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NumeracyAbility to write legibly
Previous relevant experience
Evidence of suitable personal and interpersonal qualities Candidates for all temporary census jobs were selected on individual merit against the criteria. Where candidates were of equal merit, preference was, where possible, given to those currently unemployed and, for the processing centre jobs, to those who had participated in a relevant Government training scheme.
Candidates for all jobs had to be at least 16 years old and those for the processing centres less than 60 years old.
Mr. McMaster : To ask the Secretary of State for Health if he will publish a table showing (a) the total projected cost of the current census, (b) staff costs and (c) property costs.
Mr. Dorrell : The 1991 census of Great Britain is estimated to cost the following over the 10-year period 1986-87 to 1995-96.
£ million
Costs |Amount
-----------------------------
Staff costs |102.0
Property costs |10.2
Other costs<1> |23.8
|---
Total |136.0
<1>Includes such items as
computing equipment,
printing, and publicity.
Mr. McMaster : To ask the Secretary of State for Health how many of his staff have been temporarily transferred or seconded to posts relating to the census ; and what arrangements have been made to cover their work.
Mr. Dorrell : The 1991 census in England and Wales is an integral part of the work of the Office of Population Censuses and Surveys, one of the departments for which my right hon. Friend is responsible. The question of transferring or seconding the office's own staff does not therefore arise. To supplement its permanent staff at the time of the census, the office engages temporary staff by direct recruitment and some staff on temporary secondment from other departments. No staff from the Department of Health are currently seconded for this purpose.
Dentists
Mr. Gorst : To ask the Secretary of State for Health if he will give the percentage increase of fees allowed to dentists in the NHS for laboratory services in 1989 and 1990 ; and if he has any plans to increase these in 1991 to take into account the raised rate of VAT in force.
Mr. Dorrell : Fees for NHS dental treatment provided under the general dental service are set by the independent dental rates study group (DRSG). Where laboratory work is involved, DRSG uses a sample of current trade catalogues to calculate the average laboratory component of each item of treatment priced. The overall increase in the laboratory costs used by the DRSG in 1989 and 1990 was 1.04 per cent. and 5.36 per cent. respectively. We expect to receive the report of the 1991 DRSG shortly, and I understand that the group's recommendations have taken account of the effect of the change in the rate of VAT.
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Mr. Gorst : To ask the Secretary of State for Health if he will take steps to ensure that NHS dentists do not cut costs by using inferior laboratory services ; and if he will ensure that all NHS dentists purchase their laboratory work only from laboratories registered with the CADLAS certification scheme.
Mr. Dorrell : General dental practitioners (GDPs) are required by their terms of service to use only materials which are suitable for the purpose for which they are used. GDPs are, however, independent contractors with family health services authorities and are free to buy products from the dental laboratories of their own choosing. It follows that, while the Government welcome CADLAS, they are not prepared to countenance the restrictive rule suggested by my hon. Friend.
Ambulance Service
Mr. Ronnie Campbell : To ask the Secretary of State for Health what steps are being taken by the Northumberland Ambulance Trust to persuade leading ambulance men to opt out of the Whitley Council pay and conditions ; how many ambulance men have stayed within the Whitley Council agreement ; and what disciplinary action has been taken against them.
Mrs. Virginia Bottomley : Staff transferring to trust employment retain their existing terms and conditions of service. Changes in terms and conditions of service are a matter for the trust and staff together and can be negotiated at any time after transfer.
Mr. Ronnie Campbell : To ask the Secretary of State for Health if he will list the current full salary and total expenses allowances and other emoluments and payments in kind to the chief ambulance officer in the Northumberland Ambulance Trust.
Mrs. Virginia Bottomley : No. That is a matter for the board of directors of the trust.
Mental Health Costs
Mr. Redmond : To ask the Secretary of State for Health what are the latest available figures of cost per patient per week of in-patients at each (a) mental handicap and (b) mental illness hospital in the Trent region.
Mr. Dorrell : As a result of the implementation of the recommendations of the steering group on national health services information (the Ko"rner committee) the costing information submitted by authorities from 1977-88 is no longer compiled on the basis of type of hospital but focuses on district-based treatment costs by speciality/speciality groups within all hospitals.
Information relating to the Trent region for the financial year 1989-90 (the latest currently available) is shown in the table.
Average Speciality Costs per Patient Day-Patients Using a Bed-
1989-90
District |Mental handicap |Other psychiatric
|£ (cash) |specialities<1>
|£ (cash)
------------------------------------------------------------------------------
North Derbyshire |35.99 |42.93
Southern Derbyshire |43.83 |42.17
Leicestershire |35.83 |43.28
North Lincolnshire |68.19 |55.16
South Lincolnshire |56.36 |41.48
Bassetlaw |30.58 |30.84
Central Nottinghamshire |63.98 |46.20
Nottingham |60.86 |51.64
Barnsley |51.22 |50.54
Doncaster |37.70 |34.38
Rotherham |47.24 |42.92
Sheffield |38.95 |40.41
<1> Includes, where applicable, mental illness, child and adolescent
phychiatry, forensic psychiatry, psychotherapy and old-agepsychiatry.
Notes
1. The figures may include treatments provided both to in-patients and day
cases (those who occupy a bed for at least a period of time but do not stay
overnight) under the recommended Korner definition "patients using a bed".
2. The figures cover direct treatment costs only. Expenditure incurred on
general services, overheads and capital is excluded.
Charges (Exemptions)
Mr. Wigley : To ask the Secretary of State for Health what would be the cost of extending exemption for all NHS charges to recipients of (a) housing benefit, (b) community charge benefit, (c) state pension, (d) invalidity benefit, (e) severe disablement allowance, (f) mobility allowance, (g) attendance allowance and (h) disability working allowance and to people in full-time education.
Mrs. Virginia Bottomley : This information is not available. People within the categories listed may already be entitled to exemption from NHS charges under the present arrangements or may qualify for full or partial remission of their charges on grounds of low income.
NHS Trusts
Mr. Sheerman : To ask the Secretary of State for Health what is the current salary of the chief executive of each NHS trust ; and what was the salary payable in each case to the equivalent post before the granting of trust status.
Mrs. Virginia Bottomley : No information is held centrally on the salaries of national health service trust chief executives, which are a matter for individual trust boards.
Mrs. Mahon : To ask the Secretary of State for Health if he will make public the report prepared by Coopers and Lybrand Deloitte on trust applications.
Mrs. Virginia Bottomley : I refer the hon. Member to the reply that I gave the hon. Member for Livingston (Mr. Cook) on 16 November 1990 at column 246.
Mr. Winnick : To ask the Secretary of State for Health if he will give a breakdown in percentage terms of the occupation of those appointed to the boards of directors of hospital trusts.
Mr. Nellist : To ask the Secretary of State for Health if he will tabulate by current occupation, or former if retired, those persons he has appointed as chairmen in the first wave of national health service trusts and as chairmen designate in the second wave.
Mrs. Virginia Bottomley : Chairmen and non-executive directors of NHS trusts are appointed on the basis of their
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personal qualities and experience and for the contribution they can make to the effective management of the trust. Each chairman's and non-executive director's curriculum vitae is submitted in confidence.Mr. Flynn : To ask the Secretary of State for Health if he will list those spheres for which he was responsible to Parliament prior to the recent reorganisation of the national health service and introduction of hospital trusts, and for which he no longer is responsible.
Mr. Waldegrave : I remain accountable to Parliament across the whole range of my responsibilities, including for all aspects of the national health service.
Productivity
Mr. Marlow : To ask the Secretary of State for Health how he measures productivity in the national health service ; and whether he intends to introduce other forms of measurement.
Mr. Dorrell : There is no single measure : the Department looks at a number of indicators, including unit costs, throughput and hospital length of stay. However, a broad measure of the overall increase in efficiency of the hospital and community health services (HCHS) can be obtained by comparing increases in activity levels with increases in expenditure. The overall increase in activity is obtained by weighting together the increases in various areas of the service by their costs. This shows improvements in efficiency of 15 per cent. since 1978, or 1.4 per cent. per year on average.
Infant Mortality
Mr. Ronnie Campbell : To ask the Secretary of State for Health if he will make a statement on the infant mortality rate in the north-east.
Mr. Dorrell : The infant mortality rate for the Northern regional health authority for the last five years is set out in the table, together with that for England and Wales.
Infant mortality rate for England and
Wales and for the Northern
Regional Health Authority<1>. Rate per
thousand live births.
Year |Northern |England
|RHA |and Wales
----------------------------------------
1986 |9.8 |9.6
1987 |8.7 |9.2
1988 |8.4 |9.0
1989 |8.4 |8.4
1990 |<2>7.9 |<2>7.9
<1>Coterminous with North standard
region.
<2>These figures are provisional.
Friern Barnet Hospital
Mr. Corbyn : To ask the Secretary of State for Health if he will call for a report from North East Thames regional health authority on the facilities for patients in Friern Barnet hospital ; and if he will make a statement.
Temporary Posts
Mr. McMaster : To ask the Secretary of State for Health if he will publish a table showing (a) the total number of temporary posts relating to the census, (b) the
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number of these posts filled by transfer or secondment from each Government Department, (c) the number of these posts filled by transfer or secondment from Government-funded agencies, (d) the number of posts filled by people who are registered as disabled and (e) the number of posts filled by temporary transfer of health board employees.Mr. Dorrell: Excluding the temporary data collection staff, the total number of temporary posts created in OPCS to handle work in connection with the 1991 census for England and Wales is 2,292. The numbers of posts expected to be filled by temporary transfers from Government Departments or executive agencies are :
|Number
--------------------------------------------------
National Savings Bank |31
The Scottish Office |20
Department of Social Security |20
Ministry of Defence |11
UK Passport Agency |6
Employment Service |4
Customs and Excise |2
Home Office |2
Central Office of Information |1
Charity Commission |1
Department of Education and Science |1
|----
|99
Not yet confirmed |24
Total |123
A total of 286 posts have been filled by the internal transfer of OPCS staff and the remaining 1,883 posts are being filled by direct recruitment.
None of the posts has been filled by transfers from other Government-funded agencies.
I will write to the hon. Member about the number of posts filled by people who are registered as disabled.
None of the posts has been filled by transfers from the health boards.
Laundry Service
Mr. Cohen : To ask the Secretary of State for Health how much is provided to fund the incontinent laundry service ; and what is his estimate of the number of patients requiring that service in (a) Waltham Forest, (b) London (c) nationally.
Mrs. Virginia Bottomley : This information is not collected centrally.
Alzheimer's Disease
Mr. Gregory : To ask the Secretary of State for Health what is his estimate of the percentage of national health service patients above the age of 65 years who are suffering from Alzheimer's disease.
Mr. Dorrell : The Department can make no reliable estimate of the number of NHS patients suffering from Alzheimer's disease. Current scientific evidence suggests that about 7 per cent. of people aged 65 years and over suffer from dementia. About 70-75 per cent. of the cases in this age band may be attributed to Alzheimer's disease.
Mr. Gregory : To ask the Secretary of State for Health (1) what is his estimate of the cost of Alzheimer's disease to social services ;
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(2) what is his estimate of the cost of Alzheimer's disease to the national health service.Mr. Dorrell : This information is not collected centrally.
Mr. Gregory : To ask the Secretary of State for Health where he ranks the development of an effective treatment for Alzheimer's disease among other priorities for elderly health care.
Mr. Dorrell : The prevention of, or the development of an effective treatment for, Alzhiemer's disease would be a major step forward in the care of the elderly. The Government support biomedical and clinical research into a wide range of disabling conditions, including Alzheimer's disease, through grants in aid to the Medical Research Council.
Mr. Gregory : To ask the Secretary of State for Health what information he has concerning the percentage of (a) all deaths, and (b) deaths beyond the age of 65 years which are attributable to Alzheimer's disease (i) throughout the world, and (ii) in the United Kingdom.
Mr. Dorrell : There are no data on mortality readily available for the world. The table shows the percentage of (a) all deaths ; and (b) deaths for persons aged 65 years and over which are attributable to Alzheimer's disease in the United Kingdom and for Great Britain for the most recent years for which data are available.
Number and percentage of deaths from
Alzheimer's disease<1> for the
United Kingdom and Great Britain 1989 and
1990.
|All ages|65 years
|plus
-----------------------------------------------
1989 United Kingdom
Deaths Number |1,220 |1,124
Percentage |0.19 |0.21
1990 Great Britain
Deaths Number |1,504 |1,397
Percentage |0.24 |0.28
<1> Ninth revision International
Classification of Disease Code 331.0
NHS (Employers' Salaries)
Mr. Ralph Howell : To ask the Secretary of State for Health, pursuant to his answer to the hon. Member for Norfolk, North of 30 April, Official Report, column 117, if he will list all those persons who are classified as employers in the national health service, stating the salary in each case.
Mrs. Virginia Bottomley : National health service employers are corporate bodies.
Condoms
Mr. Cohen : To ask the Secretary of State for Health how much has been specifically provided to general practitioners for them to supply condoms to at-risk patients in relation to family planning and the spread of AIDS ; and if he will indicate their areas.
Mrs. Virginia Bottomley : There is no provision for general practitioners to prescribe condoms. District health authorities, where they perceive a local need, are able to supply condoms to local GPs for free distribution to any patient, if this is thought desirable. Condoms are also available without charge at family planning clinics.
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Leukaemia
Dr. Cunningham : To ask the Secretary of State for Health whether he has yet received advice from COMARE, the Committee on Medical Aspects of Radiation in the Environment, on the study of parental occupations of children with leukaemia, published in the British Medical Journal on 23 March.
Mr. Dorrell : Yes. The Government are grateful to COMARE for its advice. We note that COMARE endorses the authors' caution in drawing conclusions from the data, and that the study findings do not warrant any specific recommendations for the Government to consider. Following is the full text of COMARE's advice :
Comare statement on LRF study
Background
1. On 23 March 1991 the British Medical Journal published the findings of a study entitled "Parental Occupations of Children with Leukaemia in west Cumbria, north Humberside and Gateshead". This study was undertaken by the Leukaemia Research Fund Centre at the University of Leeds in conjunction with the Childrens' Cancer Unit at the University of Newcastle-upon-Tyne.
2. The authors' stated objective was to determine whether parental occupations and chemical and other specific exposures are risk factors for childhood leukaemia.
3. This study is independent of the programme of research recommended by the Committee on Medical Aspects of Radiation in the Environment (COMARE) which includes research aimed at elucidating any relationship between parental occupational exposure to ionizing radiation and development of childhood leukaemia and non-Hodgkin's lymphoma (NHL). Nevertheless, aspects of the study are clearly of relevance to the work of COMARE which has undertaken to update its advice to government as further research data concerning possible associations between ionising radiation and childhood leukaemia--NHL become available. In view of this, the Department of Health and the Health and Safety Executive have referred the results of this study to COMARE for consideration and advice.
The Study
4. 151 Children under 15, diagnosed with leukaemia/NHL between 1974 and 1988 while resident in west Cumbria, north Humberside or Gateshead were ascertained from the Yorkshire Regional Children's Tumour Registry and the Northern Region Children's Malignant Disease Registry. Those who had been born in the same area as that in which they were resident at diagnosis met the criteria of eligibility for analysis. Interview data were obtained for 109 such cases. 5. Controls, obtained mainly from district health authority birth registers, were matched for sex, date of birth and health district of birth. The study design aimed to obtain two controls for each case. For those controls for whom interview data could not be obtained, replacement controls were recruited where possible but not all cases had two controls.
6. A complete history of employment and of exposure to specific substances and radiation was obtained for the biological parents from the time they started work to the end of the analysis period. Similar data were collected for any other adults living with the child for more than three months from before birth to the time of diagnosis. 9 industrial and occupational groupings, coded according to Office of Population, Censuses and Surveys (OPCS) classifications were tested as hypotheses. In addition, data on 15 specific exposures and a check list of 22 known chemical carcinogens were analysed. In all 480 comparisons were computed.
7. A fundamental part of the study design was a separate analysis of the data for evidence of risk through six pathways : each of the biological parents both prior to conception and during gestation (four pathways) and all adult male and female household contacts (includes biological parents) from birth to diagnosis (two pathways). In all cases where a
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statistically significant result was found for exposure of bilogical fathers during gestation the fathers had also been exposed around the time of conception.8. For the 25 fathers who reported radiation exposure prior to birth, a subclassification of their exposure to ionising radiation was produced after checks with the National Registry for Radiation Workers (NRRW) at the National Radiological Protection Board (NRPB) and British Nuclear Fuels PLC, Sellafield, Cumbria (BNFL). Exposures were classified as "certain" for those recorded on the NRRW or by BNFL and "possible" for other contract workers on nuclear sites and industrial radiographers. Those reporting exposures in occupational settings such as education and medicine were classified as "unlikely". The remainder reported non-ionising radiation exposure and included radar and radio operators.
9. Selected results of the occupational analyses were reported, including the results that were statistically significant in any one of the six pathways analysed. Adjustment was made for
inter-dependence of some results and in some instances interpretation was aided by direct inspection of the data. In addition the authors undertook comparative analyses of the six exposure pathways. 10. The authors state that few risk factors were identified for mothers but note that the results show some associations for mothers working in food-related occupations or in catering, cleaning and hairdressing before conception. However they consider that the absence of any specific range of occupations accounting for the significantly raised risks suggests that the finding may be due to chance. The only other preconceptional risk for mothers that reached statistical significance was exposure to wood dust. Preconceptional exposure of biological fathers showed the greatest numbers of significant odds ratios. After adjustment for possible confounding factors independent contributions to risk in the preconceptional period were found for exposure to wood dust, radiation and benzene. 11. The authors urge that the results be interpreted cautiously because of the small numbers, overlap with another study and multiple exposure of some parents. They state further, that it is important to distinguish the periods of parental exposures since the risk factors identified were almost exclusively restricted to the time before the child's birth.
Comare's Advice to Government
General considerations
12. This study has been undertaken independently of COMARE's recommendations and the committee is grateful to the authors for making a draft available for discussion.
13. We agree with the authors that the results must be interpreted cautiously and we would stress that interpretation of this type of research is a complex matter. Demonstration of a statistical association does not necessarily imply a causative relationship. Proper interpretation requires that the study be considered in the context of other research, both epidemiological and biological. There is, in general, little consistency amongst the findings of epidemiological studies relating to possible links between parental occupation and childhood malignancies and the authors of this study draw attention to some of the reasons for this in their Discussion. 14. Although this statement contains some general observations which apply to all the findings, the remit of COMARE has necessarily led us to restrict detailed discussion to those findings which relate to radiation exposure.
Methodology
15. The use of retrospective questionnaires is inevitably open to some reporting bias.
People who agree to participate as controls in such studies may be intrinsically different from those who refuse. The findings for the controls may therefore be unrepresentative and replacement of non responders will not necessarily ameliorate this effect.
16. The original study design did not incorporate any means of validating the occupational and exposure histories. The interpretation of the results hinges on the validity of the data and the study's potential value would be enhanced considerably if validation could be achieved. The data relating to radiation exposures has been validated to some extent by
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cross checking with the NRRW and BNFL records. However the validation is incomplete since it did not include those parents who did not report occupational exposure to radiation. Furthermore, validation was not attempted of the radiation exposures of contract workers and industrial radiographers.Results
17. A large number (480) of comparisons were computed in the analysis and we share the authors' view that some significant associations might have been expected purely by chance. Indeed, we note that the number of significant associations found, falls within the limits of chance expectation. This observation reinforces both our and the authors' caveats against using the results to draw conclusions about causal links.
18. The authors report a threefold risk associated with radiation exposure during the preconceptional period which remained significant after adjusting for possible confounding factors. They state that the finding is not independent of that of Gardner et al. in West Cumbria because of the geographical overlap for cases and similarity of methods of selecting controls. However they also state that this risk is not confined to Cumbria and that exposed case fathers did not work exclusively in the nuclear industry.
19. The above statements refer to the results derived from the basic data prior to any attempt at validation by cross checking with the NRRW and BNFL records. However, for those fathers subsequently classified as having "certain" exposure to ionising radiation, the statistical significance of the result is dependent on the cases common to both this and the case control study of leukaemia and lymphoma among young people near Sellafield nuclear plant in West Cumbria undertaken by Gardner et al. Thus, while this study's findings offer some confirmation of those of Gardner they do not provide independent evidence of an association between objectively confirmed paternal exposure to ionising radiation prior to conception and development of leukaemia/NHL in children. The data do not provide firm evidence of a risk to children of fathers exposed to radiation outside the nuclear industry.
General Conclusions
20. This study has documented various parental occupational exposures as having a statistically significant association with cases of childhood leukaemia/NHL in the three areas studied. The authors have been cautious in drawing conclusions from the data and we feel that this is appropriate. We do not consider that the findings, of themselves, warrant our making any specific recommendations. However, we urge the authors to explore the possibility of extensive validation of the occupational and exposure histories and welcome the authors stated intention of considering further analyses.
Reference
1. Gardner M.J., Snee M.P. et al., Results of a Case Control Study of Leukaemia and Lymphoma among young people near Sellafield nuclear plant in west Cumbria, BMJ 1990, 300, 423-429.
Fluoridation Act 1984
Miss Lestor : To ask the Secretary of State for Health what measures have been taken to implement the Fluoridation Act 1984.
Mr. Dorrell : The Fluoridation Act 1984 provides that fluoridation of water supplies is a matter for local decision. In the past five years funds have been made available to a number of health authorities to assist with the costs of new fluoridation schemes and to contribute towards the major costs of replacement of outdated plant and equipment.
In the Water Act 1989 provision was made for my right hon. Friend the Secretary of State for Health to indemnify any statutory water undertaker against liabilities and costs incurred in connection with anything done by the undertaker for the purpose of increasing the fluoride content of any water supplied by the undertaker.
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Tooth Decay
Miss Lestor : To ask the Secretary of State for Health what percentage of five-year-old children in the north-west region suffered tooth decay in (a) 1985, (b) 1986, (c) 1987, (d) 1988, (e) 1989 and (f) 1990.
Mr. Dorrell : Surveys of five-year-old schoolchildren in the north- west region carried out in the school years 1985-86, 1987-88 and 1989-90 showed that 58 per cent., 55 per cent. and 56 per cent. respectively suffered tooth decay.
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