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Professional Association of Teachers

National Association of School Masters/Union of Women Teachers National Association of Head Teachers

Assistant Masters and Mistresses Association

Special Educational Needs

Local Authority Social Services Departments

Centre for Studies of Integration in Education

National Council for Special Education

Royal National Institute for the Blind

Royal National Institute for the Deaf

The Spastics Society

Special Educational Needs National Advisory Council

National Association of Independent and Non- Maintained Special Schools

Local Authority Professional Associations

Society of Education Officers

Society of Chief Architects in Local Authorities (SCALA) Association of Heads of County Property Departments

Society of Chief Electrical and Mechanical Engineers

Society of Chief Building Surveyors

Ethnic Minority Organisations

Afro-Caribbean Teachers Association

Asian Teachers Association

British Association of Muslims

Board of Deputies of British Jews Education Office

Federation of Bangladeshi Associations

Caribbean Teachers Association

Greek Cypriot Teachers Association

National Association of Hindu Associations

National Muslim Education Council for U.K.

Sikh Education Council

Standing Conference of Asian Organisations U.K.

The Islamic Academy

The Council of Mosques : U.K. and Eire

The Islamic School Trust

Muslim Educational Trust

Muslim Educational Services

Muslim Education Co-ordinating Council U.K.


The Chartered Institute of Building

National Confederation of Parent Teacher Associations

Association of Community Councils in Rural England (ACRE) Organisations maintaining non-maintained special schools Royal National Institute for the Blind


National Children's Home

The Shaftesbury Society

Invalid Children's Aid Nationwide

Order of the Sacred Hearts of Jesus and Mary (Essex)

Order of the Sacred Hearts of Jesus and Mary (Merseyside) The English Province of the Daughters of the Cross

The Sisters of Charity of St. Vincent de Paul

Order of the Dominicans

Royal London Society for the Blind

Christian Service Union

Boys' and Girls' Welfare Society

The Royal Eastern Counties Schools Ltd.


Henshaw's Society for the Blind

The Birmingham Royal Institute for the Blind

The Smith Foundation

The Royal Catholic Diocese of Arundel and Brighton

Other bodies

Local authority social services departments

Other organisations or individuals are of course welcome to write to the Department offering their views. The Welsh Office will, I understand, be consulting separately with organisations in Wales within the same time scale.

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Hospital Food Purchases

Mr. Nicholas Winterton : To ask the Secretary of State for Health what was the total cost of food purchased by NHS hospitals in each region in the last year for which figures are available.

Mr. Dorrell : Information derived from the annual accounts of regional and district health authorities in England is shown in the table.

Revenue expenditure on Hospital and Community Health Services           

Northern          |14,487                                               

Yorkshire         |15,718                                               

Trent             |17,945                                               

East Anglian      |8,566                                                

North West Thames |14,784                                               

North East Thames |19,886                                               

South East Thames |15,917                                               

South West Thames |13,676                                               

Wessex            |11,527                                               

Oxford            |8,668                                                

South Western     |12,950                                               

West Midlands     |21,548                                               

Mersey            |10,805                                               

North Western     |18,596                                               


Regions total     |205,073                                              


1. The expenditure relates to provisions purchased for patients and     

staff and is incurred predominately in hospitals; elements included for 

other services covered by HCHS-for example, community health-are not    

separately identifiable in the annual accounts.                         

2. The table excludes expenditure by the special health authorities for 

the London postgraduate teaching hospitals. Expenditure incurred by     

regional and district health authorities under contract catering        

arrangements, totalling some £14.1 million in 1989-90, is similarly     


Departmental Achievements

Mr. Pawsey : To ask the Secretary of State for Health if he will make a statement on the principal achievements of his Department since June 1987.

Mr. Waldegrave : The principal achievement since June 1987 has been the enactment of the reforms of the health service set out in the National Health Service and Community Care Act 1990. The reforms build on the fundamental principles of the national health service and on the achievements of the last 40 years, to secure the best possible use of the record level of resources now available for health care and to give patients, wherever they live in the United Kingdom, better health care and greater choice of services. Improved organisation and management of the national health service through clearer definition of responsibility between those purchasing health services in line with the needs of their local population and those providing and managing those services will be key elements. The national health service has made a positive response and welcomed the greater devolution and delegation of responsibility. Fifty- seven hospital trusts have already been announced and will come into effect from next April along with a substantial number of general practitioner fund holders. Considerable interest has been

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expressed by others wishing to follow in subsequent waves. These changes mean putting quality and responsiveness to the patient at the top of the agenda.

Since 1987, and throughout their period of office, the Government have remained firmly committed to the national health service as a service free to all regardless of means and funded primarily from central taxation. Gross United Kingdom spending has increased from £21.8 billion in 1987 -88 to a level of planned expenditure of £32.6 billion in 1991-92. United Kingdom per capita expenditure on the health service will have risen from £383 in 1987-88 to £567. The numbers of patients receiving treatment has continued to rise each year. Targets set in 1986 for cataracts and bone marrow transplants have been met and the target for hip replacements is close to being achieved. There has been a 23 per cent. increase in the total number of heart and lung transplants and a 72 per cent. increase in the number of liver transplants.

Besides the increases in the number of direct care staff, doctors and nurses are better paid. The Government have responded positively to the recommendations made by the respective independent review bodies. Last December, broad agreement was reached with the medical profession to reduce to 72 hours per week the long hours worked by junior hospital doctors in hard-pressed posts.

The NHS and Community Care Act 1990, also provides the framework for the development of domiciliary day and respite services to enable people to live in their own homes wherever feasible and sensible. This programme will have a phased introduction to avoid overburdening the agencies involved.

Since 1987, the Government have placed particular emphasis on the importance of health promotion and disease prevention. In 1990, immunisation and vaccination targets were set under the terms of the new contract for GPs. These have already led to improvements, particularly in the inner city areas where rates were generally low. Since 1988 all English health authorities have had a computerised call and recall system for cervical cancer screening. All women aged between 20 and 64 are expected to be brought into the programme by 1993. The first nationwide breast cancer screening programme in the European Community has been established, and important initiatives have been taken on teenage smoking, alcohol misuse, drug misuse, diet, food safety and coronary heart disease. In January 1988, the world summit of Ministers of Health was held in London, to look at programmes for combating the spread of AIDS. More than £10 million has been made available annually to health authorities and voluntary organisations to continue this work. Further progress has been made towards the WHO European region's 38 "Health For All" targets with many of those relating to health trends, lifestyles and healthy environment having been achieved. With the support of the leading health professions, the Government expect to produce a consultative document in the early part of 1991, which will form the first stages of a health strategy for England and provide the means for measuring improved health outcomes.

Other developments since June 1987 include the improved approach to child care practice under the Children Act 1989. Close working between magistrates courts, the higher courts and local authorities with the need for understanding new court processes will be

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important factors. The Human Fertilisation and Embryology Act 1990 addresses the complex legal and ethical issues surrounding embryos and embryo research.

Newmarket Hospital

Sir Eldon Griffiths : To ask the Secretary of State for Health when he expects to receive the Eastern regional health authority's proposals to run down Newmarket hospital to a community facility.

Mrs. Virginia Bottomley : The West Suffolk district health authority is currently consulting widely on the future of Newmarket hospital. The consultation period will end on 28 February. The district health authority will then make proposals to the East Anglian regional health authority. The regional health authority will consider these findings within the wider context of its proposed strategy for acute services in the south western part of the region. If the scheme preferred by the region and the district is formally opposed it will be referred to my right hon. Friend the Secretary of State.

The Gulf

Ms. Primarolo : To ask the Secretary of State for Health what is his estimate of the cost to the NHS arising from increased prescription of tranquilisers to those service men and women and their families who are suffering from trauma, stress and long-term mental illness consequent upon the war in the Gulf.

Mrs. Virginia Bottomley : There is no information available on which to base any such estimate.

Ms. Primarolo : To ask the Secretary of State for Health if the Chief Medical Officer is proposing to issue guidance to general practitioners in regard to the treatment of servicemen and women and their families suffering from trauma, stress and long-term mental illness following upon war in the Gulf with regard to the cost implications and avilability of psychotherapeutic treatment and drug-based treatment.

Mr. Dorrell : The Chief Medical Officer does not intend to issue guidance on what is a clinical matter. General practitioners regularly deal with people suffering from stress and mental illness using psychotherapeutic methods and drug treatment. Previous major incidents have given an increased understanding of the approaches which are most helpful.

Service men and women will be treated primarily by the services medical organisations. Families will in the main receive care from their general practitioners, in the usual way under national health service arrangements.

NHS Hospitals (Re-admissions)

Mr. Wray : To ask the Secretary of State for Health if he will make it his policy to collect central data of the number of patients in England and Wales who, having been discharged from national health service hospitals, required subsequent hospitalisation for (a) the same complaint or (b) a different but related complaint.

Mr. Dorrell : There are no plans to do so. Decisions about discharge are a matter for clinical judgment. Such decisions will be informed by medical audit but not by central collection of data.

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Food Hygiene Regulations

Mr. Steen : To ask the Secretary of State for Health whether Scotland will be exempted from the Food Hygiene (Amendment) Regulations 1990 ; and if he will make a statement.

Mr. Dorrell : The Food Hygiene (Amendment) Regulations 1990 apply to England and Wales only. Separate food hygiene regulations apply in Scotland, and amendments are under consideration in the Scottish Office.


Mr. Bellotti : To ask the Secretary of State for Health what plans the bio products laboratory has to import unlicensed high purity Factor VIII products from abroad for the treatment of haemophilia A patients ; and if he will make a statement.

Mr. Dorrell : The bio products laboratory--BPL--is responding to the demand from clinicians for high purity Factor VIII made from plasma provided by United Kingdom unpaid voluntary donors as recommended in World Health Organisation and EC guidelines. It has licensed the appropriate manufacturing technology and is modifying its production facility to manufacture the product locally. For a limited period while those modifications are carried out, and in the interest of meeting the demands as quickly as possible, the BPL has contracted Kabi of Sweden to undertake part of the manufacturing process from an intermediate material supplied by the BPL. This work will be undertaken under the supervision of BPL staff.

The BPL is not at present covered by the licensing requirements of the Medicines Act because of Crown immunity. However, some of its products and facilities are already so licensed and it will be seeking licences for other products, including high purity Factor VIII, under the arrangements leading to the removal of Crown immunity. For many years the BPL has been inspected by the medicines inspectorate and its product have been tested by the National Institute of Biological Standards and Control, as are similar licensed pharmaceutical products.

Mr. Bellotti : To ask the Secretary of State for Health what recent guidelines he has issued with regard to treatment of haemophilia A patients ; and what representations he has received.

Mr. Dorrell : Several representations have been received concerning the use of high purity factor VIII for the treatment of haemophilia A patients. The Department has not issued guidance on this matter ; decisions whether this treatment is appropriate for individual patients rest with the clinicians within the arrangements and protocols set locally for determining priorities among patient services, including prescribing costs.

NHS Trusts

Mr. Robin Cook : To ask the Secretary of State for Health what is the estimated level of (a) capital repayments, (b) interest payments, and (c) public dividend payments by national health service trusts to the Treasury in 1991-92.

Mr. Dorrell : We estimate that the level of capital repayments and interest payments to be made by NHS

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trusts in 1991-92 will be £70.2 million and £189 million respectively. Dividends payable on public dividend capital will not normally be declared or paid until after the end of the financial year once audited accounts are received.


Mr. Robin Cook : To ask the Secretary of State for Health by how much hospital and community health services revenue plans have been enhanced in 1991-92 to meet the provision in national health service trust prices for depreciation.

Mr. Dorrell : HCHS revenue plans have been enhanced by £164 million in the 1991-92 financial year to take account of depreciation provided for in NHS trust prices.

Junior Doctors

Mr. Terry Davis : To ask the Secretary of State for Health what reduction has taken place in the number of junior hospital doctors with a rota commitment greater than 1 : 3 in the west midlands region since 18 January 1989.

Mrs. Virginia Bottomley : This information is not held centrally. The hon. Member may wish to contact the chairman of the West Midlands regional health authority for details.

Hormone Drugs

Mr. Pendry : To ask the Secretary of State for Health what timetable, agency and funding has been agreed for his Department's survey into the use and misuse of hormone drugs ; and if he will make a statement.

Mr. Dorrell : The Government have decided in principle that a survey should be carried out into the prevalence of the misuse of steroid drugs. We are urgently considering the best way to take the survey forward. We hope to be able to give further details shortly and I will write to the hon. Member when these are available.

Food Poisoning, Preston

Dr. David Clark : To ask the Secretary of State for Health whether he is investigating the source of the outbreak of food poisoning caused by E. coli in the Preston area ; what other action he is taking in respect of this ; and if he will make a statement.

Mr. Dorrell : This outbreak is the subject of ongoing investigation by the public health laboratory service. The Department's Chief Medical Officer has issued a statement about the need for beefburgers and similar minced meat products to be thoroughly cooked before they are eaten. All local authority environmental health departments were notified of the outbreak and asked, through the Department's hazard warning system, to remind food businesses of the need to ensure beefburgers are properly cooked. Both the CMO's statement and the hazard warning notice have been placed in the Library.

The Government will consider the need for additional action in the light of the PHLS findings on the outbreak and other cases of human illness due to E.coli 0157 phage type 31 (variant) which have been reported around the country.

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