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Mr. Baldry : The strategic guidance for Tyne and Wear, published in 1989, stated that the five unitary development plans should provide for a basic requirement of 30,100 dwellings to be built between the beginning of 1988 and the end of 2001. The necessity to review and roll forward this strategic guidance has been discussed at a number of meetings with officers from the city of Newcaso account when setting new guidelines for housebuilding beyond the year 2001.
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House Renovation Grants
Mr. Quentin Davies : To ask the Secretary of State for the Environment what changes he proposes to make to the house renovation grant system following his recent consultation exercise.
Sir George Young : After considering the response to the consultation paper on the future of private housing renewal programmes, my right hon. Friend the Secretary of State for Wales and I have today laid before the House Renovation Grant Limit Order, under which the upper limit for mandatory renovation grants to owners, tenants and landlords in England will be £20,000. The order will come into force on 14 January 1944. I propose no change, for the moment, to the Exchequer subsidy rate in England of 60 per cent. or to the test of applicants' resources.
The consultation paper included longer-term options which I am considering further. The Government's objective is to ensure that the resources available for private housing renewal are targeted effectively.
My right hon. Friend the Secretary of State for Wales is making an announcement today covering arrangements for Wales.
Air Pollution
Mr. Brandreth : To ask the Secretary of State for the Environment what progress has been made in implementing the system of local authority air pollution control introduced under part 8 of the Environmental Protection Act 1990.
Mr. Yeo : By the end of March this year, some 13,000 applications for authorisation had been received by local authorities, of which over 5,500 had been decided. Only 12 appeals were received by my Department during the first two years of operation of the new air pollution controls.
I am pleased to say that the evidence from the data that have been collected and from a review of 25 local authorities conducted by my Department is that local authorities are getting on well with tackling their new responsibilities. None the less, there remains a heavy workload to determine the outstanding applications and to ensure that the necessary improvement are made by operators.
Housing, Brent
Sir Rhodes Boyson : To ask the Secretary of State for the Environment what progress has been made with the proposal for a housing action trust in Brent.
Sir George Young : I am pleased to announce that I have decided, after careful consideration of tenants' views and of the detailed feasibility study for the estate, that there should be a ballot of tenants on the proposal to establish a housing action trust for the Stonebridge estate in Brent. This is a further example of the Government's determination to tackle the problems of rundown estates and improve their management in close consultation with the people who live there.
I shall announce the ballot date in due course. In the meantime, further consultations with the tenants will take place, so that they can ask the questions and receive the answers which will enable them to understand the implications for them of the establishment of a housing action trust.
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I have decided to appoint Mr. Tony Wade MBE and Mr. Clive Lloyd CBE, respectively, as prospective chairman and deputy chairman for the trust. They will carry forward the further consultations with tenants and help prepare for the major tasks which the housing action trust will undertake, if established.Market Franchise Rights
Mr. Alfred Morris : To ask the Secretary of State for the Environment what representations he has had from Manchester city council in regard to proposals on market franchise rights ; what reply he is sending ; and if he will make a statement.
Mr. Baldry [holding answer 20 October 1993] : We have received representations from the council objecting to the Government's proposals. The representations are being carefully considered along with other consultees' views.
Correspondence
Dr. John Cunningham : To ask the Secretary of State for the Environment when he intends to reply to the letters of 3 October and 14 October from Mr. N. T. P. Murphy, a constituent of the right hon. Member for Copeland, concerning Nirex.
Mr. Yeo [holding answer 29 October 1993] : My officials replied to Mr. Murphy on 3 November 1993.
Urban Development Corporations
Dr. Wright : To ask the Secretary of State for the Environment if he will publish a table showing the total gross public spending for each year since 1981-82, and the projected expenditure for each year to 1995-96, in 1992-93 prices, for the urban development corporations.
Mr. Baldry [holding answer 2 November 1993] : The urban development corporations' programmes are supported by grant in aid, receipts from their activities and receipts from the European Community. Actual grant in aid paid to the urban development corporations for each year from 1981-82 and the projected public expenditure plans to 1995-96, at 1992-93 prices, are set out in the table.
Year |Actual expenditure
|£ million
---------------------------------------------------------------------------
1981-82 |37.1
1982-83 |61.9
1983-84 |94.8
1984-85 |88.4
1985-86 |81.9
1986-87 |89.3
1987-88 |<1>160.2
1988-89 |254.7
1989-90 |476.8
1990-91 |607.5
1991-92 |601.4
1992-93 |515.8
|Public expenditure plans
|(1992-93 prices)
1993-94 |349.2
1994-95 |273.2
1995-96 |255.3
<1> The figures include provision for the docklands light railway from
1987-88 onwards.
Urban Regeneration Agency
Dr. Wright : To ask the Secretary of State for the Environment if he will publish a table showing the projected expenditure for each year to 1995-96 in 1992-93 prices, for the Urban Regeneration Agency.
Mr. Baldry [holding answer 2 November 1993] : The Urban Regeneration Agency's programme will be supported by grant in aid, receipts from its activities and receipts from the European Community. As the agency has yet to be established, the receipts it may generate cannot be predicted accurately. Payments from the European Community will depend upon approval for projects under the European regional development fund community support frameworks which have yet to be determined. Public expenditure plans for the grant in aid to the Urban Regeneration Agency, derived from the 1993 departmental annual reports and expressed in 1992-93 prices, are set out in the table.
Public Expenditure Plans ( 1992-93 prices) Year |£ million ------------------------------ 1994-95 |169 1995-96 |190
HEALTH
Service Quality
Ms Primarolo : To ask the Secretary of State for Health (1) what plans she has to ensure that existing knowledge about effectiveness is used to improve service quality ;
(2) how the Government's autumn initiative on quality in purchasing will ensure that existing knowledge about effectiveness is used to improve service quality.
Mr. Sackville : The Department of Health's research and development division has published its strategy, "Research for Health", part of which relates to the dissemination of existing knowledge on effectiveness of treatment. A unit that will provide a focal point for review and dissemination of research will shortly be set up. In addition the Department has commissioned a series of effective health care bulletins. Each bulletin consists of a systematic review and synthesis of literature on clinical effectiveness,
cost-effectiveness and acceptability of health service interventions. These bulletins are designed to aid purchasers in drawing up effective contracts.
As part of the national health service research and development programme, the Cochrane centre has been set up in Oxford, to establish a database of controlled trials, and to provide an information service.
The Department of Health's central health outcomes unit and the United Kingdom outcomes clearing house in Leeds have been set up to develop and promote the assessment of outcome of services. A recently published departmental consultation document on population health outcome indicators is based on the collation of existing knowledge about effectiveness.
In addition clinical audit has been established whereby procedures used for diagnosis, care and treatment are compared against standards of proven effectiveness, with the aim of improving quality of patient care. As a part of
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this, the health professionals are currently working with the Department to develop nationally agreed guidelines, based on knowledge about effectiveness and appropriateness of services, for use in purchasing high-quality care.Copies of these documents will be placed in the Library.
NHS Race Unit
Ms Primarolo : To ask the Secretary of State for Health what is the remit of the new NHS race unit ; what are its planned staffing level and budget ; and where it is to be sited.
Mr. Sackville : The remit of the national health service ethnic health unit is described in the executive letter sent to NHS general managers and chief executives--EL(93)89,--copies of which will be placed in the Library. The letter explains that the unit is being set up
"to help to ensure that black people and people from different ethnic backgrounds derive full benefit from the Health of the Nation strategy, from local health purchasing policies, the Patient's Charter, the Care in the Community initiatives and the developing role of primary care".
The unit will begin operation this November and will have a budget of £500,000 for the remainder of the financial year and a staff complement of not more than six people. Since the unit will be directly accountable to the NHS Management Executive, it, too, will be based in Leeds.
Smoking
Mrs. Wise : To ask the Secretary of State for Health if she will list the projects commissioned since 1975 by her Department and by its predecessor Department to evaluate methods of getting smokers to give up smoking ; if she will list for each project the name and institution of the principal investigator and the titles of the reports in which the findings were published ; and if she will place a copy of each report in the Library.
Mr. Sackville : The Department of Health and its predecessor has participated in a number of programmes of basic social/behavioural research on factors affecting smoking habits, and several large, ad hoc research studies. These provide a wealth of information on which more specific, targeted smoking cessation interventions are based. A list of the studies will be placed in the Library.
The studies are listed and those marked* were concerned specifically with the evaluation of smoking cessation interventions. Also listed are three specific evaluation projects which are currently in planning.
Mrs. Wise : To ask the Secretary of State for Health if she will list the projects commissioned since 1975 by the Health Education Authority and its predecessor, the Health Education Council, to evaluate methods of getting smokers to give up smoking, and for each project the name and institution of the principal investigator and the titles of the reports in which the findings were published ; and if she will place a copy of each report in the Library.
Mr. Sackville : Little of the research work of the Health Education Authority or its predecessor the Health Education Council has been specifically devoted to evaluation of smoking cessation interventions but many of the studies carried out by or on behalf of these bodies
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contain information on the social/behaviourial factors affecting smoking habits. They therefore form the basis for specific targeted smoking cessation interventions.A full list of Health Education Council and Health Education Authority publications on smoking will be placed in the Library.
Nuclear Emergency Planning
Mr. Llew Smith : To ask the Secretary of State for Health what guidance has been issued to health authorities on their expected role in nuclear emergency planning and the distribution of potassium iodate tablets ; and if she will make a statement.
Mr. Sackville : The Department's guidance to English health authorities on their role in nuclear emergency planning is contained in the circular HC(89)8 and its annex, copies of which are available in the Library. Earlier this month, the circular was amended to include revised guidance to health authorities on planning for the distribution of potassium iodate tablets for use in the event of a nuclear emergency. Copies of this amendment will be placed in the Library.
Mr. P. B. Horsburgh
Mr. Redmond : To ask the Secretary of State for Health on what date Mr. P. B. Horsburgh will relinquish his position as chairman of the Doncaster Healthcare NHS trust ; what reasons he gave for leaving his post ; what position within the national health service he will be taking up ; if he will be eligible for severance pay ; and if she will make a statement.
Dr. Mawhinney : Mr. Peter Horsburgh's appointment as chairman of the Doncaster Healthcare national health service trust ends on 30 November 1993. He has no appointment pending to any other non-executive post in the region. Severance pay is not appropriate.
GP Fund Holders
Mr. Robert Ainsworth : To ask the Secretary of State for Health (1) what action she will take regarding the waiting time policy being operated by the George Eliot hospital, Nuneaton, with respect to general practitioner fund holders ;
(2) what measures she will take to prevent disparities in waiting time developing between fund-holding and non-fund-holding practices in the Coventry and Warwickshire area.
Dr. Mawhinney : Joint guidance--EL(91)84--issued by the Department and the profession, copies of which will be placed in the Library, makes it clear that contracts offered to one purchaser should not disadvantage the patients of another. National health service managers are responsible for ensuring that this guidance is implemented locally. The George Eliot hospital is meeting its contracts with the district health authority. General practitioner fund holders, like all purchasers, are free to purchase spare hospital capacity, on behalf of their patients, where this is available.
Mr. Tony Banks : To ask the Secretary of State for Health if she will provide details of the number of fund-holding general practitioners in each of the London boroughs in terms of numbers and as a percentage of general practitioners.
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Dr. Mawhinney : This information is not available centrally.
Ms Primarolo : To ask the Secretary of State for Health what was the number and percentage of general practitioner fund holders that have spent more than their budgets for 1992-93.
Dr. Mawhinney : This information will not be available until final accounts have been audited and the information collected at the end of November.
Ms Primarolo : To ask the Secretary of State for Health if she will list the items general practitioner fund holders can spend their savings on.
Dr. Mawhinney : The purposes for which general practitioner fund holder savings may be used are clearly set out in regulation 24 of the National Health Service (Fund-holding Practices) Regulations 1993, Statutory Instrument No. 567 1993, copies of which are available in the Library.
Ms Primarolo : To ask the Secretary of State for Health what assessment she has made of the extent to which general practitioner fund- holding patients are being treated ahead of non-fundholding patients with the same clinical need.
Dr. Mawhinney : All emergencies are treated immediately. Joint guidance issued by the Department and the
profession--EL(91)84--and a letter from the national health service chief executive about urgent issues dated 22 February 1993 require hospitals to hold common waiting lists for urgent and seriously ill patients and to give urgent cases priority within local timescales. NHS managers and clinicians are responsible for implementing this guidance locally. Copies of the guidance, and the executive letter, will be placed in the Library.
Ms Primarolo : To ask the Secretary of State for Health if she will estimate the number of general practitioners and general practitioner fund holders who own their premises.
Dr. Mawhinney : The information is not available centrally on which such an estimate could be based.
Mr. Blunkett : To ask the Secretary of State for Health, pursuant to her oral statement of 21 October, Official Report, columns 398-400, if she will make a statement on the role and position of general practitioner fund holders within the restructured NHS.
Dr. Mawhinney : General practitioner fund holding has been one of the major successes of the reformed national health service. More than 6,000 GPs in 1,200 practices are now fund holders. From next April, over a third of the population will be served by fund-holding GPs. This reflects the real achievements in improving patient care. The new arrangements for district health authorities and family health services authorities will not undermine the role of GP fund holders in providing a competitive edge in purchasing.
Cold-related Diseases
Mrs. Mahon : To ask the Secretary of State for Health how many people in Britain died of cold-related diseases in each of the last five years.
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Mr. Sackville : This information is not available.
VAT (Domestic Fuel)
Mrs. Mahon : To ask the Secretary of State for Health if she will conduct an analysis of the health implications of VAT on fuel.
Mr. Sackville : No. We are aware of analysis aimed at predicting the effect on household consumption of fuel, and of evidence concerning the effect on health of variation in domestic ambient temperatures. It is not possible, however, to combine these data to make any reliable inference about the health consequences of change in the cost of fuel.
Disciplinary Procedures
Mr. Cousins : To ask the Secretary of State for Health what procedures exist in hospital trusts to ensure proper examination of wrongful or inappropriate conduct of consultants and other senior clinical staff.
Dr. Mawhinney : Trusts are required to follow the existing arrangements in relation to the handling of clinical complaints against national health service consultants and other senior clinical staff set out in departmental circular HC(88)37, copies of which are available in the Library. It is for trusts to establish arrangements for investigating other allegations of misconduct by consultants or other senior clinical staff.
Osteoporosis
Mr. David Atkinson : To ask the Secretary of State for Health what targets she has for the reduction in osteoporosis ; and if she will make a statement.
Mr. Sackville : None specifically. However, alongside specific interventions such as hormone replacement therapy, available through general practitioners and clinics, important measures which should help reduce the incidence of osteoporosis include increasing levels of physical activity, cutting down excess alcohol, avoiding cigarette smoking, and eating a balanced diet. We are promoting all these lifestyle measures through the health strategy "The Health of the Nation", a copy of which is available in the Library.
Patient Expenditure
Mrs. Mahon : To ask the Secretary of State for Health what increase in patient expenditure is experienced within the NHS during January to March, over that of the months from July to September.
Mr. Sackville : From the information available to the Department, we estimate that hospital and community health services expenditure in the months of January, February and March 1993 was between 4 and 5 per cent. higher than that in the months of July, August and September 1992. The hon. Member should note that this information is based on unaudited management information as the audited accounts of health authorities do not include the figures required.
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Consultants
Ms Primarolo : To ask the Secretary of State for Health what is the annual cost of the distinction award system for hospital consultants ; and what plans she has to increase openness and public accountability for the scheme.
Dr. Mawhinney : I refer the hon. Member to the reply I gave her on 27 October at column 694.
Chrysoidine
Mr. George Howarth : To ask the Secretary of State for Health what is her policy on the use of the maggot dye chrysoidine and the link between it and cancer.
Mr. Sackville : The Committee on the Carcinogenicity of Chemicals in Food, Consumer Products and the Environment considered the dye chrysoidine up to 1985. On the last occasion, the committee reaffirmed its earlier advice that it would be prudent for anglers who wanted to use chrysoidine to avoid skin contact with the dye. The Government conveyed this advice to the National Federation of Anglers and the angling press at that time.
Winter Hospital Admissions
Mrs. Mahon : To ask the Secretary of State for Health what percentage increase in patient admissions occurs in the winter months, January to March, as opposed to the summer months, July to September.
Mr. Sackville : Providers reported that in 1992-93 the number of finished consultant episodes in the general and acute specialties in January to March was about 3 per cent. higher than in July to September.
Surgery (Consent)
Mr. Cousins : To ask the Secretary of State for Health what guidance is in force laying out the procedures doctors and surgeons should carry out if they discover cases where they have reason to believe informed consent for radical surgery has not been obtained ; and who has the responsibility of ensuring those procedures are properly carried out in (a) directly managed units and (b) hospital trusts.
Mr. Sackville : It is for doctors and health professionals themselves to ensure that valid consent is obtained from their patients for any treatment proposed. The common law requirement for consent is reflected in guidance issued by the National Health Service Management Executive and by health professionals' own ethical codes. Treatment of a patient capable of giving consent, without obtaining consent, could leave health professionals, health authorities or trusts open to legal action.
Individual members of staff in the NHS have a right and duty to raise with their employer any matters of concern they may have about health service issues concerned with the delivery of care to a patient in their authority, trust or unit. Guidance issued to the NHS, EL(93)51, copies of which are available in the Library, recommends that local policies and procedures be introduced to allow these rights and duties to be fully and properly met.
Mr. Cousins : To ask the Secretary of State for Health what guidelines she regards as being in force for the obtaining of informed consent for radical surgery.
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Mr. Sackville : Guidance on consent to examination and treatment was issued to the national health service by the NHS Management Executive in August 1990, HC(90)22, copies of which are available in the Library. It advises that patients have the right under common law to give or withhold consent. Sufficient information must be given to patients to ensure that they understand the nature, consequences and any substantial risks of the treatment proposed.
Diabetes
Mr. David Atkinson : To ask the Secretary of State for Health what assessment has been made of the extent to which there is a shortage of specialist dieticians to counter diabetes ; and if she will make a statement.
Mr. Sackville : The numbers of dieticians working in the national health service has grown from 1,140 in 1987 to 1,410 in 1992. It is for purchasers and providers to determine the numbers of dieticians required to provide an effective service to people with diabetes.
Suicide
Mr. David Atkinson : To ask the Secretary of State for Health what support is being given to voluntary organisations to meet the target set in the "Health of the Nation" regarding the rate of suicide.
Mr. Bowis : In the mental illness field, more than 40 grants are being made to some 28 voluntary bodies at a total cost of £2 million in 1992-93. Most of these organisations provide help and support for mentally ill people in the community and make a contribution towards meeting our "Health of the Nation" target to reduce the rate of suicide.
Nebulisers
Mr. David Atkinson : To ask the Secretary of State for Health what plans she has to make the prescriptions of nebulisers available on the NHS ; and if she will make a statement.
Dr. Mawhinney : Hand-operated nebulisers are already available on general practitioner prescription and powered nebulisers may be prescribed by consultants for patients in hospital and in the community. No changes are planned in these arrangements.
Welfare Milk Tokens
Mr. Gordon Prentice : To ask the Secretary of State for Health when welfare milk tokens ceased to be valid for exchange for soya, goat's, fully skimmed and long-life milks ; and what were the reasons for the change.
Mr. Sackville : There has been no recent change in the products available under the welfare food scheme. Milk tokens have never been valid for soya, goat's or fully skimmed milk. Long life--UHT--milk is obtainable for milk tokens.
Perioperative Deaths
Ms Primarolo : To ask the Secretary of State for Health what plans she has to require all surgeons and anaesthetists to provide audit data for national confidential inquiry into perioperative death.
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Mr. Sackville : I refer the hon. Member to the reply I gave her on 28 October at column 766 . We strongly support the participation of all clinicians in medical audit and in national confidential inquiries, but to be effective we believe that this must be done on a voluntary basis. All surgeons and anaesthetists are encouraged to take part in the national confidential inquiry into perioperative deaths by their respective royal colleges.
Mr. Batiste : To ask the Secretary of State for Health if she will make a statement on the Government's response to the report of the national confidential inquiry into perioperative deaths published in September.
Mr. Sackville : We have welcomed the report of the national confidential enquiry into perioperative deaths--NCEPOD--and its general conclusion that across the range of specialties covered, patients can rely on excellent standards. The report acknowledges that progress has been made to resolve a number of problems identified in earlier enquiries and provides important messages about high standards of surgical and anaesthetic care in this country. We are committed to a programme of work to improve the quality of patient information, including the development of a single patient identifier to provide a means for health event linkage.
Through careful assessment of clinical standards this enquiry helps to ensure that the medical profession retains a critical approach to its work. The Government wish to encourage all surgeons and anaesthetists to continue to support NCEPOD, and national health service managers and the profession to act on the results. We expect all doctors to participate in peer review activities, and we provide continuing financial support for medical and clinical audit, as well as for NCEPOD. In these ways doctors can develop confidence in their clinical performance and identify areas where they can further develop their expertise.
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