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Health Authority Deficits
92. Mr. John P. Smith : To ask the Secretary of State for Health how many district health authorities expect to be in deficit at the end of the current financial year.
124. Mr. Rees : To ask the Secretary of State for Health how many district health authorities expect to be in deficit at the end of the current financial year.
Mr. Kenneth Clarke : We do not collect information about the financial position of individual district health authorities centrally.
Cochlear Implants
94. Mr. Bill Walker : To ask the Secretary of State for Health if he will make a statement about progress on the recently announced cochlear implant programme.
Mr. Freeman : Health authorities were asked to submit applications for funding of up to six centres overall for cochlear implants by 28 February. Fifteen applications have been submitted, and are now being considered. I would hope to be able to make an announcement about which centres have been chosen early in April.
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Alcoholics
96. Mr. Atkinson : To ask the Secretary of State for Health what representations he has received to ring-fence community care funding for the rehabilitation of alcoholics ; and if he will make a statement.
Mrs. Virginia Bottomley : We have received a number of representations about the special needs of problem drinkers within the proposed community care arrangements including a paper from Alcohol Concern, the national voluntary agency on alcohol misuse. Local authorities will be responsible for drawing up plans to meet community care needs of all groups requiring such care ; where appropriate we would expect them to include problem drinkers as one of these groups. Effective planning will require that local authorities respond flexibly to local needs and circumstances.
Inflation
97. Mr. Hardy : To ask the Secretary of State for Health what is his estimate for the level of inflation which will be experienced within the National Health Service in 1990 ; and what funding will be available to cover the additional costs incurred.
Mr. Freeman : The Government do not make estimates of inflation in the National Health Service before the end of the financial year concerned.
Funding for the NHS, as for most other areas of public expenditure, is based on cash plans agreed in the context of the public expenditure survey and detailed subsequently in the "Government's Expenditure Plans 1990-91 to 1992-93" (Cm. 1013).
In 1990-91 the NHS in England alone will have additional resources equivalent to nearly £2.5 billion compared with 1989-90 ; this includes an extra £166 million announced on 1 February to help meet the additional costs of the 1990 review body pay awards for doctors and dentists and nurses and midwives.
DHA Contracts
100. Mr. Quentin Davies : To ask the Secretary of State for Health what assessment he has made of the effect of the proposals for contracts within the National Health Service on services to patients.
Mr. Andrew F. Bennett : To ask the Secretary of State for Health if he will make a statement on provisions for new district health authority contracts with hospitals outside their area.
Mrs. Virginia Bottomley : The proposals for contract funding for hospitals by district health authorities within the National Health Service will result in better standards of care and more choice for patients. They will enable the district health authorities to use their resources to obtain the best value for money in terms of high quality consumer- responsive services for their population. Districts will have a clear responsibility to ensure that a full range of health care services is available. They will specify the services required from each hospital or other unit, whether or not it is under their direct managerial control. More important, they will also specify the quality standards expected and ensure that these are met.
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Social Work
110. Mr. Worthington : To ask the Secretary of State for Health when he last met representatives of the Central Council for Education and Training in Social Work.
Mrs. Virginia Bottomley : My right hon. and learned Friend the Secretary of State has not yet met the Central Council for Education and Training in Social Work. However, I met the chairman and director on 27 November 1989 at the annual review meeting of the council.
Hospital Projects
112. Mr. Anthony Coombs : To ask the Secretary of State for Health how many hospital capital projects have been completed or programmed since 1979.
Mr. Freeman : Information held centrally shows that 448 health building schemes each costing over £1 million have been completed in England since 1979. There are currently 516 such schemes in regions' capital programmes with a total value of over £5 billion of which 141 are under construction. This represents the largest sustained capital investment ever in the NHS.
Resource Management
116. Mr. Maples : To ask the Secretary of State for Health what progress is being made on the implementation of resource management.
Mr. Freeman : I refer my hon. Friend to the reply I gave my hon. Friend the Member for Fylde (Mr. Jack) on 20 February at column 695.
NHS Service
118. Mr. Pawsey : 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.
125. Mr. Lee : To ask the Secretary of State for Health what action is being taken to improve the quality of service being given by the National Health Service.
Mr. Burns : To ask the Secretary of State for Health what steps are being taken to improve the quality of care given by the National Health Service.
Mrs. Virginia Bottomley : I refer my hon. Friends to the reply I gave my hon. Friend the Member for Gainsborough and Horncastle (Mr. Leigh) on 20 February at column 712.
Voluntary Groups
119. Mr. Bowis : To ask the Secretary of State for Health what help is being given to voluntary groups working with under five-year-olds.
137. Mr. Franks : To ask the Secretary of State for Health what help is being given to voluntary groups working with under five-year-olds.
Mrs. Virginia Bottomley : I refer my hon. Friends to the reply I gave my hon. Friend the Member for Stroud (Mr. Knapman) earlier today.
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Intensive Care
121. Sir Michael McNair-Wilson : To ask the Secretary of State for Health whether he directs regional health authorities to maintain a ratio of intensive care beds per thousand of their population.
Mr. Freeman : No. It is for health authorities to determine the facilities required in the light of local needs.
Hepatitis B
123. Mr. Litherland : To ask the Secretary of State for Health if he has any proposals for the future funding of an educational campaign for hepatitis B high-risk groups ; and if he will make a statement.
Mr. Freeman : The Department recognises the seriousness of hepatitis viruses. A new edition of the Joint Committee on Vaccination and Immunisations' memorandum "Immunisation Against Infectious Disease" will be published shortly and this includes advice on hepatitis B. The Health Education Authority is also reviewing its educational material about sexually transmitted diseases, including hepatitis B.
We are pleased to note a welcome decline in the incidence of hepatitis B from 1,785 reported cases in 1985 to approximately 600 cases in 1989.
Medical Audit
126. Mr. Cash : To ask the Secretary of State for Health what progress is being made on the proposals for medical audit.
Mrs. Virginia Bottomley : Good progress is being made towards medical audit with the support of the profession. A total of £31 million has been allocated to the National Health Service and national professional bodies.
Draft health circulars setting the organisational framework required for the successful implementation of medical audit programmes in hospital and general practice have been widely circulated for consultation.
Crown Immunities
130. Mr. Shersby : To ask the Secretary of State for Health if he will make a statement on the removal of Crown immunities in the National Health Service.
Mr. Freeman : Crown immunity was removed from hospital kitchens and the health and safety legislation was applied to the National Health Service in 1986. We are committed to the extension of this policy to other areas of National Health Service activity wherever it is practicable to do so and provisions to this effect are contained in the National Health Service and Community Care Bill.
The Government propose to retain Crown immunity in only a few areas relating to insurance and finance matters, where it makes sense to do so and, where abolition would impose an additional administrative burden on the Health Service without any extra benefit accruing to patients or staff. In all other matters, for example relating to building
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standards, health authorities and National Health Service trusts will be legally obliged to meet legal standards and requirements.Health Care (Southend)
131. Mr. Teddy Taylor : To ask the Secretary of State for Health what is Southend health authority's budget for health care ; what is the average for other health authorities ; and if he will make a statement.
Mr. Freeman : The initial revenue allocation to Southend health authority for 1989-90 was £57,555,200. The district's gross revenue expenditure rose by over 66 per cent. in cash terms between 1982-83 and 1988-89, equivalent to 23 per cent. in real terms. Financial allocations to district health authorities are decided by regional health authorities. Overall, resources for the National Health Service have risen by £2.5 billion this year. Next year they will rise by nearly £3 billion more. That is a 20 per cent. cash increase in two years, bringing the total spending on the Health Service up to £29.1 billion for 1990-91. This includes £19 billion for hospital and community health services throughout the United Kingdom--some £15.2 billion in England alone.
Speech Therapists
144. Mr. Wareing : To ask the Secretary of State for Health what plans he has to improve the recruitment and maintenance in post of speech therapists.
Mrs. Virginia Bottomley : Improving recruitment and retention are essentially local issues, but health authorities have been encouraged to consider part-time employment, flexible hours and job sharing. The recent pay settlement gives across the board increases of 9 per cent. over an 18- month period commencing 1 April 1989 and provides for a review of the grading structure to be brought forward with any changes to be implemented from 1 October 1990.
Health Authorities (Finance)
Mr. Battle : To ask the Secretary of State for Health (1) if he will publish for each health authority in Humberside and Yorkshire (a) the net income from private patients and clinics and (b) the amounts written off as bad debts in each year since 1979 ; (2) if he will publish for each Yorkshire health authority (a) the net income from private patients and clinics and (b) the amounts written off as bad debts in each year since 1979.
Mr. Freeman : Following are figures recorded in the 1985-86 to 1988- 89 annual accounts of the district health authorities providing health services in Yorkshire and Humberside. The income shown arises from charges to private patients under sections 65 and 66 of the National Health Service Act 1977 and is recorded under each heading net of sums written off in each financial year (which sometimes include amounts due from earlier years). Separate write-off figures for income due under sections 65 and 66 were not collected centrally.
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Income from private patients (under Sections 65 and 66 of the National Health Service Act 1977) and related losses
Income Amounts written off Income Amounts written off
|In-patients (Section 65) |Out-patients (Section 66)|In-patients (Section 65) |Out-patients (Section 66)|In-patients (Section 65) |Out-patients (Section 66)|In-patients (Section 65) |Out-patients (Section 66)
|£ |£ |£ |£ |£ |£ |£ |£
District health authorities
Hull |112,339 |30,434 |0 |0 |81,385 |34,250 |0 |0
East Yorkshire |95,924 |16,011 |0 |0 |62,261 |14,248 |2,685 |33
Grimsby |109,282 |49,598 |485 |1,287 |98,694 |54,149 |2,019 |1,969
Scunthorpe |119,830 |22,889 |440 |81 |92,448 |27,063 |427 |379
Northallerton |57,741 |10,153 |0 |34 |64,384 |12,081 |0 |25
York |99,517 |53,182 |0 |86 |132,768 |47,794 |180 |157
Scarborough |14,149 |6,029 |0 |12 |9,588 |10,309 |0 |157
Harrogate |209,620 |16,717 |0 |67 |175,271 |19,753 |790 |190
Bradford |110,416 |54,209 |175 |294 |96,515 |51,423 |583 |159
Airedale |303,969 |28,730 |237 |2,098 |370,736 |36,782 |164 |117
Calderdale |239,727 |26,808 |0 |394 |94,241 |22,280 |0 |3,721
Huddersfield |71,107 |24,604 |0 |622 |9,745 |28,263 |31 |208
Dewsbury |39,844 |26,939 |0 |228 |27,550 |21,310 |0 |0
Leeds Western |1,012,402 |95,536 |0 |0 |996,810 |108,550 |0 |0
Leeds Eastern |275,225 |43,550 |0 |0 |220,309 |55,795 |2,151 |0
Wakefield |53,895 |17,286 |6 |960 |52,634 |20,316 |0 |197
Pontefract |14,969 |10,400 |0 |170 |16,035 |10,973 |258 |60
Barnsley |41,703 |16,799 |0 |16 |30,465 |17,481 |0 |112
Doncaster |39,260 |22,679 |0 |0 |43,502 |27,307 |0 |257
Rotherham |0 |0 |0 |0 |0 |0 |0 |0
Sheffield |212,775 |76,659 |718 |320 |208,298 |75,013 |2,681 |885
Income Amounts written off Income Amounts written off
|In-patients (Section 65) |Out-patients (Section 66)|In-patients (Section 65) |Out-patients (Section 66)|In-patients (Section 65) |Out-patients (Section 66)|In-patients (Section 65) |Out-patients (Section 66)
|£ |£ |£ |£ |£ |£ |£ |£
District health authorities
Hull |120,678 |37,096 |1 |137 |128,204 |41,128 |48 |528
East Yorkshire |64,148 |11,915 |84 |0 |63,423 |9,326 |0 |144
Grimsby |75,777 |42,578 |2,769 |1,644 |52,457 |46,376 |0 |1,175
Scunthorpe |110,150 |37,073 |1,014 |247 |194,781 |37,496 |0 |74
Northallerton |76,737 |12,176 |1 |73 |97,298 |11,690 |0 |14
York |202,275 |41,305 |645 |257 |77,257 |32,977 |167 |86
Scarborough |10,304 |9,707 |0 |246 |6,161 |10,526 |0 |90
Harrogate |186,485 |19,084 |956 |183 |242,649 |23,584 |0 |189
Bradford |55,456 |61,304 |655 |508 |58,011 |61,187 |1,892 |0
Airedale |341,600 |48,814 |4,420 |963 |432,680 |68,115 |0 |2,115
Calderdale |43,396 |19,269 |620 |656 |21,057 |15,403 |3,261 |124
Huddersfield |16,354 |23,185 |680 |358 |12,152 |30,556 |0 |0
Dewsbury |18,697 |15,318 |0 |0 |10,549 |11,087 |0 |0
Leeds Western |1,128,573 |143,212 |2,290 |466 |1,249,793 |190,012 |2,563 |493
Leeds Eastern |301,276 |52,699 |2,055 |446 |348,600 |87,460 |1,634 |787
Wakefield |50,935 |21,146 |8,366 |658 |53,102 |22,865 |147 |377
Pontefract |12,267 |14,356 |0 |156 |13,527 |7,157 |0 |106
Barnsley |32,344 |18,807 |0 |7 |39,065 |22,343 |0 |138
Doncaster |33,525 |27,861 |0 |226 |38,038 |29,531 |43 |56
Rotherham |0 |3,872 |0 |0 |0 |4,708 |0 |0
Sheffield |222,972 |70,923 |11,923 |3,260 |313,542 |131,734 |3,520 |269
Notes to the table:
1. The table includes all the district health authorities comprising the Yorkshire health region with the addition of Barnsley, Doncaster, Rotherham and Sheffield health authorities which form part of the Trent region.
2. The table excludes income due under Section 58 of the NHS Act 1977 (which arises mainly from services provided to private health care establishments) and which for the authorities shown totalled some £236,800 in 1988-89. Separate write-off figures for this category of income are
not collected centrally.
Disabled People
Mr. Wigley : To ask the Secretary of State for Health (1) what representations he has received from Act Now on full implementation of the Disabled Persons (Services, Consultation and Representation) Act 1986 ;
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(2) what representations he has received on full implementation of the Disabled Persons (Services, Consultation and Representation) Act 1986 and in particular on section 3 of that Act.Mr. Freeman : Since the beginning of this year hon. Members have addressed five parliamentary questions on
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this issue to my right hon. and learned Friend the Secretary of State. In addition, an amendment to the National Health Service and Community Care Bill was put down in Committee, the effect of which would have been to implement the remaining sections of the Act. Over this period, the Department also received four letters on the subject, one from Act Now. In two instances, representations made particular mention of section 3.Mr. Wigley : To ask the Secretary of State for Health when he expects to complete his consultation on sections 1, 2 and 3 of the Disabled Persons (Services, Consultation and Representation) Act 1986.
Mr. Freeman : It is too soon to give a precise date. Officials wrote to the local authority associations, asking for their comments by 31 May. This will be followed by discussions, the number and length of which will depend on the initial response.
Mr. Wigley : To ask the Secretary of State for Health which Minister in his Department is responsible for full implementation of the Disabled Persons (Services, Consultation and Representation) Act 1986 ; and if he will take steps to ensure that all correspondence and representations concerning the Act reach the same section of the Department.
Mr. Freeman : My right hon. and learned Friend the Secretary of State has ultimate responsibility for decisions on implementation of legislation relating to health and personal social services. Correspondence and representations concerning the Act are normally directed to designated officials within the Department.
Mr. Wigley : To ask the Secretary of State for Health with which organisations he is consulting on implementation of sections 1, 2 and 3 of the Disabled Persons (Services, Consultation and Representation) Act 1986.
Mr. Freeman : We are currently consulting the Association of County Councils, the Association of Metropolitan Authorities, and the Association of Directors of Social Services.
Dental Health
Mr. Marland : To ask the Secretary of State for Health if he will make a statement on the conclusions of the chief medical officer's annual dental health report published last month.
Mr. Freeman : In the dental section of his annual report the chief medical officer noted that in common with many other industrialised countries, a substantial improvement in dental health had taken place in the United Kingdom in recent years. This had been manifested particularly in children where a marked decline in dental caries had occurred since the early 1970s. The report went on to detail the changes that had occurred and to consider demographic variations in current levels of disease. Reasons for the changes were discussed and some international comparisons on caries levels were presented. In discussing future prospects for further improvements in the dental health of the population, the report stressed the importance, among other things, of the dissemination of more information to guide the public on dental care, including the labelling of food products to show their sugar content.
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Mr. Marland : To ask the Secretary of State for Health what information he has as to what national or international medical studies on dental caries have suggested concerning (a) the frequency of sugar consumption and (b) the amount, in contributing to tooth decay ; and which studies have recommended a reduction in sugar consumption.
Mr. Freeman : Scientific literature on the relationship between sugar and dental caries was extensively reviewed by an expert panel of the Committee on Medical Aspects of Food Policy in its report "Dietary Sugars and Human Disease" which was published in late 1989. The section devoted to sugars and dental caries contained no fewer than 61 references to world literature. We are not aware of any official report which has not recommended a reduction in sugar consumption.
Regional Functions
Mr. Caborn : To ask the Secretary of State for Health what functions his Department carries out at the regional level ; where the regional offices are located in each of the regions ; what staff are employed and at what grades ; what proportion of his Department's budget is spent in each of the regions ; and what geographical boundaries determine his Department's regions.
Mr. Freeman : The Department of Health is not organised on a regional basis. Three functions are, however, provided from a number of locations across England chosen so that the functions may be performed effectively and economically. These are the regional medical service (RMS 170 staff), provided by senior medical officers and medical officers ; social services inspectorate (130 staff) provided by assistant chief inspectors and inspectors : and NHS audit (about 200 staff) provided by 10 statutory auditors at principal level and scheduled to become part of the Audit Commission at 1 October 1990. All of these functions are also supported by administrative staff who are included in the figures quoted. The functions of the RMS will progressively be transferred to regional health authorities, family practitioner committees and the Department of Social Security from 1 April 1990. The transfer of responsibility will be complete by 1 April 1991.
In addition some 700 DH headquarters staff work outside London. The regionally based staff account for approximately 12 per cent. of the DH's manpower budget. Non-manpower costs are not identified separately.
Infant Mortality
Mr. Robert Banks : To ask the Secretary of State for Health what advice he has received from the medical profession on measures to reduce infant mortality at birth.
Mrs. Virginia Bottomley : The Government's reply to the first report from the Social Services Committee Session 1988-89 on perinatal, neonatal and infant mortality (Cm 741) reflected medical advice. The main measures announced in the report were :
(i) the establishment of a working group to report to the Chief Medical Officer on introducing a form of confidential inquiry into stillbirths and infant deaths ;
(ii) a requirement for all Regions to have at least one paediatric pathologist in post by April 1991 and to have reviewed their need for further posts by 1992 ;
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(iii) the introduction in all regions where they do not already exist of epidemiological surveys of stillbirths and neonatal deaths ;(iv) The Medical Research Council to undertake a major review of the literature relating to Sudden Infant Death Syndrome and advise on what new research is needed.
Mr. Robert Banks : To ask the Secretary of State for Health what studies, funded by his Department, are being undertaken into infant mortality.
Mrs. Virginia Bottomley : The Medical Research Council, which receives grant in aid from the Department of Education and Science, is the Government agency responsible for the promotion of bio-medical research.
In addition, the Department of Health funds research on public health and health management issues. Expenditure from these funds on maternity and neonatal services is currently running at about £400, 000 per annum. The largest single allocation is to the national perinatal epidemiology unit at Oxford whose programme of research consists of three main elements :
(i) surveys to describe the characteristics of people using the perinatal health services, the care they receive and the mortality and morbidity they experience ;
(ii) randomised control trials to assess the relative merits of alternative forms of perinatal care ;
(iii) formal syntheses and dissemination of the results of research evaluating the effects of care.
Health Authorities (Capital Charges)
Mr. Cohen : To ask the Secretary of State for Health if he is now in a position to publish updated estimates of the capital charges for health authorities under his Department's proposals.
Mr. Freeman : Health authorities are still making good progress in compiling asset registers in preparation for capital charging. Estimates of capital charges will be available when these have been completed and valued, which should be early in the next financial year.
NHS Employees (Outside Interests)
Mr. Win Griffiths : To ask the Secretary of State for Health when the hon. Member for Bridgend may expect to receive a substantive reply to his letter of 8 February to the Minister of State in his Department concerning the answers given by her on National Health Service employment on 5 February, Official Report, column 489.
Mrs. Virginia Bottomley : As the hon. Member will know, I passed his letter to my right hon. Friend the Secretary of State for Wales and a reply was sent on 12 March. I refer the hon. Member to the answers I gave on 5 February at column 489 and on 16 March at column 383 concerning further guidance.
Psychiatric Care
Mr. Harry Greenway : To ask the Secretary of State for Health how many people are in psychiatric care (a) currently, (b) five and (c) 10 years ago ; and if he will make a statement.
Mr. Freeman : It is estimated that there were 56,200 in-patients under the care of consultant psychiatrists in National Health Service mental illness hospitals and units in England on 31 March 1989. This compares with 77,300 at the end of 1979 and 66,000 at the end of 1984.
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Management Consultants
Ms. Harman : To ask the Secretary of State for Health how much has been spent on management consultants by (a) the Department of Health and (b) National Health Service regions and districts in England in each of the 10 years 1979-89 ; and what quality controls were used by (a) the Department of Health and (b) the National Health Service to ensure that these expenditures are good value for money.
Mr. Freeman : We cannot apportion expenditure between the Departments of Health and Social Security prior to 1985-86. The estimated expenditure for each succeeding financial year from 1985-86 on fees and expenses for management consultants on health matters is as follows :
1985-86 |0.479
1986-87 |2.103
1987-88 |1.244
1988-89 |1.584
1989-90 |4.870
The figures are approximate since expenditure up to and including the 1988- 89 year was from a joint health and social security budget. In some cases expenditure has been apportioned where consultants have been engaged on both health and social security matters. The figures also include social services consultancy and some computer consultancy where these cannot be identified separately.
The figure for 1989-90 is estimated expenditure.
The Department of health controls and monitors the use of management consultants in line with the requirements laid down from time to time by the Treasury.
The employment of management consultants by the NHS is a matter for individual health authorities. Their accounts do not separately identify any expenditure incurred.
Breast Cancer Screening
Ms. Harman : To ask the Secretary of State for Health in the light of clinical and economic evidence produced since the publication of the Forrest report on breast cancer screening, what is the current cost/quality adjusted life year estimate for this procedure.
Mrs. Virginia Bottomley : I refer the hon. Member to the reply I gave her on 16 November at column 432. We have received the report describing the computer model that has been developed as part of the economic evaluation of the United Kingdom trial of the early detection of breast cancer. We understand that one further specific report is planned : on the use of diagnostic resources and costs of treatment. The various elements will then be incorporated into a final report on the economic evaluation of the trial.
In the interim the Department has been looking at the mortality reductions reported in the trial. These suggest that the cost per quality adjusted life year quoted in the Forrest report was of the correct order.
Pensioners (Monitoring)
Ms. Harman : To ask the Secretary of State for Health what research has been undertaken and what conclusions reached on whether annual monitoring of the over 75-year-olds is cost effective.
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Mrs. Virginia Bottomley : There is wide support for the over-75s being seen regularly, at least once a year and preferably in their own homes ; the objective being to establish whether there are any medical or social conditions which would otherwise go unreported, but are easily remediable.Such interventions are intended to minimise disability and hence improve the quality of life and to attempt to avoid "crisis" admissions to hospitals.
There are clear cost-effective benefits if the well-being of patients is maintained or improved as a result of the marginal costs involved.
In introducing the requirement in the new contract for general practitioners to offer an annual check-up and a home visit for their patients aged 75 and over, we considered the extensive literature in the field of care of the elderly that is available both in this country and internationally.
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