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GP Fund Holders
Mrs. Helen Jackson : To ask the Secretary of State for Health how many general practitioner fund holders in each region have had their fund- holding status withdrawn. Dr. Mawhinney : One practice in the Trent region has had fund-holding status withdrawn.
Mrs. Helen Jackson : To ask the Secretary of State for Health how frequently the accounts of general practitioner fund-holding practices are checked by (a) the regional health authority and (b) the family health services authority.
Dr. Mawhinney : Each fund-holding unit is required to provide monthly accounts to the family health services authority. Regional health authorities are responsible for monitoring the scheme and request reports as necessary.
Mrs. Helen Jackson : To ask the Secretary of State for Health if she will introduce into the patients charter a requirement that patients registered with a fund-holding general practitioner are notified as soon as the general practitioner's budget for any element of national health service provision is exhausted.
Ms Primarolo : To ask the Secretary of State for Health if she will place in the Library a copy of each Audit Commission report on general practitioner fund-holding practices.
Dr. Mawhinney : The auditors appointed by the Audit Commission examine general practitioner fund holders' accounts annually and issue and audit certificate, but have not published any formal audit reports on fund- holding practices.
Ms Lynne : To ask the Secretary of State for Health what specific conditions are laid down relating to the contractual arrangements between general practitioner fund-holding practices and private health providers wholly or partially owned by partners in the fund-holding practice.
Dr. Mawhinney : These arrangements are governed by the National Health Service (Fundholding Practice) (General) Regulations 1991 and Amendment regulations of 1992. An amendment to these regulations was laid before the House on 10 March 1993, to come into effect on 1 April 1993. This amendment provides that payments from the fund to GP fund holders for providing services other than general medical services to patients of their practice, will be made directly to the medical practitioner who provides the services or to the partnership of which he is a member, rather than through a third party such as a limited company.
Ms Lynne : To ask the Secretary of State for Health what regulations or guidelines she has issued regarding the circumstances in which, and the grounds on which, regional health authorities may remove recognition from members of a fund-holding practice.
Dr. Mawhinney : The circumstances in and grounds on which a regional health authority may remove recognition from a fund-holding practice are set out in the General Practitioner Fundholding General Regulations, 1991.
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Ms Lynne : To ask the Secretary of State for Health what guidelines she has issued to regional health authorities concerning the supervision and monitoring of general practitioner fund-holding practices with regard to the quality of service and financial management.
Dr. Mawhinney : The following guidance has been issued : Management Allowance, EL(90)P84.
GP Fundholding : Financial Matters, EL(91)36.
Joint Guidance to Hospital Consultants on GP Fundholding, EL(91)84.
Contracting for 1992-93 : Involvement of GPs (including GP Fundholders), EL(91)120.
The Patient's Charter : monitoring and publishing information on performance, HSG(92)36.
GPFHs Public Availability of Contracts, EL(92)68.
GPFH : Guidance on setting budgets for 1993-94, EL(92)83. The Manual of Accounts.
Copies are available in the Library.
Ms Lynne : To ask the Secretary of State for Health what training her Department and regional health authorities provide to members of general practitioner fund-holding practices to help them effectively manage their budgets.
Dr. Mawhinney : Training is a matter for regional health authorities who provide training to reflect local needs.
Mr. Blunkett : To ask the Secretary of State for Health what guidance she has issued in respect of general practitioner fund-holders buying services from members of their own family ; and if she will make a statement.
Dr. Mawhinney : The National Health Service (Fund-holding Practices) (General) Regulations 1991, issued at the commencement of the GP fund- holding scheme, provide that regional health authority consent is required where a fund holder proposes to purchase services from a family member.
Psychiatric Care
Mr. Wigley : To ask the Secretary of State for Health if she will list the health authorities and local authorities who do not provide care programmes for all those under the care of a consultant psychiatrist who live within the community in general.
Mr. Yeo : All authorities have implemented the Care Programme Approach.
Public Bodies
Dr. Wright : To ask the Secretary of State for Health how many appointments to the public bodies listed in "Public Bodies" for his Department were made from names supplied by the public appointments unit ; and if she will list them.
Mr. Sackville : The public appointments unit provides names of suitably qualified candidates for consideration for a wide range of appointments. Information on the source of names of individual appointees to public bodies could be provided only at
disproportionate cost.
Dr. Wright : To ask the Secretary of State for Health what percentage shares of total departmental spending was accounted for by non- departmental public bodies in each year since 1979.
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Mr. Sackville : The Department of Health came into existence in April 1988, having previously been a part of the Department of Health and Social Security. Figures for the period 1988-89 to 1991-92 are shown in the table ; those for 1992-93 are not yet available.
i
Year |Total expenditure by|Total departmental |(a) as a percentage
|non-departmental |spending £ |of (b)
|public bodies £ |million<1> (b)
|million<1> (a)
---------------------------------------------------------------------------------------------------------
1988-89 |180 |18,460 |0.98
1989-90 |190 |19,970 |0.95
1990-91 |220 |22,470 |0.98
1991-92 |240 |25,560 |0.94
<1>Rounded to the nearest £10 million.
Consultants
Ms Primarolo : To ask the Secretary of State for Health what is the average age at which doctors achieve consultant status in England ; and what comparable information she has in respect of each of the other EC countries.
Dr. Mawhinney : The median age of consultants appointed during the year ending 30 September 1991 in England was 37. The equivalent data are not available in respect of other EC countries. Ms Primarolo : To ask the Secretary of State for Health what is the ratio of consultants per head of population in England ; and what information she has about comparable figures in other EC countries.
Dr. Mawhinney : As at 30 September 1991 there were 3,300 people per consultant in England. The equivalent data are not available in respect of other EC countries. Bone Marrow Transplants
Mr. Blunkett : To ask the Secretary of State for Health what action she is taking to protect bone marrow transplant services for children with metabolic disorders in the Westminster area ; and if she will make a statement. Mr. Sackville : Children with metabolic disorders are able to receive these services if clinicians agree that a bone marrow transplant is an appropriate course of treatment and a suitable donor is available. The location at which such procedures are carried out is determined by the availability of the necessary expertise.
Dental Care
Mr. Clapham : To ask the Secretary of State for Health what is the average amount spent on dental care per capita in each of the G7 countries.
Dr. Mawhinney : The latest available information is for 1991 and shows that in England the average expenditure per head on national health service dental care was £25.66. Information relating to Wales, Scotland, and Northern Ireland is a matter for my right hon. Friends the Secretaries of State for Wales and Scotland and my right hon. and learned Friend the Secretary of State for Northern Ireland. We do not have comparable information for the other G7 countries.
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Child Abduction
Mr. Olner : To ask the Secretary of State for Health what services are made available for parents and children suffering the effects of child abduction.
Mr. Yeo : There is no separate requirement upon local authorities to provide services for parents and children suffering the effects of child abduction except in so far as these children fall within the definition of "children in need" as defined by section 17(10) of the Children Act 1989. In these circumstances local authorities are required to provide a range and level of services appropriate to the needs of the children and their parents identified within their area.
Competitive Tendering
Mr. Morgan : To ask the Secretary of State for Health what representations she has received from the Cleaning and Support Services Association in relation to the Transfer of Undertakings (Protection of Employment) Regulations 1981 and compulsory competitive tendering by health authorities.
Mr. Sackville : We have received a number of representations from the Cleaning and Support Services Association over the past months seeking clarification of the implication of Transfer of Undertakings (Protection of Employment) Regulations 1981 for the national health service market testing programme. I refer the hon. Member to the reply my right hon. Friend the Secretary of State gave my hon. Friend for Hertford and Stortford (Mr.Wells) on 11 March at column 713 . A copy of the guidance has been passed on to the association.
Infertility
Mr. Spring : To ask the Secretary of State for Health what steps she has taken to remove the inconsistency between the provisions of the Access to Health Records Act 1990, the Data Protection Act 1984 and the Human Fertilisation and Embryology Act 1990 with regard to information about certain infertility treatments.
Mr. Sackville : On 17 March, we laid before the House the Access to Health Records (Control of Access) Regulations 1993 which preclude access under the Access to Health Rcords Act 1990 to any part of a health record which would identify a person born as a result of "treatment services" under the Human Fertilisation and Embryology Act 1990. Section 33(8) of that Act contains provision, subject to certain safeguards, in particular counselling, for obtaining access via the Human Fertilisation and Embryology Authority to information relating to such treatment.
Access to health records generally is governed by the Data Protection Act 1984, for computerised health records, and the Access to Health Records Act 1990, for written records. Human Fertilisation and Embryology Act 1990 modified the Data Protection Act 1984 to provide that access to information held on computer relating to treatment services is to be afforded under the 1990 Act rather than the 1984 Act. These new regulations will similarly preclude access under the Access to Health Records Act 1990 to written records relating to treatment services. Access to such records will then be available only
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on application to the Human Fertilisation and Embryology Authority under section 33 of the Human Fertilisation and Embryology Act 1990.GP Surgeries
Mr. Milburn : To ask the Secretary of State for health if she will make it her Department's policy to oblige general practitioners to include details of the accessibility of their surgeries in information for their patients.
Dr. Mawhinney : General medical practitioners are obliged by their terms of service to make available a practice leaflet to each patient on his or her list. This leaflet must specify whether the doctor's practice premises have suitable access for all disabled patients and, if not, the reasons why they are unsuitable for particular types of disability.
Drug Prescribing
Mr. Milburn : To ask the Secretary of State for Health if she will make it her Department's policy to oblige pharmacists to inform a patient if an item on a prescription may be obtained more cheaply over the counter.
Dr. Mawhinney : When a doctor prescribes an item which can be bought over the counter at a cost which is less than the prescription charge, there is no objection to the pharamacist selling it to the patient.
Nursing Home Residents
Dr. Godman : To ask the Secretary of State for Health what advice she has issued to family health service authorities to deal with the de- registering or the refusal by general practitioners to register elderly residents of nursing homes.
Dr. Mawhinney : I refer the hon. Member to the reply I gave to the hon. Member for Makerfield (Mr. McCartney) on 12 March at column 759.
Physiotherapy
Mr. Milburn : To ask the Secretary of State for Health if she will make it her Department's policy to ensure that all general practitioners have direct access for their patients to open access physiotherapy.
Dr. Mawhinney : Direct access to physiotherapy is increasingly available. The precise mix of local services is a matter for health authority purchasers, in consultation with general practitioners, and for GP fund holders.
Caring for People"
Mr. Blunkett : To ask the Secretary of State for Health how many copies of "Caring for People" were published ; how much each cost ; what was the overall cost ; and to whom the publication was sent.
Mr. Yeo : A total of 61,000 copies of the caring for people information pack for the voluntary and private sectors were printed at a cost of £105,706. A loose leaf version was produced at a unit cost of £4.80 and distributed to national, regional and local advice centres. A bound version was produced at a unit cost of £1.13. It was sent to registered residential care and nursing homes
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in England and made available to the voluntary sector and others with an interest in the community care reforms. Copies were also sent to directors of social services, health authorities, national health service trusts and all right hon. and hon. Members representing English constituencies.Locums
Mr. David Young : To ask the Secretary of State for Health what checks into the medical background of doctors hired as locums are made by health authorities.
Dr. Mawhinney : Employing bodies are responsible for deciding, in consultation with their occupational health advisers, what health checks are required of locum doctors.
Doctors (AIDS)
Mr. David Young : To ask the Secretary of State for Health (1) if she will make it the duty of a practice employing a doctor with AIDS to inform the district health authority of his condition ; (2) if she will make a statement on the case of the doctor with AIDS who was employed by Bolton health authority as a locum on casualty ; and what measures she will take to ensure that such a case does not recur.
Dr. Mawhinney : The United Kingdom health departments' guidance to health care workers, who perform or assist in invasive procedures and know or suspect that they have been exposed to HIV, states that they must obtain occupational advice on the possible need to alter their work practices and remain under close medical supervision if they continue to work. Ethical guidance from the professional bodies makes clear that health care workers have an overriding duty to put their patients' interests first. Failure to follow this guidance would raise the question of serious professional misconduct.
The chief professional officers to the Department of Health will meet the General Medical Council, the General Dental Council and the United Kingdom Central Council for Nursing, Midwifery and Health Visiting on 19 March to consider further steps that can be taken to ensure that their guidance in relation to health care workers and their ethical duties towards patients is known and understood by all health care workers.
Mr. David Young : To ask the Secretary of State for Health if she will take steps to release the name of the Bolton doctor who died of an AIDS-related disease, with details of all his previous work in the NHS ; and if she will make appropriate counselling available to all his previous patients.
Mr. Sackville : Bolton health authority has released the name of the health care worker involved, and the health boards for which he worked. It has set up a helpline to offer reassurance through counselling and if requested, testing. All patients seen by the doctor at Bolton royal infirmary have been identified and are being contacted. The two health boards in Northern Ireland have similarly set up helplines and are contacting former patients whose treatment by the health care worker involved invasive procedures.
Mr. David Young : To ask the Secretary of State for Health under what guidelines the condition of a doctor with AIDS can be known to his colleagues in the practice but withheld form patients treated by the doctor.
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Dr. Mawhinney : All medical information is confidential except for well defined circumstances where there is a risk to the public health. The United Kingdom health departments' guidelines "AIDS--HIV Infected Health Care Workers" requires health care workers who know or suspect they have been exposed to HIV to seek medical and occupational advice on the need to modify their work practices and refrain from invasive procedures.
In cases where the health care worker has performed invasive procedures and a study is needed, involving contacting former patients, his employer is necessarily involved. Wherever possible the identity of the health care worker is kept confidential.
AIDS Grant (Bromley)
Mr. Dowd : To ask the Secretary of State for Health, pursuant to her answer of 14 January, Official Report, column 800 , upon which date a further decision was taken with regard to HIV/AIDS support grant in 1992-93 for the London borough of Bromley ; and what are the details of that decision.
Mr. Sackville : The London borough of Bromley was notified on 12 March that the Department was able to offer it funding from the AIDS support grant scheme. Bromley has been awarded £10,500 towards the costs of the authority's contract with the Terrence Higgins Trust for the provision of services for people with HIV/AIDS.
Cystic Fibrosis
Mr. Blunkett : To ask the Secretary of State for Health (1) how many people in the United Kingdom presently suffer from cystic fibrosis ;
(2) how many babies are born each year with cystic fibrosis ; (3) how many people die each year because of cystic fibrosis ; (4) what is the current average lifespan of a cystic fibrosis sufferer ; and what was the figure in 1979.
Mr. Sackville : The latest Office of Population Censuses and Surveys information is that 110 people were certified as having died from cystic fibrosis in England in 1991. The other information requested is not available centrally. The report "Cystic Fibrosis in Adults" published by the Royal College of Physicians in November 1990 includes estimates for the prevalence of the disease and survival rates, a copy of which is available in the Library.
AIDS (Hospital Beds)
Mr. Blunkett : To ask the Secretary of State for Health what is (a) the total number of hospital beds in London currently available for people with AIDS and (b) the number that will remain following implementation of the recommendations of the report "Making London Better"; and if she will make a statement.
Mr. Sackville : The number of beds currently available in London is not collected centrally. Whilst some hospitals have beds specifically designated for AIDS patients, the vast majority of beds used are not reserved solely for this purpose.
After the implementation of the recommendations set out in the report "Making London Better", the Thames
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regions will continue to determine the level of provision for people with AIDS, in the light of guidance issued by the Department.Regional Health Authorities
Mr. Blunkett : To ask the Secretary of State for Health what steps she is taking to reorganise regional health authorities ; what is the timetable for reorganisation ; and if she will make a statement.
Dr. Mawhinney : My right hon. Friend the Secretary of State announced in a speech to the National Association of Health Authorities and Trusts on 23 February, a copy of which is available in the Library, that regional health authorities would continue to form part of the National Health Service's organisational arrangements until all providers are trusts and the NHS reforms have been fully implemented. RHAs will continue to be responsible for delivering NHS objectives in their region. They will manage purchasers and concentrate on the development of effective purchasing. They will maintain strategic oversight in their region to ensure that a comprehensive range of NHS services remains available. RHAs must embrace change so that they can work more easily with the grain of the NHS reforms. We have advised RHAs that typically they should employ a maximum of 200 people.
There will be a review of the functions and manpower of the present intermediate tier of NHS management and its interrelationships with the NHS management executive. Substantial progress will be made by the review by the summer.
The timetable for change will depend on RHAs own plans for slimming down, some of which are well developed, and on the conclusions reached by the review.
South Yorkshire Ambulance Service
Mr. Blunkett : To ask the Secretary of State for Health when the Parliamentary Under-Secretary of State for Health, the hon. Member for Bolton, West (Mr. Sackville) last communicated with the chairman of the South Yorkshire ambulance service ; what subjects were raised ; and if she will make a statement on the performance and response times of that ambulance service.
Mr. Sackville : I have had no correspondence with the chairman of South Yorkshire metropolitan ambulance and paramedic
service--SYMAPS--national health service trust. I have written to the chairman of Trent regional health authority on 9 February about the response time achieved by SYMAPS against the patients charter standard. The management of SYMAPS and the four South Yorkshire purchasing districts have been closely monitoring response times and are working to bring the accident and emergency performance standards into line with the patients charter.
Anti-diarrhoeals
Sir Patrick McNair-Wilson : To ask the Secretary of State for Health if she will publish a list showing the prescribed brands of anti- diarrhoeals and the price of a day's supply.
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Dr. Mawhinney [holding answer 9 March 1993] : The
anti-diarrhoeal drugs--British National Formulary section 1.4--dispensed in England in 1991 by community pharmacists and appliance contractors dispensing doctors and personal administration were as follows :
Aroben powder
Arret adult syrup
Arret capsules (2mg)
Arrowroot (solid)
Chalk and catechu mixture paediatric BNF 1963
Chalk and opium aromatic mixture (BP)
Chalk aromatic mixture
Chalk aromatic power BPC
Chalk (solid) BP
Chalk mixture paediatric BP
Codeine phosphate/magnesium chloride mixture
30/250mg/5ml
Collis Browne's mixture
Collis Browne's tablets
Diareze capsules 2mg
Diarphen tablets
Diarrest liquid
Diocalm ultra capsules 2mg
Diocalm tablets
Diocare sachets
Enterosan tablets
Imodium capsules (2mg)
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