mr. Ron Davies : To ask the Secretary of State for Health what assessment has been made of the health implications of the recent invasion of the Hertfordshire and Essex hospital in Bishop's Stortford by mink.
Mr. Freeman : This is for the local health authority, which I understand has dealt with the matter.
Homeless People (Storm Shelter)
Mr. Bill Walker : To ask the Secretary of State for Health whether he is making any arrangements to safeguard the health of people sleeping rough in central London in the event of severe weather by providing some form of temporary shelter.
Mr. Freeman : In the event of exceptionally cold weather I have prepared contingency plans for temporary shelters to be provided by certain health authorities, local authorities and voluntary organisations. The estimated total cost of this service for this winter, if the scheme is activated, is £450,000. Parliamentary approval to expenditure by local authorities on this new service will be sought in a supply estimate for the Department of Health administration, miscellaneous health services and personal social services, England vote (class XIV vote 3). Pending that approval urgent expenditure estimated at £40,000 will be met by repayable advances from the contingencies fund.
Kidney Transplants
Mr. Dalyell : To ask the Secretary of State for Health what is the currently available figure for the shortage of kidney organs for transplant.
Mr. Freeman : The shortage of cadaveric kidneys available for transplant is conveniently measured by the waiting list held by the United Kingdom transplant service. The United Kingdom waiting list on 8 February 1990 comprised 3,485 patients.
Calderdale Hospital
Mrs. Mahon : To ask the Secretary of State for Health if the proposed new Calderdale district hospital is subject to the Government's review of new capital projects.
Mr. Freeman : There is no Government review of capital projects in the National Health Service.
Visual Handicap
Mr. Kirkwood : To ask the Secretary of State for Health (1) what discussions his Department has had with local authority associations on the training of specialist workers with visually handicapped people ;
(2) what progress has been made to remedy the deficiency in training of workers with blind and visually handicapped people, identified in paragraph 181 of the social services inspectorate report, "A Wider Vision".
Mrs. Virginia Bottomley : The Department has not discussed this subject specifically with the local authority associations. Following the publication of "A Wider Vision", the social services inspectorate organised a number of seminars aimed at senior managers in social services departments and involving national voluntary
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organisations, covering a wide range of issues arising from the report. Discussions are in progress with the Central Council for Education and Training in Social Work and others to consider how developments in social work education can incorporate the training needs of staff working with people in visual handicap.Airports
Mr. Wareing : To ask the Secretary of State for Health what guidelines he is giving to local health authorities with hospitals in the vicinity of, and servicing, airports.
Mr. Freeman : None. When drawing up plans for dealing with major accidents and other contingencies, district health authorities take account of such factors as airports in their locality.
Chipboard Factories
Mr. Beith : To ask the Secretary of State for Health what assessment he has made of any potential health hazards resulting from emissions to the air from chipboard factories ; and if he will make a statement.
Mr. Freeman : None. Environmental pollution is a matter for my right hon. Friend the Secretary of State for the Environment, and I understand that emissions to the air from chipboard factories are controlled by the local authority, under public health legislation. The Department of Health would, on request, provide medical and toxicological advice on specified substances emitted.
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