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Mr. Hannam : To ask the Secretary of State for Health what steps he is taking to improve the awareness of health professionals of the contra- indications to measles and whooping cough vaccines.
Mr. Dorrell : Clear advice on contra-indications and false "contra- indications" is given in the new edition of the memorandum "Immunisation Against Infectious Disease", a copy of which has been issued to all doctors and to other health professionals involved in immunisation. Copies of the memorandum have been placed in the Library.
Mr. Hannam : To ask the Secretary of State for Health what records his Department holds of the number of deaths which have occurred through non-vaccination.
Mr. Dorrell : Reports are made to the Office of Population Censuses and Surveys of deaths from diseases for which vaccination is recommended, but it is not possible to say that all those deaths occurred in unvaccinated individuals.
Mr. Wigley : To ask the Secretary of State for Health what records his Department holds of the number of cases of disablement caused through non-vaccination.
Mr. Dorrell : This information is not held centrally.
Mr. Hannam : To ask the Secretary of State for Health what steps he is taking to monitor the effects of the new general practitioner's contract on immunisation uptake in inner city areas.
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Mrs. Virginia Bottomley : Immunisation uptake rates in all areas are monitored routinely. The target payment system introduced in the new contract is one of a number of current initiatives aimed at increasing uptake rates. It will therefore not be possible to measure the impact of the new contract arrangements in isolation. The Government are satisfied that the target system provides a powerful incentive for GPs to undertake immunisations in all areas including inner cities.
Mr. Wigley : To ask the Secretary of State for Health what steps he is taking to encourage immunisation uptake among ethnic minority groups.
Mr. Dorrell : Public information leaflets on immunisation, funded by the Department and prepared by the Health Education Authority, including new leaflets for use in the national campaign later this year, are produced in a number of ethnic languages. In addition, health authorities with substantial ethnic minority populations mount local initiatives.
Mr. Hannam : To ask the Secretary of State for Health what measures he is taking to improve the level of take-up of vaccines in inner city areas.
Mr. Dorrell : The Department arranged a three-day immunisation seminar last September for the 25 lowest achieving districts in England. These districts were mainly but not exclusively "inner city". The seminar analysed the reasons for low uptake. One of these was failure by parents to bring their babies for the full course of vaccinations against diphtheria, tetanus, whooping cough and polio, which were recommended at three, four to five and eight to 11 months. This finding contributed to the decision to accelerate the schedule from 1 May this year to two, three and four months, when mothers and babies are still attending the doctor's surgery for other reasons. In addition posters on immunisation produced by the Health Education Authority have been targeted on low uptake areas, which include the inner cities.
Mr. Hannam : To ask the Secretary of State for Health what representations he has received concerning the levels of immunisation uptake.
Mr. Dorrell : Frequent representations on immunisation uptake are received from hon. Members, and from members of the public and the health professions.
Subjects raised recently have included the publication of a new edition of the handbook "Immunisation Against Infectious Disease" (issued to all doctors) a copy of which is available in the Library ; the target levels we have urged general practitioners to aim for ; immunisation record cards and compulsory immunisation.
We are pleased to say that our present policy of providing the health professionals with the fullest possible information on immunisation--to enable them to persuade parents of its benefits--is leading to steady improvement in uptake, with the latest estimates showing 88 per cent. coverage for diphtheria, tetanus and polio, 85 per cent. for measles and 80 per cent. for whooping cough.
Labour Force Survey
Mr. Battle : To ask the Secretary of State for Health, if he will publish a table from the latest Labour Force Survey showing the population resident in each metropolitan county broken down by ethnic origin, showing both the number resident and the proportion of each ethnic group.
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Mr. Dorrell : The tables give the information requested from the Labour Force Survey. To improve their reliability the data are presented as averages from three year's surveys (1986, 1987, and 1988) ; nevertheless, the data are still subject to sampling errors. The volumes for 1986 and 1987 have both been published and copies are available in the Library. The 1988 volume is expected to be published in 1991. A similar table will also be published in Regional Trends 25, later this year.Column 673
|c|Estimated private household population resident in metropolitan counties by ethnic group, Great Britain,
1986-88|c|
|c|(a) Number of people (thousands)|c|
Ethnic group Metropolitan county of residence
|Greater |Greater |West |West |Other |All |Great
|London |Manchester|Midlands |Yorkshire |Metropoli-|Metropoli-|Britain
|tan |tan
|counties |counties
-------------------------------------------------------------------------------------------------------------------
White |5,462 |2,397 |2,256 |1,856 |3,736 |15,707 |51,470
All ethnic minority groups |1,100 |134 |326 |162 |77 |1,820 |2,577
West Indian or Guyanese |288 |20 |77 |18 |7 |410 |495
African |77 |2 |3 |2 |6 |91 |112
Indian |333 |36 |130 |38 |8 |546 |787
Pakistani |72 |47 |70 |80 |13 |282 |428
Bangladeshi |51 |4 |17 |5 |7 |84 |108
Chinese |51 |5 |1 |2 |9 |69 |125
Arab |31 |3 |4 |3 |6 |48 |73
Mixed |104 |13 |18 |11 |15 |160 |287
Others |92 |3 |5 |4 |6 |110 |163
Not stated |78 |29 |18 |13 |32 |170 |472
All groups |6,640 |2,560 |2,600 |2,031 |3,845 |17,675 |54,519
Northumberland Health Authority
Mr. Beith : To ask the Secretary of State for Health on what date the existing members of Northumberland health authority will cease to hold office and carry out the duties of their office ; on what date new members of the authority will take office ; and whether he will list both the retiring members and the new members who will serve on the authority.
Mrs. Virginia Bottomley : Subject to parliamentary approval for the National Health Service and Community Care Bill, it is proposed that the terms of office of existing district health authority members will be brought to an end approximately 11 weeks after Royal Assent. New members of the reconstituted health authority will take office on the following day. Responsibility for appointing the current members of Northumberland health authority rests with Northern regional health authority and certain local authorities. The new non-executive members of Northumberland health authority would be appointed similarly by Northern regional health authority. Lists of district health authority members are not held centrally.
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Drugs
Sir Michael McNair-Wilson : To ask the Secretary of State for Health if he has any proposals to change the procedures followed by the Committee on Safety of Medicines in licensing new drugs ; and whether he will bring forward proposals for an interim procedure before full licensing while medical data about side-effects are established.
Mrs. Virginia Bottomley : The internal procedures of the Committee on Safety of Medicines (CSM) are a matter for CSM itself under schedule 1, paragraph 4 of the Medicines Act 1968. We respect and value the independent scientific judgments made by the CSM on the information laid before it and have no plans to amend schedule 1, paragraph 4.
Measures are already in place and are already used to assess safety and efficacy before a licensing decision is taken. Applicants for licences are required to report
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information and data derived from tests laid down in detail by directive 75/318 EEC, including toxicity tests and clinical trials. After licensing, data sheets communicate to doctors the licensed uses of medicines and precautions, warnings, and necessary information about side-effects. Newly introduced medicines are subject to the black triangle scheme on product literature for at least two years after initial marketing. This is to alert doctors to report all adverse reactions (side-effects) to these medicines to CSM. Also, CSM monitors them intensively and takes appropriate action for example, by special "current problem" communication to all doctors, if new adverse reactions are identified. In addition, there is a legal requirement on companies to report adverse reactions to their own products. Since 1986, the CSM has recommended that companies carry out post-marketing surveillance studies on new medicines for widespread long-term use.The existing system is therefore comprehensive in its scope to the objects of making the best scientific judgment before licensing and for monitoring after licensing. It is in line with present European Community pharmaceutical directives.
Corwin
Sir Michael McNair-Wilson : To ask the Secretary of State for Health what discussions have been held between the medical profession and the Committee on Safety of Medicines about withdrawing the heart drug Corwin ; and if he will make a statement.
Mrs. Virginia Bottomley : Information on the quality, efficacy and safety of Corwin was rigorously assessed by the Committee on Safety of Medicines (CSM) prior to the granting of a product licence. It was placed on the market in May 1988, licensed for the treatment of mild to moderate heart failure. It was clearly recommended that the drug should not be used in severe heart failure as it had not shown benefit in these patients.
Corwin has been carefully monitored since its introduction on to the market and the CSM has collected and assessed extensive information on the effects of the product. In 1989 the findings of a clinical trial showed that the drug could cause deterioration in patients with severe heart failure ; other information from the yellow card adverse drug reaction monitoring scheme indicated that it was sometimes being used inappropriately in such patients. A letter from ICI Pharmaceuticals, which markets the product, was sent to all doctors in August 1989 warning them of the dangers of the use of the product in severe heart failure, clearly defining those patients who should not be given the drug. The product's data sheet was amended accordingly.
In January 1990, on the basis of further information, the CSM made recommendations severely restricting the use of Corwin. Doctors were informed of this advice in a letter from ICI Pharmaceuticals and in the CSM bulletin "Current Problems" No. 28 of May 1990, a copy of which is available in the Library. The CSM is satisfied that the product can be used safely if these recommendations are followed, but will continue to monitor the situation.
Mr. Alex Carlile : To ask the Secretary of State for Health if he will make a statement on the number of prescriptions involving use of the drug Corwin.
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Mrs. Virginia Bottomley : Available figures relate to the issue of prescriptions in England, in 1988, and are based on a sample of all prescriptions. Prescriptions issued for Corwin were 3,800 and for Xamoterol the generic equivalent were 1,420.
Mr. Alex Carlile : To ask the Secretary of State for Health what information he has on deaths connected with the use of the drug Corwin ; and if he will make a statement.
Mrs. Virginia Bottomley : The Committee on Safety of Medicines CSM has received 29 spontaneous reports under the yellow card scheme of deaths occurring in patients receiving treatment with Corwin. The report of a suspected reaction does not necessarily imply a causal association with the drug. In the case of patients treated with Corwin, the majority of those who died were critically ill and receiving a number of concurrent drugs.
In a clinical trial carried out in severe heart failure, the findings suggested a 2.5-fold greater mortality in association with Corwin compared to the group given no drug treatment.
As a result of this study's findings the CSM has recommended restrictions on the use of Corwin to ensure it is not used in patients with moderate to severe heart failure but only in patients with mild heart failure who benefit from treatment. Doctors and pharmacists were informed of these restrictions by the CSM's "Current Problems" bulletin distributed in May 1990, a copy of which is available in the Library.
Steroids
Mr. Ken Hargreaves : To ask the Secretary of State for Health how many cases of drug reaction were reported in each year of operation of the yellow card reporting system ; what percentage of the cases reported each year were steroid related ; and if he will make a statement.
Mrs. Virginia Bottomley : The number of reports received in each year were :
Year |Reports ------------------------ 1964 |1,414 1965 |3,987 1966 |2,600 1967 |3,500 1968 |3,466 1969 |4,463 1970 |3,601 1971 |2,837 1972 |3,638 1973 |3,619 1974 |4,818 1975 |5,052 1976 |6,490 1977 |11,255 1978 |11,873 1979 |10,840 1980 |10,179 1981 |13,032 1982 |10,922 1983 |12,689 1984 |12,163 1985 |12,652 1986 |15,527 1987 |16,431 1988 |19,022 1989 |19,246
Information on the numbers of these reports which are steroid related is not readily available ; to prepare percentage figures per year for such reports would incur disproportionate costs. Adverse reactions to medicinal products are reported to the CSM on a voluntary basis by doctors and dentists under the yellow card scheme and there is a statutory requirement for pharmaceutical companies to submit reports. The more reports received the better the system works. We have encouraged reporting in a number of ways over the years.
Smoking
Mr. Robin Cook : To ask the Secretary of State for Health how many health authorities in England and Wales provide counselling services for people trying to reduce cigarette smoking.
Mr. Dorrell : We do not hold information centrally about the provision of such services in England. The hon. Member may wish to contact the chairmen of the regional health authorities. Responsibility for the provision of health services in Wales is a matter for my right hon. Friend the Secretary of State for Wales.
Eye Tests
Mr. Michael : To ask the Secretary of State for Health what percentage of children aged under 16 years received free eye tests in England (a) in each quarter of 1988-89 and (b) in each quarter in 1989-90.
Mrs. Virginia Bottomley : I refer the hon. Member to the reply I gave him on 20 June.
Northern Region
Mr. Cousins : To ask the Secretary of State for Health what was the remuneration of (a) the chair of the Northern regional health authority, (b) members of the Northern regional health authority, (c) the chairs of every district health authority in the Northern region, (d) the members of each district health authority in the Northern region, (e) the chair of every family practitioner committee in the Northern region and (f) the members of each family practitioner committee in the Northern region on 1 April ; and what he now proposes it to be in each case.
Mrs. Virginia Bottomley : Until 1 April 1990 the chairman of Northern regional health authority and the chairmen of each district health authority received £12,462 per annum.
New rates authorised with effect from 1 April for the chairmen of the regional health authority and district health authorities are :
|£
----------------------------------------
Regional health authority
Northern |18,921
District health authority
Darlington |13,674
Durham |13,674
East Cumbria |15,503
Gateshead |13,674
Hartlepool |13,674
Newcastle |17,437
Northumberland |15,503
North Tees |13,674
North Tyneside |13,674
North West Durham |13,674
South Cumbria |13,674
South Tees |15,503
South Tyneside |13,674
South West Durham |13,674
Sunderland |15,503
West Cumbria |13,674
Until 1 April 1990 FPC chairmen received £5,000 per annum. New rates authorised for 1 April 1990 for FPCs in Northern region are :
|£
-----------------------------
Cleveland |10,600
Cumbria |10,600
Durham |10,600
Gateshead |9,805
Newcastle |10,600
North Tyneside |9,805
Northumberland |10,600
South Tyneside |9,805
Sunderland |10,600
At present members of health authorities and FPCs do not receive remuneration, although they are eligible to claim expenses for travel and subsistence. Subject to parliamentary approval for the NHS and Community Care Bill, non-executive members of the reconstituted RHAs, DHAs and family health services authorities will receive remuneration at the rate of £5,000 per annum.
Water (Aluminium)
Mr. Simon Hughes : To ask the Secretary of State for Health if he has made an assessment of the health implications of the presence of aluminium in water ; and if he will make a statement.
Mr. Dorrell : Aluminium and its salts are of low toxicity, and no disease is known to be caused by aluminium naturally present, or as a result of approved use, in drinking water.
Aluminium in water used for haemodialysis is a recognised cause of degenerative diseases of the bone and brain in patients with chronic renal failure. To avoid this possibility it is standard practice to ensure that water used for dialysis has low levels of aluminium.
Mr. Simon Hughes : To ask the Secretary of State for Health what assessment he has made of the possible connection between aluminium in water and the onset of Alzheimer's disease ; and if he will make a statement.
Mr. Dorrell : The cause or causes of Alzheimer's disease are unknown. However, the question of a possible relationship with aluminium is one of several hypotheses under investigation. The independent expert scientific and medical advisory Committee on Medical Aspects of the contamination of air, soil and water advised in November 1988 that,
"it has not been established that a reduction in the aluminium intake of the general population would be likely to reduce the incidence of Alzheimer's disease. The association between Alzheimer's disease and aluminium concentrations in drinking-water, suggested by recent studies in Norway and the United Kingdom, was too tentative to justify changes in the use of aluminium sulphate in water treatment,"
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and therefore,"further research is important, particularly on the bioavailability of aluminium from all sources".
Research on the bioavailability of aluminium from food and water is in progress at the trace metabolism unit at Southampton with funding from the Ministry of Agriculture, Fisheries and Food. Further epidemiological and neuropathological research is in progress at the Medical Research Council units in Southampton and Newcastle. Research into Alzheimer's disease in general, and into the aluminium hypothesis in particular, is expanding nationally and
internationally. This research will be kept under review.
Ambulance Dispute (Costs)
Mr. Frank Field : To ask the Secretary of State for Health if he now has the bills from the Army and the police incurred during the ambulance dispute ; if he will detail the total costs from both the sources ; and how they are being divided between each health region.
Mrs. Virginia Bottomley : The bill for the provision of military assistance during the ambulance dispute was £7.2 million. The cost, which stemmed partly from the training and general preparations needed to achieve a state of readiness across the country, is being shared between all regional health authorities in proportion to their share of main hospital and community health service revenue allocations. Information is not held centrally on the costs of assistance by police and other organisations which are being met directly by the health authorities concerned.
Baby Milk Food
Mr. Fearn : To ask the Secretary of State for Health (1) if he will make a statement on the restrictions on mothers' choice of baby milk formulas resulting from some health authorities' financial arrangements with manufacturers of infant formula ;
(2) if he will list, so far as the information is available to him, the district health authorities in England and Wales which have made financial arrangements with manufacturers of infant formula to stock only one brand of baby milk food.
Mrs. Virginia Bottomley : Other than infants formulas supplied under the welfare food scheme, health authorities are free to purchase from the full range of available infant formulas. Purchases by authorities are determined on the advice of relevant health professionals. Information about purchases by individual district health authorities in England is not collected centrally. However, authorities are aware of problems that may arise by purchasing from only one manufacturer. Information about purchases in Wales is a matter for my right hon. Friend the Secretary of State for Wales.
SCOTLAND
Transport to Europe
Mr. Wray : To ask the Secretary of State for Scotland what steps he has taken in respect of the availability of transport of passengers and manufactured goods from Scotland to Europe after 1 January 1993.
Lord James Douglas-Hamilton : Our plans to upgrade the A74 to motorway, together with the completion of the
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M40 and the proposed widening of the M6, M1 and M25, will substantially increase road capacity to Europe. In addition, the Scottish Development Department is undertaking a major review to ensure that the strategic Scottish trunk and key principal road network will meet future demands. We are encouraging potential Scottish rail customers to make known to British Rail their requirements for services to Europe via the channel tunnel. The Government's policy of liberalising air services will assist operators to provide improved services where demand exists.Local Government Finance
Dr. Godman : To ask the Secretary of State for Scotland what is the average cost per person of collecting the poll tax ; and if he will make a statement.
Lord James Douglas-Hamilton : On the basis of local authorities' budget estimates, the cost of collecting the community charge in 1990-91 will be £13.86 per personal charge payer. This figure includes the cost of the registration work but excludes the cost of operating the rebate and transitional relief schemes. Full account has been taken in successive revenue support grant settlements of the costs incurred by local authorities in collecting the community charge.
Dr. Godman : To ask the Secretary of State for Scotland what is his latest estimate of the number of people who have not so far paid the poll tax for 1989-90 ; and if he will make a statement.
Lord James Douglas-Hamilton : The information requested is not held centrally but we understand that in most regions 85 to 95 per cent. of those eligible for the community charge have made some payment, with a figure of 98 per cent. in one area. Payment levels are increasing as local authorities employ procedures for recovering arrears.
Employment Training
Dr. Godman : To ask the Secretary of State for Scotland if he will give the amount of money in real terms for employment training for each of the years from 1979 including the current year and the proposed amount for 1991 ; and if he will make a statement.
Mr. Lang : As employment training started in September 1988, the information requested is available from that time only. At constant 1988-89 prices, details (inclusive of training allowances and income support) are as follows :
Financial Year |£ million
|(1988-89
|prices)
---------------------------------------------------------------
1988-89<1> (actual expenditure) |46.8
1989-90 (actual expenditure) |116.8
1990-91 (estimated expenditure) |130.0
<1> (Half-year September to March only)
Registers
Mrs. Margaret Ewing : To ask the Secretary of State for Scotland whether following the conversion of the Registers of Scotland to agency status, he intends to (a)
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increase the levels of recording dues and registration dues and (b) introduce charges for provision of any services which are at present provided free of charge.Lord James Douglas-Hamilton : I refer the hon. Member to the answer I gave her on 11 June. The fees order referred to there makes relatively minor adjustments to the main fee scales, leaving most recording dues and registration dues unchanged. Some new fees are to be introduced so that increasingly each service is paid for by its users. The fees order will increase income so that extra staff can be recruited to provide a better service.
A full-scale review of fees is to take place this year as provided for in the framework document for the Department of the Registers of Scotland, which was published on 6 April when the department became an agency.
Shellfish Ban
Mr. Andrew Welsh : To ask the Secretary of State for Scotland if he will take steps to compensate fishermen for losses resulting from the shellfish ban.
Lord James Douglas-Hamilton : No ban was imposed. The Government issued a warning to the public on 26 May that consumption of locally caught shellfish taken from the coast between Montrose and the Humber could cause illness. The risk arose from a natural cause and the Government acted to safeguard public health. In such circumstances compensation would not be appropriate.
Handicapped Prisoners
Dr. Godman : To ask the Secretary of State for Scotland if he has commissioned any research studies into the experiences and needs of prisoners with mental and/or physical handicaps in prisons.
Lord James Douglas-Hamilton [holding answer 19 June 1990] : The Scottish Home and Health Department has recently commissioned two studies which are concerned with the needs of mentally disturbed people in prison.
The first, under the direction of Dr. David Cooke of the Douglas Inch clinic, Glasgow, is designed to examine the prevalence of various forms of mental illness among the prison population and to develop training packages to assist prison personnel in dealing with these groups of offenders. The second is being conducted by Dr. James McManus of Dundee university, and is concerned with the possible impact which regime factors may have in the creation and exacerbation of mentally disturbed behaviour.
Both studies began in January 1989 and are scheduled to report in December 1991.
In addition, the Scottish Home and Health Department is currently in discussion with a Scottish university over the possibility of conducting work on the problems faced by physically handicapped persons while in prison.
Adult Education
Mrs. Margaret Ewing : To ask the Secretary of State for Scotland (1) what steps he has taken to monitor the provision by education authorities in Scotland of community-based adult basic education and English as a second language service ; what criteria he has used to
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determine whether or not those are adequate (a) in terms of scale and (b) in terms of quality ; and what conclusions he has drawn from the application of these criteria ;(2) what plans he has to ensure that all those leaving long-stay institutions without essential skills in literacy and numeracy receive adult basic education tuition ;
(3) what guidance he has issued to Scottish education authorities in order to ensure the development of an educational dimension to care in the community ; and what steps has he taken to ensure that these guidelines have been implemented ;
(4) what steps he has taken to assess (a) increases in volume and (b) improvement in quality in community-based adult education over the past 10 years.
Mr. Lang [holding answer 20 June 1990] : I refer the hon. Member to the reply that I gave on 12 June to the hon. Member for Linlithgow (Mr. Dalyell) at columns 123-24.
Mrs. Margaret Ewing : To ask the Secretary of State for Scotland what was the total amount of funds made available in each of the past five years to train and accredit adult basic education practitioners in Scotland.
Mr. Lang [holding answer 20 June 1990] : The funding of adult basic education practitioners in Scotland is primarily the responsibility of education authorities to determine in the light of local needs and with regard to their own priorities and the total resources available to them, including the resources provided by central Government.
In addition to revenue support grant, the Government have made available to education authorities in both 1989-90 and 1990-91 specific grant of £30,000 towards the costs of in-service training for adult basic education practitioners.
Railways
Mr. David Marshall : To ask the Secretary of State for Scotland if he will give details of the grant aid paid by central Government to British Rail for (a) the restoration of double track and related modernisation of the Perth to Inverness line and (b) the resignalling of the Perth to Inverness line since 1970 ; what grant, other than section 56 grant, was paid towards these two projects ; and what was the economic rate of return, both before and after grant, for each project, or the project as a whole, on the basis of which grant was paid.
Mr. Freeman : I have been asked to reply.
Detailed information on these schemes is not held in the Department. However, public service obligation grant is paid towards the difference between the costs and revenues of the subsidised sectors of British Rail. It is not hypothecated to particular costs or individual projects.
A rate of return would not have been calculated in assessing these projects, because there is no requirement for investment which renews existing assets of services supported by public service obligation grant to earn a specific rate of return. The option chosen is that which maintains services at least net cost.
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