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1989-90 |5,805
1990-91 |8,116
1991-92 |10,432
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Workplace Nurseries
Mr. Dowd : To ask the Secretary of State for Employment what plans her Department has to encourage employers in the London area to adopt or maintain workplace nurseries.
Mr. McLoughlin : The Department encourages employers throughout the country to consider family-friendly employment policies including flexible working and help with child care, through publications such as "The Best of Both Worlds". The new out-of-school child care grant delivered by training and enterprise councils will create some 50,000 new child care places for school aged children over the next three years, which may include workplace facilities.
Employment Schemes
Mr. Dobson : To ask the Secretary of State for Employment what was the average amount spent per person on (a) ET, (b) YT, (c) the job interview guarantee scheme and (d) job clubs for each year for which figures are available.
Mr. McLoughlin [pursuant to his reply, 3 March 1993, c. 209-10] : I regret that my original reply contained an error. The figures given for the average amount spent per participant on YT for Great Britain given in my reply of 3 March 1993, Official Report, col. 209-10 ; were incorrect, due to a clerical error. The correct information for the average amount spent per person on employment training (ET), youth training (YT), the job interview guarantee scheme (JIG) and job clubs, in Great Britain, for each year for which figures are available is as follows :
£ thousands Programme |1987-88 |1988-89 |1989-90 |1990-91 |1991-92 ---------------------------------------------------------------------- ET |n/a |5,540 |5,404 |5,384 |6,014 YT |n/a |n/a |2,620 |2,375 |2,735 JIG |n/a |n/a |n/a |n/a |57 Jobclub |<1>247 |<1>190 |140 |141 |147 <1>External Providers (contracted by the Employment Service) only. Figures exclude job clubs run by the Employment Service.
HEALTH
GP Prescribing
Dr. Marek : To ask the Secretary of State for Health (1) what assessment she has made of the annual saving achieved in the NHS hospital sector by general practitioners' prescribing of oral contraceptives in respect of prevention of unwanted pregnancies and of abortions ;
(2) what assessment she has made of the annual savings achieved in the NHS hospital sector by general practitioners' prescribing of (a) anti- hypertensive medicines, (b) medicines for treatment of late onset diabetes, (c) medicines for treatment of psoriasis and eczema and (d) medicines for the treatment of peptic ulcers.
Dr. Mawhinney : The Department has made no such specific assessment. General practitioners are aware that the cost-effective use of drugs can lead both to better patient care and to financial savings elsewhere in the national health service and in the public sector generally.
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Policies on prescribing are designed to encourage such cost-effective prescribing while maintaining the pressure to cut out wasteful expenditure on drugs.Health Checks
Mr. Wigley : To ask the Secretary of State for Health if it remains her policy for automatic health checks to be given to people who reach the age of 75 years ; and if she will make a statement.
Dr. Mawhinney : It remains policy that family doctors should offer all their patients aged 75 and over an annual health check.
Medicines
Mr. Radice : To ask the Secretary of State for Health in how many cases in 1991-92 the licensing authority determined an application for the grant of a licence under the Medicines Act in a way which differed from the advice of the Medicines Commission ; and if she will identify each of those cases.
Mr. Radice : To ask the Secretary of State for Health (1) if she will place in the Library a copy of the Committee on Safety of Medicines' policy on the disclosure of information about adverse drug reactions ;
(2) if she will place in the Library a copy of the Medicines Control Agency's policy on disclosure of information.
Dr. Mawhinney : The Medicines Control Agency has access to company data about medicinal products to carry out its functions under the provisions of the Medicines Act 1968. The Act places a responsibility on Ministers to protect the confidentiality of that information and makes it an offence for anyone to disclose it except in the performance of their duty.
It is the policy of the Medicines Control Agency to maintain the commercial confidentiality of information provided by the pharmaceutical industry and to protect the anonymity of individuals identified in information to which it has access ; this applies to information made available to the Committee on Safety of Medicines. Information on adverse drug reactions is disclosed by the agency to doctors, pharmacists and related groups when relevant to specific safety concerns.
Pharmacies
Mr. Burden : To ask the Secretary of State for Health what representations she has received regarding the effect on small pharmacies of the limit on the rise for 1993-94 in the global amount paid by her Department for pharmaceutical services.
Dr. Mawhinney : We have offered to increase the global sum out of which pharmacists' fees are paid by 1.5 per cent. in 1993-94. This accords with the Government's wider policy on public sector pay. How this money is allocated is a matter for discussion with the pharmacists' representatives. Those discussions are continuing.
Mr. Cox : To ask the Secretary of State for Health what survey her Department has undertaken on the number of pharmacies closing in the Merton, Sutton and Wandsworth areas ; and if she will make a statement.
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Dr. Mawhinney : Three pharmacies have closed between 1 October 1990 and 30 September 1992.
London Ambulance Service
Mr. Dowd : To ask the Secretary of State for Health, further to her statement of 25 February, Official Report, column 1005, when she expects the South West Thames regional health authority to report on its proposals for strengthening accountability of the London ambulance service.
Mr. Sackville : I refer the hon. Member to the reply my right hon. Friend the Secretary of State gave my hon. Friend the Member for Surbiton (Mr. Tracey) on 31March at cols. 241-42 .
Mr. Dowd : To ask the Secretary of State for Health how many outpatients' appointments have been cancelled by the London ambulance service for each month since October 1992.
Mr. Sackville : This information is not available centrally. The hon. Member may wish to contact Mr.Martin Gorham, chief executive of the London Ambulance Service, for details.
Drugs
Mr. Radice : To ask the Secretary of State for Health if she will list the 10 established drug substances and six drug classes investigated in 1991-92 because of potential safety hazards not previously recognised ; and what are the findings of each of the investigations.
Dr. Mawhinney : The information requested on the potential drug safety hazards investigated by the Medicines Control Agency is as follows :
The six drug classes
Non-steroidal anti-inflammatory drugs (NSAIDs). These drugs, used to treat arthritis, can cause rare cases of meningitis of a non-infective origin, and in some patients, kidney damage. The findings of investigations into these issues were published in Current Problems No. 32, issued in October 1991.
Angiotensin Converting Enzyme (ACE) inhibitors. Anaphylactoid reactions can occur when patients on ACE inhibitors, undergo renal dialysis with a particular type of dialysis membrane. The findings of an investigation into this issue were published in Current Problems No. 33, issued in February 1992.
Beta-agonists. Following concerns regarding a possible association between the use of beta-agonists in the treatment of patients with asthma and an increase in asthma mortality and morbidity, a Working Party was set up by the Committee on Safety of Medicines to review information on the safety of beta-agonists in asthma patients. They concluded that available evidence did not support a causal link between beta-agonist use and death from asthma. The findings of the Working Party were published in a report published in early 1992, and summarised in Current Problems No. 33, issued in February 1992.
Radiographic contrast media. Concerns have been expressed in Europe regarding the comparative safety of intravascular use of high- and low- osmolar contrast media. After review of the data it was concluded that there was no convincing evidence to suggest a difference between these types of media with respect to life-threatening or fatal reactions. The review has been published in Pharmaceutical Medicine 1993, 7 ; 47-55.
Quinolones. These antibiotics can cause convulsions in patients with or without a history of epilepsy ; this reaction can also be induced by an interaction between these antibiotics and non-steroidal anti-inflammatory drugs. The findings of an investigation into this issue have been published in Current Problems No. 32, issued in October 1991.
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Cephalosporins. These antibiotics can cause rare cases of pseudomembraneous colitis, a severe inflammatory condition of the colon. The findings of an investigation into this issue have been published in Current Problems No. 32, issued in October 1991. The 10 drug substancesGadolinium. Concern was raised from in vitro studies that gadolinium (Magnevist), a radiographic contrast medium, could affect viral infectivity. After review of the data it was concluded that the findings were unlikely to have relevance to the in vivo use of the agent.
Vitamin K. Concern arose from epidemiological studies reporting an association between intramuscular administration of vitamin K to newborn babies and the subsequent development of childhood cancer. After review of the studies the Committee on Safety of Medicines concluded that there was insufficient evidence to support the conclusions reached in the study. A letter was sent to all doctors by the Chief Medical Officer and the Chief Nursing Officer in December 1992 informing them about this matter. This issue is being kept under review.
Terodiline. This drug, used in the treatment of urinary incontinence, can cause rare but serious disturbances of cardiac rhythm. As a result of an investigation into this issue, the Chairman of the Committee on Safety of Medicines wrote to all doctors, dentists and pharmacists in July 1991, informing them of their findings. Following further reports of such reactions, the drug was withdrawn voluntarily by the pharmaceutical company. The findings of the review of the data were published in Current Problems Number 32, issued in October 1991.
Triazolam (Halcion). This drug is used in the short-term treatment of severe insomnia. Following a review of the data by the Committee on Safety of Medicines (CSM) this drug was withdrawn from the market in the United Kingdom in October 1991 and all doctors, dentists and pharmacists were informed by a letter from the Chairman of the CSM. The manufacturer of Halcion has appealed against the proposed action to revoke the product licences for Halcion, this matter is still under appeal.
Atenolol. Concern was raised by an epidemiological study which revealed that men receiving antenolo, had a higher death rate from cancer than those receiving diuretic or placebo. On review of the data it was concluded that it was unlikely that atenolol treatment was causally associated with increased cancer mortality in men and no action was considered necessary. This issue has been kept under review and the decision has been lent further support by two further studies which failed to find an association between atenolol treatment and increased cancer mortality.
Fenfluramine and dexfenfluramine. These drugs can cause the rare but serious adverse effect of pulmonary hypertension. The findings of an investigation into this issue were published in Current Problems Number 34, issued in June 1992. An epidemiological study is underway to investigate this matter further.
Carbimazole. This drug, used in the treatment of hyperthyroidism, can cause rare cases of serious white blood cell disorders. The findings of an investigation into this issue were published in Current Problems No. 32, issued in October 1991.
Flecainide. This drug, used in the treatment of cardiac rhythm disorders, can cause rare long-term adverse effects on the eyes, lungs or nervous system. The findings of an investigation into this issue were published in Current Problems No. 31, issued in June 1991.
Omeprazole. This drug, used in the treatment of peptic ulcers, can cause skin rashes, diarrhoea and headache, which can be severe. The findings of an investigation into these side effects were published in Current Problems No. 31, issued in June 1991. Flucloxacillin. This antibiotic can cause jaundice. The findings of an investigation into this issue were published in Current Problems No. 35, issued in November 1992.
Copies of all the publications referred to will be placed in the Library.
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Child Health Services
Ms Primarolo : To ask the Secretary of State for Health (1) to what extent hospitals are meeting the guidelines suggested in "Welfare of Children and Young People in Hospital" regarding (a) the provision of a named nurse for each child admitted, (b) the provision of accommodation for parents of children admitted to hospital, (c) education and play facilities for children, (d) separate facilities for adolescents and (e) the provision of separate facilities for children in (i) accident and emergency departments and (ii) out-patients departments ;
(2) what plans she has for monitoring child health services ; and if she will make a statement ;
(3) what progress is being made towards ensuring that all children admitted to hospital are accommodated in separate wards.
Mr. Yeo : This information is not available centrally. A recent study by the Audit Commission, "Children First" (HMSO 1993), concluded that the standards set in our good practice guide, "Welfare of Children and Young People in Hospital" have not been fully implemented. We intend to address this through the review procedure whereby the national health service management executive holds health authorities to account for specified aspects of their performance.
Ms Primarolo : To ask the Secretary of State for Health what steps she is taking to reduce inequalities in child health.
Mr. Yeo : The Government's approach to variations in the health of children and other groups was set out in "The Health of the Nation" Green and White Papers (Cm. 1523 and 1986), copies of which are available in the Library. The five key areas include accidents as the most common cause of death in children over the age of one year, but the White Paper recognises that in other fields too success with children will be crucial to the long- term success of the strategy. Our aim is to reduce variations by tackling specific issues and needs which can be targeted for effective action. Examples of such action within the field of child health include national and local initiatives to reduce perinatal death, including cot deaths, which area is already showing significant results ; improved immunisation, already at record levels, to ensure protection against death and disability from preventable disease ; and increased participation by general practitioners in child health surveillance, thereby providing screening and health promotion for children individually as part of integrated family health care.
In making such changes, the Government will continue to make the best use of improved arrangements for the delivery of health care. We have provided guidance and are undertaking monitoring to support health authorities in assessing children's health care needs locally, and in integrating family, community and hospital services.
Ms Primarolo : To ask the Secretary of State for Health what steps she is taking to ensure that children engaged in sufficient levels of physical activity to establish good health in later life.
Mr. Sackville : We have recently announced the setting up of a "Health of the Nation" task force on physical activity which will consider how to encourage people to
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obtain lifelong benefits from such activity. The task force will be able to build on the Government's recent initiative whereby physical education is a compulsory subject for all pupils in maintained schools between the ages of five to 16. It serves to give young people a knowledge of the long-term benefits of a healthy lifestyle and encourages the practice of health-related exercise.NHS Pay
Mr. Battle : To ask the Secretary of State for Health (1) what representations she has made to managers of trust hospitals in Leeds concerning pay awards for (a) professional and technical staff and (b) nursing staff ;
(2) what guidelines have been provided to trust hospitals concerning pay awards for ancillary workers.
Dr. Mawhinney : A copy of my right hon. Friend the Secretary of State's letter of 12 November 1992 to chairmen of all health service- employing bodies which set out arrangements for implementing the policy of public sector pay restraint throughout the national health service, is available in the Library. We have made no specific representations to Leeds NHS trusts. Management guidance has been issued by the chief executive of the national health service management executive relating to all staff in health authorities and trusts.
Child Psychologists
Ms Primarolo : To ask the Secretary of State for Health how many child psychologists were working in the NHS in each of the last five years, by region.
Dr. Mawhinney : This information is not available centrally.
Drugs (Side-effects)
Mrs. Helen Jackson : To ask the Secretary of State for Health what plans she has to establish a national computer record of the side-effects of drugs.
Dr. Mawhinney : Such a computer record already exists. Under the yellow card scheme introduced in 1964, doctors are requested to report suspected adverse drug reactions, and pharmaceutical companies have a statutory requirement to report these reactions to the licensing authority. Such reports are entered on to a computer database operated by the Medicines Control Agency. In 1991, a new computer system, adverse drug reactions on-line information tracking--ADROIT--was introduced to improve the speed and effectiveness of monitoring adverse drug reactions.
Female Circumcision
Ms Primarolo : To ask the Secretary of State for Health, pursuant to her answer to the hon. Member for Redcar, Ms Mowlam of 18 February, Official Report , column 322 , what further guidance she plans to issue to GPs on female circumcision.
Special Health Authorities
Ms Primarolo : To ask the Secretary of State for Health if she will list the budget of each special health authority for (a) 1992-93 and (b) 1993-94 ; and what is the projected distribution of funds for these authorities for 1994-95.
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Mr. Sackville : The budget allocations for 1992-93 and 1993-94 for special health authorities are given in the table. The figures include both capital and revenue.
SHA |1992-93 |1993-94 (see notes |(£ million)|(£ million) -------------------------------------------------------------------------- Central Blood Laboratory Authority/ National Blood Authority (CBLA/NBA) |4.550 |8.649 NHS Supplies Authority |20.767 |16.630 UK Transplant Special Services Authority (UKTSSA) |4.479 |5.372 Bethlem Royal & Maudsley (BR&M) |36.366 |36.643 Eastman Dental Hospital (EDH) |9.092 |9.926 Hammersmith & Queen Charlotte's (& Acton) (HQC) |81.408 |83.648 Moorfields Eye Hospital (MEH) |22.111 |22.871 Hospitals for Sick Children (Gt Ormond St & Queen Elizabeth's) (HSC) |61.467 |67.653 National Heart & Lung Hospitals (Brompton & London Chest) (NH&LH) |52.245 |50.562 National Hospitals for Neurology & Neurosurgery (Queen Square, Maida Vale, Finchley & Chalfont) (NHNN) |41.356 |37.307 Royal Marsden Hospital (Fulham & Sutton) (RMH) |38.085 |39.982 The figures for UKTSSA do not include money allocated to the SHA for reimbursement of donor hospitals as the money does not contribute to the running costs of the organisation. The HA in effect manages the funds used to reimburse donor hospitals for maintaining cadavers prior to transplantation, for the Department. The figures for 1992-93 are subject to validation by audit. The figures for 1993-94 are initial allocations, which will be added to by in-year adjustment, as appropriate. Figures for 1994-95 cannot be projected at this early stage. The CBLA became the NBA with effect from 1 April 1993.
Hepatitis B
Ms Primarolo : To ask the Secretary of State for Health what is her Department's estimate of the number of hepatitis B carriers in each of the last five years for which figures are available.
Mr. Sackville: It is estimated that about one person per 1,000 of the population in the United Kingdom is a carrier of hepatitis B. This proportion is unlikely to have changed significantly over the past five years. The number of cases of hepatitis B has been falling over the same period and was at the lowest level recorded in 1991, the latest year for which figures are available, at 517 cases.
NHS Information
Ms Primarolo : To ask the Secretary of State for Health, pursuant to her answer of 26 March, Official Report, column 751, how information is classified as validated ; and what other kinds of information are held by the NHS management executive but not regarded as information held centrally.
Dr. Mawhinney : Validated information is that which has been checked by the Department for accuracy,
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consistency and statistical reliability. The national health service management executive also holds a disparate range of administrative and management data obtained from a number of sources which may not be compiled on a comparable basis or use common definitions, or which may contain subjective judgments.NHS Pay Award
Mr. Battle : To ask the Secretary of State for Health what assessment she has made of the effects upon recruitment to the national health service of the 1.5 per cent. pay award.
Dr. Mawhinney : We do not expect recruitment or retention of national health service staff to be adversely affected.
Child Protection Teams
Ms Primarolo : To ask the Secretary of State for Health how many child protection teams were working in the NHS in each of the last five years, by region.
Mr. Yeo : This information is not available centrally. The organisation of child protection teams and the planning of the investigations is a matter for local authority social services departments and police, with other agencies which have specialist knowledge such as medical services with the national health service.
Drug Licences
Mrs. Helen Jackson : To ask the Secretary of State for Health what is the average test period for new drugs granted a licence in (a) the United Kingdom and (b) other EC states.
Dr. Mawhinney : For the period January 1992 to December 1992, the average gross time taken to grant a product licence for new drugs was 17 months.
Comparable statistics for other EC states are not available.
Hospital Waiting Lists
Ms Primarolo : To ask the Secretary of State for Health what plans she has to conduct an inquiry into the numbers and causes of deaths among patients on waiting lists for national health service treatment.
Mr. Sackville : None. Patients may die from a wide range of causes, in common with the rest of the population, while waiting for non-urgent treatment. Emergencies are always treated immediately and patients who need urgent treatment are given priority.
Data Protection Act 1984
Mr. Cohen : To ask the Secretary of State for Health how many certificates have been signed under the terms of section 27 of the Data Protection Act 1984 for each year since 1987.
Mr. Sackville : There have been none so far as the Department of Health is concerned.
Paediatric Waiting Lists
Ms Primarolo : To ask the Secretary of State for Health if she will provide details of paediatric waiting lists for each of the last five years by region.
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Mr. Sackville : Waiting time information by speciality is given in "Hospital Waiting Lists, In-patients and Day Cases", published twice a year, copies of which are available in the Library.
Child Accident Prevention
Ms Primarolo : To ask the Secretary of State for Health how much is being spent by her Department on child accident prevention in the current financial year.
Mr. Yeo : The cost of the accident prevention work carried out within the national health service cannot be precisely calculated. In 1992- 93 we awarded a grant of £103,000 per year for three years to the Child Accident Prevention Trust towards its central administrative costs. In 1993-94 we have awarded the trust a project grant of £10,000 per year for three years towards the cost of a project to promote the adoption of accident prevention measures by health and local authorities.
GP Fund Holders
Mrs. Helen Jackson : To ask the Secretary of State for Health if she will publish the up-to-date guidance given to GP fund holders about how they construct their budget.
Dr. Mawhinney : Budget setting guidance was issued in November 1992 under cover of EL (92)83. A copy is available in the Library.
Mrs. Helen Jackson : To ask the Secretary of State for Health when the guidelines for the financial arrangements governing GP fund holders were last updated.
Dr. Mawhinney : The updated general practitioner fund holder manual of accounts was issued in March 1993.
Mrs. Helen Jackson : To ask the Secretary of State for Health if she will make it her policy to ensure that GP fund holders' budgets and accounts are kept in a common form.
Dr. Mawhinney : The general practitioner fund holder manual of accounts sets out the accounting rules to be followed by all fund holders. It includes common formats for monthly budget monitoring reports and annual accounts.
Mr. Blunkett : To ask the Secretary of State for Health what guidance has been issued by her Department to general practitioners wishing to become fund holders with regard to prior consultation with the patients of the practice concerned.
Mr. Hunter : To ask the Secretary of State for Health what audit her Department has carried out to assessthe quality of patient care administered by general practitioner fund-holding practices and non-fund holding practices.
Dr. Mawhinney : Every family health services authority was required to establish a medical audit advisory group by 1 April 1991 to direct, co- ordinate and monitor medical audit activities within all general medical practices in its area. In exercising their purchasing role, general practitioner fund holders are also subject to monitoring and scrutiny by regional health authorities, which are responsible for the management of the fund-holding scheme.
lation to its study of GP fund-holding in 1991-92.
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