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Mr. Dorrell : The following professional organisations were sent invitations to take part in consultations on working paper 11 : Association of Anaesthetists

Association of British Paediatric Nurses

Association of Chief Ambulance Officers

Association of Clinical Biochemists

Association of Cytogeneticists

Association of Clinical Pathologists

Association of District Medical Officers

Association of District and Superintendent Chartered

Physiotherapists

Association of Domestic Management

Association of Health Care Information and Medical Record Officers

Association of Microbiologists

Association of National Health Service Supplies Officers Association of National Health Service Officers

Association of Occupational Therapists

Association of Professions for the Mentally Handicapped British Association of Operating Department Assistants

British Dental Association

British Dietetic Association

British Institute of Radiology

British Medical Association

British Paediatric Association

British Psychological Society

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Chartered Society of Physiotherapy

College of Occupational Therapists

College of Speech Therapists

Community Psychiatric Nurses Association

District Nursing Association

English National Board for Nursing, Midwifery and Health Visiting Faculty of Community Medicine of the Royal College of Physicians General Medical Services Committee of the BMA

Health Care Financial Management Association

Health Visitors Association

Hospital Consultants and Specialists Association

Hospital Physicists Association

Institute of Child Health

Institute of Chiropodists

Institute of Health Services Management

Joint Committee of Professional Nursing, Midwifery and HVAs Mental Handicap Nurses Association

National Association of Family Planning Nurses

National Association of Health Service Personnel Officers National Association of Theatre Nurses

Psychiatric Nurses Association

Royal College of General Practitioners

Royal College of Midwives

Royal College of Nursing in the United Kingdom (RCN)

Royal College of Obstetricians and Gynaecologists

Royal College of Pathologists

Royal College of Physicians of London

Royal College of Psychiatrists

Royal College of Radiologists

Royal College of Surgeons of England

Royal Pharmaceutical Society of Great Britain

Society of Administrators of Family Practitioner Services Society of Chiropodists

Society of Community Medicine

Society of Family Practitioner Committees

Society of Nurse Advisers, Child Health

Society of Radiographers

Drug Reaction

Mr. Ken Hargreaves : To ask the Secretary of State for Health if he has any plans to improve the yellow card reporting system for drug reaction ; and if he will make a statement.

Mrs. Virginia Bottomley : Adverse reactions to medicinal products are reported to the Committee on Safety of Medicines (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. A new improved computer system is currently being developed to support the scheme.

Reporting by prescribers is encouraged in a number of ways, for example by organising lectures to doctors on adverse reactions, exhibitions and a video to publicise the scheme, and by including yellow cards in publications used regularly by prescribers, for example, the British National Formulary, the Association of the British Pharmaceutical Industry data sheet compendium and MIMS--the monthly index of medical specialities.

Specialist yellow cards are produced for anaesthetists ; these are to be included in the drug administration record books used in operating theatres. The format of the yellow card is in the process of being revised in order both to help and improve reporting ; CSM will undertake a publicity drive to promote the yellow card scheme once the revision has been completed.

CSM regional monitoring centres have also been set up in a number of national health service regions to encourage adverse reaction reporting locally and to

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improve follow-up. There is a freefone service available to all parts of the United Kingdom for doctors seeking advice and information on adverse reactions.

Corwin

Mr. Ieuan Wyn Jones : To ask the Secretary of State for Health what guidelines have been given by his Department to doctors concerning the prescribing of the heart drug Corwin.

Mrs. Virginia Bottomley : I refer the hon. Member to the reply I gave my hon. Friend the Member for Newbury (Sir M. McNair-Wilson) on 21 June.

Tampons

Mr. Vaz : To ask the Secretary of State for Health (1) whether his Department has any plans to provide tampons and sanitary towels free of charge to all women ;

(2) how many representations his Department has received since 1979 calling for the provision of tampons and sanitary towels free of charge through national health service clinics.

Mrs. Virginia Bottomley : Figures on the number of representations made on this subject are not available. We have not recently received any representations from organisations on this matter, although it has been raised from time to time in correspondence from Members of Parliament and members of the public.

It would not be appropriate to provide sanitary protection products through the national health service free of charge. We are satisfied that it is more appropriate to assist disadvantaged people through income support and other similar measures, which are the responsibility of the Department of Social Security.

Homelessness

Mr. Robert Hughes : To ask the Secretary of State for Health what action he is taking to tackle the problem of homelessness among young people and people with a mental illness.

Mr. Kenneth Clarke : My right hon. Friend the Secretary of State for the Environment has today announced a number of initiatives to address the problem of people sleeping rough in London. My Department is also initiating a number of measures specifically to address the needs of two particularly vulnerable groups of homeless people--young people, and those with a mental illness. We hope to be in a position to make a further announcement on plans that we are developing for this latter group in central London as soon as possible.

It is important that young people who arrive in London without adequate support have somewhere to go where they can receive help and advice in a safe place, and where efforts can be made to pave the way for a return home. For a number of years, my Department has provided funding for the Children's Society to run a refuge of this kind for runaway children in London, and this year we have agreed a further grant totalling around £200,000 over three years for it to run a short-stay annex attached to this refuge.

I am particularly keen to develop work with young people outside London who are at risk of becoming roofless and possibly heading for the capital. This requires close working between a number of local agencies and

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voluntary bodies. I intend to make funds available to help establish a number of projects in towns outside London run by voluntary organisations in collaboration with local agencies. We will allocate £250,000 from my Department's budget to start up these projects in the present financial year, and the provision of resources for future years will be discussed in the public expenditure survey process over the next few months. The projects will be targeted at young people who are, or are at risk of becoming, roofless. Their specific aim will be to help these young people find a stable environment which enables them to stay in their home community. The details of the scheme will be discussed with the voluntary sector and local authorities, and I hope that it will yield valuable lessons for service providers more generally.

A significant proportion of young runaways appear to have been at some time in local authority care, and there is clearly scope for improving the arrangements that local authorities make for children in their care, particularly in preparing them for leaving it. The Children Act 1989 gives local authorities enhanced duties and powers, and my Department will shortly be issuing draft guidance on how they should fulfil their leaving care responsibilities under the Act. I have also this year agreed a grant of £118,000 to a voluntary organisation, First Key, to provide authorities with advice on good practice in leaving care ; and research has been commissioned from Leeds university to assess various approaches to leaving care policy and practice which should help local authorities to develop and improve their services.

Taken together, these measures will make an important contribution to overall Government policies aimed at reducing the risks of young people leaving home or care and coming to live in our cities without adequate protection or support.

Executive Agencies

Mr. Burns : To ask the Secretary of State for Health if he has identified any candidates within his Department for agency status under the "next steps" initiative.

Mr. Kenneth Clarke : Following a detailed feasibility study, I have identified my Department's estates directorate as a candidate for possible executive agency status.

Agency status could enable the directorate to operate with greater freedom and clearer responsibility within an agreed framework of objectives, performance targets and resources, and to respond more readily to the needs of the Department, the NHS management executive and the NHS.

The agency proposal and other options, including extending the scope of contracting out, will be considered further. Detailed discussions, which will include the preparation of a draft agency framework document have been set in hand. I will be considering other candidates for agency status in due course.

NHS Laboratories

Mr. Key : To ask the Secretary of State for Health what steps national health service management has taken to improve staffing levels in national health service laboratories and the pay and conditions of service of the staff who work in them.

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Mr. Kenneth Clarke : Since 1979 the number of qualified medical laboratory and scientific officers (MLSOs) in post has increased by 38 per cent. NHS management also undertook an extensive pay review and grade restructuring for this group of staff in 1988-89 to make a career in NHS laboratories attractive and to reward increased levels of skills and responsibilities. As a result of this review, the salary of the basic grade of qualified MLSOs, which includes 44 per cent. of all qualified MLSOs, increased by 11 per cent. in that year. Many MLSOs received substantially greater increases on assignment to the new grade structure. Current pay scales for qualified staff range from £7,897 to £20,244. These are currently under review in the Whitley council. In addition, about 25 per cent. of MLSOs now receive up to £2,527 extra through the discretionary local pay supplements for special skills or responsibilities. Many MLSOs also earn allowances relating to "out of hours" duties averaging 15 per cent. of their basic pay.

Local NHS management has not reported any significant difficulties in recruiting and retaining laboratory staff except in some places mainly in the south-east. Essential patient services are not affected.

In order to overcome local staffing difficulties NHS management, through the Whitley council management side has proposed a system of local pay supplements of up to 30 per cent., which could mean increases of up to £3,647 for basic grade MLSOs, greater flexibility in the way hours are worked and extra duty paid for and further local discretion on starting pay. These have all so far been rejected by the trade unions.

NHS management has taken positive steps in recent years to improve the pay and conditions of service of MLSOs and to resolve local recruitment and retention problems. Partial, inadequate and misleading surveys of the type recently published by the hon. Member for Peckham (Ms. Harman) serve only to undermine NHS management and the laboratory service.

Births (Registration)

Mr. Wigley : To ask the Secretary of State for Health what steps he will take to ensure that babies born in hospitals outside Wales but which serve people within Wales, can be registered in the Welsh language.

Mr. Dorrell : The Government's White Paper "Registration : proposals for change" (Cm. 939), a copy of which is available in the Library, has proposed new arrangements whereby, provided that a declaration is made at a registration office in Wales of a birth or death taking place in an English hospital, it will be possible to register that event in both languages. However, introducing such a procedure requires amendment to the present law ; it is therefore one of the measures which the Government will bring forward when an opportunity arises to legislate on registration matters.

Cot Deaths

Mrs. Maureen Hicks : To ask the Secretary of State for Health what consideration is being given to making the care of the next infant programme available nationwide, in order to support families who have experienced cot death.

Mrs. Virginia Bottomley : The Foundation for the Study of Infant Deaths has developed this programme for use by health authorities. The Department helped with the

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printing costs of guidance leaflets. I understand that there is already widespread take-up and the foundation's promotion of the programme is continuing. We will monitor use of the CONI programme, but believe the initiative is best taken forward through collaboration with the voluntary sector.

Children Act 1989

Mr. Michael : To ask the Secretary of State for Health whether he intends to implement the Children Act 1989 in whole or in phases.

Mrs. Virginia Bottomley : Some provisions of the Children Act 1989 are already in force. We plan to implement the remaining provisions in October 1991.

Departmental Publications

Mr. Robin Cook : To ask the Secretary of State for Health if he will list all working papers, implementation documents, departmental circulars, and other publications whether in draft or final form that have been issued to date arising from the National Health Service and Community Care Bill, "Working for Patients", "Caring for Patients" and associated Government initatives.

Mrs. Virginia Bottomley [holding answer 19 June 1990] : The main documents issued in England include :

"Working for Patients" and Discussion Documents :

"Self-Governing Hospitals" (Working Paper 1) (HMSO ; 1989) "Funding and Contracts for Hospital Services" (Working Paper 2) (HMSO ; 1989)

"Practice Budgets for General Medical Practitioners" (Working Paper 3) (HMSO ; 1989)

"Indicative Prescribing Budgets for General Medical Practitioner" (Working Paper 4) (HMSO ; 1989)

"Capital Charges" (Working Paper 5) (HMSO ; 1989)

"Implications for Family Practitioner Committees" (Working Paper 8) (HMSO ; 1989)

"Capital Charges : Funding Issues" (Working Paper 9) (HMSO ; 1989) "Education and Training" (Working Paper 10) (HMSO ; 1989) "Framework for Information Systems : Overview" (Working Paper 11) "Self-Governing Hospitals : An Initial Guide" (HMSO ; 1989) "Contracts for Health Services : Operational Principles" (HMSO ; 1989)

"Funding General Practice" (DOH ; 1989)

"Contracts for Health Services : Operating Contracts" (DOH ; 1990) "Improving Prescribing" (DOH ; 1990)

Interim Report of the Steering Group on the "Undergraduate Medical and Dental Education" ("First France Report")

Second Report of the Steering Group on the "Undergraduate Medical and Dental Education" (France Report) (June 1990)

"Caring for People"--Implementation and Discussion

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