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Dr. Mawhinney : A total of 187 cases of legionnaire's disease were reported in England and Wales to the national surveillance scheme for legionnaire's disease at the PHLS communicable disease surveillance centre in 1990. Three of these cases were associated with hospitals and four other cases may possibly have been associated with a hospital stay.
In 1991 there were 111 cases--provisional--of legionnaire's disease in residents of England and Wales. Three of these cases were associated with a hospital and a further 10 cases may possibly have been associated with a hospital stay.
Cases are reported under a voluntary national surveillance scheme and identification of individual hospitals would jeopardise national infectious desease control.
Geriatric Patients
Mr. Redmond : To ask the Secretary of State for Health what guidelines her Department has issued to health authorities about moving geriatric patients without relatives outside their home district for continuing care.
Mr. Yeo : The guidance on discharge procedures, HC(89)5, a copy of which is available in the Library, makes it clear that patients and, with their agreement, carers and relatives, are fully consulted at all stages on the arrangements made for their future care needs. This is also one of the nine national standards set out in the patients charter. A thorough assessment of the health and social care needs of each patient should be carried out, prior to discharge, to ensure that any services required are provided in the most appropriate way.
Disability
Mrs. Dunwoody : To ask the Secretary of State for Health (1) if she will discuss with regional health authorities the training of informal care providers in the prevention and treatment of pressure sores and incontinence for the physically disabled ;
(2) what plans she has to help local health authorities to set realistic objectives and targets for services for physically disabled people ;
(3) what plans she has to encourage the funding of rehabilitation programmes under the National Health Service and Community Care Act 1990 ;
(4) what plans she has to discuss establishing new methods of measuring the performance of services for the disabled.
Mr. Yeo : Rehabilitation spans the responsibilities of health authorities, social services departments and a number of other agencies including the employment
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services. Health authorities fund rehabilitation services out of their general allocations and existing guidance sets out the range of services we would typically expect to see.The professions involved have done much to promote rehabilitation in recent years, and we are considering what further action is needed to develop services to meet the needs of people with disability or chronic illness and to identify and disseminate good practice including methods of measuring the performance of services, the setting of realistic but challenging targets and the provision of training.
Health authorities are responsible for purchasing services to meet the health care needs of their populations. The assessment of needs for rehabilitation services is a complex matter. Special co-ordination is needed in the case of young people leaving full-time education and seeking to live as independently as possible. The Department will shortly make available to health authorities an epidemiologically-based assessment of the needs of young adults with physical disabilities to assist in deciding what services to purchase.
We will encourage the development of good practice in the prevention and management of complications which often impede rehabilitation. We reaffirm the view expressed in our consultative document on the Health of the Nation, Cm 1523, that an annual reduction of at least 5 to 10 per cent. in the incidence of pressure sores is a reasonable target for health authorities and will initiate steps to identify and disseminate the best ways of achieving this. In July 1991 we published the agenda for action on continence services, which commended to health authorities the elements of an effective local service. We shall be taking further steps to keep key professions well informed and adequately trained on good practice, and to identify the prevention and treatment services which are most effective, taking account of the role of informal care providers. We will also be taking action to encourage the development of clinical protocols, standards of good practice, targets and performance indicators for services used by the people with impaired hearing or vision.
We are providing £1 million to improve rehabilitation services following brain injury, and we are also funding a major research study of the 12 sites around the country receiving these funds to evaluate their services.
There is insufficient knowledge about appropriate performance targets to make rehabilitation one of the key areas in our White Paper on the health of the nation but the Department will work with relevant experts to ensure that rehabilitation can become a national key area in due course. In the meantime we will pursue with regional health authorities where developments have progressed sufficiently the possibility of its adoption as a key area in those regions.
Mrs. Dunwoody : To ask the Secretary of State for Health what plans she has to discuss the dissemination to the physically disabled of the services available to them under the national health service.
Mr. Yeo : From 1 April 1992, the patients charter requires regional health authorities to set up general information services for the public. This will empower the patient to make more informed choices about health care, with improved access to information about the range of treatments available, greater knowledge of their condition and detailed information on waiting times.
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Mrs. Dunwoody : To ask the Secretary of State for Health what plans she has to improve respite care for the physically disabled.
Mr. Yeo : We are looking to health and local authorities to develop respite care services as part of the implementation of the White Paper, "Caring for People". We recognise the contribution which such services can make to providing practical support for carers.
Mr. Frank Field : To ask the Secretary of State for Health when she intends to implement sections 1, 2 and 3 of the Disabled Persons (Services, Consultation and Representation) Act 1986.
Mr. Yeo : The requirements of these sections are now, to a very large extent, reflected in our new and wide-ranging reforms of community care, which demonstrate our commitment to high quality care and which are responsive to the needs and wishes of service users and carers. The need to implement these sections of the Act will be reviewed in the light of several years' experience of the community care arrangements.
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Resource Management
Mr. Redmond : To ask the Secretary of State for Health what expenditure was incurred on developing resource management in England by each health authority in each year since 1988-89 ; and what financial benefits have been identified and evaluated to date.
Mr. Sackville : The sums made available by the Department to regional and special health authorities to develop resource management in the years 1989-90 to 1991-92 are shown in the table. Regional and district health authorities and individual hospitals have provided some additional funding for individual projects. In 1988-89, the Department contributed £2.3 million to projects in six acute resource management pilot sites.
The resource management programme aims to secure improvements in patient care through better management of resources at hospital level, and is not concerned solely with financial benefits. Assessment of benefits is an integral part of resource management projects in individual hospitals, but there has been no comprehensive national survey of those assessments.
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£ million
1991-92 1990-91 1989-90
Regional health authority |Revenue |Capital |Revenue |Capital |Revenue |Capital
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Northern |3.377 |1.885 |2.541 |1.648 |1.677 |1.350
Yorkshire |4.145 |1.079 |2.992 |4.748 |2.106 |1.849
Trent |3.352 |2.157 |2.768 |2.229 |1.434 |2.786
East Anglian |1.735 |1.889 |1.345 |0.706 |0.300 |0.440
North West Thames |3.277 |2.351 |2.382 |3.527 |0.022 |-
North East Thames |4.249 |3.677 |2.895 |2.789 |- |-
South East Thames |3.148 |2.128 |2.364 |2.848 |1.414 |0.822
South West Thames |2.543 |0.638 |1.496 |0.242 |- |-
Wessex |2.125 |2.431 |1.786 |0.549 |0.448 |0.050
Oxford |2.418 |1.461 |1.819 |2.766 |0.970 |0.470
South Western |2.245 |1.183 |1.566 |2.810 |0.005 |-
West Midlands |5.100 |4.998 |3.606 |4.600 |0.865 |0.050
Mersey |2.219 |0.076 |2.206 |1.924 |1.178 |1.363
North Western SHAs |4.358 |4.719 |2.835 |3.414 |1.045 |0.060
National Heart and Lung |0.165 |0.475 |0.211 |0.011 |- |-
Hammersmith |0.165 |0.181 |0.094 |0.171 |- |0.110
Hospitals for Sick Children |0.165 |- |0.186 |0.461 |0.025 |-
Total<1> |44.786 |<2>31.286 |33.092 |35.433 |11.489 |9.350
<1> Expenditure incurred by the Department of Health centrally is not included in the totals.
<2> Excludes £10.616 million made available to 30 NHS trusts via external financing limits.
Dentistry
Mr. Gareth Wardell : To ask the Secretary of State for Health if she will now issue guidance on the criteria to be used by family health service authorities in measuring cross-infection rates in dental surgeries.
Dr. Mawhinney : We have no plans to do so.
Ms. Lynne : To ask the Secretary of State for Health if she will make a statement on her plans to recruit salaried dentists in the event of large numbers of dentists leaving the national health service.
Dr. Mawhinney : Health service guidance contained in HSG(92)27, a copy of which is in the Library, was issued to family health services authorities in June 1992 and advises on the action to take if they wish to employ a salaried dentist. It is for the FHSA to decide, in the light of the circumstances in its locality, whether it should seek to employ a salaried dentist. Any application made to my right hon. Friend the Secretary of State for approval of
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such employment will be dealt with speedily. There is no reason to believe that large numbers of dentists intend to leave the national health service.Mr. Kirkwood : To ask the Secretary of State for Health on what date the new schedule of dental fees which she announced on 25 June was sent to the Government's printers with instructions to print it ; and if she will make a statement.
Dr. Mawhinney : Tuesday 23 June 1992 ; this being the date on which, pursuant to regulation 19(3) of the National Health Service (General Dental Services) Regulations 1992, my right hon. Friend the Secretary of State amended the statement of dental remuneration.
Ms. Janet Anderson : To ask the Secretary of State for Health if she will give an estimate of the anticipated delay in treating national health service patients requiring orthodontic treatment costing in excess of £200, as a result of the new regulations requiring prior approval to be
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sought from the Dental Practice Board for patients (a) under 18 years of age, (b) 18 to 25 years of age and (c) 25 years of age and older.Dr. Mawhinney : I refer the hon. Member to the reply that I gave to the hon. Member for Wakefield (Mr. Hinchliffe) on 13 July at columns 517- 18. The age of the patient is irrelevant to this process.
Ms. Walley : To ask the Secretary of State for Health if she will negotiate a new system of dental remuneration.
Dr. Mawhinney : I refer the hon. Member to the reply that I gave to my hon. Friend the Member for Brigg and Cleethorpes (Mr. Brown) on 9 July at column 337.
Ms. Janet Anderson : To ask the Secretary of State for Health how many orthodontic national health service patients required treatment costing in excess of £200 in each year since 1987 for patients (a) under 18 years of age, (b) 18 to 25 years of age and (c) 25 years of age and older.
Dr. Mawhinney : The information could be provided only at disproportionate cost.
Ms. Janet Anderson : To ask the Secretary of State for Health if she will consider raising the limit of £200 per patient on orthodontic treatment not requiring prior approval from the Dental Practice Board ; and if she will make a statement.
Dr. Mawhinney : We see no reason to raise the prior approval limit in respect of orthodontic treatment. The changes to regulations and the scale of fees which my right hon. Friend the Secretary of State announced on 23 June took account of concerns raised by orthodontists, in ways which will significantly reduce the effects on orthodontists of lowering the prior approval limit. The Dental Practice Board has estimated that some 70 per cent of all orthodontic treatment will be able to proceed without the need for prior approval.
Ms. Janet Anderson : To ask the Secretary of State for Health how many staff have been employed by the Dental Practice Board in each year since 1987 ; and if she will make a statement.
Dr. Mawhinney : The information requested is as follows :
Year ending |Staff<1>
|31 March
------------------------------------
1986-87 |1,631
1987-88 |1,497
1988-89 |1,369
1989-90 |1,268
1990-91 |1,220
1991-92 |1,126
<1>Full-time equivalent of
permanent and temporary staff
including allowance for overtime
employed on average during the
year.
Ms. Walley : To ask the Secretary of State for Health if she will instruct the Staffordshire family health services authority to employ a salaried dentist as a matter of urgency.
Dr. Mawhinney : It is for family health services authorities to decide whether they should apply for authority to appoint a salaried dentist.
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Departmental Objectives
Mr. Sproat : To ask the Secretary of State for Health if she will set out the objectives of each division and branch of her Department.
Mr. Sackville : The Department of Health's objectives for 1992-93 and beyond are set out in a statement of aims, goals and priorities, publication of which was announced by my right hon. Friend the then Secretary of State, in his reply to my hon. Friend the Member for Gedling (Mr. Mitchell) on 10 March at column 434 . Each part of the Department has its own more detailed objectives flowing from the statement.
GP Fund Holding
Mr. Cousins : To ask the Secretary of State for Health what guidance she has issued on the scope of community health services to be covered by general practitioner fund holding from April ; and whether health visitors, district nursing, occupational therapy, speech therapy, physiotherapy or community psychiatric nursing services are to be included in general practitioner fund holding financed services.
Dr. Mawhinney : Guidance is to be issued soon. Occupational therapy, speech therapy and physiotherapy are already included in the fund holding scheme. Health visiting, district nursing, community psychiatric nursing as well as community mental handicap nursing are to be added from April 1993.
Mental Illness Hospitals
Mr. Allen : To ask the Secretary of State for Health if she will list the specialist mental illness hospitals planned for closure by 1997, by district health authority concerned, together with the total number of beds currently in each and the number of beds currently occupied by patients.
Mr. Yeo : It is planned that the following mental illness hospitals should close by 1997 :
----------------------------------------------------------------------------------------------------- St. Mary's Morpeth |Gateshead |389 Clifton |York |97 De La Pole |East Yorkshire |390 Scalbor Park |Airedale |140 Highroyds |Leeds |36 Stanley Royd |Wakefield |359 Pastures |South Derbyshire |326 Carlton Hayes |Leicestershire |394 Mapperley |Nottingham |259 Middlewood |Sheffield |298 Whittingham |Preston |400 Barnsley Hall |Bromsgrove and Redditch|42 St. Mary's |Hereford |30 St. Matthews |South East Staffs |180 Central |South Warwicks |215 Ruberry Hill |South Birmingham |200 Hollymoor |Solihull |100 St. Crispin's |Northants |294 Littlemoor |Oxfordshire |270 Old Manor |Salisbury |216 Coney Hill |Gloucester |304 Tone Vale |Somerset |355 St. Lawrence |Cornwall |373 Horton |Riverside |620 Friern |Hampstead |350 Hellingly |Eastbourne |119 St. Augustine's |Canterbury and Thanet |282 Tooting Bec |West Lambeth |600 Maidstone (Psychiatric wing) |Maidstone |390
The number of beds in each hospital currently occupied by patients is not held centrally.
Clinical Standards Advisory Group
Mr. Cousins : To ask the Secretary of State for Health if she will list the membership of her Clinical Standards Advisory Group ; and what is the scope of its work on hospital-acquired infection.
Dr. Mawhinney : The Clinical Standards Advisory Group is as follows :
Sir Gordon Higginson (Chairman)
Professor June Clark
Professor Rhys Davies
Sir Terence English
Miss Pam Hibbs
Miss Jennifer Hunt
Mrs. Rosemary Jenkins
Miss Elizabeth McLean
Professor John Murray
Professor John Richmond
Professor Michael Rosen
Mr. Derek Seel
Professor Andrew Sims
Dr. Nuala Sterling
Professor Victor Tindall
Dr. Colin Waine
Professor Sir Dillwyn Williams
The group has been giving preliminary consideration to the possibility of a study on hospital-acquired infections. We look forward to receiving in the near future the group's specific suggestions on the scope of any such study.
Computers
Mr. Redmond : To ask the Secretary of State for Health what assessment has been made of the value for money of the expenditure on computers by health authorities in England over the last five years ; and what action has been taken by the chief executive to ensure such purchases of systems and hardware are adequately evaluated.
Mr. Sackville : The implementation of computer systems is a local responsibility. Local managers take investment decisions in line with their business requirements, and in doing this are expected to obtain value for money. They are expected to identify the potential benefits of any investment before decisions are taken and to assess whether those benefits are actually realised.
The National Health Service Management Executive is responsible for providing leadership and advice and establishing a strategic framework for computer developments. In particular the executive has been developing national standards within which local managers can evaluate commercial systems. The aim is to publish revised guidance on procurement, investment appraisal and benefits realisation later this year. Further support is being provided through a national training strategy for managers which will develop the skills required to choose, implement and manage information systems.
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Regional Health Authority Members
Mr. Cousins : To ask the Secretary of State for Health what is the present remuneration and expiry of term of office of each member of each regional health authority.
Dr. Mawhinney : All regional health authority non-executive members receive remuneration of £5,000 per annum. The names and terms of office of non-executive members of regional health authorities are as follows :
Regional health authority/ |Term of appointment
Name of member
-------------------------------------------------------------------------------------------------------------------------------------------
Northern
Mr. A. G. Brown |26 July 1990 |to |31 October 1993
Professor M. D. Rawlins |26 July 1990 |to |31 October 1993
Mr. P. H. Reay |26 July 1990 |to |31 October 1993
Mr. R. C. Spoor |26 July 1990 |to |31 October 1993
Yorkshire
Mr. J. A. Ferguson |26 July 1990 |to |31 October 1992
Professor S. B. Brown |26 July 1990 |to |31 October 1992
Cllr. W. Kilgallon |26 July 1990 |to |31 October 1993
Mrs. J. A. Barden |26 July 1990 |to |31 October 1993
Mr. M. A. J. Morgan |27 May 1991 |to |31 October 1993
Trent
Mr. M. Dassau |26 July 1990 |to |31 October 1993
Dr. K. J. R. Edwards |26 July 1990 |to |31 October 1993
Mrs. P. B. Wildgoose |26 July 1990 |to |31 October 1993
Mr. G. R. H. Clemons |26 July 1990 |to |31 October 1993
Mr. D. Bertram |26 July 1990 |to |31 October 1993
East Anglian
Mrs. J. L. Hopwood |26 July 1990 |to |31 October 1993
Professor D. K. Peters |26 July 1990 |to |31 October 1993
Mr. J. B. Mowson |26 July 1990 |to |31 October 1993
Mr. L. Rice |26 July 1990 |to |31 October 1993
Mrs. S. E. Sida-Lockett |26 July 1990 |to |31 October 1993
North West Thames
Mr. D. Bucks |26 July 1990 |to |31 October 1993
Mrs. J. B. Hanham |26 July 1990 |to |31 October 1993
Mr. M. G. Storey |26 July 1990 |to |31 October 1993
Mrs. E. J. Davies |26 July 1990 |to |31 October 1993
Professor S. Sutherland |1 May 1992 |to |31 October 1994
North East Thames
Maj. Gen. R. P. W. Wall |26 July 1990 |to |31 October 1992
Mr. P. Holwell |26 July 1990 |to |31 October 1992
Baroness Gardner of Parkes |26 July 1990 |to |31 October 1992
Dr. J. F. Moorhead |26 July 1990 |to |31 October 1992
South East Thames
Mr. A. J. L. Barnes |26 July 1990 |to |31 October 1993
Mr. I. D. Gainsford |26 July 1990 |to |31 October 1993
Professor P. M. Higgins |26 July 1990 |to |31 October 1993
Mr. R. F. Holland |26 July 1990 |to |31 October 1993
Mrs. W. Mitchell |26 July 1990 |to |31 October 1993
South West Thames
Dr. G. S. Spathis |26 July 1990 |to |31 October 1993
Mr. J. R. Harris |26 July 1990 |to |31 October 1993
Mr. G. J. Howe |26 July 1990 |to |31 October 1993
Mrs. J. K. Pearman |1 January 1992 |to |31 December 1994
Mrs. M. McNaughton |1 January 1992 |to |31 December 1994
Wessex
Mrs. J. Perons |26 July 1990 |to |31 October 1993
Professor J. M. Higgins |26 July 1990 |to |31 October 1993
Mr. R. C. Donnelly |26 July 1990 |to |31 October 1993
Mr. A. S. D. Service |26 July 1990 |to |31 October 1993
Mr. P. A. Waring |1 April 1992 |to |31 October 1994
Oxford
Mr. P. D. M. Gell |26 July 1990 |to |31 October 1993
Professor H. Harris |26 July 1990 |to |31 October 1993
Mr. C. J. N. Ward |26 July 1990 |to |31 October 1993
Mrs. V. Rubenstein |26 July 1990 |to |31 October 1993
Mr. W. A. Rooke |26 July 1990 |to |31 October 1993
South Western
Mr. D. F. Strachan |26 July 1990 |to |31 October 1993
Sir John Kingman |26 July 1990 |to |31 October 1992
Mr. C. Spence |26 July 1990 |to |31 October 1992
Mr. L. M. Urquhart |26 July 1990 |to |31 October 1992
Dame Margaret Fry |26 July 1990 |to |31 October 1992
West Midlands
Cllr. B. Stoten |26 July 1990 |to |31 October 1993
Professor Sir Michael Thompson |26 July 1990 |to |31 October 1993
Mr. E. M. Worley |26 July 1990 |to |31 October 1993
Mr. T. D. Morris |26 July 1990 |to |31 October 1993
Mrs. S. M. Beesley |26 July 1990 |to |31 October 1993
Mersey
Mrs. R. H. Hawley |26 July 1990 |to |31 October 1993
Professor A. M. Breckenridge |26 July 1990 |to |31 October 1993
Mr. J. F. Kane |26 July 1990 |to |31 October 1993
Mr. N. L. Banner |18 March 1991 |to |31 October 1993
Mr. B. Jenkins |1 November 1991 |to |31 October 1993
North Western
Mr. E. Parker |26 July 1990 |to |31 October 1993
Professor R. D. H. Boyd |26 July 1990 |to |31 October 1993
Mrs. J. A. Hytner |26 July 1990 |to |31 October 1993
Dr. A. K. Banerjee |26 July 1990 |to |31 October 1993
Wheelchairs and Artificial Limbs
Mrs. Dunwoody : To ask the Secretary of State for Health what plans she has to discuss the timely provision of wheelchairs and artificial limbs.
Mr. Yeo : The purchase of appropriate services for the provision of wheelchairs and artificial limbs is a matter for district health authorities. The quality of service is monitored by regional health authorities and the NHS Management Executive keeps it under review.
Sexual Health
Mr. Cousins : To ask the Secretary of State for Health what performance indicators she now requires from the annual reports of directors of public health in national health service districts on activities promoting sexual health.
Mr. Sackville : In July 1991 regional health authorities were asked to undertake a comprehensive review of their family planning services. Regions were asked to report by the end of June 1992 on the criteria they have set purchasing authorities for securing more effective family planning services and the specific targets that will be set for district health authorities and family health services authorities for 1993-94. Criteria and targets will depend on the priorities set as a result of assessment of local needs. Careful consideration will be given to the reports from regions and, in the light of these, to the future development of family planning service provision.
Deregulation
Mr. Sproat : To ask the Secretary of State for Health what visits she has made to her EC counterparts in each member state to discuss deregulation matters since 18 April ; what agreements came out of such meetings ; and what plans she has for making further progress in deregulation matters during the United Kingdom presidency of the EC.
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Dr. Mawhinney : We have had no such meetings. We expect to meet a number of the Health Ministers of other member states during the presidency to discuss matters on the agenda of the Health Ministers Council.
Civil Servants' Shareholdings
Mr. Simon Hughes : To ask the Secretary of State for Health what guidance, other than the civil service pay and conditions of service code and the establishment officers' guide, her Department provides relating to civil servants' shareholdings ; if she will list the number of occasions within the last five years on which civil servants have reported shareholdings to establishment officers in her Department ; what regulations apply to the staff of the next steps agencies within her Department ; what mechanisms are in place to prevent potential conflicts of interest ; and if she will make a statement.
Mr. Sackville : The Department's staff rules place a duty on every member of staff who comes into contact with a matter concerning a business organisation in which he or she has an interest, including shareholdings, to disclose that interest to his or her senior manager and to ask that some other official deal with the matter. Staff rules are given to and apply to all civil servants working in the Department, including its agencies. Individuals and their managers are expected to consult the Department's establishment officer about the desirability of acquiring or retaining shares where this might give rise to a potential conflict of interest. The Department's establishment officer has been consulted on such matters on two occasions since the Department separated from the former Department of Health and Social Security.
Wheelchair Access
Mrs. Dunwoody : To ask the Secretary of State for Health if she will hold discussions about providing access for people in wheelchairs to national health service buildings which they need to enter.
Mr. Yeo : Health authorities should ensure compliance with the patients charter standard that buildings can be used by people in wheelchairs. The Department has issued guidance to health authorities on the design of premises to take account of the special needs of physically disabled people.
Hospital Accounts
Mr. Redmond : To ask the Secretary of State for Health if he will make it his policy to collect information on the number of firms refusing to supply, or delaying supplies, to health authorities or trusts because of delays in settling accounts.
Medical Practitioners
Ms. Lynne : To ask the Secretary of State for Health if she will make a statement on the expected costs of compensation for individual medical practitioners whose legal status is not recognised by the current United Kingdom system of accreditation, as a result of EC directives 75/362 and 75/363 and of the Frankovitch case in the European Court of Justice.
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Dr. Mawhinney : It is not possible to make such an estimate.Hospital Trusts
Ms. Primarolo : To ask the Secretary of State for Health if she will set out her reserve powers to override the decisions of hospital trust management.
Dr. Mawhinney : The powers of my right hon. Friend the Secretary of State to make directions to national health service trusts are laid down in the National Health Service and Community Care Act 1990, schedule 2, paragraph 6.(1) and 6.(2). These powers will not be used routinely, and only under the most exceptional circumstances will there be any intervention in trusts' affairs.
Dog Bites
Lady Olga Maitland : To ask the Secretary of State for Health how many people have been treated for dog bites in national health service hospitals in the last year for which figures are available.
Mr. Sackville : There were 1,134 hospital admissions for dog bites in 1989-90. Information about dog bites treated in accident and emergency departments is not collected centrally.
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