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Mrs. Virginia Bottomley : There is no compulsion to apply for trust status : it is a decision to be taken by each
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unit independently. We have no intention of limiting the numbers of units which can become trusts other than by rejecting applications where the selection criteria are not fulfilled.Mr. Hinchliffe : To ask the Secretary of State for Health if he will publish the guidance which has been given to the chairmen and chief executives of NHS trusts with regard to their making political statements or comments ; and if he will make a statement.
Mr. Waldegrave : No such guidance has been issued.
Mr. Hardy : To ask the Secretary of State for Health if he will seek powers to prevent health service trusts from entering commercial activity other than those related to matters of direct relevance to health ; and if any trusts have commenced engagement in such activity.
Mrs. Virginia Bottomley : Powers, which are already available to health authorities, were extended to trusts to enable them to enter into commercial activities, for the purpose of generating additional income, provided that these activities do not adversely affect or reduce services to national health service patients ; that profits are reinvested back into the health service and that the scheme does not conflict with national policy or cause ethical or legal problems.
It is for the trusts themselves to determine how to use these powers to the benefit of patients.
Mr. Hardy : To ask the Secretary of State for Health what salaries or other emoluments are paid to the doctors of those NHS trusts which have been established within south Yorkshire.
Mrs. Virginia Bottomley : This information is not held centrally. The salaries of doctors of national health ervice trusts and those of other staff are a matter for the trust board. The hon. Member may wish to write to the chairman of the NHS trusts concerned for details.
Mr. Robin Cook : To ask the Secretary of State for Health if he will publish details of the originating debt, including its division between public dividend capital and interest bearing debt, of each of the national health service trusts.
Mr. Waldegrave [holding answer 20 May 1991] : The originating capital debt for national health service trusts will be equal to the value of the net assets transferred to the trusts on 1 April 1991, which will be determined when the accounts of the relevant health authorities have been prepared and audited. At that stage an order will be made by statutory instrument under section 9 of the National Health Service and Community Care Act 1990 setting out the composition and terms of the originating capital debt.
Census
Mr. Wigley : To ask the Secretary of State for Health what instructions were given to census enumerators in Wales with regard to making freely available to each household a set of census forms in the Welsh language ; and if he will make a statement.
Mr. Dorrell : Census enumerators were instructed to offer all households in Wales the choice of a Welsh or English form as part of the form delivery procedure.
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Regrettably, reports were received that some enumerators had not done so. Special instructions were therefore issued to ensure that when the enumerator called back to collect completed forms, anyone who had not been offered a Welsh form could obtain one from the enumerator who would call back later to collect it when completed. All English language household forms used in Wales contained a prominent note enabling people who wanted a Welsh language form to get one by telephoning the census inquiry number.I hope that these measures have ensured that everyone in Wales who wanted to use a Welsh form was able to do so.
Mr. Wigley : To ask the Secretary of State for Health how many of the forms used at the recent census were printed in the Welsh language.
Mr. Dorrell : All public census forms for issue in Wales were available in both Welsh and English ; 200,000 household forms, 90,000 individual forms, and 10,000 listing forms for use in communal establishments were printed in Welsh. Figures are not yet available on how many were used.
Mr. Wigley : To ask the Secretary of State for Health how many complaints he has received arising from the administration of the recent census, arising from (a) England, (b) Scotland, (c) Wales and (d) Northern Ireland, respectively ; and if he will list the main grounds of complaint in each country.
Mr. Dorrell : We received 73 letters between 1 April and 21 May from right hon. and hon. Members in England and Wales conveying comments from constituents on aspects of the census. The Registrar General is replying to 69 other letters from right hon. and hon. Members who have written to him or whose letters have been forwarded to him from Ministers in other Departments. No analysis of the different aspects of the census mentioned in the correspondence is available yet.
Information relating to Scotland and Northern Ireland, is a matter for my right hon. Friends the Secretaries of State for Scotland and for Northern Ireland.
Resource Management Initiative
Mr. Robin Cook : To ask the Secretary of State for Health what has been the total level of expenditure on the resource management initiative.
Mr. Waldegrave : At 31 March 1991, the Department had made available £97.6 million of central funds to support the resource management initiative and the subsequent resource management programme. Regional and district health authorities and individual hospitals have provided some additional funding for individual projects.
Mr. Robin Cook : To ask the Secretary of State for Health what progress has been made in the joint evaluation of the resource management initiative by the NHS management executive and the joint consultants committee.
Mr. Waldegrave : Discussions between the NHS management executive and the joint consultants committee in 1989 and 1990 concluded that a formal full-scale joint evaluation of the resource management initiative was
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impracticable. The NHS management executive has taken account of evidence from the evaluation of resource management commissioned from Brunel university and other sources in reaching decisions to extend the resource management programme. The joint consultants committee issued its own guidance on hospital management arrangements in June 1990.Mr. Robin Cook : To ask the Secretary of State for Health what work has been undertaken by his Department and by consultants retained by his Department on the effectiveness of the resource management initiative ; and what have been the conclusions of this work.
Mr. Waldegrave : The Department commissioned Brunel university to undertake an evaluation of resource management as demonstrated at the six acute pilot sites included in the initial resource management initiative. The evaluation began in 1988 and was completed at the end of 1990. The final report, "The Brunel University evaluation of Resource Management", a copy of which will be placed in the Library, concluded that progress in implementing
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resource management at the pilot sites has been slower than originally anticipated, but that substantial progress has been made and continues to be made at each of the sites. The report also suggested that the pilot sites have provided valuable lessons for the future development of resource management. A copy of the report has been placed in the Library.Hospital and Community Health Services
Mr. Robin Cook : To ask the Secretary of State for Health what was the total level of HCHS net capital expenditure in (a) cash, (b) constant prices adjusted by the gross domestic product deflator and (c) constant prices adjusted by the changes in input unit costs in the years (1) 1974-75 to 1978-79 and (2) 1979-80 to 1990-91.
Mr. Waldegrave : The information requested is given in the table. In order to give a complete picture of capital investment in the national health service, spending financed through proceeds of land and property is also shown.
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HCHS Capital since 1974-75
Public expenCapital receTotal ExpendTotal at 1990-91 prices adjus
(mainly land sales) by the GDP dfor the change in
input unit costs
|A |B |A |B |A |B |A |B |A |B
--------------------------------------------------------------------------
1974-75 |- |243 |- |- |- |243 |- |1,101|- |1,157
1975-76 |- |327 |- |- |- |327 |- |1,181|- |1,192
1976-77 |- |356 |- |- |- |356 |- |1,132|- |1.159
1977-78 |- |315 |- |- |- |315 |- |881 |- |897
1978-79 |- |358 |- |8 |- |366 |- |923 |- |933
1979-80 |- |395 |- |10 |- |405 |- |876 |- |855
1980-81 |- |540 |- |16 |- |556 |- |1,016|- |933
1981-82 |- |651 |- |20 |- |671 |- |1,118|- |1,091
1982-83 |- |682 |- |19 |- |701 |- |1,091|- |1,122
1983-84 |- |692 |- |33 |- |725 |- |1,078|- |1,137
1984-85 |- |767 |- |50 |- |817 |- |1,156|- |1,230
1985-86 |899 |803 |85 |85 |985 |888 |1,322|1,192|1,400|1,262
1986-87 |915 |- |149 |- |1,064|- |1,380|- |1,441|-
1987-88 |914 |- |201 |- |1,115|- |1,373|- |1,436|-
1988-89 |922 |- |279 |- |1,201|- |1,377|- |1,462|-
1989-90 |1,206|- |232 |- |1,438|- |1,549|- |1,603|-
1990-91 |1,458|- |220 |- |1,678|- |1,678|- |1,678|-
Because of transfers between programmes it is not possible to produce a
consistent run of figures over the whole period. Figures in Presentation
A have been adjusted to reflect the transfer to HCHS of FHS
Administration, Disablement Services Authority and FHS cash limited
spending.
The figures in Presentation B do not reflect these transfers and are
therefore not comparable with those for later years.
NHS (Waiting Times)
Mr. Rowe : To ask the Secretary of State for Health what information is kept by the NHS on the length of time NHS staff at (a) doctor level and (b) other levels wait for various types of operation.
Mrs. Virginia Bottomley : Information is not collected on waiting time by occupational group.
Sign Language Interpreters
Mr. Redmond : To ask the Secretary of State for Health, pursuant to his answer of 7 May, Official Report, column 423, to the hon. Member for Don Valley, if he will make it his policy to collect information centrally in respect of health authorities that provide British sign language interpreters for deaf and hard of hearing patients.
Mr. Dorrell : It is up to providers of health services to make arrangements locally to assist communication with
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patients with hearing impairment. We see no useful purpose in collecting information centrally on these arrangements.Dentists (Doncaster)
Mr. Redmond : To ask the Secretary of State for Health how many dentists to date in the Doncaster area have withdrawn from the national health service since the introduction of the new dental contracts.
Mr. Dorrell : Between 1 October 1990, the date the new dental contract was introduced, and 30 April 1991, the latest date for which figures are available, four dentists withdrew from Doncaster family health services authority's dental list, out of a total of 85. Two have joined dental lists in other areas. During the same period the names of 11 dentists have been added to Doncaster's dental list.
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Intestinal Cancer
Mr. Pawsey : To ask the Secretary of State for Health if he will fund the introduction of a national screening system for the early detection of intestinal cancer via occult foetal blood tests.
Mrs. Virginia Bottomley : It would be premature to consider this before we know the outcome of a study, which the Department and the Medical Research Council are currently funding, to evaluate screening for colorectal cancer.
Discharged Patients
Mr. Redmond : To ask the Secretary of State for Health if he will list for the last 12 months for each (a) regional health authority and (b) district health authority in England and Wales, the number of national health service patients who have been discharged from national health service hospitals, and who within three months required subsequent hospitalisation for (i) the same complaint or (ii) a different but related complaint.
Mr. Dorrell : This information is not collected centrally.
World No Tobacco Day
Mr. Amos : To ask the Secretary of State for Health what plans his Department has to mark World No Tobacco Day on 31 May ; and if he will make a statement.
Mr. Dorrell : The main United Kingdom event in this field, on which efforts are concentrated, is our own long established and successful No Smoking Day. We recognise, however, the importance of World No Tobacco Day, particularly in those countries which do not organise their own national event and we try to give it suitable recognition. This year the Health Education Authority (HEA) will be supplying each health education unit and environmental health unit in England with question and answer booklets on passive smoking together with posters, stickers and ideas for action.
The HEA is also co-operating with Taxi magazine in a promotion designed to encourage smoke-free cabs.
Dental Technicians
Mr. Teddy Taylor : To ask the Secretary of State for Health how many prosecutions were taken by the General Dental Council against dental technicians during the year 1990 for illegal practice of dentistry in the provision of dentures ; and what was their outcome.
Mr. Dorrell : I understand from the General Dental Council that one dental technician was prosecuted during 1990 for practising dentistry illegally. The defendant pleaded guilty to three separate charges and was fined £750 on each count and ordered to pay costs of £200.
Conisbrough Hospital, Doncaster
Mr. Redmond : To ask the Secretary of State for Health what response he has made to the notification by the chairman of Doncaster health authority of the intended closure of Conisbrough hospital.
Mr. Dorrell : I understand that Doncaster health authority is due to consult locally on the proposed closure
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of Conisbrough hospital at the end of May. If after full and public consultation the community health council contests the proposed closure, it will be put to my right hon. Friend the Secretary of State for a decision.Budgeting and Charging (Doncaster)
Mr. Redmond : To ask the Secretary of State for Health what arrangements he has made with the chairman of Doncaster health authority concerning a smoothing mechanism operating after 1 April in respect of the new budgeting system and the new charging system for cross-border flows of patients to hospitals and clinics.
Mrs. Virginia Bottomley : District health authorities as commissioners of health services consulted general practitioners in their areas before making contracts with hospital and other providers to reflect their views and existing referral patterns. They are also holding cash reserves for patients referred by general practitioners outside the contractual framework.
Junior Hospital Doctors
Mr. Wigley : To ask the Secretary of State for Health if he will make a statement on what progress has been achieved in reducing the hours worked by junior hospital doctors.
Mrs. Virginia Bottomley : The ministerial group on junior doctors' hours, which I chair, is making good progress in implementing the heads of agreement on junior doctors' hours signed in December last year, a copy of which is available in the Library. Task forces have been set up in every region and have already received guidance on the role they are to play in reducing the hours and improving the working conditions of doctors in training. Funding for an additional 200 consultant and 50 staff grade posts has been allocated to the regions, along with notice of 100 additional senior house officer posts to assist in the initiative. In conjunction with the profession, we hope to launch the full package of guidance outlined in the heads of agreement in the near future.
Nurses
Mr. Redmond : To ask the Secretary of State for Health if he will give for the latest date he has available, for each health authority in England and Wales (a) the number of nurses employed as (i) nursing assistants, (ii) enrolled nurses, (iii) staff nurses and (iv) charge nurses and (b) the numbers in absolute and percentage terms at which nurses are employed in each category ; and what were the comparable figures five and 10 years ago.
Mrs. Virginia Bottomley : This information could be provided only at disproportionate cost.
Buerger's Disease
Mr. Straw : To ask the Secretary of State for Health how many cases of Buerger's disease have been recorded in each of the last five years for which data are available ; and in how many cases this has been given as the cause of death.
Mr. Dorrell : The only information held centrally which can be provided without incurring disproportionate cost is given in the table. This relates to the number of patients
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treated in NHS hospitals in England where Thromboangiitis obliterans (Buerger's disease) has been recorded as the primary diagnosis.Estimated numbers of discharges and deaths (1984-85) and ordinary and day case admissions (1987-88/1989-90) where main diagnosis was ICD 443.1: thromboangiitis obliterans (Buerger's disease) 443.1 Buerger's disease Year |Number of in-patients ------------------------------------------------------------------ 1984 |93 1985 |103 1987-88 |143 1988-89 |123 1989-90 |114 Source: HIPE 1984-85 and HES 1987-88/1989-90. Data compiled by SM12A.
These numbers are provisional estimates based on incomplete data and may be subject to revision.
Mr. Straw : To ask the Secretary of State for Health what research has been carried out into the link between smoking and Buerger's disease ; and what assessment he has made of the adequacy of the publicity given to the dangers of Buerger's disease from smoking.
Mr. Dorrell : We are not aware of any current research in this area. Buerger's disease is a rare form of peripheral vascular disease, the cause of which remains unknown, although a close association with the habitual use of tobacco, particularly cigarette smoking, is indisputable. The Health Education Authority is aware of the association between smoking and Buerger's disease and seeks to publicise this as part of its anti-smoking programmes, although other smoking-related diseases result in far higher levels of mortality and morbidity.
St. Charles Youth Treatment Centre
Mr. Hinchliffe : To ask the Secretary of State for Health if he will publish his Department's report on the St. Charles youth treatment centre in Brentwood, Essex ; and if he will make a statement.
Mrs. Virginia Bottomley : Earlier this year, a young person made a number of serious complaints about aspects of treatment while at St. Charles youth treatment centre. These have been investigated on behalf of the Department by a team of independent experts. They have submitted their report. This contains confidential personal and medical information and cannot be made public. The Department is urgently considering the team's findings, and will make its conclusions public after the young person involved has been informed of the outcome. Any action required in the light of the team's findings will be taken with the utmost vigour.
Diabetics
Mr. Morley : To ask the Secretary of State for Health whether cassette needles used by diabetics will be made available free of charge on the same basis as existing needles and syringes supplied for their needs ; and if he will make a statement.
Mrs. Virginia Bottomley : National health service supply arrangements for insulin pens and needles need to be considered together. Subject to our normal evaluation of individual brands, we would consider making pens and
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needles prescribable, as an alternative to syringes, provided that this can be done without additional cost. Discussions with suppliers are currently in progress.Incontinence Aids
Mr. Hinchliffe : To ask the Secretary of State for Health if he will list (a) which regional health authorities have a policy of providing incontinence aids free to residents of private residential or nursing homes who have been referred by doctors or nurses and (b) which district health authorities do not provide incontinence aids free in the same circumstances.
Mr. Dorrell : This information is not held centrally.
Leeds General Infirmary
Mr. Fatchett : To ask the Secretary of State for Health whether he will review the proposals made by the Leeds general infirmary hospital trust to increase the number of private beds at the Leeds general infirmary ; and if he will make a statement.
Mrs. Virginia Bottomley : The provision of private beds at the Leeds general infirmary and associated hospitals national health service trust is a matter for the management board. I understand from the management of the trust that there are no plans to increase the number of private beds.
Sudden Infant Death Syndrome
Mr. Ashley : To ask the Secretary of State for Health on what date he received the report of the independent experts examining the possibility of a link between the release of toxic gases from certain cot mattresses and sudden infant death syndrome ; if he will give a date for its publication ; and if he will make a statement.
Mrs. Virginia Bottomley : The report was given to the chief medical officer on 5 February, publication is imminent and the Department will then respond to the recommendations of the expert group.
General Practitioners
Mr. Blunkett : To ask the Secretary of State for Health what action he intends to take to ensure that non-fund-holding general practices in the city of Sheffield are able to place patients in hospitals outside the authority area, where required for the most appropriate patient care and speediest treatment ; and if he will make a statement.
Mrs. Virginia Bottomley : General practitioners remain free to refer patients to hospitals outside their district boundaries. Indeed, the reforms offer improved arrangements to giving practical effect to this freedom.
Guidance, "Contracts for Health Services : Operational Principles", issued to the national health service on 29 September 1989, a copy of which is available in the Library, made it clear that district health authorities' objective should be to secure contracts which reflect the referral patterns local general practitioners prefer. There has been an unprecedented level of consultation between district health authorities and local general practitioners to achieve this. District health authorities are also holding reserves of funds for referrals where no contract has been secured in advance.
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Mr. Blunkett : To ask the Secretary of State for Health if he will publish general practitioner fund-holding contracts.Mr. Dorrell : Guidance to the National Health Service (EL(90)MB24, a copy of which is available in the Library) has made it clear that contracts for health services with both public and private providers should be made publicly available once they are signed.
Mr. Blunkett : To ask the Secretary of State for Health what guidance he has given on the relationship between general practitioner fund -holding practices and community health councils regarding their health purchasing policies of such general practitioners.
Mr. Dorrell : None. The community health council has a statutory relationship with the district health authority which retains overall planning responsibility for the provision of health services to all residents, including those on the lists of fund-holding general practitioners.
Mr. Blunkett : To ask the Secretary of State for Health what representations he has received concerning the Far Lane general practitioner fund-holding practice in Sheffield ; and if he will make a statement.
Mr. Dorrell : I have received one such representation from the Sheffield local medical committee, whom I met on Wednesday 22 May. The Far Lane fund-holding practice in Sheffield has legitimately set up a company which is employing consultants to provide a range of services for patients. Regional health authorities are required to agree to such arrangements only where they constitute good value for money by comparison with the alternatives and meet the requisite quality standards for the provision of care. The Trent regional health authority has confirmed that it is content with the arrangements at this practice.
Mr. Blunkett : To ask the Secretary of State for Health what guidelines he has issued concerning the use of general practitioner fund holders' premises for private practice ; and if he will make a statement.
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Mr. Dorrell : No guidance has been issued specifically to fund holders. GPs, as independent contractors, are free to use as they like the premises which they own. The conditions for payments to GPs in respect of their surgery premises, are set out in the statement of fees and allowances.
Creutzfeldt-Jakob Disease
Dr. David Clark : To ask the Secretary of State for Health if he will give the incidence for Creutzfeldt-Jakob disease over the last 10 years in each standard cohort age range of onset of clinical symptoms ; and if he will make a statement.
Mr. Dorrell : The information requested is not available centrally. Accurate information on current and previous cases of
Creutzfeldt-Jakob disease should be forthcoming from the study being conducted by Dr. R. G. Will supported by the Department of Health. In the 1970s, the last time this analysis was undertaken, the peak age-specific incidence was for the 65 to 69 year age group and was 1.7 cases per million per year. Copies of Dr. Will's publication on this analysis will be placed in the Library.
Steroid Drugs
Mr. Pendry : To ask the Secretary of State for Health further to the written answer of 19 February, Official Report, column 87, to the hon. Member for Stalybridge and Hyde, what progress has been made on deciding the timetable, agency and funding of the Government's proposed survey into the prevalence of the misuse of steroid drugs.
Mr. Dorrell : We have identified a research facility with the relevant expertise to carry out this survey and, subject to final contract negotiations, plan to conduct the survey in the autumn. We estimate that the survey will take approximately one year to complete.
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NORTHERN IRELAND
Millisle Tourist Project
Mr. John D. Taylor : To ask the Secretary of State for Northern Ireland if he has any information about foul sewage discharge from Ballycopeland outlet going into the lagoon at the new Millisle tourist development project when there is a north wind and an incoming tide ; and if he will make a statement.
Mr. Needham : Sewage effluent is discharged from the Ballycopeland outlet only on the outgoing tide as soon after high tide as possible and is thus carried away from the lagoon.
The Millisle tourist development project is the responsibility of Ards borough council and there have been no complaints from it or others about sewage entering the lagoon.
Mr. John D. Taylor : To ask the Secretary of State for Northern Ireland if he is satisfied with the condition of the beach near Drumfads road, Carrowdore, County Down ; whether untreated raw sewage is being pumped out to the Irish sea near this location ; whether an overspill flows down to Millisle ; and if he will make a statement about foul sewage disposal at this location.
Mr. Needham : The bathing waters at Millisle are routinely monitored under, and comply with, the
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mandatory standards of the EC bathing water directive. Sewage is held in a retention tank on the shore at Ballywhiskin where it is screened before discharge to the sea on the ebb tide. There is no overspill flowing to Millisle. Sewage discharges to the sea are being examined in the context of the recent EC directive on municipal waste water treatment.Mr. John D. Taylor : To ask the Secretary of State for Northern Ireland what proposals he has for a new sewage treatment plant for Millisle ; and if he will make a statement.
Mr. Needham : Existing sewage treatment facilities at Millisle are being examined in the context of the recent EC directive on municipal waste water treatment.
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