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Written Answers to Questions
Thursday 22 July 1993
NATIONAL HERITAGE
Sports Council (Restructuring)
Mr. Pendry : To ask the Secretary of State for National Heritage, pursuant to his statement of 9 July, Official Report, column 599 (1) at what date and at what time he informed the chairmen-designate of the proposed United Kingdom Sports Commission and Sports Council for England of his decision to discontinue work to put these bodies in place of the current Sports Council for Great Britain from 1 October ;
(2) at what date he had consulted the chairmen-designate of the proposed United Kingdom Sports Commission and the Sports Council for England with regard to his decision to proceed no further with work to put those bodies in place of the current Sports Council of Great Britain from 1 October.
Mr. Brooke : I received in November 1992 the Sports Council's proposals for the detailed split of functions and resources between the bodies which the Government had proposed, in their December 1991 sports policy statement "Sport and Active Recreation", should succeed the present Sports Council of Great Britain.
My officials subsequently had extensive discussions with the Sports Council, including the chairmen-designate of the proposed successor bodies, on its proposals for the allocation of resources, notably to staffing. I also consulted my right hon. Friends the Secretaries of State for Scotland and for Wales and my right hon. and learned Friend the Secretary of State for Northern Ireland on the Sports Council's proposals.
As a result of these discussions, I informed the chairmen-designate of the proposed successor bodies on 8 July that the Government no longer intended to proceed with their original plans.
DUCHY OF LANCASTER
Recruitment and Assessment Services Agency
Mr. Robert B. Jones : To ask the Chancellor of the Duchy of Lancaster when the annual report of the Recruitment and Assessment Services Agency will be published.
Mr. Waldegrave : The second annual report of the Recruitment and Assessment Servcies Agency was published yesterday and copies have been placed in the Library of the House.
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HEALTH
Medical Services, Inner London
Ms Primarolo : To ask the Secretary of State for Health if she will give the general medical services budgets for each inner London family health services authority for each year since 1988-89 and the amount in real terms from each budget spent on fund-holding.
Mr. Sackville : General medical services (GMS) expenditure for each year from 1988-89 to 1991-92 is shown in table A. Figures for 1992-93 will be available later this year. Expenditure on fund-holding within GMS expenditure is not separately identifiable. However, the total cost of general practitioner fund-holding expenditure for each inner London family health services authority (FHSA) is shown in table B.
Table A Expenditure on General Medical Services £000s FHSA |1988-89|1989-90|1990-91|1991-92 ---------------------------------------------------------------------------- Brent and Harrow |16,382 |18,438 |23,260 |28,990 Kensington, Chelsea and Westminster |11,639 |13,492 |18,281 |19,291 Camden and Islington |12,099 |13,674 |17,124 |19,226 City and East London |18,144 |21,019 |30,174 |33,901 Lambeth, Southwark and Lewisham |22,482 |25,024 |31,906 |37,783 Merton, Sutton and Wandsworth |17,420 |19,639 |22,707 |26,916 Source: Annual accounts of FHSAs and the predecessor bodies.
Table B
GP Fund holders' expenditure for 1991-92
FHSA |Total expenditure
|£s
------------------------------------------------------------------------
Brent and Harrow |nil
Kensington, Chelsea and Westminster |789,923
Camden and Islington |1,406,503
City and East London |1,842,910
Lambeth, Southwark and Lewisham |4,094,110
Merton, Sutton and Wandsworth |4,585,639
Source: Annual accounts of FHSAs.
Note:
1. The above totals include expenditure for practice staff, hospital
purchases, drugs and appliances.
2. GP fund-holding expenditure is available only for 1991-92. Details
for 1992-93 will be available later this year.
GP Fund Holders
Ms Primarolo : To ask the Secretary of State for Health if she will list the benefits to patients available from GP fund-holding practices relative to non-fund-holding practices.
Mr. Sackville : Fund-holding is one of the major successes of the national health service reforms and the improvements secured by fund- holders are extending widely to benefit patients in non-fund-holding practices. We are delighted at how both general practitioner fund-holders and district health authorities are seizing the opportunities of the new NHS to secure more appropriate, high-quality care for patients.
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Among the benefits are shorter waiting times, better liaison between hospitals and community services when patients are discharged and more services provided in GP surgeries.Minimal Invasive Therapy
Ms Primarolo : To ask the Secretary of State for Health what plans she has to encourage the development of minimal invasive therapy.
Mr. Bowis : We shall shortly be announcing decisions on expanded training facilities for minimally invasive therapy, jointly funded by the Government and the Wolfson Foundation.
British Orthopaedic Association
Mr. Flynn : To ask the Secretary of State for Health when she next expects to meet the British Orthopaedic Association ; and what subjects she intends to discuss.
Mr. Sackville : There are currently no plans for Ministers to meet the British Orthopaedic Association (BOA) in the near future. However, the chief medical officer will be meeting the BOA's president on 17 August to discuss hip prostheses and the quality of care.
Clothier Inquiry
Mr. Blunkett : To ask the Secretary of State for Health, following the publication of the White Paper on open government, if she will consider making the Clothier inquiry an open inquiry under the Tribunals and Inquiries Act 1971.
Mrs. Virginia Bottomley : The public interest will be better served by an investigative type of inquiry rather than an adversarial one, in other words, by the type of inquiry that Sir Cecil Clothier is now leading.
NHS (Product Purchasing)
Mr. Flynn : To ask the Secretary of State for Health what is her policy on the use of inducements offered by manufacturers of drugs and hip and knee prostheses to NHS personnel to persuade them to buy their products.
Mr. Sackville : Unequivocal guidance issued to the health service in January--HSG(93)5--states that under
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no circumstances must purchasing decisionsGP Practices
Ms Primarolo : To ask the Secretary of State for Health, pursuant to her answer of 14 July, Official Report , column 532 , how many (a) non-fund -holding practices and (b) fund-holding practices she has visited in the last year.
Mrs. Virginia Bottomley : I refer the hon. Member to the reply I gave her on 14 July at column 532 .
General Practitioners
Ms Primarolo : To ask the Secretary of State for Health what were the average earnings of (a) all general practitioners and (b) fund-holding general practitioners by the smallest geographical base for the most recent available period.
Mr. Sackville : Information about the geographical distribution of general practitioners' earnings or the earnings of general practitioner fund holders compared with non-fund holders is not available. The intended average net remuneration for an unrestricted principal providing general medical services in Great Britain in 1993-94 is £40,610. Payments for achieving higher levels of coverage for childhood immunisations and cervical screening and for administering the Hib meningitis vaccine are made in addition. The most recent information suggests these added an estimated £2,750 to the average general practitioner's remuneration in 1992-93.
Mr. Gunnell : To ask the Secretary of State for Health how many students gained their final qualifications to practise medicine in the United Kingdom in 1990-91, 1991-92 and 1992-93 ; and how many of them entered general practice in the United Kingdom from each of those years.
Mr. Sackville : The available information is shown in the tables.
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Year ending:
|31 July 1991|31 July 1992|31 July 1993
--------------------------------------------------------------------------------------------------------------
Students obtaining their first registerable qualification
from medical schools in the United Kingdom |3,573 |3,644 |n/a
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Year ending:
|30 June 1991|30 June 1992|30 June 1993
-----------------------------------------------------------------------------------------------------------
Doctors joining general practice in the United Kingdom |1,609 |1,510 |n/a
The doctors covered by the two tables will not be the same, as a period of training follows first
registerable qualification before admission to general practice. The second table will include doctors who
qualified outside the United Kingdom.
Fluoride Prescriptions
Ms Primarolo : To ask the Secretary of State for Health what was the cost to the NHS of fluoride prescriptions for each quarter of 1992 and the first three months of 1993.
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Mr. Sackville : The information for England is shown in the table.
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Period |Net ingredient cost
|(£'000s)
------------------------------------------------------------
1st Quarter 1992 |10.2
2nd Quarter 1992 |10.3
3rd Quarter 1992 |8.7
4th Quarter 1992 |8.9
1st Quarter 1993 |66.9
Note: The net ingredient cost is the basic cost of the drug
before any discount and not including dispensing costs or
fees. The data cover prescriptions dispensed by community
pharmacists and appliance contractors, dispensing doctors,
and prescriptions submitted by prescribing doctors and
dentists. Dental practitioners providing general dental
services in the national health service have, from 1
January 1993, been able to prescribe fluoride supplements
under the national health service.
Needy Children
Mr. Dafis : To ask the Secretary of State for Health if he will make it his policy to secure that the children of homeless families are classified as children in need and gain access to services provided under the Children Act.
Mr. Bowis : We have no plans to do so. The definition of "in need" in the Children Act 1989 is in terms of a child's health and development, including disablement. It is for local authorities to seek out the extent of children in need in their areas and to publish services available to help them and their families.
Mr. Ieuan Wyn Jones : To ask the Secretary of State for Health what monitoring has been undertaken by her Department into the definition of in need according to part III of the Children Act 1989 used in practice by local authorities ; and what plans she has to introduce new guidelines.
Mr. Bowis : The first report to Parliament of the working of the Children Act 1989--Cm 2144--was published in January 1993. We are keeping the position under review, but have no reason to believe that the guidance on this subject in "The Children Act 1989 : Guidance and Regulations Volume 2 Family Support, Day Care and Educational Provision for Young Children", a copy of which is available in the Library, is in need of amendment.
Children's Residential Care
Mr. Brazier : To ask the Secretary of State for Health if she will announce the final terms of reference and the membership of the support force for children's residential care.
Mr. Bowis : Further to my reply to my hon. Friend the Member for Esher (Mr. Taylor) on 24 June at columns 249-50, the terms of reference are as follows :
1. (a) to offer advice to individual authorities on the interrelated issues of quality of care and management in children's residential care, with particular reference to the appointment and selection, personnel management, support, development and internal training of children's residential care staff.
(b) to offer advice to individual authorities and, where appropriate, groups of authorities on suitable mechanisms for matching needs and supply in their localities or regions, taking account of the
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potential contributions of voluntary, private and public sectors ; and on related commissioning and contractual issues. A particular focus of the work will be to assist authorities and the voluntary and private sectors to improve occupancy rates and hence reduce unit costs in children's residential homes where this is appropriate. (c) to prepare material for a code of employment practice, for discussion with employer and other interests.2. The support force for children's residential care will work under Department of Health auspices, and from time to time as requested, report on its programme and progress. It will work with social services and, as appropriate, other agencies by invitation in a consulting and facilitating role ; by implication it will draw attention to and disseminate examples of good practice. The social services inspectorate's advice will be available to it. It will work within the framework of the Children Act 1989 and regulations and guidance issued following that and other relevant legislation ; the Warner report and Government decisions on it ; and other material that may be relevant. Its remit is for a period of two years from the summer of 1993. Ministers will then review the progress made. The members of the support force are :
Adrianne Jones CBE
Leader of the support force. Formerly director of social services for Birmingham and Hillingdon. Member of the Warner committee on the recruitment, selection and development of staff in children's homes. Louise Bessant
Co-ordinator, Young People's Forum, Birmingham social services. James King OBE
Former director of the Caldecott Community.
Brendah Malahleka
Service manager, children and families, London borough of Ealing. Steven Moss
Assistant director, finance and administration, Manchester city council social services department.
Robert Sykes
Assistant director operations, Oxfordshire social services. Susan Thomas
Chief personnel officer, London borough of Lewisham. Member of the Warner committee.
Mike Nichol
Formerly chief education officer for the Wirral, Cheshire. Now working as an educational consultant for Coopers and Lybrand.
Sellafield
Ms Lynne : To ask the Secretary of State for Health (1) if she will consult the Committee on Medical Aspects of Radiation in the Environment in the event of any application being made to vary the discharge licence from British Nuclear Fuel's Sellafield installation ;
(2) what advice she has received from the Committee on Medical Aspects of Radiation in the Environment concerning the health risk resulting from the proposed liquid and gaseous radioactive discharges from British Nuclear Fuel's Sellafield installation ; and if she will publish the advice.
Mr. Sackville : Applications to dispose of radiactive waste from a licensed site are considered by Her Majesty's inspectorate of pollution and the Ministry of Agriculture,
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Fisheries and Food--"the inspectorates". It is for them to decide who they should consult in any particular case, subject to any relevant statutory requirements.The Committee on Medical Aspects of Radiation in the Environment (COMARE) commented to the inspectorates on British Nuclear Fuel's application for revised discharge authorisations at the Sellafield site. We have arranged for copies of COMARE's response to be placed in the Library. The inspectorates carefully considered all the responses made in the consultation including that from COMARE, before coming to the conclusion announced by my right hon. Friend the Secretary of State for the Environment on 28 June at column 392.
Private Ambulances
Mr. Blunkett : To ask the Secretary of State for Health what consideration she has given to the regulation of private ambulance operators.
Mr. Sackville : The code of practice recently agreed by the Department of Health's ambulance policy advisory group sets out minimum standards for non-national health service patient transport providers. It is for prospective purchasers of private ambulance services to satisfy themselves that operators are competent to provide the required service.
Patients (Major Surgery)
Mrs. Peacock : To ask the Secretary of State for Health what plans she has to ensure that patients entering (a) NHS and (b) private hospitals have all necessary facilities to safeguard them following major surgical procedures ; and if she will make a statement.
Mr. Sackville : A private hospital is required by law to register with the district health authority, which must satisfy itself that the statutory requirements, and any local conditions of registration, are being met at all times, including adequate medical, surgical and nursing equipment and adequate treatment facilties. It is for national health service providers to assess the level of service need to support surgical procedures, and to provide the staff and facilities to meet those needs. It is for NHS purchasers to satisfy themselves about the quality of the service provided to patients. We have no plans to alter the present arrangements.
NHS Dental Treatment
Mr. Blunkett : To ask the Secretary of State for Health what has been the average cost of a course of NHS dental treatment per patient liable to full charge in each year since 1979.
Mr. Sackville : The information is shown in the table.
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General Dental Services (GDS)-England
Year |Patients liable to|Patients wholly
|full charge |exempt or remitted
|Average Cost (£) |Average Cost (£)
----------------------------------------------------------------------------
1979 |13.32 |15.48
1980 |16.26 |19.20
1981 |18.13 |26.14
1982 |19.38 |27.71
1983 |20.10 |34.42
1984 |21.49 |37.07
1985 |21.70 |39.19
1986-87 |23.46 |42.64
1987-88 |25.84 |45.13
1988-89 |28.46 |49.23
1989-90 |30.24 |47.48
1990-91 |n/a |n/a
1991-92 |31.83 |51.69
1992-93 |n/a |n/a
Notes:
1. Data from 1979 to 1985 are shown in calendar years. Thereafter they are
shown in financial years.
2. Data for 1990-91 are not available as the introduction of the new dental
contract interrupted the data series.
3. Data for 1992-93 are not yet available.
4. The small number of courses of treatment where charges were partly
remitted has not been included in the calculations.
5. Before 1 January 1989 dental examinations did not attract a patient
charge. Therefore, a course of dental treatment which included only a
dental examination did not attact a patient charge. Such courses of dental
treatment have been allocated in this table to the appropriate category
whether the patient was liable to charges or not.
Medical Care (Proposed Authority)
Mrs. Peacock : To ask the Secretary of State for Health (1) what plans she has to set up a medical/surgical equivalent to the Committee on Safety of Medicines ;
(2) what plans she has for the creation of an Office of Medicine as a statutory body to oversee standards of medical care ;
(3) what plans she has to introduce legislation to ensure that the NHS and the private medical sector are equally accountable and bound by the same regulations under one single regulatory authority.
Mr. Sackville : We have no such plans.
Surgeons
Mrs. Peacock : To ask the Secretary of State for Health what plans she has to ensure that surgeons do not undertake procedures for which they have not received specific training or accreditation.
Mr. Sackville : The accreditation of training posts and systems of postgraduate education, examination and training are matters for the responsible professional bodies. A doctor has a professional responsibility not to undertake a procedure which he or she is not competent to perform.
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EMPLOYMENT
Occupational Hazards
Ms Primarolo: To ask the Secretary of State for Employment if he will list the 10 most frequent occupational related causes of death for the latest available period.
Mr. Michael Forsyth : The most frequent causes of recorded occupationally related mortality in 1991 and/or 1992 were : mesothelioma ; accidental trauma ; pneumoconiosis ; asbestosis ; accidental poisoning and gassing ; lung cancer due to asbestos ; byssinosis ; other cancers ; and allergic alveolitis, including farmer's lung. There were only occasional deaths recorded from other causes.
Social Charter
Mr. Spearing : To ask the Secretary of State for Employment in what manner Her Majesty's Government have published or publicised the text of the social charter of the European Economic Community as agreed by 11 of its member states at Strasbourg on 9 December 1989.
Mr. Michael Forsyth : The Government have never published or publicised the text of the social charter agreed by the other 11 member states.
Employment Rehabilitation Centre, Ingol
Mrs. Wise : To ask the Secretary of State for Employment what was the capital cost of the purpose-built employment rehabilitation centre at Ingol, Preston, at the time it was built, expressed in 1993 values ; and what price has been agreed for its sale.
Mr. Michael Forsyth [holding answer 20 July 1993] :
Responsibility for the subject of the question has been delegated to the Employment Service Agency under its chief executive. I have asked him to arrange for a reply to be given.
Letter from M. E. G. Fogden to Mrs. Audrey Wise, dated 22 July 1993 :
As the Employment Service is an Executive Agency, the Secretary of State has asked me to write to you direct to respond to your Parliamentary Question to him about the capital cost of Preston (Ingol) Employment Rehabilitation Centre (ERC) when it was built and the price agreed for its sale. This is something which falls within the responsibilities delegated to me as Chief Executive of the Agency.
The building of Preston ERC was completed in 1978 and the centre was opened in 1979. The work involved in retrieving the exact total capital costs of the ERC and converting these to 1993 prices would incur disproportionate costs. I am therefore unable to supply this information.
The ERC was closed on 31 December 1992 and tenders were invited for its sale. A price has been agreed and the site has been sold subject to contract. You will appreciate that, until the sale is completed and contracts are exchanged, the price agreed is still classified as "Commercial in Confidence" and cannot be revealed.
I am sorry to have to send you a disappointing reply. However, I am satisfied that all the correct tendering procedures have been followed to ensure we obtain the best possible price for the site. As decided by the Administration Committee of the House of Commons, Chief Executive replies to written Parliamentary Questions will now be published in the Official Report. I will also place a copy of this letter in the Library of the House.
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NATIONAL FINANCE
Insurance
Mr. Burns : To ask the Chancellor of the Exchequer what conclusions he has reached on the report by the Director General of Fair Trading on the marketing and sale of investment-linked insurance products.
Mr. Kenneth Carlisle : The Director General of Fair Trading (DGFT) reported to my predecessor in March about the rules on marketing and sale of investment-linked life insurance products , made last July by the Securities and Investments Board (SIB) and the Life Assurance and Unit Trust Regulatory Organisation (LAUTRO). These rules had been drawn up in response to the then Secretary of State for Trade and Industry in December 1990, who asked for changes in the rules to meet the concerns raised in the report of April 1990 by the previous DGFT.
The marketing and sale of investment-linked insurance products. The rules of the Securities and Investments Board and the Life Assurance and Unit Trust Regulatory Organisation. A report by the Director General of Fair Trading to the Chancellor of the Exchequer, March 1993.
In his report under the Financial Services Act 1986 (FSA), the DGFT was of the opinion that four aspects of the new rules were likely to have significantly anti-competitive effects. Under the FSA, the Treasury must consider whether the rules are likely to have significant anti-competitive effects and, if it considers that they do, whether those effects are greater than necessary for investor protection.
In April, the Treasury invited comments on the DGFT's report as well as on his separate report under the Fair Trading Act 1973 . Many hon. Members have written to me about the reports, and a large number of written submissions have been received from interested parties, many of which have been discussed in detail with officials. I have taken account of the views and arguments put during this consultation process in reaching my conclusions.
I endorse the director general's finding that four aspects of the rules have or are likely to have significantly anti-competitive effects. I do not find that these effects are necessary to protect investors. The Treasury is therefore directing SIB to develop a new approach to the regulation of the marketing of life insurance products through rules to rectify the deficiencies identified. My reasons, and the changes the Treasury now requires, are set out below.
"Fair Trading and Life Insurance Savings Products : A Report by the Director General of Fair Trading", March 1993.
There has been a good deal of justified criticism concerning the proportion of long-term policies surrendered early and the low surrender values of policies surrendered in the early years. The relevant SIB rules are designed to improve regulation and to help the investor by requiring life offices both to disclose surrender values for the first five years of life policies and to indicate the point at which the surrender value may equal or exceed the amount paid by the investor if the crossover point falls outside the first five years. The rules prevent life offices disclosing surrender values for a longer period.
The DGFT has welcomed the rule changes in so far as they give the investor more information about the long-term and illiquid nature of these investments and about likely surrender values in the early years. However, the DGFT concludes that the absence of information ter years of the policy limits the ability of investors to make properly informed choices among the products of different life offices and between life products and other investments ; and hence is likely to restrict and distort competition to a significant extent.
SIB and LAUTRO have concentrated on better disclosure of surrender values in the early years where the major concerns have arisen. Surrender values, however, do vary considerably between life offices in the later years and I agree with the DGFT that lack of information is likely significantly to restrict and distort competition. I have also taken into account other factors relevant to investor protection ; in particular, the risk that disclosure of likely cash surrender values for each year of a policy could appear to offer guaranteed returns and could be in serious danger of overloading the investor with a huge array of figures. Any profile of figures which appeared to offer guaranteed returns would have investor disadvantages in so far as it altered life offices' investment behaviour and thus ultimately reduced the returns delivered or raised the cost of a given return ; equally, a detailed array of figures, added to all the other quantitative information, could overload investors with complex and confusing details and thereby defeat the object of disclosure. I have examined these arguments and options and concluded that, through fuller disclosure of the implications of early surrender on the value of policies, it should be possible to remove the anti-competitive effect of non- disclosure of surrender values in later years in a way which avoids the danger of appearing to give guarantees and which does not overload the investor.
The Treasury is therefore directing SIB to develop a new approach and to bring forward rules which will provide a clear and quantified account of the effect of life offices' intended surrender value practices on the value of the policy if cashed in early beyond the initial five years, without implying guaranteed projections or overloading the investor with figures. The new requirements should provide, in plain terms, a clear description of the effect on surrender values throughout the duration of the policy.
While own charges--the charges currently levied by the particular life office--are required to be used in the calculations of likely surrender values during the first five years of a policy, SIB's and LAUTRO's rules require that illustrations of projected future returns on policies use standard--approximately average--assumptions about the charges levied by life offices. Illustrations are not mandated by the regulators but are a strong marketing tool. Requiring the use of standard charges prevents life offices from producing illustrations which demonstrate the relative merits of their products, thus restricting their ability to compete with others in the market. Use of own charges should also bring downward pressure on costs. I therefore agree with the DGFT that the requirement to use standard charges in illustrations is likely significantly to restrict and distort competition among life offices. Investor protection considerations also argue in favour of use of own charges. Use of standard charges can be misleading to investors by implying that charges do not affect performance when, in reality, charges of life offices to not alter rapidly and do influence total returns. In their joint submission to the Treasury commenting on the DGFT's report SIB, LAUTRO and the Financial Intermediaries, Managers and Brokers Regulatory Organisation accept that own charges ought now to be used in illustrations.
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