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Mrs. Virginia Bottomley : The majority of acute hospitals in the London area now have experience in looking after people with HIV infection and AIDS. Of these, Westminster (St. Stephen's), St. Mary's, the Middlesex, the Central Middlesex and the Royal Free hospitals have found the need to establish designated beds for the treatment of HIV because of high prevalence in their catchment areas.
In addition, a range of voluntary sector bodies provide community care for people with HIV and AIDS and have been given substantial Government financial support to assist them in this.
Mr. Chris Smith : To ask the Secretary of State for Health what representations he has made in relation to the practice of insurance companies of sometimes not revealing the result of an HIV test to an applicant for life insurance who has undergone a test at the company's request.
Mrs. Virginia Bottomley : We have discussed with the Association of British Insurers the procedures which insurers follow when asking an applicant for life insurance to have an HIV test. The Association of British Insurers has also discussed this issue with the Terrence Higgins Trust. The Association of British Insurers produced guidance in 1988 which laid out recommended procedures for counselling, and provided advice on the disclosure of a positive result to an applicant for life insurance. I understand from the Association of British Insurers that it intends to revise its guidance to include advice on the disclosure of negative results.
Mr. Chris Smith : To ask the Secretary of State for Health whether the Government have reconsidered their response to the recommendation in the seventh report from the Social Services Committee in Session 1988-89 that issuers should not ask proposers for life insurance whether they have ever had a test for HIV ; and what steps the Government have taken since the publication of the report to consider with the insurance industry the effects of asking proposers whether they have ever had a test for HIV.
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Mrs. Virginia Bottomley : I refer the hon. Member to the reply I gave the hon. Member for Birkenhead (Mr. Field) on 11 December at column 363 .Mr. Chris Smith : To ask the Secretary of State for Health whether the Government intend to initiate a voluntary or compulsory process of contact tracing for HIV.
Mrs. Virginia Bottomley : We have no plans to institute a mandatory procedure for contact tracing for HIV. It has always been the policy of staff of genito-urinary medicine clinics to counsel people who are HIV- positive of the desirability of informing their partners. Handling must be at the discretion of the staff of the clinics ; the wishes of the person concerned are, and must remain, paramount.
Mr. Chris Smith : To ask the Secretary of State for Health what funds are paid to the voluntary sector for HIV-AIDS work, other than direct grants from his Department.
Mrs. Virginia Bottomley : The Department makes substantial sums available to both health and local authorities for services for people affected by AIDS-HIV. Authorities are able to use these funds to make grants to voluntary groups in the AIDS field. However this is a matter for local discretion and the Department does not hold central records of such grants made.
Life Insurance (High-risk Groups)
Mr. Chris Smith : To ask the Secretary of State for Health what representations he has made to insurance companies in the United Kingdom in connection with references in the supplementary questionnaire for life insurance applications to high-risk groups established by health authorities ; and what consideration he has given, in relation to public education on the risk of HIV infection, about the relative merits of reference to high-risk groups and to high-risk behaviour.
Mrs. Virginia Bottomley : We occasionally hear of letters from insurers which imply, or are taken to imply, that the Government require insurers to send supplementary lifestyle questionnaires to applicants for life insurance. This is not the case, and we bring cases that come to our attention to the Association of British Insurers so that it can take the matter up with the company involved. We no longer refer to risk groups, as it is a person's behaviour which determines whether they are at risk of contracting HIV, not their membership of a particular group in society. Our public education campaign messages reflect this.
Human Fertilisation and Embryology Act
Mr. Alton : To ask the Secretary of State for Health what plans he has to ensure the publication of statistics regarding the operation of the Human Fertilisation and Embryology Act 1990 ; and what statistics will be published.
Mrs. Virginia Bottomley : Under section 7 of the Human Fertilisation and Embryology Act, the Human Fertilisation and Embryology Authority is required to send to my right hon. Friend the Secretary of State an annual report on the authority's activities. It will be for the authority itself to decide whether and how to publish any statistics.
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Mr. Alton : To ask the Secretary of State for Health what plans he has to ensure that the public are consulted prior to licences being issued under the Human Fertilisation and Embryology Act 1990.
Mrs. Virginia Bottomley : Responsibility for licensing arrangements will rest with the Human Fertilisation and Embryology Authority which was established under section 5 of the Human Fertilisation and Embryology Act. The Act does not require the authority to consult the public prior to the issue of licences.
Abortion
205. Mr. Alton : To ask the Secretary of State for Health what plans he has to ensure that doctors aborting babies of 24 weeks' gestation and more attempt to preserve the baby's life.
Mrs. Virginia Bottomley : The decision as to the most suitable method of treatment in any particular case is a matter for the clinical judgment of the doctor concerned in the light of all the relevant clinical issues and circumstances of the case.
Mr. Alton : To ask the Secretary of State for Health what information he has on the complication rate associated with mothers undergoing an abortion in the NHS as compared with those undergoing abortion in a private clinic.
Mrs. Virginia Bottomley : The available information is in the following table :--
Complications of legal abortions to residents and non residents 1989
(England and Wales)
All Gestations
NHS Rates per Non-NHS
1,000 abortions Rates per 1,000
abortions
Reported Complication Total |544 |7.68 |91 |0.80
Sepsis |35 |0.49 |2 |0.02
Haemorrhage |211 |2.98 |27 |0.24
Perforation |120 |1.69 |43 |0.38
Other |178 |2.51 |19 |0.17
This information is derived from the notification forms submitted to the chief medical officer. The Department has sponsored a long-term prospective study by the Royal College of General Practitioners and the Royal College of Obstetricians and Gynaecologists into this matter. Some results were published in 1985 in the Journal of the Royal College of General Practitioners, vol. 35, pages 175-180, appendix III, a copy of which has been placed in the Library.
Mr. Alton : To ask the Secretary of State for Health what studies his Department has conducted of the reasons for the rise in the abortion rate from 1969 to 1989.
Mrs. Virginia Bottomley : No studies on this specific issue have been funded by the Department.
RU 486 Abortion Pill
Mr. Alton : To ask the Secretary of State for Health (1) what studies his Department has conducted or is aware of concerning the effect on the mental health of the mother of the RU 486 abortion pill ;
(2) in what percentage of cases the use of the RU 486 abortion pill caused abortion without recourse to any further methods of abortion ;
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(3) if he will list known short-term side effects on the mother of the RU 486 abortion pill ;(4) in what percentage of cases the use of the RU 486 abortion pill is supplemented by the use of (a) prostaglandins, (b) surgical methods and (c) both of these ;
(5) what information he has on the effects on the unborn child of the RU 486 abortion pill in those cases where abortion does not occur ;
(6) if he will list the known long-term side-effects on the mother of the RU 486 abortion pill.
Mrs. Virginia Bottomley : I understand that the manufacturer of RU 486 has applied for a product licence under the Medicines Act. Section 118 of that Act precludes the disclosure of any information relating to a produce licence application. However, studies in the use of RU 486 are well documented in the British Journal of Obstetrics and Gynaecology , June 1990, Vol. 97, pp 480-486 and in The New England Journal of Medicine, March 8 1990, Vol. 322, No. 10 pp 645-648, copies of which have been placed in the Library.
Day Surgery Facilities
Ms. Harman : To ask the Secretary of State for Health if he intends to issue any guidelines about the proportion of new day surgery facilities which may be used for (a) private and (b) national health service patients.
Mr. Dorrell : This is a matter for local decision.
Mentally Disordered Offenders
Mr. Burt : To ask the Secretary of State for Health if he will make a statement about the review of services for mentally disordered offenders.
Mr. Dorrell : A review of health and social services for mentally disordered offenders is being undertaken jointly by the Department and the Home Office. We have appointed a steering committee, whose terms of reference are :
"To plan, co-ordinate and direct a review of the Health and social services provided in England by the NHS, Special Hospitals Service Authority, and local authorities for mentally disordered offenders (and others requiring similar services without having come before the courts), with a view to determining whether changes are needed in the current level, pattern, or operation of services and identifying ways of promoting such changes, having regard to :
the development of new management arrangements in the NHS and the proposals for the development of community care ;
the implications for NHS forensic psychiatry of action to follow up the report of the Home Office Efficiency Scrutiny on the Prison Medical Service ;
any relevant recommendations of the inquiry into the Strangeways prison disturbances (the Woolf Inquiry and other prison-related inquiries) ;
and including consideration of :
present arrangements for funding services and service developments, and their possible improvement ;
relevant research studies.
To produce regular reports to the Department of Health and the Home Office on the progress of the review and its findings, together with its recommendations.
The review will be essentially concerned with assessing how services should be developed within the framework of existing legislation. It is not intended as a review of the law. However, the steering committee may propose amendments to the law if it considers that they would materially further the longer-term objectives of the review."
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The following have been appointed to membership of the steering committee :Dr. J. L. Reed (Senior Principal Medical Officer, Department of Health) (Chairman)
Mr. R. Baxter (Grade 5, Home Office) (Joint Secretary) Professor R. S. Bluglass (Professor of Forensic Psychiatry, University of Birmingham)
Miss E. A. Crowther (Director of Social Services, City of London) Mr. A. J. Davies (Director of Operations, Special Hospitals Service Authority)
Mr. A. H. Fender (Director of Strategic Planning, Wessex Regional Health Authority)
Professor J. Gunn (Department of Forensic Psychiatry, Institute of Psychiatry)
Mr. P. R. Herring (Director of Finance, St. Helens and Knowsley Hospital Trust)
Mr. I. Jewesbury (Grade 5, Department of Health) (Joint Secretary)
Mr. L. R. Joyce (Unit General Manager, Mental Illness Care Group, Newcastle Health Authority)
Dr. J. O'Grady (Consultant Psychiatrist, Newcastle Health Authority)
Mr. E. Packer (Clerk to Wimbledon Magistrates)
Mr. J. Parry (Senior Nurse Manager, Regional Forensic Services, Mersey Regional Health Authority)
Mr. G. W. Smith (Chief Probation Officer, Inner London Probation Service)
Mr. J. G. Smith (Assistant Chief Inspector, Social Services Inspectorate)
Mr. J. Tait (Principal Nursing Officer, Department of Health) Dr. Pamela M. Taylor (Director of Medical Services, Special Hospitals Service Authority)
Dr. Rosemary Wool (Director, Prison Medical Service)
Discussions are in progress with the police and prison services about how those interests might be represented.
The committee will begin its work early in the new year. The review is due to be completed by mid-1992.
Disabled People
Mr. Burt : To ask the Secretary of State for Health when he will next be reporting under section 11 of the Disabled Persons (Services, Consultation and Representation) Act 1986.
Mr. Dorrell : I have today laid before the House the report required by section 11 of the Disabled Persons (Services, Consultation and Representation) Act 1986. This report draws together the major initiatives taken by the Government during 1990 to improve services for people suffering from mental illness and mental handicap.
During 1990, the Government have authorised extra health and social service expenditure of £154 million over three years on services for people with a mental illness.
1. The new mental illness specific grant will support revenue expenditure of £90 million by social service departments. 2. The capital loans fund will provide £50 million to allow health authorities to provide modern facilities to replace long-stay psychiatric hospitals.
3. The Government has authorised £10 million of capital expenditure by local authorities in 1991-92 to develop facilities for the mentally ill.
4. The homeless mentally ill initiative will provide capital expenditure of £4 million to tackle the problem of homeless mentally ill people in London.
In addition to these extra resources, health authorities will be required from April 1991 to have instituted a care programme approach for people being treated in the community. This will ensure that the needs of each patient are assessed and that effective arrangements are made to ensure that those needs are met.
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The Government have also announced a review of services for mentally disordered offenders. I am today announcing the membership of a steering committee whose task will be to review provision for mentally disordered offenders to ensure that they receive care and treatment in hospitals designed to meet their needs, rather than finding their way by default into the criminal justice system. This is a record of progress which demonstrates the Government's commitment to provide high- quality locally based services, which meet the needs of people who suffer from mental illness and mental handicap. I expect to make a statement about the further development of services for people with a mental handicap early in 1991.Clinical Audit
Mr. Roger King : To ask the Secretary of State for Health what steps he is taking to extend the benefits of clinical audit in the national health service beyond the medical and nursing professions.
Mrs. Virginia Bottomley : We welcome efforts by all health care professions to look systematically at the quality and effectiveness of their work. The Department is working with the professional bodies of the clinical psychology, occupational therapy, physiotherapy and speech therapy professions on the development of clinical audit in these fields. Last month, we established an initial research study which will start by examining the feasibility of multidisciplinary audit across these areas. This will report early next year, and will be followed up by further development work. I have no doubt that clinical audit will enable these vital professions to improve the service they give to patients still further, just as it will in medicine and nursing.
Macfarlane Trusts
Mr. Robin Cook : To ask the Secretary of State for Health what will be the source of the funding of the £42 million additional payment through the Macfarlane Trusts ; and whether this will be met by a fresh allocation to his departmental budget.
Mrs. Virginia Bottomley : The payment will be made from class XIII, vote 3, as have previous payments to the Macfarlane Trusts and subject to parliamentary approval of the necessary supplementary estimate, the cash limit for this vote will be increased accordingly.
GPs (Reimbursements)
Mr. Parry : To ask the Secretary of State for Health if he will give an immediate reply to the letter from the hon. Member for Liverpool, Riverside concerning general practitioners'
reimbursements.
Mr. Dorrell : My noble Friend the Parliamentary Under-Secretary of State replied on 14 December.
Mr. Parry : To ask the Secretary of State for Health how many general practitioners have had their reimbursements stopped in Liverpool in each of the past five years.
Mrs. Virginia Bottomley : We wrote to the chairman of Liverpool family health services authority on 14 December asking her to supply the hon. Member directly with this information about rent and rates reimbursements.
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Motor Neurone Disease
Mr. Ashley : To ask the Secretary of State for Health what steps he is taking to ensure that health authorities and local authorities are enabled to respond quickly to the community care needs of people with motor neurone disease.
Mr. Dorrell : In November 1988, the Department issued guidance to health and local authorities which drew attention to the particular needs of people with progressive neurological conditions including motor neurone disease. The provisions of the National Health Service and Community Care Act 1990 and the associated policy guidance are designed to ensure collaboration between authorities in drawing up community care plans and in assessing needs for community care on an individual basis.
Mr. Ashley : To ask the Secretary of State for Health (1) what research his Department has carried out into the incidence of motor neurone disease (a) in the United Kingdom and (b) in other developed countries ;
(2) how much his Department spends annually on research into the causes of motor neurone disease ;
(3) what research his Department has carried out or commissioned into the causes of motor neurone disease.
Mr. Dorrell : The Department has not carried out or commissioned research into the causes or the incidence of motor neurone disease. The main agency through which the Government support biomedical and clinical research is the Medical Research Council, which receives its grant in aid from the Department of Education and Science.
Mr. Ashley : To ask the Secretary of State for Health what is his Department's estimate of the number of people who have motor neurone disease.
Mr. Dorrell : Information on the prevalence of motor neurone disease is not collected centrally.
Ambulance Services
Mr. Corbyn : To ask the Secretary of State for Health by what criteria appointments were made to the board of the London ambulance service ; for how long their appointments will last ; and if he will make a statement.
Mr. Dorrell : The board of the London ambulance service was appointed by South West Thames regional health authority, which has overall responsibility for the London ambulance service. The five board members were chosen for the contributions they could make to the various activities of the LAS. Four were nominated by the Thames regional health authorities, and one member was the chairman of the former ambulance service panel. Each appointment is for two years.
Mr. Corbyn : To ask the Secretary of State for Health what arrangements are permissible for ambulance authorities to pay supplemental housing allowances for their chief officers ; how many such arrangements have been approved by him ; and if he will make a statement.
Mrs. Virginia Bottomley : Health authorities have discretion to determine local conditions of service for senior national health service managers, including chief ambulance officers, subject to any overriding national agreement or direction. There is no applicable central
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agreement providing for housing allowances, nor have Ministers been asked to approve any special arrangements.Mr. Corbyn : To ask the Secretary of State for Health if he will call for a report from the Hertfordshire ambulance service on its practice of charging hospice residents for use of non-emergency services ; and if he will make a statement.
Mr. Dorrell : I understand that Hertfordshire ambulance service is not charging national health service patients for transportation to and from hospices.
Mr. Corbyn : To ask the Secretary of State for Health what meetings he or officials of his Department have held with the chair and chief officer of the London ambulance service.
Mr. Dorrell : My right hon. and learned Friend the then Secretary of State for Health met the chairman of the London ambulance service on his appointment, and my noble Friend the Parliamentary Under-Secretary of State for Health met the chief executive of the LAS in October to discuss general issues. Additionally, the Department's ambulance adviser has regular, informal meetings with the chief executive of the LAS.
Mr. Corbyn : To ask the Secretary of State for Health what advice is given to ambulance services concerning the purchase of computer information systems ; what compatability exists between systems ; and if he will make a statement.
Mr. Dorrell : General advice on the procurement of information technology has been issued to the national health service. Decisions on the purchase of equipment for ambulance services rest with local health authority management who would have regard to prevailing local strategies for information systems and value for money.
Hospices
Mr. Corbyn : To ask the Secretary of State for Health how much money was paid per year, for each of the last 10 years, by his Department to voluntary hospices, and how much was paid by local health authorities.
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