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National Treatment Protocols
Ms Primarolo : To ask the Secretary of State for Health what plan she has to develop national treatment protocols.
Mr. Sackville : The National Health Service Management Executive is considering ways of working closely with national clinical professional bodies to develop and provide guidelines of good practice.
Patient Confidentiality
Ms Primarolo : To ask the Secretary of State for Health what plans she has to investigate breaches of patient confidentiality by district health authorities and family health services authorities.
Mr. Sackville : I will write to the hon. Member.
Foreign Patients
Mrs. Ray Michie : To ask the Secretary of State for Health how many patients are being treated in NHS trust hospitals are from countries outwith the EC ; what are the funding arrangements for these patients ; and if she will make a statement.
Dr. Mawhinney : This information is not available centrally. The National Health Service (Charges to Overseas Visitors) Regulations 1989 require overseas visitors to pay for NHS treatment unless they fall within certain exempt categories including people with communicable diseases and people from countries with which the United Kingdom has reciprocal health agreements.
GPs' Pay
Ms Primarolo : To ask the Secretary of State for Health what plans she has to review the geographical inequalities in average net remuneration of general practitioners.
Dr. Mawhinney : We continue to keep the operation of the remuneration system under review, in consultation with the profession.
NHS Trust Employees (Infectious Diseases)
Mr. Blunkett : To ask the Secretary of State for Health through which body payment for the treatment and care of a national health service trust employee who contracts an infectious disease through the course of his or her work should be made ; and if she will make a statement.
Dr. Mawhinney : I will write to the hon. Member.
NHS Charges
Mr. Blunkett : To ask the Secretary of State for Health (1) what categories of person are exempted from charges for national health service sight tests ; and how much would be saved by removing the exemption from charges for each one of those categories ; (2) what categories of person are exempted from charges for national health service dental examinations ; and how much would be saved by removing the exemption from charges for each one of those categories ;
(3) what categories of person are exempted from charges for national health service prescriptions ; and how much would be saved by removing the exemption from charges for each of those categories ;
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(4) what proportion of people receiving (a) national health service sight tests, (b) national health service dental examinations and (c) national health service prescriptions are exempted from charges ;(5) what was the number of national health service dental examinations paid for by the national health service for each six-monthly period since October 1990 ;
(6) how much additional revenue would be raised by increasing the standard charge for national health service prescriptions to (a) £4.50, (b) £4.75 and (c) £5 ;
(7) what are the latest figures for estimated annual income from national health service sight test charges ;
(8) how much extra revenue would be raised by increasing the standard charge for national health service sight tests by (a) 5 per cent., (b) 10 per cent. and (c) 20 per cent ;
(9) how much extra revenue would be raised by increasing the standard charge for national health service dental examinations by (a) 5 per cent., (b) 10 per cent. and (c) 20 per cent ; (10) what would be the total saving to the Exchequer from changing the exemption criteria for NHS prescription charges to those currently applied to NHS sight test charges.
Dr. Mawhinney : I will write to the hon. Member.
Psychiatric Hospitals (Closures)
Mr. Blunkett : To ask the Secretary of State for Health how much money has been saved in each of the past 10 financial years through the closure of psychiatric hospitals.
Mr. Bowis : I will write to the hon. Member.
NHS Finance
Mr. Blunkett : To ask the Secretary of State for Health if she will provide total outturn figures, covering NHS review expenditure, for hospital and community health services revenue, HCHS capital, family health services and centrally funded services/Department of Health administration for (a) 1991-92 and (b) 1992-93, and the estimated total outturn to date for those categories for 1993-94.
Dr. Mawhinney : I will write to the hon. Member.
Pay Review Bodies
Mr. Blunkett : To ask the Secretary of State for Health if she will make a statement on the future of the pay review bodies.
Dr. Mawhinney : I will write to the hon. Member.
Speech Therapy
Ms Hoey : To ask the Secretary of State for Health what is the amount of expenditure on language and speech therapy as a percentage of the total NHS budget.
Mr. Bowis : I will write to the hon. Member.
Influenza Vaccines
Ms Primarolo : To ask the Secretary of State for Health if she will make a statement about the causes for the shortage of influenza vaccines.
Mr. Sackville : As a result of production difficulties, one manufacturer is unable to supply its product this year.
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However, other manufacturers have increased production so that at least as much vaccine as was used during last year's programme will be available, although there may be some delay in delivering new orders.The Department has issued a press release giving details of the present situation. Copies are available in the Library.
Hearing Aids
Ms Coffey : To ask the Secretary of State for Health how many national health service patients attending the audiology department at the Manchester Royal Infirmary were issued last year with commercial hearing aids not available through the national health service, and purchased with national health service funds and the total amount of money paid by patients in extra consultancy charges for this service.
Mr. Bowis : This information is not available centrally.
Ms Coffey : To ask the Secretary of State for Health what is the number of national health service departments of audiology that stopped issuing hearing aids before the end of the year in 1992-93 due to budgetary constraints.
Mr. Bowis : This information is not available centrally.
Locality Commissioning
Ms Coffey : To ask the Secretary of State for Health how much money has been made available to district health authorities since 1 April 1991 to develop locality commissioning ; and how much money has been spent in the same period on fund holder management allowances.
Dr. Mawhinney : District health authorities' prime task is to purchase the best possible quality, value for money services for their resident populations and should use all of their resources to this end. Over £14 million has been made available by the National Health Service Management Executive since April 1991 to support the development by district health authorities of various aspects of purchasing, including locality arrangements. The amount of money allowed for fund holder management arrangements is shown in the table.
Year |£ million ------------------------------ 1991-92 |14.1 1992-93 |29.4
Ms Coffey : To ask the Secretary of State for Health how many applications have been made (a) nationally and (b) in Stockport jointly by a fund-holding practice, a district health authority and a social services department to establish a joint locality commissioning agency for health and social care with a small geographical area ; to what extent such applications on an experimental basis are consistent with national policies ; and which applications have been granted.
Dr. Mawhinney : All purchasers are required to work closely together, within the existing legislative framework, in drawing up strategies and plans to secure high-quality, appropriate services for their local populations. Close liaison with local authority social services departments is a pre-requisite for effective locality commissioning.
Ms Coffey : To ask the Secretary of State for Health how much money will be made available to a group of
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general practitioners as a management allowance if they decide to constitute a locality commissioning network as a fund-holding consortium ; and how much will be made available to a district health authority to manage such a network where general practitioners decide they would prefer to constitute it through the district health authority.Dr. Mawhinney : Each fund-holding unit is entitled to receive reimbursement of the cost of managing a fund of up to £35,000 a year. Where practices join together in a fund-holding unit to meet the list size requirements, the unit as a whole is entitled to receive up to the same £35,000 management allowance per year as a single practice fund- holding unit. Where single practice or group fund-holding units join together to pool their management arrangements each fund-holding unit remains entitled to claim up to the maximum management allowance of £35,000 per year. Disrict health authorities' main task is to
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purchase health care on behalf of their resident population and they are required to make the necessary arrangements to secure the best quality and value for money for patients from these resources.Sight Tests
Mr. Cousins : To ask the Secretary of State for Health how many sight tests were carried out as part of NHS services each year since 1987- 88 in the family health service authority areas of Newcastle upon Tyne, North Tyneside, South Tyneside, Gateshead and Northumberland, the area of the Northern regional health authority and England as a whole.
Dr. Mawhinney : The number of national health service sight tests paid for by each of the family health services authorities is shown in the table.
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NHS sight tests
thousands
|1987-88 |1988-89 |1989-90<1>|1990-91 |1991-92 |1992-93
-------------------------------------------------------------------------------------------------
Northumberland |66.6 |71.3 |26.7 |27.5 |28.7 |34.2
Gateshead |45.6 |53.2 |28.3 |21.0 |25.7 |28.0
Newcastle-upon-Tyne |89.3 |96.2 |46.4 |33.5 |37.2 |39.0
North Tyneside |39.3 |40.0 |19.1 |15.6 |18.0 |21.2
South Tyneside |27.9 |30.6 |15.7 |13.8 |15.4 |17.3
Northern RHA |698.0 |740.4 |336.8 |275.6 |314.7 |345.9
England |11,694.8 |12,492.8 |5,279.8 |4,153.7 |4,979.4 |5,527.6
<1> From 1 April 1989, NHS sight tests were restricted to certain groups in the population. The
sight tests paid for in 1989-90 include some conducted prior to 1 April 1989 when sight tests
were universally available. The remainder paid for in 1989-90 do not represent a full year under
the new system, because of the delay in payments. The figure for 1989-90 is not, therefore,
directly comparable with that for 1990-91.
Salmonella
Mr. Welsh : To ask the Secretary of State for Health in how many cases of salmonella food poisoning foods containing eggs were found to be the source for each of the last five years.
Mr. Sackville : Information on salmonella food poisoning has been published for the last five years in the "PHLS/SVS Update on Salmonella Infection", copies of which have been placed in the Library.
Drug Deaths
Mr. Cousins : To ask the Secretary of State for Health if she will publish a table showing the numbers of deaths each year from the taking of analgesics, anti-depressants, asthma drugs and therapies, cardio-vascular drugs, sedatives, stimulants, vitamins and vitamin supplements in each year from 1987.
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Mr. Sackville : Information on the underlying cause of death is available in the International Classification of Diseases (9th Revision).
The table shows deaths from 1987-92 where the underlying cause was coded to accidental, self-inflicted, undetermined, whether accidental or purposeful, poisoning and adverse effect of correctly administered drugs in the broad classes of drugs, analgesics, antidepressants, agents acting primarily on the cardiovascular system, sedatives, hypnotics, tranquilisers and central nervous system/psychostimulents. It excludes death due to homicides and the adverse effect of agents correctly administered.
In addition, a detailed table showing all substances mentioned on the death certificates assigned to accidental and other poisoning by solid or liquid substances is published by the Office of Population, Censuses and Surveys in "Series DH4 : Injury and Poisoning Table 10" for each year. Copies of these are available in the Library.
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|1987|1988|1989|1990|1991|1992
-----------------------------------------------------------------------------------------
Antiasthmatics |4 |5 |5 |3 |0 |1
Cardiovascular |26 |42 |45 |35 |27 |55
Antidepressants |291 |326 |307 |328 |294 |346
Analgesics |693 |678 |654 |721 |754 |877
Stimulants |2 |2 |3 |1 |10 |10
Sedatives, hypnotics and benzodiazepine tranquilisers |340 |360 |285 |246 |246 |232
More detailed information is not available centrally.
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Fuel Costs
Mr. Battle : To ask the Secretary of State for Health what plans he has to meet the Royal College of Midwives to discuss their concerns for pregnant women and newly born babies in the event of the imposition of VAT on fuel.
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Mr. Sackville : I will write to the hon. Member.
Health Services, East London
Mr. Spearing : To ask the Secretary of State for Health what are the terms of reference, duties and functions, of the City and East London family and community health services ; what is the source of its funding ; by whom it is appointed ; to whom it is accountable ; what comparable bodies have been, or are planned ; and if she will distinguish its role from the responsibilities of the relevant family health services authority.
Dr. Mawhinney [holding answer 21 October 1993] : I will write to the hon. Member.
Regional Health Authorities
Mr. Blunkett : To ask the Secretary of State for Health how many people were employed in each regional health authority in (a) April 1992 and (b) October 1993 using whole time equivalents.
Dr. Mawhinney [holding answer 27 October 1993] : The information available is shown in the table. Separate figures for the numbers of staff employed by each regional health authority have not been routinely collected since September 1990. The figures in the table were collected in a special exercise in July 1992 and show only the numbers of whole-time equivalent staff employed in centrally managed, core functions in RHAs. These figures exclude RHA staff who work in other functions such as supplies, blood transfusion services, ambulance services and those medical consultants and registrars whose contracts are held by RHAs but who are managerially accountable to district health authorities.
|Numbers
----------------------------------
Northern |656
Yorkshire |518
Trent |509
East Anglian |292
North West Thames |361
North East Thames |580
South East Thames |604
South West Thames |611
Wessex |331
Oxford |567
South Western |559
West Midlands |1,168
Mersey |313
North Western |785
|-------
Total |7,854
Since this exercise was conducted
RHAs have been asked to reduce
their core staff numbers to an
average of 200 per RHA.
Midwives
Mr. Blunkett : To ask the Secretary of State for Health if she will list for 1992 for each regional health authority and district health authority the number of nurses, midwives and health visitors, by clinical grade and pay grade title, as specified by the Whitley Council.
Mr. Sackville [holding answer 21 October 1993] : I will write to the hon. Member.
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Sellafield
Mr. Simon Hughes : To ask the Secretary of State for Health what the health detriment in terms of fatal and non-fatal cancers and genetic effects to the population of the United Kingdom, Europe and the world would result for each year of discharge from BNFL's Sellafield installation if (i) the draft HMIP authorisations were approved, (ii) technologies were introduced to remove krypton for the gaseous discharges from Sellafield and (iii) dry storage was selected as an option rather than reprocessing.
Mr. Yeo : I have been asked to reply.
I will write to the hon. Member.
Mr. Simon Hughes : To ask the Secretary of State for Health if she will conduct a comparative study of the estimated health detriment, in terms of fatal and non-fatal cancers and genetic effects, to the population of the United Kingdom, Europe and the world that would result from each year of discharge from BNFL's Sellafield installation with the health detriment arising from the nuclear reprocessing plant at Cap de la Hague, France.
Mr. Yeo : I have been asked to reply.
Assessments of the radiological impact of discharges from Sellafield and Cap de la Hague have been published by the United Nations Scientific Committee on the Effects of Atomic Radiation. The 1993 report shows that discharges from the two plants have been similar through the late 1980s. As the Cap de uld be of no help.
Mr. Simon Hughes : To ask the Secretary of State for Health what facts she has taken into account in deciding the extent to which the health detriment that may arise as a result of the proposed discharges from BNFL's Sellafield installation would be acceptable.
Mr. Yeo : I have been asked to reply.
The basic objectives set out in the White Paper "Radioactive Waste Management" Cmnd 8607 are such as to protect individual health and the environment. The use of the target for exposure from one site of 0.5 mSv coupled with a constraint of 0.3 mSv for any new plant will ensure these basic principles are met as they are for the proposed revised authorisation for BNFL Sellafield.
NATIONAL FINANCE
Tax Reliefs
Mr. Dewar : To ask the Chancellor of the Exchequer if he will update his answer to the hon. Member for Hartlepool (Mr. Mandelson) of 8 June, 1993 Official Report, column 202, on the cost of direct income tax reliefs to include estimates for 1994-95.
Mr. Dorrell : Available information on the major income tax reliefs based on projections of the survey of personal incomes and other surveys is given in the table. The projections for 1994-95 are based on statutory indexation and measures announced in the March Budget and on the conventional assumption of no further changes in the mortgage interest rate.
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Higher rate Basic or lower
taxpayers rate taxpayers
|Cost of relief |Number of taxpayers|Average income of |Cost of relief |Number of taxpayers|Average income of
|with relief |taxpayers |with relief |taxpayers with
|relief
|£ million |million |£ |£ million |million |£
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
1991-92
Mortgage interest relief |720 |1.0 |55,000 |4,970 |7.7 |16,000
Employees contributions to occupational pension schemes |690 |0.7 |48,000 |1,630 |7.7 |15,000
Contributions to personal pension schemes<1> |480 |0.3 |58,000 |620 |3.1 |13,000
Other reliefs |420 |0.5 |60,000 |270 |2.6 |14,000
1992-93
Mortgage interest relief |690 |1.1 |53,000 |4,140 |7.8 |16,000
Employees contributions to occupational pension schemes |750 |0.8 |48,000 |1,600 |7.4 |16,000
Contributions to personal pension schemes<1> |490 |0.4 |58,000 |590 |3.0 |13,000
Other reliefs |450 |0.6 |61,000 |280 |2.6 |15,000
1993-94
Mortgage interest relief |690 |1.2 |52,000 |3,280 |7.9 |16,000
Employees contributions to occupational pension schemes |820 |0.9 |48,000 |1,600 |7.2 |16,000
Contributions to personal pension schemes<1> |500 |0.4 |58,000 |570 |2.9 |13,000
Other reliefs |480 |0.6 |61,000 |270 |2.4 |15,000
1994-95
Mortgage interest relief |680 |1.7 |49,000 |2,620 |7.6 |17,000
Employees contributions to occupational pension schemes |950 |1.1 |46,000 |1,590 |7.0 |16,000
Contributions to personal pension schemes<1> |540 |0.4 |57,000 |580 |2.9 |13,000
Other reliefs |510 |0.6 |60,000 |270 |2.4 |15,000
<1> Includes retirement annuity premia and free-standing additional voluntary contributions
Mortgage Tax Relief
Mr. Dewar : To ask the Chancellor of the Exchequer if he will update the answer of 25 February, Official Report, column 677 on mortgage tax relief giving estimates for 1994-95 and for a full year.
Mr. Dorrell : The estimated costs at 1994-95 levels of increasing or decreasing the limit for mortgage interest tax relief are shown in the table. The estimates are based on the distribution of existing mortgages and exclude behavioural effects which might result. The figures are based on the conventional assumption of no further changes in interest rates and allow for tax relief at 20 per cent. as announced in the March Budget.
h Cost (yield) from increasing (decreasing) the limiton mortgage interest tax relief at 1994-95 levels Limit on size of loan (£) | £ million 40,000 |600 35,000 |300 32,000 |100 31,000 |100 29,000 | (100) 28,000 | (200) 25,000 | (400) 20,000 | (900)
VAT (Domestic Fuel)
Mr. Dewar : To ask the Chancellor of the Exchequer if he will estimate the average weekly expenditure in 1993-94 and 1994-95 of (a) all households, (b) families with children, (c) non-retired households and (d) retired
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households, on domestic fuel, showing separately for 1994-95 the extra expenditure as a result of VAT at 8 per cent.Sir John Cope : Estimates on expenditure in 1993-94 are in the table. Expenditure in 1994-95 will depend on what happens to fuel consumption following the introduction of VAT on fuel and on changes in fuel prices.
Average weekly household expenditure on fuel
and power in 1993-94<1>
|£ per week
-----------------------------------------------
All households |13.40
Households with children |16.10
Non-pensioner households |14.10
Pensioner households<2> |11.10
<1> Estimates based on 1989-91 Family
Expenditure Surveys uprated to 1993-94.
<2> Single benefit unit households where the
head is over retirement age.
Duties
Mr. Dewar : To ask the Chancellor of the Exchequer what would be the impact on the retail prices index of a 10 per cent. increase in duties on (a) beer and cider, (b) wine, (c) spirits, (d) tobacco, (e) petrol, (f) derv and (g) vehicle excise duty.
Sir John Cope : The effect on the retail prices index of 10 per cent. duty increases is estimated to be :
|Per cent.
-----------------------------------
Beer and cider |+0.09
Wine |+0.06
Spirits |+0.07
Tobacco |+0.24
Petrol |+0.22
Diesel |+0.01
Vehicle excise |+0.09
These figures show the growth in the retail prices index excluding mortgate interest payments. They assume that the full increase in tax would be passed on to consumers in the form of higher prices. Where the tax falls on business, there is likely to be a further effect on the RPI which is not taken into account in these figures.
Mr. Whittingdale : To ask the Chancellor of the Exchequer what is the total amount raised in excise duty on
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(a) beers, (b) wines and (c) spirits since 1 January ; and what was the amount for each category in the equivalent period for each of the last five years.Sir John Cope : Duty receipts for alcohol are generally received in the month following clearance. The table therefore shows duty receipts from February to September of each year.
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Duty receipts in months February to September
£ million
|1993 |1992 |1991 |1990 |1989 |1988
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
(a) |Beer |<1>1,397 |1,578 |1,511 |1,479 |1,390 |1,346
(b) |Wines (including cider)|685 |618 |573 |544 |489 |483
(c) |Spirits |951 |925 |911 |917 |826 |838
<1> As a result of previously announced changes in the system for the collection of beer duty which took effect on 1 June 1993, there was a delay of about 1 month in receiving duty payments. This led to a cash flow
loss of some £200 million duty in July.
VAT
Mr. Dewar : To ask the Chancellor of the Exchequer if he will estimate the average weekly expenditure in 1993-94 and 1994-95 of (a) all households, (b) families with children, (c) non-retired households and (d) retired households on items which are currently zero-rated, excluding domestic fuel, giving figures separately for each item.
Sir John Cope : Estimates in the form requested are not available. The latest information on household expenditure, including expenditure on goods currently zero-rated for VAT, is published in the 1992 family expenditure survey.
Mr. Cash : To ask the Chancellor of the Exchequer what estimate he has made of the proportion of the theoretical yield if VAT were imposed on magazines at 17.5 per cent. that would actually accrue to the Exchequer.
Sir John Cope : The figure published in table 9 of the publication "Tax Ready Reckoner and Tax Reliefs", which is in the House of Commons Library, shows the cost of zero rating books, newspapers and magazines to be £1.1 billion. Magazines represent approximately 20 per cent. of this figure. The proportion of this figure actually accruing to the Exchequer if VAT were imposed would depend on the behaviour of individual companies and consumers.
Mr. John Marshall : To ask the Chancellor of the Exchequer what is the current level of VAT on books in other EC countries.
Sir John Cope : The rates of VAT applied to books in other EC countries are shown in the table.
VAT on books in other EC countries
Country |Rate percentage
------------------------------------------------
Belgium |6
Denmark |25
France |5.5
Germany |7
Greece |<1>4
|(3)
Ireland |0
Italy |4
Luxembourg |3
Netherlands |6
Portugal |<2>5
|30
|(4
|21)
Spain |3
Note: The following rates apply generally in
Corsica: 0.9 per cent., 2.1 per cent., 8 per
cent. and 13 per cent.
<1> Rates in brackets apply in the Departments
of Lesbos, Chios, Samos, the Dodecanese and the
Cyclades, and in the islands of Thasos, the
Northern Sporades, Samothrace and Sykros.
<2> The rates in brackets apply in the
autonomous regions of Madeira and the Azores
Archipelagoes. The lower rates apply to books
which are considered in the legislation
covering these items to be of a cultural,
educational, recreational or sporting nature.
The higher rates apply to books of an obscene
or pornographic nature.
Source: VAT in Europe (International Bureau of
Fiscal Documentation).
Mr. Peter Bottomley : To ask the Chancellor of the Exchequer how VAT could be applied to free newspapers and magazines.
Sir John Cope : "Free" newspapers and magazines are usually financed by sales of advertising and VAT already applies.
National Savings
Mr. Cousins : To ask the Chancellor of the Exchequer if he will publish a table showing changes in the number and type of national savings accounts in each of the last five years, distinguishing those deposits of under £10 in value together with total sums held in such accounts.
Mr. Nelson : The number and balances outstanding of National Savings ordinary and investment accounts at 31 December in each of the last five years are as follows :
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