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Diabetic Kidney Patients

Sir Michael McNair-Wilson : To ask the Secretary of State for Health what percentage of diabetic kidney patients are receiving treatment ; and whether any patients in this category have been refused care.

Mr. Dorrell : Information is not available in the form requested. According to information provided by the European Dialysis and Transplant Association, the number of diabetic patients receiving treatment in the United Kingdom for end stage renal failure at 31 December 1988 was approximately 800.

Romanian Orphans

Mr. Thurnham : To ask the Secretary of State for Health if he will issue guidance to local authorities on the charges to be levied on parents for documents required to adopt Romanian orphans ; and if he will make a statement.


Column 648

Mrs. Virginia Bottomley : Local authorities have been advised that they can charge prospective adopters to cover the costs of assessment and preparation of reports in connection with the adoption of children from overseas. The charges made are a matter for the authorities. The local authority associations are considering whether there is any advice which they can offer to authorities about the level of charges.

South-East Thames Region Mr. Moate : To ask the Secretary of State for Health what are the figures for revenue and capital expended in the South East Thames region hospital service in each year on a comparable basis since 1974.

Mr. Dorrell : Information on the expenditure by the South East Thames regional health authority and the district health authorities (and their predecessor authorities) comprising the South East Thames region, derived from annual accounts submitted to the Department in cash and at constant prices, is shown in the table. Over such a long period the figures are not entirely comparable.


Total revenue and capital expenditure on Hospital and        

Community                                                    

Health Services (HCHS)-South East Thames Region              

£'000s                                                       

Year        Revenue Expenditure Capital Expenditure          

           |(Cash)   |(1989-90 |(Cash)   |(1989-90           

                     |Prices)            |Prices)            

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

1974-75    |208,755  |877,512  |19,970   |83,945             

1975-76    |279,572  |934,623  |25,625   |85,666             

1976-77    |321,373  |947,915  |23,529   |69,401             

1977-78    |356,258  |923,139  |17,539   |45,447             

1978-79    |395,880  |926,656  |23,026   |53,898             

1979-80    |471,151  |944,300  |25,992   |52,094             

1980-81    |603,001  |1,021,261|35,138   |59,511             

1981-82    |662,702  |1,022,291|39,422   |60,813             

1982-83    |700,421  |1,007,717|46,327   |66,652             

1983-84    |739,438  |1,016,387|51,988   |71,460             

1984-85    |772,108  |1,011,045|49,853   |65,281             

1985-86    |807,525  |1,003,624|55,181   |68,581             

1986-87    |857,088  |1,030,203|76,517   |91,972             

1987-88    |928,872  |1,059,685|91,148   |103,984            

1988-89    |1,039,270|1,106,823|92,284   |98,282             

<1>1989-90 |1,116,191|1,116,191|103,905  |103,905            

<1>Provisional figures-as yet subject to audit.              

Notes:                                                       

1.The figures for earlier years have been expressed at       

1989-90 prices by the use of the Gross Domestic Product      

deflator.                                                    

2.HCHS covers all health authorities' services including     

hospital, community health, patient transport (i.e.,         

ambulance) and blood transfusion. Expenditure on family      

practitioner services is excluded. However, the figures      

prior to 1 April 1985 include small elements related to the  

administrative expenses of family practitioner committees (  

FPCs).                                                       

3.The figures from 1987-88 exclude an element for the costs  

of the London Ambulance Service which in earlier years was   

shared by all four Thames RHAs.                              

4.Capital expenditure for particular authorities and regions 

tends to fluctuate year on year mainly reflecting changes in 

the pattern of capital investment throughout the country.    


Column 649

HEALTH

Hospices

Mr. Wigley : To ask the Secretary of State for Health how many hospices there are in each of the counties of England ; and what is his policy regarding the expansion of hospice provision in England.

Mrs. Virginia Bottomley : Information is not available in the form requested. The following table gives an analysis by health district. The Government value the contribution made by the hospice movement to improving services for people with a terminal illness and their families. We expect health authorities to take the lead in planning and co-ordinating such services, in consultation with hospices and other interested organisations.


Hospice in-patient units                                                                                         

                                                               |Number                                           

Health district                       |Existing                |Proposed                                         

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

Airedale                              |2                       |0                                                

Aylesbury Vale                        |1                       |0                                                

Barking, Havering and Brentwood       |1                       |0                                                

Barnet                                |0                       |2                                                

Barnsley                              |0                       |0                                                

Basildon and Thurrock                 |0                       |1                                                

Basingstoke and North Hampshire       |0                                                                         

                                      |Bassetlaw               |0                                                

Bath                                  |1                       |0                                                

Bexley                                |0                       |0                                                

Blackburn, Hyndburn and Ribble Valley |1                       |0                                                

Blackpool, Wyre and Fylde             |1                       |0                                                

Bloomsbury                            |1                       |0                                                

Bolton                                |0                       |1                                                

Bradford                              |0                       |0                                                

Brighton                              |2                       |1                                                

Bristol and Weston                    |0                       |0                                                

Bromley                               |1                       |0                                                

Bromsgrove and Redditch               |0                       |0                                                

Burnley, Pendle and Rossendale        |0                       |0                                                

Bury                                  |0                       |1                                                

Calderdale                            |1                       |0                                                

Camberwell                            |0                       |0                                                

Cambridge                             |2                       |0                                                

Canterbury and Thanet                 |1                       |-                                                

Central Birmingham                    |-                                                                         

Central Manchester                    |-                                                                         

Central Nottinghamshire               |-                       |1                                                

Cheltenham and District               |1                       |-                                                

Chester                               |1                       |-                                                

Chichester                            |2                       |-                                                

Chorley and South Ribble              |-                       |-                                                

City and Hackney                      |1                       |-                                                

Cornwall and Isles of Scilly          |3                       |-                                                

Coventry                              |-                                                                         

Crewe                                 |-                       |1                                                

Croydon                               |-                       |-                                                

Darlington                            |-                       |-                                                

Dartford and Gravesham                |1                       |1                                                

Dewsbury                              |-                       |-                                                

Doncaster                             |-                       |1                                                

Dudley                                |-                       |-                                                

Durham                                |-                       |1                                                

Ealing                                |1                       |-                                                

East Berkshire                        |1                       |-                                                

East Birmingham                       |-                       |-                                                

Eastbourne                            |2                       |-                                                

East Cumbria                          |-                       |1                                                

East Dorset                           |1                       |2                                                

East Hertfordshire                    |-                       |1                                                

East Suffolk                          |1                       |-                                                

East Surrey                           |1                       |-                                                

East Yorkshire                        |-                       |-                                                

Enfield                               |-                       |-                                                

Exeter                                |1                       |1                                                

Frenchay                              |-                       |-                                                

Gateshead                             |-                       |-                                                

Gloucester                            |-                       |-                                                

Great Yarmouth and Waveney            |1                       |-                                                

Greenwich                             |-                       |1                                                

Grimsby                               |1                       |-                                                

Halton                                |-                       |-                                                

Hampstead                             |1                       |-                                                

Haringey                              |-                       |-                                                

Harrogate                             |1                       |-                                                

Harrow                                |-                       |-                                                

Hartlepool                            |1                       |-                                                

Hastings                              |1                       |-                                                

Herefordshire                         |2                       |-                                                

Hillingdon                            |3                       |1                                                

Hounslow and Spelthorne               |-                       |-                                                

Huddersfield                          |1                       |-                                                

Hull                                  |-                       |1                                                

Huntingdon                            |-                       |-                                                

Isle of Wight                         |1                       |-                                                

Islington                             |-                       |-                                                

Kettering                             |-                       |1                                                

Kidderminster                         |-                       |-                                                

Kingston and Esher                    |1                       |-                                                

Lancaster                             |1                       |-                                                

Leeds Eastern                         |3                       |-                                                

Leeds Western                         |-                       |-                                                

Leicestershire                        |2                       |-                                                

Lewisham and North Southwark          |-                       |-                                                

Liverpool                             |1                       |-                                                

Maccelesfield                         |1                       |-                                                

Maidstone                             |-                       |1                                                

Medway                                |1                       |-                                                

Merton and Sutton                     |1                       |-                                                

Mid-Downs                             |1                       |-                                                

Mid-Essex                             |1                       |-                                                

Mid-Staffordshire                     |-                       |-                                                

Mid-Surrey                            |-                       |-                                                

Milton Keynes                         |1                       |-                                                

Newcastle                             |2                       |-                                                

Newham                                |-                       |-                                                

Northallerton                         |-                       |-                                                

Northampton                           |1                       |-                                                

North Bedfordshire                    |1                       |1                                                

North Birmingham                      |-                       |-                                                

North Derbyshire                      |1                       |-                                                

North Devon                           |-                       |-                                                

North East Essex                      |1                       |-                                                

North Hertfordshire                   |-                       |1                                                

North Lincolnshire                    |1                       |-                                                

North Manchester                      |-                       |1                                                

North Staffordshire                   |1                       |-                                                

North Tees                            |1                       |-                                                

North Tyneside                        |-                       |-                                                

Northumberland                        |-                       |-                                                

North Warwickshire                    |-                       |1                                                

North West Durham                     |-                       |-                                                

North West Hertfordshire              |1                       |-                                                

North West Surrey                     |1                       |-                                                

Norwich                               |1                       |-                                                

Nottingham                            |1                       |-                                                

Oldham                                |-                       |1                                                

Oxfordshire                           |2                       |1                                                

Parkside                              |2                       |-                                                

Peterborough                          |-                       |-                                                

Plymouth                              |1                       |-                                                

Pontefract                            |-                       |1                                                

Portsmouth and South-East Hampshire   |1                       |1                                                

Preston                               |1                       |-                                                

Redbridge                             |-                       |-                                                

Richmond, Twickenham and Roehampton   |-                       |-                                                

Riverside                             |-                       |1                                                

Rochdale                              |1                       |-                                                

Rotherham                             |-                       |1                                                

Rugby                                 |-                       |-                                                

St Helen's and Knowsley               |1                       |-                                                

Salford                               |2                       |-                                                

Salisbury                             |1                       |-                                                

Sandwell                              |-                       |-                                                

Scarborough                           |1                       |-                                                

Scunthorpe                            |1                       |-                                                

Sheffield                             |1                       |-                                                

Shropshire                            |1                       |-                                                

Solihull                              |1                       |-                                                

Somerset                              |2                       |-                                                

Southampton and South-West Hampshire  |1                       |1                                                

South Bedfordshire                    |1                       |1                                                

South Birmingham                      |2                       |-                                                

South Cumbria                         |1                       |-                                                

South East Kent                       |-                       |-                                                

South East Staffordshire              |1                       |-                                                

Southend                              |1                       |-                                                

South Derbyshire                      |1                       |1                                                

South Lincolnshire                    |-                       |-                                                

South Manchester                      |1                       |-                                                

Southmead                             |2                       |-                                                

Southport and Formby                  |-                       |1                                                

South Sefton                          |1                       |-                                                

South Tees                            |-                       |1                                                

South Tyneside                        |-                       |-                                                

South Warwickshire                    |1                       |-                                                

South West Durham                     |-                       |-                                                

South West Hertfordshire              |1                       |1                                                

South West Surrey                     |1                       |-                                                

Stockport                             |-                       |-                                                

Sunderland                            |1                       |-                                                

Swindon                               |1                       |-                                                

Tameside and Glossop                  |-                       |-                                                

Torbay                                |1                       |-                                                

Tower Hamlets                         |1                       |-                                                

Trafford                              |-                       |-                                                

Tunbridge Wells                       |-                       |-                                                

Wakefield                             |1                       |-                                                

Walsall                               |-                       |-                                                

Waltham Forest                        |1                       |-                                                

Wandsworth                            |-                       |-                                                

Warrington                            |1                       |-                                                

West Berkshire                        |2                       |1                                                

West Birmingham                       |1                       |-                                                

West Cumbria                          |1                       |-                                                

West Dorset                           |-                       |-                                                

West Essex                            |-                       |1                                                

West Lambeth                          |1                       |-                                                

West Lancashire                       |1                       |-                                                

West Norfolk and Wisbech              |-                       |1                                                

West Suffolk                          |-                       |1                                                

West Surrey and North East Hampshire  |1                       |-                                                

Wigan                                 |1                       |-                                                

Winchester                            |1                       |-                                                

Wirral                                |1                       |-                                                

Wolverhampton                         |1                       |-                                                

Worcester and District                |-                       |-                                                

Worthing District                     |1                       |-                                                

Wycombe                               |-                       |1                                                

York                                  |1                       |-                                                

                                                                                                                 

Special Health Authorities            |3                       |-                                                

                                                                                                                 

Total                                 |128                     |44                                               

Northern Region

Ms. Armstrong : To ask the Secretary of State for Health what total sum has been made available for the distinction awards to hospital consultants in the northern


Column 652

region in the financial year 1988-89 and in the current financial year ; and how much will be available in the 1990-91 financial year.

Mrs. Virginia Bottomley : No specific sum is allocated to authorities for the payment of distinction awards. Health authorities are expected to meet the cost of distinction awards from their own resources.

Health Education

Mr. Andrew Bowden : To ask the Secretary of State for Health what plans he has to increase the funding of organisations working with elderly people to enable them to develop additional health education programmes.

Mr. Dorrell : The Department grant-aids a number of voluntary organisations under section 64 of the Health Services and Public Health Act 1968, several of which include a health education element in their programmes. The overall funding available through this source will be increased to £15,680,000 for the financial year 1991-92. We are currently receiving applications for funding, all of which will be carefully considered. It is too early to say at this stage what proportion of the overall funding will be allocated to organisations working with and for elderly people.

Mr. Andrew Bowden : To ask the Secretary of State for Health what will be the total saving to the Health Education Authority arising from the ending of the health in old age programme.

Mr. Dorrell : During 1990-91 £106,000 will be spent by the Health Education Authority on its health in old age programme. The ending of the Programme is not intended to achieve a financial saving, but to enable the Authority to utilise its resources more effectively by addressing the health education needs of elderly people across the whole range of its activities rather than by being restricted to a specific programme. It is too early to say what resources the Authority will devote to the health education needs of elderly people in 1991-92 and beyond.

Mr. Andrew Bowden : To ask the Secretary of State for Health what representations he has received concerning the future of the age well programme.

Mr. Dorrell : Officials are in discussion with Age Concern, who have responsibility for the age well programme, to discuss its future. We are not aware of any representations other than those made by the hon. Member.

Consultants

Ms. Armstrong : To ask the Secretary of State for Health if he will list the amount of distinction awards paid to consultants in each of the health authorities in the Northern region for the last five years.

Mrs. Virginia Bottomley : Information on the amount of distinction awards paid, as given in a footnote to the annual accounts of the Northern Regional Health Authority (RHA) and the district health authorities comprising the Northern region, is shown in the table.


Column 653


Northern Region-Medical and Dental Consultants Distinction Awards          

National Health Service Staff                                              

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

Northern RHA   |49,910   |24,580   |26,720   |20,280   |33,030             

Hartlepool     |38,848   |37,862   |37,412   |32,107   |28,261             

North Tees     |105,967  |103,333  |121,653  |131,614  |131,048            

South Tees     |198,514  |172,333  |220,474  |227,172  |227,187            

East Cumbria   |110,142  |122,868  |157,775  |187,120  |178,712            

South Cumbria  |109,420  |77,509   |83,556   |88,922   |n/g                

West Cumbria   |84,001   |93,706   |101,939  |103,750  |95,124             

Darlington     |n/g      |56,768   |n/g      |n/g      |n/g                

Durham         |66,280   |103,005  |n/g      |95,727   |63,824             

NW Durham      |43,316   |35,532   |38,123   |35,051   |53,836             

SW Durham      |46,210   |62,348   |58,220   |49,705   |43,764             

Northumberland |97,217   |125,181  |136,574  |153,078  |118,341            

Gateshead      |50,316   |71,533   |77,370   |97,511   |104,482            

Newcastle      |703,120  |755,680  |784,866  |986,739  |1,292,602          

North Tyneside |26,151   |18,785   |35,958   |47,338   |75,779             

South Tyneside |25,648   |29,257   |31,592   |42,456   |87,931             

Sunderland     |102,596  |138,534  |168,635  |160,714  |172,934            

<1>1989-90 figures are "provisional" in that the annual accounts for that  

year are as yet subject to audit.                                          

n/g-Not given.                                                             

Ms. Armstrong : To ask the Secretary of State for Health (1) what was the number of hospital consultants who received top-up bonuses in each health authority in the Northern region in the financial year 1988-89 and in the current financial year ;

(2) what sums have been made available for top-up bonuses to hospital consultants in each health authority in the Northern region in the financial year 1988-89 and in the current financial year ; and how much will be budgeted for each authority for the 1990-91 financial year.

Mrs. Virginia Bottomley : NHS hospital consultants do not receive "top-up bonuses".

Menopause Services

Mrs. Gorman : To ask the Secretary of State for Health if he will place in the Library copies of the guidance notes issued by his Department asking health authorities to balance the services provided by specialist clinics and those provided by general practitioners as they relate to the menopause.

Mrs. Virginia Bottomley : The guidance referred to in my reply to my hon. Friend on 24 July at column 176 , relates to family planning services. No specific guidance has been issued on menopause clinics. The provision of services for the women concerned is a matter for local health authorities to determine in the light of local needs and priorities.

Social Services (Unallocated Cases)

Mr. Vaz : To ask the Secretary of State for Health if he will list the number of unallocated cases for each social services area.

Mrs. Virginia Bottomley : I refer the hon. Member to the reply I gave the hon. Members for Bridgend (Mr. Griffiths), for Mid-Staffordshire (Mrs. Heal), for Renfrew, West and Inverclyde (Mr. Graham) and for Newcastle upon Tyne North (Mr. Henderson) on 3 July at column 535.


Column 654

DES/Stilboestrol

Miss Emma Nicholson : To ask the Secretary of State for Health (1) if he will meet the representatives of the DES/Stilboestrol Action Group in England ;

(2) if his Department plans to examine the conclusions of the DES/Stilboestrol symposium held in Dublin on 14 September ; (3) if his Department will inquire into reports that the grandchildren of patients treated with the drug DES/Stilboestrol have suffered ill effects.

Mrs. Virginia Bottomley : The Committee on Safety of Medicines (CSM) carefully monitors all issues of drug safety. There is also a statutory obligation for pharmaceutical companies to provide details of any suspected adverse drug reactions which they may receive in relation to one of their products. Any new information relating to side effects from stilboestrol will be monitored in the usual way when it becomes available to the CSM. There are no plans to meet representatives of the DES Action Group.

Travellers

Miss Emma Nicholson : To ask the Secretary of State for Health what information is routinely collected by his Department about health authority plans, targets and services for traveller mothers and babies.

Mrs. Virginia Bottomley : Routine information is not collected centrally. We recognise that meeting the health care needs of traveller families requires special attention from health authorities in areas with a significant traveller population. To help develop good practice the Department provides financial support to a travellers information and liaison unit run by the Save the Children Fund.

Tehidy Hospital, Cornwall

Mr. Mudd : To ask the Secretary of State for Health when he expects to announce his decision on the future of Tehidy hospital, Cornwall.


Column 655

Mr. Dorrell : South Western regional health authority will consider on 6 November a proposal by Cornwall and Isles of Scilly Health Authority to develop a community hospital at Barncoose, and to sell Tehidy hospital. If the regional health authority supports the proposal it will be referred to my right hon. and learned Friend the Secretary of State for the final decision.

Myalgic Encephalomyelitis

Mr. McNamara : To ask the Secretary of State for Health what treatment is available for ME on the National Health Service.

Mr. Dorrell : The Department of health and the National Health Service recognise myalgic encephalomyelitis as a debilitating and distressing disease. Its causes are not yet fully understood, nor is there a generally agreed method of treatment. Treatment to alleviate the various symptoms is a matter for medical judgment in individual cases. A number of licensed medicines, prescribable under the NHS, have been found to bring relief to some patients.

Mr. McNamara : To ask the Secretary of State for Health how much money has been spent by his Department in funding research on myalgic encephalomyelitis for each year for the past three years.

Mr. Dorrell : The Department of Health is aware of several studies being conducted into myalgic encephalomyelitis although it has not sponsored this research. The main Government agency responsible for the promotion of biomedical and clinical research is the Medical Research Council (MRC) which receives grant-in-aid from the Department of Education and Science. I refer the hon. Member to the reply my hon. Friend the Parliamentary Under-Secretary of State for the Department of Education and Science gave my hon. Friend the Member for Rugby and Kenilworth (Mr. Pawsey) on 2 February at column 422 .

London Ambulance Service

Mr. Corbyn : To ask the Secretary of State for Health if he will list the total staff of the London ambulance service for each month since January 1989.

Mr. Dorrell : Data is not collected in the form requested but annual figures are available in a national ambulance survey prepared by York health authority. The total numbers of staff for the last two available financial years for the London ambulance service are given in the table. Total staffing figures include officers, operational staff and general staff such as mechanics and domestics.

Table file CW901019.027 not available

The management of the London ambulance service is the responsibility of the London ambulance service board, chairman Mr. James Harris, to whom the hon. Member may wish to write for further information.

Mr. Corbyn : To ask the Secretary of State for Health if he will list the average response time for the London ambulance service in emergencies for each week since January 1989.


Column 656

Mr. Dorrell : Data are collected centrally only on a financial year basis. In both 1987-88 and 1988-89 the median response time to emergency calls was less then 10 minutes. The management of the London ambulance service is the responsibility of the London ambulance service board, chairman Mr. James Harris, to whom the hon. Member may wish to write for more detailed information.

Mr. Corbyn : To ask the Secretary of State for Health if he will list (a) the total number of vehicles and (b) vehicle miles covered by the London ambulance service for each week since January 1989.

Mr. Dorrell : Data is not collected in the form requested but annual figures are available in a national ambulance survey prepared by York health authority. The total numbers of vehicles and vehicle miles for the last 2 available financial years for the London ambulance service are given in the table. Vehicles included ambulance and other ambulance service vehicles such as major incident vehicles and recovery vehicles.


London ambulance service: vehicles and vehicle  

miles                                           

               |1987-88   |1988-89              

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

Vehicles       |994       |963                  

Vehicles miles |12,369,411|12,199,647           

The management of the London ambulance service is the responsibility of the London service board, chairman Mr. James Harris, to whom the hon. Member may wish to write for further information.

Birth Statistics

Ms. Harman : To ask the Secretary of State for Health (1) if he will give for England and Wales for 1988, for births within marriage and jointly registered births outside marriage, the numbers of live births, still births, early neonatal deaths, late neonatal deaths and post-neonatal deaths of babies with mothers with occupations in : (a) social class I, (b) social class II, (c) social class III non-manual, (d) social class III manual, (e) social class IV, (f) social class V, (g) in other occupations and (h) with no stated occupation ;

(2) if he will give for England and Wales for 1988 the numbers of live births, still births, early neonatal deaths, late neonatal deaths and post- neonatal deaths of babies with mothers with occupations in (a) social class I, (b) social class II, (c) social class III non-manual, (d) social class III manual, (e) social class IV, (f) social class V, (g) other occupations and (h) with no stated occupation.

Mr. Dorrell : I shall write to the hon. Member shortly.

Ms. Harman : To ask the Secretary of State for Health, if he will give the numbers of women resident in (a) Dacorum local government district and (b) St. Albans local government district who gave birth in 1989 in (i) St. Albans City Hospital, (ii) Luton and Dunstable Hospital, (iii) Queen Elizabeth II Hospital, Welwyn Garden City, (iv) Watford general hospital, (v) Royal Bucks hospital, Aylesbury, (vi) RAF Halton maternity unit, (vii) other hospitals, (viii) at home and (ix) elsewhere.

Mr. Dorrell : The information requested is as follows :


Column 657


                                    |Dacorum   |St. Albans           

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

St. Albans City hospital            |1,016     |1,124                

Luton and Dunstable hospital        |39        |51                   

Queen Elizabeth II hospital, Welwyn                                  

   Garden City                      |8         |145                  

Watford general hospital            |279       |77                   

Royal Bucks hospital, Aylesbury     |186       |-                    

Non-NHS hospitals<1>                |189       |6                    

Other NHS hospitals                 |78        |101                  

At home                             |31        |11                   

Elsewhere                           |3         |0                    

                                    |-----     |-----                

                                    |1,829     |1,515                

<1>Figures for individual non-NHS hospitals are not available for    

1989.                                                                

Ms. Harman : To ask the Secretary of State for Health if he will give for England and Wales for 1983 and 1988 the


Column 658

estimated total numbers of live births within marriage and jointly registered births outside marriage of singleton babies weighing (i) under 1000g, (ii) 1000-1499g, (iii) 1500-1999g, (iv) 2000-2499g, (v) 2500g and over and (vi) with unstated birthweights for babies with fathers in (a) social class I, (b) social class II, (c) social class III non-manual, (d) social class III manual, (e) social class IV, (f) social class V, (g) other occupations and (h) with no stated occupation.

Mr. Dorrell : The information is shown in the table. The data on social class are derived from a 10 per cent. coding of occupation details, and weighting factors have been applied to this sample to give estimated data. It should also be noted that the two years are not exactly comparable in the "other occupations" and "no stated occupation" categories due to a change in coding practice.


Column 657


Birthweight within marriage and jointly registered outside marriage by father's social class for singleton livebirths                                                                                                                                                                                                                                                                                       

4                                                                                                                                                                                                                                                                                                                                                                                                           

Social class of father              |1,000                              |1,000-1,499                        |1,500-1,999                        |2,000-2,499                        |2,500                              |Not stated                         |Total                                                                                                                                          

1983                                                                                                                                                                                                                                                                                                                                                                                                        

Within marriage                                                                                                                                                                                                                                                                                                                                                                                             

I                                   |80                                 |110                                |310                                |1,030                              |36,720                             |50                                 |38,300                                                                                                                                         

II                                  |120                                |400                                |910                                |3,680                              |109,150                            |130                                |114,380                                                                                                                                        

IIIN                                |90                                 |220                                |370                                |1,860                              |53,360                             |70                                 |55,970                                                                                                                                         

IIIM                                |330                                |910                                |1,910                              |6,620                              |174,910                            |180                                |184,860                                                                                                                                        

IV                                  |170                                |310                                |870                                |3,640                              |69,850                             |80                                 |74,920                                                                                                                                         

V                                   |30                                 |160                                |350                                |1,580                              |28,480                             |70                                 |30,680                                                                                                                                         

Other occupations<1>                |40                                 |140                                |190                                |760                                |18,030                             |80                                 |19,240                                                                                                                                         

Occupation not stated               |10                                 |10                                 |30                                 |70                                 |950                                |-                                  |1,070                                                                                                                                          

                                                                                                                                                                                                                                                                                                                                                                                                            

Total                               | 870                               |2,260                              |4,940                              |19,240                             |491,150                            |660                                |519,420                                                                                                                                        

                                                                                                                                                                                                                                                                                                                                                                                                            

Jointly registered outside marriage                                                                                                                                                                                                                                                                                                                                                                         

I                                   |10                                 |-                                  |10                                 |20                                 |920                                |-                                  |960                                                                                                                                            

II                                  |30                                 |60                                 |50                                 |380                                |6,500                              |10                                 |7,020                                                                                                                                          

IIIN                                |10                                 |20                                 |40                                 |130                                |3,460                              |-                                  |3,660                                                                                                                                          

IIIM                                |80                                 |170                                |390                                |1,290                              |23,250                             |30                                 |25,210                                                                                                                                         

IV                                  |40                                 |20                                 |210                                |690                                |10,620                             |30                                 |11,610                                                                                                                                         

V                                   |50                                 |90                                 |80                                 |570                                |8,420                              |-                                  |9,210                                                                                                                                          

Other occupations<1>                |10                                 |40                                 |40                                 |50                                 |1,690                              |10                                 |1,840                                                                                                                                          

Occupation not stated               |-                                  |10                                 |10                                 |30                                 |590                                |-                                  |640                                                                                                                                            

                                                                                                                                                                                                                                                                                                                                                                                                            

Total                               | 230,                              |410                                |830                                |3,160                              |55,450                             |80                                 |60,150                                                                                                                                         

                                                                                                                                                                                                                                                                                                                                                                                                            

1988                                                                                                                                                                                                                                                                                                                                                                                                        

Within marriage                                                                                                                                                                                                                                                                                                                                                                                             

I                                   |70                                 |90                                 |150                                |1,020                              |39,190                             |80                                 |4,600                                                                                                                                          

II                                  |290                                |550                                |1,070                              |3,280                              |117,500                            |210                                |122,900                                                                                                                                        

IIIN                                |120                                |260                                |470                                |1,700                              |51,120                             |50                                 |53,710                                                                                                                                         

IIIM                                |470                                |940                                |1,540                              |6,270                              |161,690                            |180                                |171,080                                                                                                                                        

IV                                  |180                                |380                                |680                                |2,770                              |63,410                             |50                                 |67,490                                                                                                                                         

V                                   |90                                 |120                                |270                                |1,230                              |23,050                             |40                                 |24,790                                                                                                                                         

Other occupations<1>                |60                                 |50                                 |190                                |710                                |21,310                             |60                                 |22,380                                                                                                                                         

Occupation not stated               |-                                  |10                                 |20                                 |110                                |1,480                              |10                                 |1,630                                                                                                                                          

                                                                                                                                                                                                                                                                                                                                                                                                            

Total                               |1,280                              |2,400                              |4,390                              |17,090                             |478,770                            |680                                |504,580                                                                                                                                        

                                                                                                                                                                                                                                                                                                                                                                                                            

Jointly registered outside marriage                                                                                                                                                                                                                                                                                                                                                                         

I                                   |-                                  |-                                  |60                                 |110                                |2,600                              |-                                  |2,770                                                                                                                                          

II                                  |50                                 |90                                 |220                                |600                                |14,640                             |40                                 |15,640                                                                                                                                         

IIIN                                |20                                 |70                                 |110                                |230                                |7,560                              |20                                 |8,020                                                                                                                                          

IIIM                                |150                                |340                                |600                                |2,220                              |47,030                             |60                                 |50,400                                                                                                                                         

IV                                  |40                                 |180                                |420                                |1,150                              |21,640                             |20                                 |23,450                                                                                                                                         

V                                   |90                                 |120                                |240                                |750                                |14,270                             |30                                 |15,500                                                                                                                                         

Other occupations<1>                |10                                 |70                                 |20                                 |210                                |3,220                              |10                                 |3,540                                                                                                                                          

Occupation not stated               |20                                 |10                                 |40                                 |60                                 |1,690                              |-                                  |1,820                                                                                                                                          

                                                                                                                                                                                                                                                                                                                                                                                                            

Total                               |30                                 |880                                |1,710                              |5,330                              |112,650                            |180                                |121,140                                                                                                                                        

<1> Other occupations = Armed Forces, inadequately described, students, independent means, permanently sick, no previous job.                                                                                                                                                                                                                                                                               


Column 659

Bloomsbury and Islington Health Authority

Mr. Corbyn : To ask the Secretary of State for Health what arrangements will be made to ensure adequate provisions of finance for the merged Bloomsbury and Islington health authority.

Mr. Dorrell : It is for North East Thames regional health authority to decide funding levels for the merged Bloomsbury and Islington health authority.

Friern Barnet Hospital (Closure)

Mr. Corbyn : To ask the Secretary of State for Health what provision has been made by his Department for the effects of the closure of Friern Barnet hospital on the neighbouring health and local authorities.

Mr. Dorrell : This is a matter for the North East Thames regional health authority and for the health and local authorities concerned.

Peak Flow Meters

Mr. Dunnachie : To ask the Secretary of State for Health (1) what is the cost per unit of peak flow meters available at present to his Department ; and what he treats as an acceptable cost ;

(2) if he will now announce a date from which peak flow meters will become available on prescription to asthmatics ; and if he will make a statement ;

(3) what information he has on the reasons for the delay in implementation of his Department's earlier announcement that peak flow meters would be made available on prescription to asthmatics ; and if he will make a statement.

Mrs. Virginia Bottomley : Peak flow meters were made available on prescription from 1 October 1990. Two brands of meter have been included in the prescribable list--the drug tariff--manufactured by Clement Clarke Limited and Vitalograph Limited.

Two models have been approved for each manufacturer : standard-range meters suitable for both adults and children and low-range meters for adults or children with serverely restricted air flow. Clement Clarke meters are priced in the drug tariff at £6.39 and Vitalograph meters at £5.99. These prices are both acceptable. Recording charts in the form of a booklet are being issued free of charge via general practitioners for making a daily record of the user's peak expiratory flow rate. The booklet covers a year's usage and includes notes on the use and care of the meter.

I announced on 21 March 1990 that peak flow meters would become available on prescription. To be accepted for listing on the drug tariff, each company's meters had to conform to a Departmental specification, meet criteria of safety, efficacy and cost effectiveness, and be available in sufficient quantity to meet potential demand. Labelling, packaging, user instructions and prices were also the subject of consultation and negotiations.

Haemophiliacs (AIDS)

Mr. Alfred Morris : To ask the Secretary of State for Health what is the total cost to the Government to date of the legal case in which people with haemophilia, having been infected with the AIDS virus in the course of national health service treatment, are suing the Government.


Column 660

Mr. Kenneth Clarke : The cost of the time spent by civil servants on this litigation and other administrative expenditure is not separately identified. So far, £25,961 has been paid in legal fees, and £10,495 in fees to expert witnesses. This does not include the costs of legal aid, which are a charge on the Lord Chancellor's Department.

Mr. Alfred Morris : To ask the Secretary of State for Health, if he will make a statement on his reaction to Mr. Justice Ognall's appeal to both sides in the legal case in which people with haemophilia, having been infected with the AIDS virus in the course of national health service treatment, are suing the Government, to give anxious consideration to a compromise solution and the judge's offer to arbitrate in a speedy settlement of the case.

Mr. Kenneth Clarke : I have carefully considered the points put forward by Mr. Justice Ognall in his statement handed down on 26 June 1990. The text of the Department's response was as follows: Thank you very much for providing me with a copy of the note handed down by Mr. Justice Ognall on 26 June 1990.

The Secretary of State has carefully considered the points put forward by the Judge, together with the advice given previously by Counsel in the light of the overall situation concerning the tragic effect on haemophiliacs of the use of Factor VIII containing the HIV virus.

The Government has recognised that the plight of haemophiliacs and the fact that the treatment which led to their infection was intended to help them to lead as near a normal life as possible, makes their case wholly exceptional. Accordingly, and in recognition of their unique position, the Macfarlane Trust was set up following an announcement by the Minister of Health in November 1987 and was provided with £10 million, to make payments on an ex-gratia basis to affected individuals and their families throughout the United Kingdom. Since then, many payments have been made out of the fund, on the basis of financial need, and this continues.

When announcing the establishment of the Macfarlane Trust, the Government made it clear that, while it considered the sum of £10 million to be appropriate at that time, it would nevertheless keep open to review the question of what funds were required. Following an announcement by the Secretary of State on 23 November 1989, a further sum of £24 million was made available for haemophiliacs. The aim was first, to make individual payments of £20,000 to each haemophiliac infected with AIDS virus as a result of treatment with blood products in the United Kingdom or the family of such a person who has died; and second, to enable the Macfarlane Trust to continue on a more generous scale to help families in particular need.

So the Government has already made available a total of £34 million to mitigate the effects of this tragedy on all haemophiliacs with HIV and their families and not just the litigants in this action. Some £24 million of this total has been distributed to individuals affected, irrespective of means, whilst the remainder has been and continues to be made available on the basis of need. None of these payments is taken into account for the purposes of social security or indeed of legal aid.

The Government proposes to keep the sums available to the Macfarlane Trust and the needs of haemophiliacs under regular review.

All these sums are of course paid on an ex-gratia basis. They are intended to provide the resources to respond positively to the particular needs of affected haemophiliacs and their families. They are not however intended to be a substitute for litigation of the issues presently before the Court.

Mr. Justice Ognall has suggested that there are actions which should perhaps be settled on the basis of moral obligation rather than on a strict assessment of legal liability. The Secretary of State has already recognised the moral argument and the strong compassionate arguments in favour of providing assistance to haemophiliacs affected by HIV in the setting up of the Macfarlane Trust and in providing resources for their treatment. In the Secretary of State's view,


Column 661

the fact that the affected haemophiliacs have chosen to pursue their legal claim does not raise any fresh moral obligation beyond that already recognised by the Government. And, of course, he has the general duty to weigh up the claims for assistance of this particular group as against the claims of other groups of sick or disabled people, within the resources voted by Parliament.

Ministers are always and understandably faced by an array of competing demands for highly desirable objectives within the inevitably finite resources available. Spending more on one group, whatever the reason for doing so, inevitably means spending less on others. The haemophiliacs with HIV infection have attracted public attention and quite rightly won the nation's sympathy, but there are many other examples of people suffering severe disability with the prospect of premature death also through no fault of their own--for example, patients with advanced cancer ; patients with end-stage renal failure ; or children born with severe congenital heart defects. It is the responsibility of Ministers and their advisers to weigh up these difficult choices and to arrive at a reasonable ordering of priorities.

Ministers are, of course, and rightly, accountable to Parliament for their decisions on policies and priorities. As you know it is the Secretary of State's case in this litigation that such decisions do not and should not give rise to a duty of care to individual members of the public such as to enable those individuals to bring a claim for damages. This is an important principle and one which would have far reaching repercussions if compromised. There are strong public policy reasons why this is so. First, it would make the process of policy formation very much less effective if every decision were subject to the risk of legal challenge in the courts. Second, if it were accepted in this particular action that Ministers did owe such a duty of care this would be likely to lead to very large numbers of costly and time-consuming claims against the Department, Licensing Authority and CSM. There is nothing unique about this aspect of the present claim.

The Secretary of State fully recognises the force of the argument that the resources likely to be taken up by this litigation would be better used to alleviate suffering. However, it would not achieve this purpose if the likely consequence of compromising these actions were to encourage other expensive litigation in future. The Secretary of State considers that the existence of this litigation on its own is not a sufficient reason to adopt different criteria from those which govern the decisions which regularly have to be made where the competing demands of many pressing and deserving causes have to be balanced in the light of the resources that are actually available. The Secretary of State is satisfied that the best and indeed the proper way of meeting the need referred to by Mr. Justice Ognall is through the machinery of the Macfarlane Trust or similar means. The Government remains committed to pursuing that course and will ensure that the needs of all affected haemophiliacs and their families are kept under review. That resolve will not be affected by the progress or outcome of the litigation.

It is recognised that it would be in the interests of everyone that the present litigation should be brought to a speedy conclusion. Apart from the anguish which it inevitably causes to plaintiffs and their families, it has placed a heavy burden on the resources of the Legal Aid Fund and of the Department and Health Authorities. That inevitably involves the diversion of scarce resources from elsewhere. It must be a matter for individual Plaintiffs and their advisers as to whether they wish to continue to pursue their allegations against the Central Defendants in the expectation or hope that they will be able to establish liability. However, whilst the Secretary of State will continue to review the position from time to time, until or unless you advise that there is a real likelihood of the Plaintiffs or any of them succeeding in establishing liability, his view is that these actions should continue to be defended firmly. Meanwhile, I know that you and Counsel will do everything possible to adhere to the timetable set by the Court.

I would be grateful if you would express the Secretary of State's thanks to the Judge for his observations and make him aware of the matters set out in this letter. A copy of this letter may be provided to the Judge if you consider this appropriate.


Column 662

Mr. Alfred Morris : To ask the Secretary of State for Health why he withheld from the courts documents that are wanted by the legal representatives of people with haemophilia who contracted the AIDS virus in the course of National Health Service treatment ; and if he will make a statement.

Mr. Kenneth Clarke : A number of documents were withheld because the Department of Health considered that a claim for public interest immunity applied to them. This immunity cannot be waived by the Crown.

The documents in question related to the period of office of both the previous Labour Government and the present Conservative Government.

Public interest immunity is a principle of law that prevents the dislosure of documents on the grounds that production of those documents would be injurious to the public interest. The immunity prevents the disclosure of, for example, documents which concern the inner workings of the Government machine or policy making within Departments. In the course of his judgment in the Court of Appeal on 20 September 1990 Lord Justice Ralph Gibson said :

"The Department of Health has raised the matter of public interest immunity so as to prevent the disclosure of [certain documents]. The Department does not do that in order to put difficulty in the way of plaintiffs, or to withhold from the Court documents which might help the plaintiffs. The Department raises the matter because it is the duty of the Department in law to do so in support of the public interest and the proper functioning of the public service, that is the executive arm of the Government It is not for the Department but for the Court to determine whether the documents should be produced. The plaintiffs acknowledge the validity of the claim to public interest immunity but ask the Court to order production notwithstanding the existence of a valid claim to immunity. It is essential that the aspect of these proceedings should be clearly understood.

The valid claim to immunity to be overridden by the order of the Court if the law requires that it should be overridden. The task of the Court is properly to balance the public interest in preserving the immunity on the one hand, and the public interest in the fair trial of the proceedings on the other".

Prescription Costs

Mr. Dunnachie : To ask the Secretary of State for Health, if his Department has considered research conducted by the Association of British Pharmaceutical Industries on estimated and actual prescription costs for the elderly; and if he will make a statement.

Mrs. Virginia Bottomley : We have received a copy of the ABPI briefing pamphlet "Trends in usage of prescription medicines by the elderly and the very elderly between 1977 and 1988". We agree with the general conclusion that the need for prescription medicines increases with aging population and progressively more so at the extreme end of the age spectrum. This will be reflected in the setting of indicative prescribing amounts for practices under the indicative prescribing scheme set out in "Improving Prescribing".

X-rays

Mr. Dunnachie : To ask the Secretary of State for Health if his Department considered research by the Royal College of Radiologists on effects of excessive X-ray treatment; and if he will make a statement.

Mr. Dorrell : We are considering the document entitled "Patient Dose Reduction in Diagnostic Radiology" issued


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