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HEALTH
Local Community Hospitals
12. Mr. Ancram : To ask the Secretary of State for Health what encouragement she can give to purchasers and providers within the health service to promote and sustain local community hospitals in rural areas.
Mr. Sackville : Both purchasers and providers now have an unprecedented opportunity to tailor health services to meet local needs. National health service trusts, in particular, have a greater freedom over day-to-day operational matters and can be more responsive to patients. Health authorities are in a better position to focus on assessing the health needs and preferences of the local population and securing services to meet those needs and preferences.
Smoking
13. Mr. Peter Bottomley : To ask the Secretary of State for Health how many death certificates mentioned smoking in 1979 and in the most recent year.
Dr. Mawhinney : Reliable information on this has not been available but, from next year, we hope that new procedures on death certification may produce more usable information.
Waiting Lists
14. Mr. Bayley : To ask the Secretary of State for Health if she will make a statement on patients' waiting times between referral and initial out-patient consultations.
Mr. Sackville : Under the patients charter, health authorities are required to publish information on the local standards for first out- patient appointments and on performance against standards. Regional health authorities have been asked to set targets to build on this progress for 1993-94.
18. Mr. Bates : To ask the Secretary of State for Health what progress she expects to make in reducing waiting times under the patients charter.
Mr. Sackville : From April 1993, there will be a new and additional patients charter guarantee of a maximum wait of 18 months for a hip or knee replacement or a cataract operation. In addition, my right hon. Friend the Secretary of State recently announced that regions would be asked to set targets for waiting time for first out-patient appointments.
19. Mr. Hain : To ask the Secretary of State for Health if she will make a statement about the latest figure for waiting lists.
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Mr. Sackville : On 11 November, I announced provisional waiting time figures for September which showed that the number of patients waiting over a year fell by 3.6 per cent. over the previous quarter.
NHS Trusts
15. Ms. Quin : To ask the Secretary of State for Health what changes she is considering to the consultation procedure relating to the creation of NHS trusts.
Mrs. Virginia Bottomley : The procedure for consulting community health councils and other appropriate bodies about establishing a national health service trust is laid down in the National Health Service and Community Care Act 1990. I am not considering any changes to that procedure.
16. Dr. Goodson-Wickes : To ask the Secretary of State for Health what level of interest she has received in the fourth wave of NHS trusts.
Mrs. Virginia Bottomley : I have given permission to 121 units to prepare national health service trust applications in the fourth wave. If they are succesful, then 95 per cent. of the hospital and community health services budget will be spent through national health service trusts from April 1994. A list of 121 units has been placed in the Library.
Addiction and Alcoholism
17. Mr. David Atkinson : To ask the Secretary of State for Health if she will make a statement on her policy on addiction and alcoholism.
Dr. Mawhinney : Our policies for preventing and reducing the damage which the misuse of alcohol and drugs can inflict are carried through in a series of co-ordinated programmes which include those being developed under "The Health of the Nation" and "Caring for People", and initiatives such as the highly successful European drug prevention week.
The Health of the Nation"
20. Mr. John Evans : To ask the Secretary of State for Health what nutritional recommendations her Department will make in order to meet the targets set out in "The Health of the Nation".
Dr. Mawhinney : As promised in the Government's White Paper, we have set up a nutrition task force, under the chairmanship of Dame Barbara Clayton, to recommend a co-ordinated action programme for meeting the nutrition targets.
The task force will meet for the first time on 16 December.
Fund-holding Practices
21. Mr. Ashby : To ask the Secretary of State for Health what is the number of complementary therapists employed in (a) fund-holding general practitioner practices and (b) non-fund-holding general practitioner practices.
Mr. Sackville : This information is not held centrally. However, my hon. Friend will wish to know that it is open to all general practitioners to employ a wide range of staff, including complemenatary therapists, where appropriate, to assist them in the provision of general medical services.
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26. Mr. Jacques Arnold : To ask the Secretary of State for Health if she will make a statement on progress being made by fund-holding practices.
Dr. Mawhinney : It is clear that fund-holding practices are delivering real benefits to patients. This is reflected in the growing number of practices joining the scheme, which we expect will cover one in four of the population from April 1993.
Prescription Charges
22. Mr. Gunnell : To ask the Secretary of State for Health what plans she has to increase prescription charges ; and if she will make a statement.
Dr. Mawhinney : Judgments are made each year about how finite health resources can be best targeted for maximum health gain. Prescription charges are one aspect of these considerations. Any announcements will be made at the appropriate time.
Elderly Population
23. Mr. Miller : To ask the Secretary of State for Health if she will give her best estimates of the impact of the increase in the elderly population on health expenditure ; and if she will make a statement.
Mr. Yeo : I refer the hon. Member to the reply I gave the hon. Member for Darlington (Mr. Milburn) earlier today.
London's Health Services
24. Ms. Hoey : To ask the Secretary of State for Health what assessment she has made in her consideration of the Tomlinson proposals of the effects on the waiting lists in south London if either St. Thomas's or Guy's hospital is closed.
Dr. Mawhinney : The Tomlinson report notes that significant progress has been made in reducing waiting times in London. We shall ensure that the proposals arising from the report continue this trend.
25. Ms. Jowell : To ask the Secretary of State for Health if she will give an undertaking that no beds will be closed in London as a result of the Tomlinson inquiry before steps have been taken to improve community health services.
Dr. Mawhinney : I refer the hon. Member to the reply I gave the hon. Member for Hampstead and Highgate (Ms. Jackson) on 26 November, at column 811 .
Dentistry
Mr. Austin-Walker : To ask the Secretary of State for Health if she will make a statement on the current situation in Greenwich and Bexley regarding the processing of formal complaints regarding NHS dental treatment.
Dr. Mawhinney : Greenwich and Bexley local dental committee has decided to withdraw its co-operation from dental service committees which are the statutory local bodies set up to investigate complaints alleging that a dentist has breached his or her terms of service. The National Health Service (Service Committees and Tribunal) Regulations require that dental service
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committees include dental practitioners nominated by the local dental committee. Therefore, for the present, dental service committee investigations cannot be conducted for this family health services authority and three complaints are awaiting investigation. I very much regret that some dentists have decided to take action which disrupts this service to patients. I hope they will agree to resume co-operation.Mr. Dover : To ask the Secretary of State for Health if she will ensure that the service of salaried dentists will be made available throughout the family health services authority covering the Chorley constituency.
Dr. Mawhinney : An application for approval to appoint a salaried dentist to provide treatment in the Chorley and South Ribble area was received on 1 December. We are dealing with the application as a matter of priority.
Mr. Dover : To ask the Secretary of State for Health when the pay review body for dentists is due to commence and complete its investigations.
Dr. Mawhinney : My right hon. Friend the Secretary of State announced on 9 July 1992 that Sir Kenneth Bloomfield had been appointed to carry out a fundamental review of the dental remuneration system. Sir Kenneth has been asked to report before the end of the year.
Patient Statistics
Mr. Nigel Evans : To ask the Secretary of State for Health what was the number of patients being treated as out-patients and in-patients in (a) England and (b) the north-west in 1975 and 1991.
Mr. Sackville : The information requested is given in the table.
|In-patients<1>|Out-patients
------------------------------------------------------------------
England
1975 |4,975,750 |30,947,482
1990-91 |7,524,192 |36,130,499
North western region
1975 |453,481 |2,737,230
1990-91 |733,809 |3,482,235
<1> For 1975, the information refers to finished hospital stays (
discharges and deaths). For 1990-91, the information refers to
finished consultant episodes.
A finished hospital stay is a discharge from a hospital-or a
death in a hospital-or transfer to another hospital.
A finished consultant episode is a completed period of care of a
patient using a bed under the care of one consultant in a
particular health authority, and will therefore tend to record a
higher count. Finished consultant episodes includes a count of
healthy live-born babies who were not counted as finished
hospital stays.
Osteopathy
Mr. Tredinnick : To ask the Secretary of State for Health (1) what recent consideration she has given to the regulation of osteopathy ; and if she will make a statement ;
(2) if she will make it her policy that patients who consult an osteopath should have a guarantee that their practitioner is trained to minimum standards of competence and is regulated by a governing body capable off enforcing an appropriate code of practice.
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Mr. Sackville : I refer my hon. Friend to the reply I gave my hon. Friend the Member for Sevenoaks (Mr. Wolfson) on 3 December at column 320.
Natural Medicines
Mr. Tredinnick : To ask the Secretary of State for Health what steps are being taken to ensure that the cost-effectiveness and value of natural medicines are known to health authorities, hospitals, doctors and community health organisations.
Mr. Sackville : The Department sponsors work on cost-effectiveness of interventions in various universities and is currently funding a team of researchers from York and Leeds universities to produce a series of "effectiveness bulletins" to provide information for the national health service. Information bulletins are also produced by the medicines resources centre which provide data on the clinical impact of various pharmaceuticals and their costs of administration. This work is of recent origin and currently covers only a small proportion of interventions. So far, there has been no work on natural medicines, but it is not ruled out in the future.
Mr. Tredinnick : To ask the Secretary of State for Health how natural medicines will be incorporated into the strategy behind the Government White Paper, "The Health of the Nation".
Mr. Sackville : The national health service, in partnership with voluntary and other organisations, may adopt a variety of approaches in meeting the targets set in the five key areas selected initially for development of "The Health of the Nation" strategy. Natural therapies may be incorporated in local programmes where they are considered appropriate and cost-effective.
Unlicensed Medicines
Mr. Tredinnick : To ask the Secretary of State for Health what plans she has to strengthen laws relating to those who supply products that are not licensed as medicines but are advertised or labelled as such.
Dr. Mawhinney : The enforcement unit of the Medicines Control Agency investigates all reports of an unlicensed product being supplied or promoted as a medicinal product, and appropriate action is taken to prevent the supply of such products.
Magnetic Resonance Imaging
Ms. Walley : To ask the Secretary of State for Health if she will list the hospitals in the west midlands region, indicating in respect of each (a) whether they provide neurosurgery and neurology and (b) whether they have the provision of magnetic resonance imaging.
Mr. Sackville : This information is not collected centrally. The hon. Member may wish to contact Sir James Ackers, the chairman of West Midlands regional health authority, for details.
Regional Health Authorities
Mr. David Martin : To ask the Secretary of State for Health what are the revenue and capital allocations for regional health authorities in 1993 -94.
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Mrs. Virginia Bottomley : Main revenue allocations for resident population are set out in table 1. These are provisional until Parliament has approved the relevant Supply estimate.
Regions are to receive an average cash increase of 2.7 per cent., and I have decided that all regions should get a minimum increase of 0.4 per cent. above forecast inflation for the hospital and community health services of 1.9 per cent.
This is mainly to enable all regions to make further progress towards resource equalisation between districts.
I will announce capital cash limits for regional health authorities and the external financing limits of national health service trusts at a later date. Table 2 sets out the planning totals for each region. Regional health authorities and NHS Management Executive outposts will be giving me agreed proposals for the deployment of these planning totals between the regional capital programme and NHS trusts within each region.
|c|Table 1|c|
|c|Regional Health Authority Allocations: 1993-94|c|
|c|Revenue Allocations for Resident Populations|c|
|Allocation for |Percentage Increase
|Resident |Over Inflation
|Populations (£000s)
--------------------------------------------------------------------------------
Northern |1,159,723 |1.03
Yorkshire |1,334,886 |0.67
Trent |1,672,751 |1.16
East Anglia |704,794 |1.18
North West Thames |1,320,749 |0.40
North East Thames |1,490,187 |0.40
South East Thames |1,439,276 |0.40
South West Thames |1,116,107 |0.40
Wessex |1,033,656 |1.48
Oxford |794,779 |0.86
South Western |1,185,708 |1.16
West Midlands |1,855,142 |1.00
Mersey |890,032 |0.58
North Western |1,505,427 |0.70
|----- |---
England |17,503,217 |0.80
|c|Table 2|c|
|c|NHS regional main capital planning totals for
1993-94|c|
Region (both NHS |Regional capital
trusts' and health |planning total (£
authorities' main |millions)
capital
expenditure)
---------------------------------------------------------
Northern |105
Yorkshire |122
Trent |154
East Anglian |67
North West Thames |102
North East Thames |115
South East Thames |119
South West Thames |91
Wessex |97
Oxford |75
South Western |111
West Midlands |170
Mersey |80
North Western |135
|-----
Total |1,543
Mr. Blunkett : To ask the Secretary of State for Health if she will publish a table showing the financial allocation for each regional health authority for 1992-93 and 1993-94.
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Mr. Sackville : The table shows the 1992-93 revenue allocation for resident population of each regional health authority as announced on 5 December 1991 by the then Secretary of State, my right hon. Friend the Member for Bristol, West (Mr. Waldegrave), at columns 262-63 . In addition to initial allocations for resident population, regions are given cash limit additions for specific purposes throughout the year.
For details of the regional allocation for 1993-94, I refer the hon. Member to the reply my right hon. Friend the Secretary of State gave my hon. Friend the Member for Portsmouth, South (Mr. Martin) today.
|1992-93 Allocation
|for resident
|population
Region |£ million
---------------------------------------------------------
Northern |1,106.7
Yorkshire |1,276.4
Trent |1,593.6
East Anglian |669.2
North West Thames |1,260.0
North East Thames |1,448.2
South East Thames |1,383.1
South West Thames |1,078.2
Wessex |980.9
Oxford |758.2
South Western |1,128.0
West Midlands |1,766.6
Mersey |856.7
North Western |1,439.6
All regions |16,745.4
Low Birth Weight
Mr. Parry : To ask the Secretary of State for Health what assessment her Department has made of the factors which result in low birth weight of children born to mothers resident in
bed-and-breakfast accommodation in receipt of income support.
Mr. Sackville : Studies have shown that there are many factors associated with low birth weight. It is difficult to identify individual risk factors which may be significant in particular circumstances, for instance, women living in bed-and-breakfast accommodation. However, the importance of a balanced diet for the general health and well-being of pregnant women and their children has long been recognised and for that reason, pregnant women receiving income support are entitled to free milk and supplementary vitamins. Other important considerations are timely access to antenatal care and advice from relevant health professionals and reducing smoking in pregnancy, the latter being a significant factor in weight differences between babies. As a priority for 1992-93, the chief executive of the National Health Service Management Executive has asked all health authorities to focus on measures to reduce smoking in pregnancy and to improve women's access to maternity services. A number of innovative schemes have been introduced by health authorities across the country to improve access to maternity care for women living in the inner city. A scheme in Mersey region, based at the Princes Park health centre in Toxteth, is directing services specifically at women living in bed-and- breakfast and hostel accommodation.
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Audit Commission
Mr. Hawksley : To ask the Secretary of State for Health if she will make a statement on the work of the Audit Commission in respect of the national health service.
Mr. Sackville : The National Health Service and Community Care Act 1990 extended the remit of the Audit Commission to include the external audit of health bodies. This encompasses the audit of financial regularity and studies aimed at improving the economy, efficiency and effectiveness with which services are provided. The work of the commission is described more fully in its annual report, copies of which are available in the Library.
NHS Chairmen
Mr. Nicholas Winterton : To ask the Secretary of State for Health what criteria she uses in selecting and appointing chairmen of national health service trusts and health authorities.
Dr. Mawhinney : Chairmen and members are appointed to national health service trusts and health authorities for the personal qualities, knowledge and skills they can bring to the post.
NHS Pay
Mr. Bill Michie : To ask the Secretary of State for Health what guidance will be issued to enforce the 1.5 per cent. pay rise ceiling she has set for NHS staff ; and if she will make a statement.
Dr. Mawhinney : I refer the hon. Member to the reply I gave the hon. Member for Bristol, South (Ms. Primarolo) on 23 November at column 505.
Medical Complaints
Mr. Pickthall : To ask the Secretary of State for Health if she will take measures to speed up medical complaints procedures and make them more patient-friendly.
Mr. Sackville : The patients charter has given people the right to have any complaint about national health service services--whoever provides them--investigated and to receive a full and prompt written reply from the chief executive or the general manager.
In addition, the recent extension of the patients charter into primary health care has set targets for family health services authorities to improve their performance in dealing with complaints about general medical services.
Hib Vaccine
Mr. Steen : To ask the Secretary of State for Health what are the arrangements for general practitioners to call in children aged seven to 11 months in order for them to be vaccinated with haemophilus influenzae type B vaccine.
Mr. Sackville : Haemophilus influenzae B (Hib) immunisation was launched on 1 October this year as a major addition to the Government's programme for the prevention of childhood diseases. General practitioners were sent an information pack at the end of July, which explained the need for a phased schedule of immunisation to ensure that those children most at risk from invasive haemophilus disease--aged up to 12 months--were
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immunised first. In accordance with the schedule children aged between seven and 11 months are being called in for immunisation between October 1992 and March 1993. The objective is to immunise all children aged under four years by September 1993.Mr. Steen : To ask the Secretary of State for Health how many children have been inoculated with haemophilus influenzae type B since it was introudced between the ages of seven and 11 months ; and how many such children have been refused such inoculation in the current year.
Mr. Sackville : Information on the numbers of children immunised with Hib vaccine between the ages of seven and 11 months is not available. Arrangements have been made for all these children to be offered Hib vaccine in accordance with the call-up schedule provided for general practitioners and clinics. Two million doses of Hib vaccine had been made available nationally by the end of November.
Mr. Steen : To ask the Secretary of State for Health how much has been spent publicising the dangers of haemophilus influenzae to children between the ages of seven and 11 months.
Mr. Sackville : The Department of Health and the Health Education Authority have worked together in preparing publicity about haemophilus influenzae b (Hib) immunisation. Publicity is being directed at parents with children aged under four years with special emphasis on children aged under one year because these children are more vulnerable to the disease. Expenditure on television advertising, local radio campaigns, display advertisements in the mother and baby press, leaflets and posters will amount to £1.4 million in the current financial year.
Mr. Steen : To ask the Secretary of State for Health how much of the haemophilus influenzae type B vaccine has been made available to general practitioners in Devon ; and if she will make a statement on the rationing arrangements for haemophilus influenzae type B vaccine to doctors in Devon for inoculation of children aged seven to 11 months.
Mr. Sackville : The distribution of the two brands of haemophilus influenzae type b (Hib) vaccine to the health districts in Devon for delivery to both general practitioners and clinics up to 30 November is set out. The number of doses of Act Hib required in each district were calculated according to a formula based on the local birth rate.
Health district |Act Hib (mainly for|Hib TITER (for
|children below 12 |children between 1
|months of age. |and 4 years of age.
|These children |These children
|receive 3 doses |receive 1 dose
|each.) |each.)
|Doses |Doses
--------------------------------------------------------------------------------
Exeter |4,240 |1,350
North Devon |3,150 |2,270
Plymouth |10,460 |3,700
Torbay |3,860 |2,870
A further delivery of the Act Hib vaccine, 3,000 doses for Exeter and 500 doses for Plymouth, was due to be made on 7 December. The orders that have been fulfilled and the amount planned for delivery over the coming months will be enough to enable all children in Devon under the age of
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four to be immunised by September 1993. It is the responsibility of local health authorities to arrange equitable distribution of the vaccine they receive, according to the requirements of clinics and general practitioners, and to make any adjustments to the supply arrangements considered necessary.Mr. Steen : To ask the Secretary of State for Health if she will make a statement about the availability of haemophilus influenza type B vaccine ; from where it is purchased ; how much has been spent on it ; and what problems have arisen in relation to distribution.
Mr. Sackville : The vaccine is supplied by two manufacturers, Merieux under the name "Act Hib", and Lederle/Praxis under the name "Hib TITER". In the first two months of the programme, 2 million doses were distributed. By March 1993, the number of doses distributed will have increased to 5 million--more than enough to cover all children aged under one year and to allow for the immunisation of many older children who would otherwise be called in at a later stage in the programme. The objective is to immunise all children under four years of age by September 1993. Expenditure so far has totalled £9 million, with further substantial payments to be made in this and future financial years. If there are any local problems on distribution, it is for the responsible health authority to take the necessary action to put matters right.
Wellbury House
Mr. Blunkett : To ask the Secretary of State for Health (1) what advice has been given to Hertfordshire social services department in relation to future steps to regulate activities at Wellbury house ; (2) what assessment she has made of the suitability of conditions at Wellbury house for people under the age of 18 years to reside in the premises ; and if she will make a statement ;
(3) what steps have been taken to register Wellbury house in Hertfordshire as a voluntary children's home ; when application forms were received ; what action she has taken ; and if she will make a statement.
Mr. Yeo : It is the responsibility of Hertfordshire county council to judge whether conditions at Wellbury house are suitable for children accommodated there. General guidance on the protection of the welfare of children has been issued to all local authorities.
Ashworth Special Hospital
Mr. Blunkett : To ask the Secretary of State for Health if she will make a statement on her plans to review conditions at Ashworth special hospital.
Mr. Yeo : The report of the committee of inquiry into complaints about Ashworth hospital, chaired by Sir Louis Blom-Cooper QC, was published on 5 August. My right hon. Friend the Secretary of State has made it clear that we and the Special Hospitals Service Authority (SHSA) accepted the great majority of the report's recommendations, and set out the action being taken on the issues it raised. The finding of improper conduct and ill-treatment of patients by a number of staff were to be dealt with in accordance with the SHSA's disciplinary procedures. As a
Column 638
result of these two of the staff concerned have now been dismissed, one has been demoted, two given final written warnings and one a first written warning. In five cases no action was taken following the disciplinary hearing and one case was not proceeded with. My right hon. Friend also stated that the SHSA were drawing up an action plan for implementing the agreed recommendations and that a task force was being formed at the hospital--with reinforcement from outside--to take immediate responsibility for carrying it out. We have approved the action plan which the SHSA submitted, as it was required to, at the end of August. The work of the task force is supervised by a steering committee comprising the chairman, vice-chairman and chief executive of the SHSA, which is submitting regular progress reports to me. We will be arranging an independent audit of the action taken on the Inquiry report during the course of next year.The inquiry reported on unacceptable literature being circulated at the hospital and two former senior police officers have been appointed to investigate this. To date, two members of staff have been suspended as a result of these investigations.
My right hon. Friend also announced that we were forming a working group to consider the most effective provision of services for patients requiring psychiatric treatment in conditions of high security, and the relationship between such services and those provided within national health service regions and the prison service. This group, which is chaired by Dr. John Reed of the Department of Health, started work in October and is due to report by April next year.
My right hon. Friend's statement made clear our concern about the findings of the Inquiry report about a number of aspects of the care and treatment provided at Ashworth hospital. It also recognised the excellent work which is done at Ashworth by many dedicated staff. The action we have taken, and which is continuing, demonstrates our commitment to support and develop this work while tackling the deficiencies revealed by the report and their underlying causes.
Cancelled Operations
Mr. Blunkett : To ask the Secretary of State for Health if she will list for every health authority in England (a) the total number and (b) the percentage of operating theatre sessions cancelled in 1991-92.
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