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on what date tertiary referrals were first separately counted for statistical purposes ; and what public announcement was made of the change.Mr. Gwilym Jones : Aggregate information on in-patient treatments in NHS hospitals in Wales continues to be collected as deaths and discharges from hospitals as in previous years.
A letter to district general managers DGM(90)123, announced that from 1 April 1991, data relating to individual patient episodes would record tertiary referrals and cross-specialty referrals separately. These data will be used to supply detailed disaggregated analyses of patients' episodes of care in hospitals relating to specific types of treatment, characteristics of patients, and categories of illness.
Mr. Morgan : To ask the Secretary of State for Wales what consultations he has had with fund-holding general practitioners concerning the introduction of separate accounting for tertiary referrals during hospital treatment ; and if he will make a statement.
Mr. Gwilym Jones : Guidance was issued in January 1991 on the handling of tertiary referrals. No indications have been received that further guidance is necessary. Fundholding general practitioners should specify in their contracts the arrangements for tertiary referrals to ensure that these are only made with their agreement. Where a referral is made without this agreement they are not liable for payment.
Health Authorities (Public Relations)
Mr. Morgan : To ask the Secretary of State for Wales what consultations he has had with the chairman of the South Glamorgan health authority concerning its public relations contract with Harrison Cowley ; what level of expenditure is planned under this contract ; which other health authorities in Wales have such contracts, with which public relations agencies and for what value ; and if he will make a statement.
Mr. Gwilym Jones : Neither my right hon. Friend nor I have discussed the public relations arrangements in place in South Glamorgan health authority with its chairman, though he has been congratulated on the professionalism with which his authority presented its waiting times policy to local people.
Responsibility for locally based public relations in the NHS rests firmly with individual district health authorities and family health services authorities. Details of the kind sought are therefore best obtained directly from the authorities themselves.
Cardiff Bay Development Corporation
Mr. Morgan : To ask the Secretary of State for Wales what is the discretionary limit for capital expenditure by the Cardiff Bay development corporation without reference to his Department ; if he will list each of the projects above that limit submitted for evaluation to his Department in each year since 1987 ; and if he will give a summary of each evaluation.
Mr. David Hunt : Details of the various financial delegation thresholds for Cardiff Bay development corporation are set out in the following table. I will write
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to the hon. Gentleman, shortly, with a list of projects that exceed those thresholds. Details of the evaluation given to each project cannot be summarised without incurring disproportionate cost. A copy of my reply to the hon. Gentleman will be placed in the Library of the House.
Schedule of delegations to Cardiff Bay Development Corporation
|£
--------------------------------------------------------------------------------------------------
Projects (including land acquisition)
Full delegation threshold |250,000
Partial delegation threshold |3,000,000
Consultancies
De minimis level (competitive tender not required) |3,000
Single tender level for urgent studies |15,000
Full consultancy delegation threshold |100,000
Administrative expenditure ("Project" items)
Delegation levels for administrative 'projects'
before full project levels are introduced:
Initial administrative delegation level (prior to approval of full budget) |20,000
Interim administrative delegation level (after approval of full budget) |50,000
Computing or information technology expenditure
(i) Purchase of computer hardware (capital cost) |50,000
(ii) Bureau services (per annum) |10,000
(iii) Consultancies (per annum) |10,000
Proposals to incur computing expenditure above these levels have to be referred to the Department
Works contracts
De minimis level (competitive tender not required) |3,000
Single tender level for specialist of fixed price
purchase |15,000
Value above which contracts must be advertised in
the Official Journal (1 million ecu) |710,000
Write-offs and gifts
Following may be written off/given without prior
reference to the Department
All cash losses, other than overpayments
Other losses not exceeding |1,000
Gifts not exceeding |500
-up to a total value in any one year of |10,000
Land disposal
Disposal on terms set out in the Notes for
Guidance may be effected without prior
reference to the Department providing the area
involved does not exceed |5 ha
Employment Action
Mr. Morgan : To ask the Secretary of State for Wales what proposals he has to reduce the waiting time for the unemployed interested in applying for employment action programmes ; and what special priority schemes approved for employment action he will allocate where length of unemployment qualification periods are shorter than the standard six months.
Mr. David Hunt : There are no proposals to change the general requirement that applicants for employment action should have been unemployed and in receipt of benefit for 26 weeks or more.
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School Maintenance
Mr. Morgan : To ask the Secretary of State for Wales what statistics he has on the total school maintenance backlog for all the counties in Wales.
Sir Wyn Roberts : Responsibility for the repair and maintenance of school buildings rests with local education authorities and statistics on the maintenance backlog are not collected centrally.
Cadw
Mr. Jonathan Evans : To ask the Secretary of State for Wales what targets he has set for Cadw, Welsh Historic Monuments executive agency.
Sir Wyn Roberts : Cadw has been set the following key targets for 1992-93 :
(i) To complete 90 per cent. of the approved conservation maintenance programme.
(ii) To promote the preservation of historic buildings and ancient monuments by completing 12 re-survey lists and 60 scheduling entries.
(iii) To resolve 75 per cent. of statutory cases within the target periods (28 days for listed building consent cases, 90 days for scheduled monument consent cases and 120 days for ad hoc listings). (
(iv) To resolve 80 per cent. of grant applications within the target periods (18 weeks for Historic Buildings Council cases, six weeks for ancient monument cases and 12 weeks for civic initiatives (heritage) grant scheme cases) ; and to pay 90 per cent. of certified claims within six weeks of receipt.
(v) To raise Cadw's market share of the number of visitors to the top twenty heritage sites in Wales from 63.7 per cent. in 1991 to 65 per cent. in 1992.
(vi) To increase the average spend per visitor from 163 pence in 1991-92 to 175 pence in 1992-93.
(vii) To operate within allocated programme and running cost budgets.
(viii) To achieve an efficiency saving of 1.5 per cent. on gross running costs.
Full details of Cadw's performance against its targets for 1991-92 are contained in the agency's annual report, which will be published shortly.
NORTHERN IRELAND
Multiple Births
Mr. Wigley : To ask the Secretary of State for Northern Ireland if he will give the total numbers of (a) sets of(i) twins, (ii) triplets, (iii) guadruplets, (iv) quintuplets and (v) sextuplets born in Northern Ireland in each year from 1980 to 1991, (b) maternities in Northern Ireland in each year and (c) multiple births of each type in each year which were conceived as a result of (1) in vitro fertilisation, (2) gamete intra- fallopian transfer and (3) other forms of assisted conception.
Mr. Hanley : The information requested is as follows :
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Type |1980 |1981 |1982 |1983 |1984 |1985 |1986 |1987 |1988 |1989 |1990 |1991<1>
-------------------------------------------------------------------------------------------------------------------------------------
(a) Sets of:
(i) Twins |298 |305 |306 |263 |304 |272 |281 |322 |287 |281 |267 |315
(ii) Triplets |4 |3 |2 |4 |3 |3 |2 |7 |1 |2 |5 |6
(iii) Quadruplets |- |1 |- |- |- |- |1 |- |1 |- |- |-
(iv) Quintuplets |- |- |- |- |- |- |- |- |- |- |- |1
(v) Sextuplets |- |- |- |- |- |- |- |- |- |- |- |-
(b) Maternities |28,542 |27,229 |26,905 |27,188 |27,547 |27,529 |27,989 |27,694 |27,614 |25,928 |25,338 |26,058
(c) <2> IVF (i) Twins<3> |- |- |- |- |- |- |- |0 |7 |5 |12 |N/K
(ii) Triplets<3> |- |- |- |- |- |- |- |0 |0 |1 |2 |N/K
GIFT |- |- |- |- |- |- |0 |0 |- |- |- |-
N/K{equals}Not Known.
<1> Provisional.
<2> Figures are not collated centrally on infertility treatment other than IVF and GIFT.
<3> These figures are the results of IVF by year of conception with IVF having been available in Northern Ireland only since 1987.
<4> GIFT was available in Northern Ireland in only 1986 and 1987.
Ards Hospital
Mr. John D. Taylor : To ask the Secretary of State for Northern Ireland what has been the total expenditure at Ards hospital in each of the past five years ; and how much in each year was for capital projects.
Mr. Hanley : The information requested is as follows :
Year |Capital works|Total
|£ |£
--------------------------------------------------------
1986-87 |118,753 |7,521,157
1987-88 |619,148 |8,712,289
1988-89 |359,464 |9,155,789
1989-90 |399,852 |9,894,402
1990-91 |665,474 |11,044,410
Hospital Services
Mr. John D. Taylor : To ask the Secretary of State for Northern Ireland what is the estimated population within each of the district councils in the areas for which the Eastern Health and Social Services area board provides hospital services ; and what were the corresponding figures five years ago.
Mr. Hanley : The most recent information, contained in the mid-year estimates of population, relates to 1990 and is as follows :
District council area |1987 |1990 ---------------------------------------------------------------------------------------- Ards |63,600 |65,400 Belfast |303,800 |295,100 Castlereagh |57,900 |58,100 Down |56,400 |57,700 Lisburn |92,900 |98,700 North Down |70,700 |72,600
Figures for 1991 will be based on data obtained from the 1991 census and will not be available until after publication of the census summary report in the autumn. I shall write to the right hon. Member when the figures are available and place a copy of the letter in the Library.
Terrorist Funding
Mr. Barnes : To ask the Secretary of State for Northern Ireland what is his estimate of the amount of money raised by terrorist sympathisers in north America and received in Northern Ireland ; and if he will make a statement.
Mr. Mates : Although for obvious reasons I cannot be precise, we understand that somewhere between $ million and $1 million is sent to Northern Ireland each year.
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Airport Police
Mr. Mackinlay : To ask the Secretary of State for Northern Ireland what statutory protection exists for constables of the Northern Ireland Airports Authority from unfair dismissal ; what statutory police federation exists to represent them ; and what statutory restrictions exist on their entitlement to join a trade union.
Mr. Atkins [holding answer 30 June 1992] : Persons employed in police service, or in any other capacity by virtue of which they have the powers or privileges of a constable are excluded from the unfair dismissal legislation. Accordingly, constables of the Northern Ireland Airports Authority have no statutory protection from unfair dismissal. There are no statutory restrictions on their entitlement to join a trade union and they are represented by the Belfast Airport Police Association rather than a statutory police federation.
HEALTH
Hospitals (Infections)
Mr. French : To ask the Secretary of State for Health (1) how many patients are known to have contracted post-operative infections in (a) national health service hospitals and (b) private hospitals in each of the last five years ; and if she will express those cases as a percentage of the total of patients treated ;
(2) what estimates she has of the cost of treating people who have contracted post-operative infections in (a) national health service hospitals and (b) private hospitals.
Mr. Sackville : The available information on numbers of patients contracting post-operative infections is based on hospital discharge summaries. The 1989-90 estimates show 17,600 patients in national health service hospitals diagnosed as suffering from post-operative infection. The corresponding number in 1985 was 15,540. In both years, this number represented 0.2 per cent. of patients treated in hospital, but information from research studies indicates that this is an underestimate of the total incidence. Data for the intervening years are not available and corresponding information is not held in respect of private hospitals.
Information is not held centrally about the cost of treating patients with post-operative infection.
Mr. French : To ask the Secretary of State for Health (1) how many people are known to have died in each of the past five years due to infections contracted while in hospital ;
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(2) what measures she intends to take to reduce the number of people who contract infections during their stay in hospital ; (3) if she will list the types of infections which are most frequently contracted during a patient's stay in hospital.Mr. Sackville : Information is not held centrally on the prevalence and type of hospital-acquired infections. A study in 1980 indicated that urinary infections, wound infections, lower respiratory infections and skin infections were those most frequently acquired. The information available on deaths relates to those known to be due to post operative infection and is given in the table. We are very much aware of the importance of preventing hospital-acquired infection to the fullest extent possible. In 1988 we issued to health authorities the guidance produced by the joint Department of Health/Public Health Laboratory Service hospital infection working group. Authorities were asked to ensure that the recommended arrangements for infection control were in place in all acute hospitals. The Department is updating and expanding this advice. The guidance assists both purchasing authorities and provider units in carrying out their respective responsibilities of ensuring that the proper preventive measures are in place and of determining the quality measures to be specified in contracts. Part of the role of the newly appointed consultants in communicable disease control is to advise their health authorities on these quality measures. Adequate surveillance is an important aspect of the control of hospital-acquired infection and guidance on methods of surveillance has recently been issued to the national health service.
The Department also welcomes the development by the professions of clinical standards in hospital infection control. The clinical standards advisory group has been undertaking preliminary work with a view to proposing further studies in this area. We are also considering a proposal for research in to the financial costs and other burdens resulting from hospital acquired infection.
Deaths from |<1> England post operative |and Wales, infections | 1987-91 Year |Deaths --------------------------------------------- 1987 |11 1988 |15 1989 |12 1990 |7 1991 |8 <1> International Classification of Diseases, 9th revision, code 998.5 source OPCS death registrations.
Pay Bargaining
Ms. Eagle : To ask the Secretary of State for Health if she will list her Department's discussion documents on the subject of pay bargaining in the private health sector ; and if she will make a statement on the Government's policy on pay bargaining in the private health sector.
Dr. Mawhinney : It is for the independent sector to set its own pay bargaining procedures.
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National Health Service Staff (Transfers)
Mr. Pike : To ask the Secretary of State for Health(1) when she proposes to make regulations under section 49 of the National Health Service and Community Care Act 1990 for transfer of staff from health service to local authority employment ;
(2) what discussions she has had with staff and staff representatives facing transfer from national health service employment to local government employment in accordance with section 49 of the National Health Service and Community Care Act 1990 ; and if she will make a statement.
Dr. Mawhinney : It is proposed to make regulations under section 49 of the National Health Service and Community Care Act 1990 at the same time as the commencement order bringing part III of the 1990 Act into force is made. Staff representatives will be consulted about the regulations in the normal way.
Dentistry
Mr. Salmond : To ask the Secretary of State for Health what estimate the Government have made of the effect of introducing a prior approval limit on treatment of £200 ; what percentage of dental treatment would require prior approval at 1992 prices with an immediate introduction of the £200 limit ; and if she will make a statement.
Dr. Mawhinney : It is good management to put cost monitoring mechanisms in place for the most expensive treatments. Prior approval does not limit the range of treatments available. At £200, it will only apply to rather less than 3 per cent. of all courses of treatment.
Mr. Salmond : To ask the Secretary of State for Health what estimate the Government have made of the loss in net income to dentists from a 7 per cent. reduction in dental treatment fees.
Dr. Mawhinney : Overall, we anticipate that these changes will not only deliver the 8.5 per cent. increase in dentists' target average net income which the review body recommended, but that dentists will on average receive some £5,000 more than this target.
London Ambulance Service
Mr. Cohen : To ask the Secretary of State for Health what complaints in each of the last three years she has received about the London ambulance service allegedly being inadequate or at fault in individual cases where it has been called out ; and in how many of those cases loss of life was involved.
Mr. Sackville : The London ambulance service--LAS--is responsible for dealing with complaints about the service. It has a formal complaints procedure that ensures that complaints are dealt with in line with the patients charter. A number of complaints have been made about the LAS both to Ministers and direct to the LAS. I can assure the hon. Member that each complaint has been thoroughly investigated. Information on the number of cases that involve loss of life is not collected centrally.
Mr. Cohen : To ask the Secretary of State for Health whether she will review the level of emergency ambulance cover for (a) Leyton and (b) London ; and if she will make a statement.
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Mr. Sackville : The London ambulance service is managed as a pan-London service. Resources available in individual geographic regions of the service are shared with other regions, as necessary. The LAS is currently reviewing manning levels and shift rosters covering the whole of London. Management information derived from the recently introduced computer-aided dispatch will further improve the ability of managers to match available resources to demands on the service.Mr. Spearing : To ask the Secretary of State for Health for what reason a ceiling budget has been placed on the accident and emergency service of the London ambulance service ; and if she will make this particular service demand led.
Mr. Sackville : Like all other ambulance services, the London ambulance service contracts to provide a full 24-hour accident and emergency service. All such services are expected to match income to expenditure, taking account of the demands placed upon them. The level of expenditure for 1992-93 has been agreed, and this includes real growth of £1 million.
Regional Health Authority Chairmen
Mrs. Browning : To ask the Secretary of State for Health if she will announce the appointment of regional health authority chairmen.
Mrs. Virginia Bottomley : I am pleased to announce that I have made two new appointments to chair regional health authorities, as follows :
South West Thames RHA, Professor Marian Hicks
South Western RHA, Ms. Rennie Fritchie
In addition, the chairmen of the following three regional health authorities have been reappointed from 1 August 1992 :
North East Thames RHA, Mr. Tim Chessells
Northern RHA, Mr. Peter Carr
Oxford RHA, Dr. Stuart Burgess
I would like to express my appreciation of the contribution to the national health service made by Mr. Charles Stuart at South Western RHA. For personal reasons, Mr. Stuart is relinquishing the regional chairmanship, and I have invited him to become the chairman-designate of the proposed Plymouth hospitals unit which has made a formal application to become an NHS trust operational from 1 April 1993.
Hospices
Mr. Burns : To ask the Secretary of State for Health how much public money has been made available (a) nationally in respect of hospice support and (b) to the Chelmsford hospice in each of the last three available years.
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Mr. Sackville : In each of the last three years the Government have allocated funds to regional health authorities to enable them to increase the support they give to hospices and similar organisations providing care and support for dying people and their families. In each of the last two years, funds have also been allocated to enable hospices to obtain supplies of drugs free of charge. The allocations are shown in the table :
|Hospices |Drugs
|(£ million)|(£ million)
1990-91 |8.00 |-
1991-92 |16.96 |3.20
1992-93 |31.70 |5.50
The allocation of funds to individual projects is a matter for local discussion and agreement. The Chelmsford hospice received £54, 000 in 1990-91 and £108,000 in 1991-92 from North East Thames regional health authority. The allocation for 1992-93 has yet to be approved by the RHA.
Disabled People
Mr. Alex Carlile : To ask the Secretary of State for Health what is the average number of days' wait for disabled people needing (a) artificial limbs and (b) wheelchairs from the national health service ; and if she will make a statement.
Mr. Yeo : This information is not collected centrally.
Hospital Waiting Lists
Mr. Bayley : To ask the Secretary of State for Health how many people had been on hospital waiting lists in England in total, and in each specialty, on 1 April 1991 and on 1 April 1992 for (a) three months or less, (b) six months or less, (c) 12 months or less, (d) 24 months or less and (e) over 24 months.
Mr. Sackville : The information as at 31 March 1991 is given in the table. Figures for 31 March 1992 by specialty are not yet available centrally. For the provisional overall picture at 31 March 1992, I refer the hon. Member to the reply my right hon. Friend the Secretary of State gave to my hon. Friend the Member for Uxbridge (Mr. Shersby) on 12 May at columns 489-92. These show that between 31 March 1991 and 31 March 1992 the number waiting over two years fell by 97 per cent. and the total number waiting dropped by 3.5 per cent. or 33, 131.
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Waiting lists England |All patients |Waiting under |Waiting under |Waiting under |Waiting under |Waiting over
|waiting |3 months |6 months |12 months |24 months |24 months
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
31 March 1991
All cases
General surgery |206,622 |86,220 |128,219 |169,553 |195,645 |10,977
Urology |58,541 |24,495 |36,241 |47,135 |54,483 |4,058
Trauma and Orthopaedics |170,648 |56,512 |95,079 |135,992 |161,305 |9,343
ENT |121,837 |50,670 |77,413 |104,092 |118,046 |3,791
Ophthalmology |95,210 |34,567 |58,125 |82,579 |93,673 |1,537
Oral Surgery |62,176 |20,852 |34,424 |49,371 |58,743 |3,433
Neurosurgery |3,913 |1,651 |2,439 |3,202 |3,724 |189
Plastic surgery |53,485 |11,424 |18,837 |28,793 |39,907 |13,578
Cardiothoracic surgery |9,236 |3,664 |5,904 |7,996 |8,937 |299
Paediatric surgery |6,202 |2,872 |4,313 |5,616 |6,109 |93
Obstetrics and gynaecology |118,235 |58,986 |84,190 |105,578 |115,724 |2,511
General medicine |9,832 |7,454 |8,428 |9,111 |9,515 |317
Cardiology |10,954 |5,418 |7,750 |10,003 |10,715 |239
Dermatology |1,557 |1,100 |1,313 |1,418 |1,514 |43
Thoracic medicine |589 |348 |438 |536 |576 |13
Medical oncology |199 |176 |180 |185 |193 |6
Neurology |2,709 |1,697 |2,166 |2,443 |2,578 |131
Rheumatology |2,426 |1,484 |1,921 |2,231 |2,352 |74
Geriatric medicine |461 |369 |413 |434 |449 |12
Mental illness |830 |357 |513 |647 |705 |125
Radiotherapy |652 |636 |645 |649 |652 |0
General practice |742 |427 |555 |657 |740 |2
Other |11,187 |7,468 |9,196 |10,261 |10,905 |282
Total |948,243 |378,847 |578,702 |778,482 |897,190 |51,053
Dentists' Pay
Mr. Michael Brown : To ask the Secretary of State for Health how the fundamental review of the dental remuneration system will be carried forward.
Dr. Mawhinney : I am pleased to announce that Sir Kenneth Bloomfield has accepted an invitation from the United Kingdom Health Ministers to review the system of dental remuneration.
The text of my invitation to Sir Kenneth is set out as follows : "I am writing on behalf of the UK Health Ministers to confirm my invitation to you to review the system of dental remuneration, and if possible to report before the end of the year.
The terms of reference are :
" "To conduct a fundamental review of the existing system of remuneration of general dental practitioners and to identify options for change"
There are a number of important points which you will need to bear in mind.
First, the review should consider the system of remuneration. The level of remuneration for general dental practitioners are a matter for recommendation by the Review Body on Doctors' and Dentists' remuneration.
Second, the aim of the review should be to identify options for remunerating general dental practitioners which would provide a proper framework of financial control ; would be fair to dentists and the public and as simple as practicable ; and would therefore contribute positively to the development of the NHS dental service. Third, I am looking to you to identify a number of options for change, rather than a single recommendation, though I would be happy for you to weigh up the advantages and disadvantages of each of them.
You will of course need to consult a number of interests in the course of the review. To assist you in this, I suggest that we establish a panel of advisers, drawn from the Government departments concerned, the NHS and the dental profession.
The Government attaches great importance to your review and looks forward to receiving your advice in due course."
NHS Statistics
Mr. Morgan : To ask the Secretary of State for Health from what date tertiary and cross-specialty referrals in hospitals were recorded as separate episodes of treatment in national health service statistics on out -patient and in-patient hospital activity ; what the estimated impact of such a change has been on time-series comparisons of hospital activity prior to and since the change in recording methods ; and if she will make a statement.
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Mr. Sackville : Hospital activity has been measured in terms of finished consultant episodes since April 1987. The move to this sytem from the previous system, which recorded discharges and deaths, was designed to monitor more accurately the volume of work carried out by each consultant in each specialty. Data continued to be collected on the old basis of discharges and deaths until 1988-89. Comparisons of in-patient cases over time should not be affected as figures for 1988-89 are available on both basis. The change had no effect on the number of out-patient consultations.
HIV
Mr. Dicks : To ask the Secretary of State for Health what assessment she has made of the reasons for the divergences between her Department's forecasts of the numbers estimated to be infected by the HIV-1 virus and the actual numbers so infected ; and for what reasons she has decided to allocate financial resources on the basis of estimated rather than actual numbers.
Mr. Sackville : Overall the forecasts contained in the 1990 Day report "Acquired Immune Deficiency Syndrome in England and Wales to end 1993" have not proved significantly different from the actual numbers diagnosed to date, after these have been adjusted for reporting delays.
Financial allocations made each year to the national health service for the treatment and care of people with HIV/AIDS are based on the numbers actually reported to the communicable disease surveillance centre for each regional health authority and not on the basis of estimates. Other non- treatment allocations including funds for prevention initiatives are made on a population basis, using Office of Population Censuses and Surveys data.
Mr. Dicks : To ask the Secretary of State for Health what assessment she has made of the different degrees of threat from the HIV virus to (a) heterosexuals and (b) homosexuals.
Mr. Sackville : HIV, the virus which causes AIDS, is primarily a sexually transmitted disease. In the United Kingdom, homosexual and bisexual men still account for the greatest number of reports of both HIV and AIDS. The number of reports of those infected heterosexually is much smaller, but reported cases are growing faster in this group than in any other.
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