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Nursing and Residential Homes
Sir Thomas Arnold : To ask the Secretary of State for Health if she will indicate the extent to which the national health service budget will be altered to reflect the transfer to local councils of responsibility for people in nursing and residential homes.
Mr. Yeo : Funding for health authorities in 1993-94 and later years will be decided in the public expenditure survey in the normal way.
Resources
Mrs. Ann Taylor : To ask the Secretary of State for Health what are the current and projected levels of hospital and community-based resources within Dewsbury, Huddersfield and Calderdale available to meeet current and expected health needs.
Mr. Sackville : This information is not held centrally. The hon. Member may wish to contact Sir Brian Askew, the chairman of Yorkshire regional health authority, for details.
Rampton Hospital
Mr. Sheerman : To ask the Secretary of State for Health how many people have died in Rampton hospital during the last 10 years ; and from what causes.
Mr. Yeo : A total of 46 people have died while patients of Rampton hospital in the past 10 years. The causes of death recorded are :
|Number
---------------------------------------------
Natural causes |36
Suicide |5
Open verdict following inquest |3
Final inquest not yet held |2
HIV
Mr. Paice : To ask the Secretary of State for Health what arrangements she is making to enable payments to be made under the special scheme for people infected with HIV as a result of national health service blood transfusion or tissue transfer.
Mrs. Virginia Bottomley : Parliamentary approval to this new expenditure, announced on 17 February, will be
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sought in a supplementary estimate for the Department of Health administration, miscellaneous health services and personal social services, England vote (class XIII vote 3). Pending that approval, expenditure estimated at £1.2 million will be met by repayable advances from the contingencies fund.Mr. Bellingham : To ask the Secretary of State for Health if she will make a statement on the implications for Government policy of the recent case in Birmingham of the transmission of HIV infection.
Mrs. Virginia Bottomley : The Government recognise that HIV/AIDS is perhaps the greatest new public health challenge this century. The Government have consistently identified the threat of HIV/AIDS. This country is a recognised world leader in the action it has taken. Between 1985-86 and 1992-93 the Government have allocated nearly £700 million to health and local authorities for the development of HIV-related services as well as over £73 million to developing a national AIDS public education campaign.
Establishing better sexual health--within which context the spread of HIV can best be minimised--is one of the five key target areas in the "Health of the Nation" White Paper. This reflects the importance the Government attach to combatting the spread of HIV.
The Birmingham case has highlighted the fact that heterosexuals cannnot ignore the risk of HIV. Past and present experience of sexually transmitted diseases indicates that the public health, and that of individuals, is best served if people at risk of infection and their sexual partners can come forward freely for confidential advice, testing and help.
The Government will take the issues raised by the Birmingham case, and other recent developments, carefully into account. These issues will be reflected in the current work of the ministerial AIDS action group which is due to report in the autumn.
Tobacco
Mr. Paice : To ask the Secretary of State for Health when she will publish the fifth annual report of the Committee for Monitoring Agreements on Tobacco Advertising and Sponsorship.
Mrs. Virginia Bottomley : The Committee for Monitoring Agreements on Tobacco Advertising and Sponsorship has submitted its fifth report to the United Kingdom Health Ministers and to the Secretary of State for National Heritage. Copies have been placed in the Library. I am very grateful to the committee, and particularly the chairman, Sir John Blelloch, for their valuable work in continuing to monitor the agreements. The report shows that the industry has continued to honour its commitments.
Geneticists
Mr. Dalyell : To ask the Secretary of State for Health what is her estimate of the need of central laboratories for clinical geneticists.
Mr. Sackville : Most clinical genetics laboratories are based in regional genetics centres. Laboratory services in respect of complex or rare disorders are provided by a national centre, such as the National Haemoglobinopathy
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reference laboratory. This laboratory is the national reference centre for carrier diagnosis and prenatal diagnosis of complex haemoglobinopathies, notably the thalassaemias and sickle cell disease. The pattern of provision will depend to a large extent on the pace of developments.Genetic Disorders
Mr. Dalyell : To ask the Secretary of State for Health (1) what proposals she has for the provision of genetic registers, and enabling such registers to play a role in the elimination of potential carriers of disease ;
(2) what provision she is making to provide genetic counselling for (a) individual patients, (b) family groups and (c) relatives of victims of genetic disorders.
Mr. Sackville : Genetic registers and genetic counselling are integral components of the rapidly developing speciality of national health service genetic services. The level of provision of health care services, including genetic services, is a matter for health authorities to decide. As purchasers of services, health authorities are in the best position to make these decisions on the basis of their assessment of local needs.
Mr. Dalyell : To ask the Secretary of State for Health how many (a) doctors and (b) nurses are currently trained in the detection and treatment of genetic disorders ; and what plans she has to increase the numbers.
Mr. Sackville : The care and treatment of patients suffering from genetic disorders is shared between a range of professionals including hospital specialists, GPs and nurses. In 1990, the latest year for which figures are available, there were 76 hospital doctors (47.4 whole time equivalent) specialising in the treatment of genetic disorders in England. Quotas for the number of training posts are set on the basis of advice from the joint planning advisory committee which includes representatives of the Royal colleges, the medical profession and the national health service.
Mr. Dalyell : To ask the Secretary of State for Health how many people in the United Kingdom suffer from genetic disorders.
Mr. Sackville : Genetic factors are present in all human disorders to varying degrees, even in conditions as relatively minor as colour blindness. It is therefore not practicable to analyse all disorders in genetic terms. One of the most common and most serious single gene disorder is cystic fibrosis which is estimated to be present in one in 2,000 unborn children.
Mr. Dalyell : To ask the Secretary of State for Health what study she has made of the practice of payment from one health authority to another in paying for tests relating to genetic disorders.
Mr. Sackville : The first point of contact for patients requiring genetic advice is usually their GP, who will refer them for tests, if appropriate. The funding arrangements are therefore the same as for any other GP referral. The national health service management executive has agreed with general managers that regions should develop appropriate arrangements to assure the purchase of specialist services, both in NHS trust hospitals and in those managed directly by districts.
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Mr. Dalyell : To ask the Secretary of State for Health (1) what plans she has to promote the early adoption of new techniques of diagnosis management, and treatment of the effect of genetic disease, including proven gene therapy ;(2) what strategy she has to use new molecular knowledge in surgery and treatment ; and what training is given to those who use manipulative techniques in this field.
Mr. Sackville : An important part of the Department's research and development strategy is to ensure that the best use is made of the high quality of our medical research to improve patient care. The Government consider that it is important that applications of new molecular biological techniques to the diagnosis, management and treatment of patients should be subjected to stringent evaluation before they are adopted for use in clinical practice.
The Committee on the Ethics of Gene Therapy was set up in 1989 to provide advice to the United Kingdom Health Ministers on scientific and medical developments which have a bearing on the safety and efficacy of human gene modification. The committee's report was published in January this year when the Government announced that they would be consulting professional, scientific and lay bodies on the committee's recommendations. The consultation process was completed on 18 May and the Government are currently studying the responses.
Each of the Royal colleges and their faculties takes the lead on professional training within its own specialty. Training in molecular biological techniques is available for clinicians in training programmes organised by the Medical Research Council, the Wellcome Trust and other bodies.
NHS Trusts
Mr. Stevenson : To ask the Secretary of State for Health if she will make it her policy to ensure that opted-out hospitals maintain responsibility for training and research for medical and nursing staff.
Dr. Mawhinney : Trusts are expected to play a full role in teaching and training, including both undergraduate and postgraduate medical and dental education and other
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professional training and research. Health authorities or purchasers are expected to take account of teaching and research interests in their purchasing decisions.Mr. Stevenson : To ask the Secretary of State for Health what percentage of beds are sold to the private sector by opted-out hospitals.
Mr. Sackville : National health service hospital trusts have powers to authorise the use of beds for private patients, subject to the statutory requirement that there is no significant interference with the performance by the trust of its obligation under NHS contracts. Beds are not sold to the private sector and remain available to NHS patients.
Mr. Godsiff : To ask the Secretary of State for Health what legal limits there are on the number of pay beds in hospital trusts.
Dr. Mawhinney : I refer the hon. Member to the reply I gave the hon. Member for Carmarthen (Mr. Williams) earlier today.
Abortion
Mr. Alton : To ask the Secretary of State for Health if she will make a statement on progress in addressing the conclusions about the workings of the conscience clause of the Abortion Act 1967 made by the Select Committee for Health in its tenth report of Session 1989-90.
Mr. Sackville : The Government's response to the Select Committee's report was published in May 1991. The action promised in paragraph 10 of the report was undertaken immediately, and the monitoring referred to in paragraphs 5 and 12 of the response continues.
Mr. Alton : To ask the Secretary of State for Health what was the percentage of hospital discharges, after abortion not legally induced, to live births for 1967-68, 1979 and the last year for which figures are available ; and if she will make a statement.
Mr. Sackville [holding answer 7 July 1992] : The information requested is shown in the table.
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Percentage of hospital discharges after abortion (not legally induced) to livebirths for 1967, 1968, 1979 and 1985
England and Wales (except 1985, England only)
Year |ICD |Description |Number of |Number of |Rate per 100
|discharges |livebirths |livebirths
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
1967 |650.0 + 651.0 |Spontaneous abortion |67,816 |832,164 |8.15
|650.2 + 651.2 |Abortion induced for other reasons<1> |285 |832,164 |.03
|650.3 + 651.3 |Other abortion |1,800 |832,164 |.22
1968 |642 |Abortion induced for other reasons<1> |550 |819,272 |.07
|643 |Spontaneous abortion |5,951 |819,272 |.73
|644 |Abortion not specified as induced or spontaneous60,824|819,272 |7.42
|645 |Other abortion |2,068 |819,272 |.25
1979 |634 |Spontaneous abortion |26,641 |638,028 |4.18
|636 |Illegally induced abortion |72 |638,028 |.01
|637 |Unspecified abortion |25,501 |638,028 |4.00
1985<2> |634 |Spontaneous abortion |32,716 |619,301 |5.28
|636 |Illegally induced abortion |93 |619,301 |.02
|637 |Unspecified abortion |18,789 |619,301 |3.03
<1> Reasons other than legal or medical indications.
<2> England only.
Note:
Data for 1967 are based on the seventh revision of the International Classification of Diseases. Data for 1968 are based on the eighth revision, and data for 1979 and 1985 are based on the ninth revision. The data for the three periods in question are not necessarily comparable.
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Mr. Alton : To ask the Secretary of State for Health what was the percentage of legal abortions to live births for 1967-68, 1979 and the last year for which figures are available ; and if she will make a statement.
Mr. Sackville [holding answer 7 July 1992] : The information requested for 1968, 1979 and 1991 is shown in the table.
Percentage of legal abortions, under the Abortion Act 1967, to
livebirths for 1968, 1979 and 1991-England and Wales
Year |Number of |Number of |Rate per 100
|abortions |livebirths
-----------------------------------------------------------------
1968<1> |23,641 |539,259 |4.38
1979 |149,746 |638,028 |23.47
1991<2> |177,642 |699,217 |25.41
<1> The number of abortions for 1968 is for the period 27 April
1968 (when the Act came into force) to 31 December 1968. The
number of livebirths for 1968 is for 1 May 1968 to 31 December
1968.
<2> The number of abortions for 1991 is a provisional figure.
Mr. Alton : To ask the Secretary of State for Health if she will make it her policy to distinguish in the annual abortion statistics between abortions conducted solely with RU486 and those conducted with RU486 and in addition prostaglandins or D and C and D and E.
Mr. Sackville [holding answer 13 July 1992] : Published statistics state the method of termination used. From 1992, statistics will include terminations using antiprogesterone (RU486) with prostaglandin.
Genetic Therapy
Mr. Dalyell : To ask the Secretary of State for Health what policy conclusions have been drawn in relation to genetic therapy and genetic counselling from the conference "Our Genetic Future" held at BMA House on 30 June.
Mr. Sackville : The conference made a valuable contribution to discussion of the implications of gene therapy and genetic counselling. The Government are currently considering their response to the report of the Committee on the Ethics of Gene Therapy (Cm 1788) and will take account of the conclusions reached at the conference.
Mr. Dalyell : To ask the Secretary of State for Health if she will publish the recent letter from the chief medical officer to public health authorities on genetic therapy.
Mr. Sackville : The most recent letter on gene therapy sent to the health authorities was issued on 16 January 1992. It invited comments on the recommendations in the report of the Committee on the Ethics of Gene Therapy (Cm 1788). A copy of the letter is attached to Department of Health press release H92/20 which is available in the Library.
DNA Information
Mr. Dalyell : To ask the Secretary of State for Health what is her policy on the provision of DNA information about patients to insurance companies.
Mr. Sackville : Any information which is obtained as a result of DNA testing is no less confidential than other personal health information and should not be disclosed to insurance companies without the patient's prior consent.
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Thalassaemia
Mr. Dalyell : To ask the Secretary of State for Health what provision is made for those suffering from thalassaemia.
Mr. Sackville : Health care for those suffering from thalassaemia is provided by district health authorities in the light of the health needs of their resident populations.
Hospital Closures
Mr. Harry Greenway : To ask the Secretary of State for Health if she has any plans for hospital closures in the London area ; and if she will make a statement.
Dr. Mawhinney : Sir Bernard Tomlinson is currently carrying out a review of the health and medical education needs of the capital. His report will form the basis for decisions about the future pattern of hospital provision in London.
Domiciliary Care
Ms. Coffey : To ask the Secretary of State for Health what steps she is taking to monitor the provision of domiciliary care to ensure it is of an adequate standard.
Mr. Yeo : Local social services authorities are responsible for the provision and management of personal social services including domiciliary care services. It is for each authority to ensure that services they supply or arrange are of adequate standard.
Care Homes
Ms. Coffey : To ask the Secretary of State for Health if she will provide information on the unit costs of residential places provided by each local authority in England and Wales, with the comparable unit costs for private homes.
Mr. Yeo : The local authority analysis of gross weekly cost per place filled excluding capital charges in local authority homes for elderly people in 1989-90, the latest date for which information is available, is given in "Key Indicators of Local Authority Social Services 1989-90", a copy of which is available in the Library. These unit costs, which relate to England only, are based on data collected by the Chartered Institute of Public Finance and Accountancy.
Information relating to local authorities in Wales is a matter for my right hon. Friend, the Secretary of State for Wales.
Information about costs in the independent sector was produced in the Price Waterhouse report commissioned by the Department of Social Security, a copy of which is available in the Library.
Ms. Coffey : To ask the Secretary of State for Health if she will make a statement about how residents and potential residents and their next of kin will be informed of which services and facilities, as laid down in regulation 10 of SI (1984) No. 1345, should be provided and what complaints procedure will operate in a regulated small home.
Mr. Yeo : We are considering responses to the consultation document issued earlier this year about the regulations which should apply to small residential care
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homes once the Registered Homes (Amendment) Act 1991 is brought into force. Our intention is that the regulations should require that local authority registers should show whether a home is registered as a small home. Those consulting the registers will then be able to see which statutory requirements apply. More detailed information about individual homes will generally be available from the people running those homes and from other, independent sources.We intend that the same requirements about complaints procedures should apply to registered small homes as already apply to larger homes.
Ms. Coffey : To ask the Secretary of State for Health if she will provide statistics on the proportion of elderly people aged over 75 years who die within three months after being moved from one residential home to another.
Mr. Yeo : This information is not collected centrally.
Ms. Coffey : To ask the Secretary of State for Health when the Registered Homes (Amendment) Act 1991 regulations and commencement order will be laid before the House.
Mr. Yeo : Regulations amending the Residential Care Homes Regulations 1984 for the purpose of their application to small homes will be laid in the next few weeks. We hope to make the commencement order specifying when the Registered Homes (Amendment) Act 1991 will be brought into force at about the same time.
Ms. Coffey : To ask the Secretary of State for Health what precautions she intends to take to safeguard residents from eviction as a result of an owner of a small home being evicted himself for rent or mortgage arrears, by fraudulently obtaining multi-mortgages in order to run a number of small homes.
Mr. Yeo : It is for local authorities to ensure that anyone in need of residential care not otherwise available is properly provided for.
Ms. Coffey : To ask the Secretary of State for Health what steps after 1 April 1993, a local authority would have to take to safeguard elderly residents, before refusing or terminating a contract with a home owner.
Mr. Yeo : It will be for local authorities to devise their procedures for placing and reviewing contracts. The Government will expect local authorities to behave reasonably and sensitively, and give sufficient notice of their contracting policies and decisions. This could include providing any suitable assistance to minimise inconvenience to existing residents caused by the failure of the home in which they live to gain or retain a contract.
Ms. Coffey : To ask the Secretary of State for Health after 1 April 1993, if the choice of potential residents in nursing and residential homes will be confined to those homes selected by local authorities, unless the residents can afford to pay the full charges.
Mr. Yeo : From April 1993 local authorities will place contracts with residential care and nursing homes on behalf of individuals who are assessed as needing such care and need to be publicly supported. We have made it clear that authorities should take into account people's preferences for the home they enter and not unreasonably
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restrict people's choice. We have also made it clear that local authorities' arrangements should be sufficiently flexible to allow relatives and friends to contribute, if they so wish, towards the cost of a place in a more expensive home than the authority would normally contract with.Ms. Coffey : To ask the Secretary of State for Health what qualifications a person running a registered small home should have other than not having been found guilty of a criminal offence.
Mr. Yeo : The Registered Homes Act 1984 provides that registration in respect of a residential care home for four or more people may be refused if a person is not considered fit to be involved in running the home. The same will apply to applications for registration from those planning to run small homes once the Registered Homes (Amendment Act) 1991 is brought into force. It is for registration authorities to interpret and apply this requirement.
Ms. Coffey : To ask the Secretary of State for Health what is her estimate of how many of the existing private nursing and residential homes will close by 1994.
Mr. Yeo : Information about the number of independent nursing and residential care homes that close is not collected centrally.
Generic Drugs
Mr. Trotter : To ask the Secretary of State for Health what percentage of prescriptions was written generically in 1991 ; what percentage was dispensed generically ; what percentage of the total drug bill related to generic items ; and whether she can give an estimate of the figures expected to apply in the current year.
Dr. Mawhinney : In 1991, 41 per cent. of all prescriptions were written generically and 35.2 per cent. were dispensed generically. Information on the percentage of the total drug bill which relates to generic items is not available. However, 26.6 per cent. of the basic cost of drugs (that is, the net ingredient cost, excluding remuneration for dispensing, VAT, container costs and discounts) related to items written generically and 13.9 per cent. of the net ingredient cost related to items dispensed generically.
In the first quarter of 1992 generic prescribing increased to 43.2 per cent.
Marriages (Immigration Purposes)
Ms. Ruddock : To ask the Secretary of State for Health, pursuant to her answer of 3 July, Official Report, column 748, on marriages for immigration purposes, how many of the cases in the London borough of Lewisham which were reported to the Registrar General, were passed on to the Home Office ; and how many of those complaints were proven.
Mr. Sackville : Of the 21 cases reported to the registrar general, information in respect of 10 was passed to the Home Office. I understand that in two of the 10 cases notified the marriage has yet to take place. In a further six cases, the marriage was followed by an application to the Home Office for leave to remain as a foreign spouse of which two have been granted and four are the subject of ongoing inquiries. Applications to remain on the basis of marriage have yet to be received in respect of the remaining two cases.
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Child Minders
Ms. Armstrong : To ask the Secretary of State for Health if she will (a) list the number of child minders registered in each local authority in 1991 and (b) list the number re-registered under the Children Act 1989 in each local authority to date ; and if she will make a statement.
Mr. Yeo : Information about the number of child minders registered by each social services department at31 March 1991 was published in "Children's Day Care Facilities at 31 March 1991 England" ; a copy of which is available in the Library.
The number of child minders who have re-registered in the period to 30 June 1992 is being collected as part of a national exercise to monitor local authority implementation of the Children Act 1989 which will be reported to Parliament by the end of 1992.
Dentists Fees
Mr. Hutton : To ask the Secretary of State for Health what was the mean fee earnings per dentist in the Cumbria family health services authority in each year since 1987 at current prices.
Dr. Mawhinney : The table shows the mean gross earnings of general dental practitioners on the dental list of Cumbria family health services authority over the five financial years from 1987-88 to 1991-92, at 1991-92 prices.
Mean gross fee earnings per DRSG dentist at 1991-92 prices Financial |Cumbria year |FHSA (£) ------------------------------ 1987-88 |75,192 1988-89 |82,893 1989-90 |76,979 1990-91 |80,503 1991-92 |87,554
These means relate only to earnings through fees and to general dental practitioners in the population used by the dental rates study group. They exclude seniority payments, maternity payments, long-term sickness payments, postgraduate education allowances and other such allowances. They relate only to those general dental practitioners who were in contract for the complete financial year in question.
Departmental Staff
Mr. Steen : To ask the Secretary of State for Health how many staff her Department currently employs ; what are the total personnel costs ; and if she will calculate the staffing level of the health section of the former Department of Health and Social Security and the associated personnel costs immediately before its separation.
Mr. Sackville : For 1991-92 the Department's estimated outturn pay costs were £100 million for 4,659 staff ; for 1987-88 (prior to the split of the former DHSS), outturn paycosts were £60 million for 3, 932 staff. The 1987-88 figures have been adjusted to reflect staff numbers and costs as they would have related to the present organisation. All paybill costs include employers' earnings related national insurance contributions.
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