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Mr. Dorrell : At September 1990, the latest date for which information is available on numbers awaiting operations, 23 per cent. of patients waiting for an operation in the Wessex region waited over a year.
Bexley Health Authority
17. Mr. Evennett : To ask the Secretary of State for Health if he has any plans to pay an official visit to Bexley health authority to look at health provision.
Mr. Dorrell : I have no plans to visit Bexley health authority at present.
Diabetics
19. Mr. Irvine : To ask the Secretary of State for Health whether he will consider introducing national health service prescription of injection pen needles for diabetics requiring insulin treatment.
Mr. Dorrell : I am considering whether injection pen systems including needles for diabetics requiring insulin treatment should be available on prescription. The pricing and cost implications of various systems are under examination.
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NHS Trusts
20. Mr. Cryer : To ask the Secretary of State for Health if he will make it his policy to obtain information on the salary increases of the national health service trust general managers together with a job description ; and if he will make a statement.
Mrs. Virginia Bottomley : There are no plans to collect this information. However, annual accounts will include details of the salary of the highest paid board member. This would normally be the chief executive.
22. Mr. Harris : To ask the Secretary of State for Health what steps the Government are taking to monitor the development of NHS trusts.
Mrs. Virginia Bottomley : We are appointing local monitoring officers in five regions to assist the existing finance team of the NHS management executive in ensuring that NHS trusts meet their financial duties.
23. Mr. McAllion : To ask the Secretary of State for Health how many hospitals have applied for trust status at the latest available date.
Mrs. Virginia Bottomley : In England, 107 hospitals and other units have applied for NHS trust status for April 1992.
24. Mr. Canavan : To ask the Secretary of State for Health how many applications have now been submitted for self-governing status for hospitals and other NHS units.
Mrs. Virginia Bottomley : To date, 107 hospitals and other units have applied to become NHS trusts in April 1992.
28. Mr. Hardy : To ask the Secretary of State for Health if he will require regional health authorities to give a favourable response to requests from hon. Members and others for public debate on proposals for the establishment of particular NHS trusts.
Mrs. Virginia Bottomley : Each national health service trust application is the subject of consultation under the terms of the National Health Service and Community Care Act 1990. It is up to regional health authorities to decide whether public debates would be appropriate.
Deprivation Formulae
21. Mr. Simon Hughes : To ask the Secretary of State for Health what approval formulae was used by health authorities to take account of relative levels of local deprivation ; how these are tabulated into sums of money ; and if he will make a statement.
Mr. Dorrell : Our guidance invites regional health authorities to consider allowing for social deprivation when they fund their districts. A number of them do so, using several approaches. Details of the monetary effect of allowing for social deprivation are not held centrally.
Waiting Lists
25. Mr. Win Griffiths : To ask the Secretary of State for Health if he will make a statement about progress in implementing initiatives to reduce waiting lists.
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Mrs. Virginia Bottomley: The waiting list initiative is progressing well. The number of patients waiting over one and two years is continuing to fall and we intend to secure further major reductions in the year ahead.
GP Fundholders
26. Mr. Harry Greenway : To ask the Secretary of State for Health when he next plans to meet the chairman of the BMA to discuss general practice fund holding ; and if he will make a statement.
Mrs. Virginia Bottomley : We regularly meet representatives of the medical profession, including the BMA. My hon. Friend will welcome the announcement which my right hon. Friend the Secretary of State was able to make recently of the agreement with the General Medical Services Committee to set up a joint working group on NHS review issues including the evaluation of GP fundholding.
Mr. Redmond : To ask the Secretary of State for Health if he will establish for community health councils rights of access to information on, and for monitoring of, the manner in which Exchequer money allocated to fundholding general practitioners for the purpose of purchasing services is used, similar to those afforded community health councils in relation to expenditure by district health authorities as purchasing authorities.
Mr. Dorrell : District health authorities retain overall purchasing responsibility for all patients, including those on the lists of fundholding GPs. This provides the mechanism for the community health council to raise any concerns or questions it may have.
Organ Donor Scheme
27. Sir Michael McNair-Wilson : To ask the Secretary of State for Health if he will make a statement on the current results of the organ donor scheme.
Mr. Dorrell : The best measure of the effectiveness of the organ donor scheme is the number of transplants performed. According to information provided by the United Kingdom transplant support service the number of transplants, including corneas, performed in the United Kingdom in 1990 was 4,938. This represents an 11 per cent. increase over 1989.
Further expansion of the transplant programme, to which this Government are committed, depends entirely on the availability of donor organs. We warmly welcome the "Transplants in Mind" initiative being taken this year by voluntary organisations, with the support of the Department of Health, to raise public awareness. It is very important that everyone is aware both of the success of organ transplantation and of the need to make a positive decision, involving the family, about becoming a donor.
NHS Reforms
29. Mr. McKelvey : To ask the Secretary of State for Health when he next plans to meet the BMA to discuss health service reforms.
Mr. Waldegrave : I met the BMA earlier this week. We have not set a date for our next meeting.
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Preventive Medicine
30. Mr. Sayeed : To ask the Secretary of State for Health what steps have been taken to encourage family doctors to focus on preventive medicine.
Mrs. Virginia Bottomley : I refer my hon. Friend to the reply I gave to my hon. Friend the Member for Stockton, South (Mr. Devlin) on 18 June at column 134.
In-patients
Mr. Page : To ask the Secretary of State for Health (1) what is the cost per bed of keeping and treating an in-patient in West Hertfordshire hospital for the last three years for which figures are available and what is the average for the North West Thames region ; (2) what is the cost per head of keeping and treating an in-patient in Watford General hospital for the last three years for which figures are available.
Mr. Dorrell : Since 1987-88 the financial returns submitted by health authorities have focused on the cost of treating patients by specialty on a district basis. The overall cost of in-patient care by hospital is therefore not held.
NHS Drugs
Mr. Michael Morris : To ask the Secretary of State for Health what was the estimated figure for savings on the national health service drugs bill in 1989 attributed to more economical prescribing by general practitioners following the introduction of prescribing analyses and costs data.
Mrs. Virginia Bottomley : From 1979 to 1988 the net ingredient cost of drugs--the cost before any discounts and pharmacy costs and fees-- prescribed by GPs increased by an average of 13 per cent. each year. In 1989 this increase was reduced to 8 per cent., representing an estimated saving of around £80 million relative to the previous trend. The introduction of PACT has been a major factor. Encouragement to cost- effective prescribing will be maintained by the indicative prescribing scheme.
Pharmaceuticals
Mr. Michael Morris : To ask the Secretary of State for Health what is the estimated percentage increase in cost to the national health service drugs budget of the European Commission's proposed regulation on patent term restoration for medicinal products ; and how any such increase would be affected by the pharmaceutical price regulation scheme.
Mrs. Virginia Bottomley : The precise cost would depend on the number and sales value of products benefiting in the future from extended protection. An estimate based on historical data, in a study commissioned by the industry, suggests the net effect could rise to around 1 per cent. of the drugs bill. The industry accepts that the pharmaceutical price regulation scheme could be used to mitigate the effect. However, as an indirect profitability control, on its present basis, it would be unlikely to produce an exact offset.
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Postgraduate Medical Education
Mr. Irvine : To ask the Secretary of State for Health what is his assessment of the combined effect of article 1(3) and article 9(1) of the draft European Community directive on the advertising of medicines upon the funding of post-graduate medical education by the pharmaceutical industry.
Mrs. Virginia Bottomley : I refer my hon. Friend to the reply I gave him on 18 June at column 141.
Hospital Food
Mr. Redmond : To ask the Secretary of State for Health if he will exclude better food from the extra services for which national health service patients may be charged ; if he will ensure that all food served to all patients is of (a) good quality, (b) varied and (c) suitable for their medical condition ; and if he will make a statement.
Mr. Dorrell : Health service managers are responsible for offering good quality, varied meals which meet the nutritional requirements of patients. As part of their income generation initiative health authorities are encouraged to offer additional services to patients. The provision of an a la carte menu offering a wider choice and luxury food items for a charge is a good example of this.
Fertility Treatment
Mrs. Gorman : To ask the Secretary of State for Health what is the average cost of a course of fertility treatment for a woman to become pregnant.
Mrs. Virginia Bottomley : This information is not held centrally.
Prescribing Costs
Mr. Redmond : To ask the Secretary of State for Health if he will issue guidelines on who has the responsibility to meet prescribing costs once a national health service patient has been discharged from an (a) national health service directly-managed unit to a fund-holding general practitioner practice, (b) national health service directly-managed unit to a non-fund-holding general practitioner practice, (c) self-governing trust to a fund-holding general practitioner practice and (d) self-governing trust to a non-fund-holding general practitioner practice.
Mrs. Virginia Bottomley : The general principle is that the doctor who has clinical responsibility has prescribing responsibility. Protocols may also be made between consultants and general practitioners to care for particular categories of patients on a shared-care basis.
Cervical and Breast Cancer
Miss Emma Nicholson : To ask the Secretary of State for Health what policies have been introduced to reduce the death rates amongst women from cervical and breast cancer since 1979.
Mrs. Virginia Bottomley : I refer my hon. Friend to the reply I gave my hon. Friend the Member for Eastleigh (Sir D. Price) on 21 February at columns 241-42 .
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NHS Funding
Mr. Redmond : To ask the Secretary of State for Health if he will list for the current financial year, how much funding has been made available to the national health service to (a) meet the real cost of inflation, (b) meet the specific costs of medical inflation, (c) target towards reducing inequalities in public health and health care provision, (d) allow for positive health measures through health promotion and education and (e) allow community care proposals to be fully implemented.
Mr. Dorrell : Expenditure on the NHS in England for all purposes this year is expected to amount to some £26.6 billion. This represented a real-terms increase of nearly5 per cent. over spending last year, and of 51 per cent. over spending in 1978-79. We do not identify sums separately for the purposes listed.
Mental Health Services
Mr. Redmond : To ask the Secretary of State for Health if he will issue guidelines to all district health authorities acute mental health services to provide a service for people with mental health problems, similar to the service currently provided by accident and emergency departments for people with medical problems.
Mr. Dorrell : It is for district authorities to assess the psychiatric needs of their populations and to provide, in the light of available resources, a range of mental health services to meet those needs, including emergency services in whatever form is deemed to be most suitable to the locality.
Artificial Limbs
Miss Emma Nicholson : To ask the Secretary of State for Health what is the average life of an artificial limb before it requires complete replacement.
Miss Emma Nicholson : To ask the Secretary of State for Health how many artificial legs are supplied annually by the national health service.
Mr. Dorrell : Approximately 16,600 per annum.
Miss Emma Nicholson : To ask the Secretary of State for Health which companies supply artificial legs to the national health service and what proportion of this market each company holds.
Mr. Dorrell : The names of the companies and the proportion of the market each holds is as follows :--
|Per cent.
-----------------------------------------------------------
Chas A Blatchford & Sons Ltd |28
F H Cossins & Son (Leeds) Ltd |2
Dorset Orthopaedic Co Ltd |2
John Drew (Midlands) Ltd |4
LIC Care Ltd |9
Oxford Prosthetics Ltd |4
Prostech Ltd |3
Prosthetics UK Ltd |2
Rehabilitation Services Ltd |5
Hugh Steeper Ltd |12
James Stubbs & Sons Ltd |3
Technology World Incorporated (UK) Ltd |12
Vessa Limited |14
Miss Emma Nicholson : To ask the Secretary of State for
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Health what is the cost to the national health service, on an annual basis, of the provision and service of artificial legs.Mr. Dorrell : The cost to the National Health Service of the provision and service of artificial legs in 1989-90 was £31.401 million and in 1990-91 it was £33.236 million.
Community Health Councils
Mr. Redmond : To ask the Secretary of State for Health if he will make it his policy to provide funding for community health councils which would allow a standardised level of service across England and Wales (a) related to the population served taking into account the distribution of areas of high dependency and (b) containing a standardised element for the training of community health council staff and members.
Mr. Dorrell : Regional health authorities, as establishing authorities, are responsible for the funding of community health councils. CHCs essentially provide a local service, and RHAs are therefore best placed to make funding decisions taking account of local needs. We see no reason, and have no plans, to change this policy.
Mr. Redmond : To ask the Secretary of State for Health if he will abolish the upper age limit of 70 years for appointment to community health councils.
Mr. Dorrell : There is no regulation limiting the age of a community health council member. Guidance issued to health authorities advises that appointing bodies should not appoint people over 70 unless there is a special reason, but it has no statutory force.
Menopause
Mrs. Gorman : To ask the Secretary of State for Health, further to his answer of 2 July, Official Report, column 117, what provision is made under the national health service for treatment of severe menopausal symptoms.
Mrs. Virginia Bottomley : Health authorities are responsible for assessing local health care needs and ensuring a comprehensive range of services for local people, including menopause services. Treatment of menopausal symptoms in any individual remains a matter for the clinical judgment of the doctor concerned.
Family Planning
Miss Emma Nicholson : To ask the Secretary of State for Health what has been the change in real terms since 1979 on spending on family planning facilities.
Mrs. Virginia Bottomley : Estimated total expenditure on NHS family planning services in England was £94.6 million in 1988-89, the latest year for which figures are available. This represents an increase in real terms of 33 per cent. since 1979.
Private Ambulance Services
Mr. Redmond : To ask the Secretary of State for Health if he will introduce legislation (i) enabling the setting up of a registration and/or regulatory body to lay down and enforce standards governing (a) staffing, (b) training, (c)
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vehicles and (d) equipment of all private ambulance services and (ii) requiring that these standards should be no lower than those applying to health authority ambulance services.Mr. Dorrell : There are no plans to introduce such legislation.
Mental Illness
Mr. Redmond : To ask the Secretary of State for Health if he will publish, in respect of his Department's circular HC(90)24, details of the way in which the specific grant is being utilised nationally ; what steps have been taken to ensure that it is not being used to support or replace the appointment of staff or the provision of services ; and if he will make a statement.
Mr. Dorrell : The social services inspectorate issued a document in November 1990 "Mental Illness Specific Grant Monitoring Arrangements" setting out fully the way the inspectorate intends to undertake the monitoring, and the information and action required from each social services authority.
The social services inspectorate will produce a report of its findings of the use of the grant, including the social care services which have been developed for people with mental illness including those with dementia, in relation to national objectives as outlined in "Caring for People" and to the care programme arrangements as referred to in HC(90)23. Copies of both the report and the circular are available in the Library.
Public Consultation
Mr. Redmond : To ask the Secretary of State for Health if he will list the (a) national health service trusts, (b) district health authorities and (c) regional health authorities which have (i) commenced or (ii) are about to commence negotiations with community health councils leading to the adoption by regional and district health authorities and trusts of codes of practice on public consultation.
Mr. Dorrell : This information is not held centrally. NHS trusts are not required to consult directly with community health councils, but have been encouraged to establish informal relations with them. Guidance has been issued to health authorities on the principles of consultation. It is for the regional health authorities and district health authorities themselves to ensure that these principles are adhered to.
Drugs Research
Mr. Wigley : To ask the Secretary of State for Health what are the terms of reference of the research being carried out by Professor Conrad Harris and funded by the Department in relation to his indicative prescribing scheme ; where this research is being undertaken ; what account is taken by the project of the generics of the drugs ; how many representatives of drug companies are working as part of this research team ; and how much of the funding of the project comes from drug manufacturers.
Mrs. Virginia Bottomley : The remit of the research is to analyse patterns of prescribing in general practice and to develop indicators to provide the NHS with information about the normal range of prescribing for certain types of
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drugs. The research is being undertaken at the department of general practice at Leeds university. No representatives of drug companies are working as part of the research team. The project is wholly Government funded. Generic prescribing is one of the factors which the team may address during its research.Women NHS Employees
Miss Emma Nicholson : To ask the Secretary of State for Health what change there has been in the number of women employed by the national health service as (1) consultants and (2) general practitioners since 1979 ; and what proportion of the totals women now form.
Mrs. Virginia Bottomley : The latest available information on the number and proportion of female consultants and general practitioners in England is given in the table. Medical staffing in Scotland, Wales and Northern Ireland is the responsibility of my right hon. Friends the Secretaries of State for Scotland, for Wales and for Northern Ireland.
:
|1979 |1989
----------------------------------------------------------
Hospital consultants (medical and
dental) numbers |1135.4|2027.7
Female consultants as proportion of
the whole percentage |10.3 |14.4
General medical practitioners (GMPs)
numbers |3,865 |6,886
Female GMPs as a proportion of the
whole percentage |16.8 |24.8
Health Authorities (Elections)
Sir Michael Neubert : To ask the Secretary of State for Health whether he will bring forward proposals for the direct election of regional and district health authorities.
Mrs. Virginia Bottomley : There are no such plans. Regional and district health authorities are responsible for ensuring that the health needs of the local population are assessed and met at local level. The direct election of members of these authorities would not materially aid that process.
Births
Ms. Harman : To ask the Secretary of State for Health if he will list the estimated national percentage of women whose deliveries were conducted by (a) a hospital doctor, (b) a general practitioner, (c) a midwife and (d) other, for each year between 1985 and 1991.
Mrs. Virginia Bottomley : Information along the lines requested was collected for the first time in 1988-89 and the latest available figures are for 1989-90.
The estimates given in the table are derived from incomplete data and, particularly in the case of 1988-89, should be regarded as approximate.
Person conducting delivery-percentages
England
|1988-89|1989-90
---------------------------------------------
Hospital Doctor |22 |24
General Practitioner |<1>0 |<1>0
Midwife |72 |72
Other |1 |2
Not Known |4 |2
<1>Less than 0.5 per cent.
Source SMI2: Hospital Episode Statistics
Cervical Smear Tests
Ms. Harman : To ask the Secretary of State for Health if he will list for every month since March 1990 the district health authorities not reaching the one month target for cervical cancer test turnround time ; and if he will state the time taken in each of those authorities.
Mrs. Virginia Bottomley : This information is not available in the form requested. At June 1991, 31 district health authorities reported that they were not meeting the one-month target for processing cervical smear tests. These were as follows :
Regional Health Authority |District Health |Number of
|Authority |weeks
--------------------------------------------------------------------------------------------------------
Northern |S. W. Durham |6.0
Yorkshire |Bradford |6.0
Trent |South Derbyshire |6.5
East Anglian |Cambridge |6.0
North East Thames |Mid Essex |7.0
|Waltham Forest |9.0
|Basildon and Thurrock |5.0
South East Thames |Brighton |8.0
|Tunbridge Wells |6.0
|Bromley |8.0
Wessex |Bath |8.5
North Western |Stockport |13.0
|Tameside |7.0
Medicines Commission
Mr. David Martin : To ask the Secretary of State for Health when he expects to receive the annual report of the Medicines Commission for 1990.
Mrs. Virginia Bottomley : We have received the report and copies have today been laid before both Houses of Parliament in accordance with the requirements of section 5(2) of the Medicines Act 1968. Bound volumes have been placed in the Library containing the 1990 reports of the Medicines Commission, the Committee on Safety of Medicines, the Veterinary Products Committee, the British Pharmacopoeia Commission, the Committee on the Review of Medicines and the Committee on Dental and Surgical Materials.
We are glad to pay tribute to the valuable work done by the distinguished members of the Medicines Act advisory bodies and thank them warmly for the time and effort which they contribute to the public interest in this most important field.
Leukaemia
Dr. Cunningham : To ask the Secretary of State for Health what progress has been made in following up the advice on chemicals of the Committee on Medical Aspects of Radiation in the Environment contained in recent reports on leukaemia incidence in young people resident in west Cumbria and other areas.
Mr. Dorrell : The Department of Health referred both the recommendation and the advice to the Committee on Mutagenicity of Chemicals in Food, Consumer Products and the Environment (COM). Its study into the chemicals used at Dounreay and Sellafield is nearing completion and I will arrange publication of the results in due course. A summary of its advice on whether there is evidence that potential exposure to chemicals may result in malignancies in the first generation offspring follows.
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The results from a limited number of laboratory animal studies suggest that paternal exposure to certain mutagenic chemicals and radiation can result in malignancies in their first generation offspring. Although the limited data available from humans exposed to cytotoxic agents used therapeutically have not indicated any such effect, the committee nevertheless felt it prudent to assume that a chemical that has been shown to be mutagenic in germ cells in laboratory animals has the potential to induce malignancies in the first generation offspring.Regarding the excess leukaemias at Sellafield COM considered possible mechanisms that could be involved if the effects were indeed a consequence of the mutagenic effects of a chemical. It was difficult to explain the observed incidence by any known mutational mechanism, but the committee felt that there was a need for a better understanding of the mechanistic basis of tumour induction following paternal exposure. They advised that further work was needed, involving both radiation and chemicals, in particular urethane. The Government are grateful to COM for this advice and will implement its recommendations.
A copy of the full text of the Committee's statement has been placed in the Library.
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