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Remploy
Mr. Waller : To ask the Secretary of State for Employment what progress has been made in establishing a new financial arrangement with Remploy.
Mr. Howard : Discussions have been taking place between my Department and Remploy to establish arrangements which would enable the company to operate a more flexible financial regime within an agreed planning framework which would include quantified annual performance targets. Tomorrow, I will join the chairman of Remploy, Sir Ivor Cohen, to sign documents setting out the financial arrangements under which Remploy will operate from 1 April 1992. These new arrangements, which will be operated on my behalf by the chief executive of the Employment Service, will enable the company to improve its efficiency, competitiveness and value for money. The greater commercial freedom which will be enjoyed by Remploy should benefit the workforce of severely disabled employees for whom the company was established.
I will arrange for copies of the documents describing the new arrangements, and in due course the annual performance agreement that I will have with Remploy, to be placed in the Libraries of both Houses. Copies will also be made available by the Employment Service on request to individuals or organisations with a genuine interest in the arrangements.
Training and Enterprise Councils
Sir Anthony Grant : To ask the Secretary of State for Employment if he will make a statement on the area boundaries laid down for the purposes of the budgets of training and enterprise councils in general, and East Anglia in particular.
Mr. Jackson [holding answer 28 February 1992] : The boundaries of all training and enterprise councils--TECs--were established in discussion with the groups of employers who joined together in local areas to respond to the government's invitation to establish TECs. Those discussions took account of such factors as travel to work patterns, local demography and the structure of industry and commerce.
The budgets for individual TECs are negotiated between the TEC and this Department's regional directors and are not related to the geographical area covered.
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HEALTH
Cost Rent Schemes
Mr. Cohen : To ask the Secretary of State for Health if he will make it his policy to ring-fence funding for the cost rent scheme ; and if he will make a statement.
Mrs. Virginia Bottomley : Cash-limited allocations made by regional health authorities to family health services authorities (FHSAs) cover spending on general practitioner premises, practice staff and practice computers. How allocations are spent between these three headings is a matter for FHSAs in the light of local needs and priorities. There are no plans to ring-fence funds for cost rent schemes within these allocations.
Mr. Cohen : To ask the Secretary of State for Health how much has been spent on cost rent schemes to improve general practitioners' surgeries in each of the last five years in (a) Waltham Forest, (b) London and (c) nationally.
Mrs. Virginia Bottomley : The information requested is shown in the table for the last two years. Records of individual cost rent expenditure prior to 1989-90 are unavailable.
Cost-rent expenditure
|1989-90 |1990-91
|£ million|£ million
-------------------------------------------------------------------
Waltham Forest (including Redbridge) |0.534 |0.785
London |15.341 |28.487
Nationally |56.766 |79.593
Drug Costs
Mr. Flynn : To ask the Secretary of State for Health what is his estimate of the cost to the NHS resulting from the prescription of branded drugs rather than their chemically identical generic version in each of the past four years for which figures are available.
Mrs. Virginia Bottomley : It is not possible to estimate such a cost.
Nebulisers
Mr. Kennedy : To ask the Secretary of State for Health if he will set out the arrangements concerning charging for NHS nebulisers ; and if he will make a statement.
Mrs. Virginia Bottomley : No charge can be made for nebulisers supplied by district health authorities as part of NHS treatment.
Myalgic Encephalomyelitis
Sir Bernard Braine : To ask the Secretary of State for Health (1) whether he will ensure that adequate resources are made available for providing treatment for and giving advice on myalgic
encephalomyelitis to general practitioners ;
(2) if he will give details of the current funding of research into the treatment of myalgic encephalomyelitis ; and what guidance is given by his Department to general practitioners in regard to treatment of this condition.
Mr. Dorrell : There is no question of patients not receiving the treatment they need when they visit their
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general practitioner, including referral to a specialist if that is necessary. It is not the practice of the Department to issue clinical guidance to doctors, but we are encourged by the increasing number of informed articles on myalgic encephalomyelitis (ME) appearing in professional journals and by the number of regional health authorities approving courses for GPs in ME ; the various ME groups do valuable work in this area too. With regard to research into causes of and treatment for myalgic encephalomyelitis, I refer my right hon. Friend to the reply I gave to my right hon. Friend the Member for Tonbridge and Malling (Sir J. Stanley) on 21 November 1991 at column 313.Mrs. Dunwoody : To ask the Secretary of State for Health if he will fund research into the physical causes of myalgic encephalomyelitis and possible treatments.
Mr. Dorrell : I refer the hon. Member to the reply that I gave my right hon. Friend the Member for Tonbridge and Malling (Sir J. Stanley) on 21 November 1991 at column 313 .
Mrs. Dunwoody : To ask the Secretary of State for Health if he will reconsider the definition of myalgic encephalomyelitis as given in the DSS disability living handbook.
Mr. Scott : I have been asked to reply.
I will write to the hon. Member.
Fazakerley Hospital
Mr. Kilfoyle : To ask the Secretary of State for Health whether he has received from the Mental Health Commission a report on staffing levels at Fazakerley hospital, Liverpool.
Mr. Dorrell : No. I understand that the commission has visited this hospital and are discussing its findings with the health authority. This reflects normal practice in handling the commission's reports.
Nurse Regradings
Mr. Redmond : To ask the Secretary of State for Health what arrangements have been made to pay arrears to nurses regraded after appeals against a grade awarded in 1988 when the hospital concerned has become a trust in the intervening period ; and if he will make a statement.
Mrs. Virginia Bottomley : Guidance issued to the national health service makes it clear that trusts assume all the rights, powers, duties and liabilities for the contracts of employment of people formerly employed by health authorities. Trusts are therefore responsible for any arrears of pay which may become due if a nurse is regraded following an appeal.
Mr. Redmond : To ask the Secretary of State for Health if he will list by individual health authority in England the provision made in the final accounts for 1990-91 for payments due to nurses who awaited settlement of the grading claims ; if he will estimate the total sum due to be paid on 31 March 1991 for grading arrears to such nurses ; and if he will make a statement.
Mrs. Virginia Bottomley : The provision made in the final accounts of health authorities for 1990-91 for payments due to nurses who awaited settlements of
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grading claims is not separately identifiable. No estimate of the total sum of arrears due to be paid as a result of grading appeals can be made.Radiotherapy
Mr. Ashley : To ask the Secretary of State for Health what representations he has received from the Radiotherapy Exposure Action Group ; and what was his response.
Mrs. Virginia Bottomley : No representations have been received.
Mr. Ashley : To ask the Secretary of State for Health if he will require all radiotherapy departments to routinely provide all patients with written information about radiotherapy they are to receive, with the information indicating any likely side effects ; and if he will ensure that written consent is requested if the treatment is in any way experimental.
Mrs. Virginia Bottomley : All patients have a right to reject or consent to treatment. They are entitled to as much information as they need, on an individual basis, to enable them to make a proper decision. Written consent should be obtained where a proposed procedure, including an experimental one, carries a substantial risk or substantial side effect. Most radiotherapy departments routinely provide patients with information on side effects of their treatment.
Mr. Ashley : To ask the Secretary of State for Health approximately how many people develop cancer annually and are treated with radiotherapy.
Mrs. Virginia Bottomley : In 1986, the latest year for which figures are available, there were approximately 193,000 registrations of newly diagnosed cases of malignant neoplasms in England. Information on whether radiotherapy forms part of a patient's treatment is not routinely collected.
Mr. Ashley : To ask the Secretary of State for Health what is the staff size of the inspectorate set within his Department to enforce the Ionising Radiation Regulations 1988 ; when it was established ; and what changes there have been in the level of radiation doses since 1988.
Mrs. Virginia Bottomley : The Department of Health inspectorate to enforce the Ionising Radiation (Protection of Persons undergoing Medical Examination or Treatment) Regulations 1988 was established in 1989 and currently warrants are held by four officials. The inspectorate is supported by the Department of Health (DH) administrative division concerned with ionising radiation. Currently, the DH inspectorate is concentrating on investigating incidents that have been reported, but since 1988 we have asked health authorities to introduce dose reduction strategies. DH has endorsed the joint report of the National Radiological Protection Board (NRPB) and the Royal College of Radiologists entitled "Patient Dose Reduction in Diagnostic Radiology" and is currently funding, at NRPB, a national survey of diagnostic radiology doses which will be published in 1993.
All these initiatives are directed towards reducing doses in the diagnostic radiology field.
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Mr. Ashley : To ask the Secretary of State for Health which professional bodies advise him on radiotherapy exposure.
Mrs. Virginia Bottomley : The Department holds regular meetings with the Royal College of Radiologists and is offered advice on an informal basis by the British Nuclear Medicine Society. Both these professional bodies advise the Department on radiotherapy exposure among other issues.
The Administration of Radioactive Substances Advisory Committee (ARSAC) advises Ministers on the administration of radioactive medicinal products and related scientific and radiological safety matters. The members appointed to this committee are proposed by the relevant professional bodies.
The chief medical officer at the Department is advised by his radiotherapy adviser, Professor Bleehan, on radiotherapy matters relating to the NHS.
Mr. Ashley : To ask the Secretary of State for Health from what sources he is provided with information about the extent and nature of damage from exposure to radiotherapy ; and if he will establish a research programme to provide comprehensive information and to look at ways of preventing damage from both excess and inadequate exposure.
Mrs. Virginia Bottomley : Information about the extent and nature of damage from exposure to radiotherapy is available in the clinical literature, as a result of research carried out by doctors, radiobiologists and related medical scientists.
The Department circulated a document "Quality Assurance in Radiotherapy" to all radiography departments in May 1991, a copy of which is available in the Library. This document was produced by a working party established by the Standing Medical Advisory Committee. A research project to establish the applicability of this approach is being funded at two centres by the Department. The results of the research will be promulgated widely.
Mr. Ashley : To ask the Secretary of State for Health if he will require his radiation inspectorate regularly to inspect radiotherapy equipment and its use in all NHS hospitals.
Mrs. Virginia Bottomley : Employers in the NHS and private health sector are required by the Ionising Radiation Regulations 1985 to ensure that radiotherapy equipment is designed, constructed, installed and maintained so as to be capable of providing the required treatment with the minimum of exposure. These regulations are enforced by the Health and Safety Executive.
Mr. Ashley : To ask the Secretary of State for Health what is his latest estimate of the number of patients damaged by (a) excess radiotherapy and (b) inadequate amounts of radiotherapy.
Mrs. Virginia Bottomley : The information on which such an estimate could be based is not available centrally.
Mr. Ashley : To ask the Secretary of State for Health if he will require all district health authorities (a) regularly to monitor exposure to radiotherapy, (b) to record every incident of excess or inadequate exposure and (c) to prepare an annual report for him, to include details on the nature, quality and age of its radiotherapy equipment.
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Mrs. Virginia Bottomley : All district health authorities are required by the Ionising Radiation (Protection of Persons Undergoing Medical Examination or Treatment) Regulations 1988 (IR(POPUMET) Regs 1988) to ensure their staff are adequately trained and that those who physically direct medical exposures"ensure a dose of ionising radiation to the patient is as low as reasonably practicable in order to achieve the required diagnostic or therapeutic purpose".
Every radiotherapy treatment is calculated for a specific patient and involves the regular monitoring of exposures from radiotherapy machines, as well as the regular review and clinical audit of the results of such treatment. All radiotherapy departments are required by the IR(POPUMET) Regs 1988) to keep an inventory of radiotherapy equipment which would include details of the nature, quality and age of that equipment.
We would expect provider units to report any untoward incidents to the Department of Health inspectorate.
Mr. Ashley : To ask the Secretary of State for Health how many qualified radiotherapists are in post within his Department.
Mrs. Virginia Bottomley : The Department does not employ any radiotherapists.
Mr. Ashley : To ask the Secretary of State for Health if he will establish a central fund to provide immediate no fault payments for those damaged by excess or inadequate radiotherapy.
Mr. Dorrell : No-fault compensation was proposed as part of the National Health Service (Compensation) Bill which was defeated on a free vote by a substantial majority at Second Reading. The Government's position remains that the basis for seeking compensation should be through proof of negligence actions through the courts.
Tinnitus
Mr. Harry Barnes : To ask the Secretary of State for Health what are his estimates of the numbers of tinnitus sufferers in the United Kingdom ; how many trained specialists are employed in the NHS to help alleviate this condition ; what funding is currently provided to charities and research institutions working on tinnitus problems ; and what are his plans for future funding and assistance.
Mr. Dorrell : It is estimated that between 0.5 per cent. and 1 per cent. of the population are seriously affected by tinnitus. There are 375 consultants in otolaryngology and 13 consultant audiological physicians employed by the NHS in England. The main agency through which the Government support biomedical and clinical research in the United Kingdom is the Medical Research Council (MRC) which receives its grant in aid from the Department of Education and Science. In 1991 the MRC spent £112,000 on research into tinnitus.
The Meniere's Society, many of whose members suffer from tinnitus, received a grant of £7,500 in 1991-92 and have applied for a further grant in 1992-93. Decisions on funding for 1992-93 onwards will be announced shortly. There are no plans for funding of any other voluntary organisations at present but any future applications will be carefully considered.
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Thalidomide
Mr. Ashley : To ask the Secretary of State for Health (1) if he will list the research publications on the absence of the side effect of peripheral neuropathy in United Kingdom leprosy patients taking thalidomide ;
(2) what, apart from producing teratogenic effects on the foetus, are the other major adverse effects of thalidomide ; if he will ensure that every patient being given thalidomide on a named patient basis is warned that the drug can cause a severe and permanent loss of sensation ; and if he will require manufacturers to give this information in a leaflet included in the packaging of the drug ; (3) if he will list the basis for the findings reported in the letter of 19 December from the Minister of Health to the right hon. Member for Stoke-on-Trent, South that none of the experts on leprosy has seen thalidomide neuropathy in their patients ; and what evidence he has of the frequency of this adverse effect in patients with other diseases taking thalidomide.
Mrs. Virginia Bottomley : A literature survey undertaken by the Department has failed to reveal any research publications on the absence of peripheral neuropathy in United Kingdom leprosy patients taking thalidomide.
Apart from the teratogenic effects of thalidomide on the foetus the other major adverse event is peripheral neuropathy. Thalidomide is used to treat a very few patients with rare diseases unresponsive to other treatments on a "named-patient" basis by an experienced group of physicians. They will be alert to the possibility of nerve damage and should be able to recognise it at an early stage.
The provision of warnings about the use of drugs prescribed on a "named- patient" basis lies with the doctor writing the prescription, not with the supplier. In the case of thalidomide, a practitioner should arrange for appropriate warnings about the possible side effects to be provided when it is dispensed to the patient. My letter of 19 December 1991 to the right hon. Member was based on the clinical findings of the panel of leprosy opinion. This experienced group of physicians who treat a condition that affects peripheral nerves have not detected signs of peripheral neuropathy associated with the use of thalidomide. Their findings are in agreement with the absence of any report in the literature that thalidomide causes peripheral neuropathy in patients treated for leprosy. Peripheral neuropathy is a well known side effect in patients with other diseases being treated with thalidomide. There are no accurate figures for the frequency of this side effect.
Abortions
Mr. Duffy : To ask the Secretary of State for Health if he will give a breakdown of the total number of abortions under the terms of the Abortion Act 1967 in the Sheffield health authority area in 1991 (a) by the ground on which they were performed and (b) how many were repeat abortions.
Mr. Dorrell : Data for 1991 are not yet available.
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Dentists' Fees
Mr. O'Brien : To ask the Secretary of State for Health (1) if he will discuss with the British Dental Association the need to avoid cuts in fees paid by his Department ; and if he will make a statement ;
(2) if he will make a statement on the payment of the arrears of fees for dentists following the recommendations by the pay review body.
Mr. Dorrell : The proposed increase in target net income of 8.5 per cent. which was recommended by the Doctors and Dentists Review Body (DDRB) was accepted by the Government. To ensure that the level at which fees are pitched in the coming year will deliver this proposed increase in dentists' net income the health departments consulted the British Dental Association (BDA). Following discussions between the British Dental Association and the health departments, agreement was reached to hold a joint inquiry to review the level of payments to dentists in 1991-92, the results of which will be considered by the Health departments and the British Dental Association in May when they reconsider the appropriate fee scale for 1992-93 ; simultaneously, they will begin a more fundamental review of the structure of dentists' remuneration.
Southern Derbyshire Health Authority
Mr. Oppenheim : To ask the Secretary of State for Health if he will give figures for the number of patients in the Southern Derbyshire health authority area who have been waiting for more than two years for an operation ; and if he will give equivalent figures for a year ago.
Mrs. Virginia Bottomley : The latest provisional figures show that at December 1991 there were 29 patients waiting over two years for treatment in the Southern Derbyshire health authority area. The equivalent figure in December 1990 was 108. The authority expects to have no patient waiting over two years by 31 March.
Mr. Oppenheim : To ask the Secretary of State for Health if he will give figures for the number of health care staff working for Southern Derbyshire health authority in 1982 and the latest year for which figures are available.
Mrs. Virginia Bottomley : The whole-time equivalent number of health care staff working for Southern
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Derbyshire health authority in 1982 and 1990 were 4,740 and 4,960 respectively. These are direct care staff, which includes nursing and midwifery (including agency), medical and dental (including permanent paid, honorary and locum staff, but excluding consultants and senior registrars whose contracts are held by the region) and professional and technical staff. The sources of the data are the Department of Health's annual censuses of national health service medical and non-medical manpower.Health Service Finance
Mr. Robin Cook : To ask the Secretary of State for Health what financial information, including sets of accounts, will be made available at the annual meetings of NHS trusts.
Mr. Dorrell : At each annual public meeting NHS trusts are required to make available their audited annual accounts and any report made on those accounts by the auditor.
Waiting Lists
Mr. Robin Cook : To ask the Secretary of State for Health if he will give details of the numbers of people waiting over two years for treatment who were removed from the lists between 1 October and 31 December because of (a) being treated and (b) for a reason other than being treated.
Mrs. Virginia Bottomley : The information requested is not yet available centrally.
Illegitimate Births
Mr. Redmond : To ask the Secretary of State for Health if he will list the number of illegitimate births to teenage girls in England in each year since 1980 in each registry area, giving the age in years of the teenage mothers.
Mr. Dorrell : Information for registry areas could be supplied only at disproportionate cost. Information for the mother's usual local authority of residence has been placed in the Library. Annual tables are available for 1980 and for 1982 to 1990 (inclusive). Industrial action by registrars means that such a detailed analysis is impractical for 1981.
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