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Mr. Morgan : To ask the Secretary of State for Wales what consultations he has had with the chairman of the Welsh Development Agency in relation to contracting-out and privatisation proposals for functions of the agency ; if he will list the agency functions proposed for out-sourcing in the next financial year ; and if he will make a statement.
Mr. Redwood : In common with other public bodies, the Welsh Development Agency is required to keep under review the efficiency and effectiveness of its organisation and to arrange for its activities to be contracted out where this represents value for money.
Mr. Bowis : Area child protection committees operate in every social services area in England to ensure close working relationships between social services departments, the police service, doctors, community health workers, the education service and others who share a common aim to protect children at risk.
Dr. Mawhinney : Pharmacies are privately owned businesses, only part of whose income comes from the national health service. However, no pharmacy which dispensed more than 1,000 prescriptions a month of average value in 1992-93 should have its NHS income reduced in 1993-94. The NHS income of pharmacies dispensing less than 1,000 prescriptions a month will depend on a number of factors, not least whether they qualify for the essential small pharmacy scheme, which we have extended.
Mr. Sackville : We are making good progress towards "The Health of the Nation" targets, most of which are for 2000 and beyond. They have been set to be challenging but achievable, and remain the right ones.
Dr. Mawhinney : We are spending £5 million per annum on campaigns to raise awareness and prevent drug and solvent misuse especially by the young. We have just launched a major new campaign to encourage and help parents to talk to their children about drug and solvent misuse. Getting the message across involves co-operation with many agencies and my officials keep in close touch with local authorities on their contribution to fighting drug misuse.
Dr. Mawhinney : The benefits of the internal market are clear ; more patients are now being treated than ever before ; people are waiting shorter times for treatment. National health service spending is also at an all-time high. Consequently, there are no plans to review the operation of the internal market.
16. Mr. Clifton-Brown : To ask the Secretary of State for Health what assessment she has made of the way in which local authority social services are using their discretion in the treatment of children placed in their care, particularly with regard to the provision for trips abroad.
Mr. Bowis : The framework for treatment of children in care by local authorities is contained in the Children Act 1989, regulations and associated guidance. It is the responsibility of the elected members of each local authority to ensure that these are complied with and that the resources involved are properly spent. I have made it clear, however, that trips abroad for young offenders are inappropriate.
Dr. Mawhinney : Each fundholding practice is entitled to the reimbursement of appropriate expenses incurred in the preparatory year to fundholding. The maximum level of reimbursement is £17,500 for a single practice fund and £20,000 for a grouped practice fund.
Dr. Mawhinney : Regional health authorities are responsible for monitoring the general practitioner fundholding scheme locally. They tell us that, as in other areas, GP fundholders are working with community health staff to improve the quality of care for patients.
Ms Primarolo : To ask the Secretary of State for Health (1) how many of the practices which expressed an interest in 1992-93 in becoming fundholders the following April but did not do so will become fundholders in April 1994 ;
(2) how many of the general practitioners practices which expressed an interest in 1991-92 in becoming fundholders the following April but did not do so subsequently became fundholding practices in 1993 or will become fundholders in April 1994 ;
(3) how many general practitioner practices have received the start-up allowance for potential fundholders more than once.
20. Mr. Nigel Evans : To ask the Secretary of State for Health what measures have been taken to improve the amount of information available to national health service patients under the patients charter.
Dr. Mawhinney : The patients charter gives patients a right to information on local health services. Health authorities are making this information available to patients in many ways, including local charters, through the local media, leaflets, posters and public meetings. All district health authorities also publish annual reports on performance against patients charter standards. Providers are also required to display details of performance. In addition in January 1993 a national freephone service--0800 665544--was introduced which provides callers with information about local national health service services, patients charter standards, common diseases, waiting times, how to complain about national health service services as well as health advice. In June 1994 the National Health Service Management Executive will be publishing national health service performance tables for the first time.
Dr. Mawhinney : I am pleased to say that progress on implementing the new deal on junior doctors' hours has been very encouraging. Between September 1990 and September 1993 junior doctors' posts contracted for more than 83 hours a week fell from over 13,000 to only 91, a reduction of 99 per cent. That represents a remarkable achievement.
I announced in December that we were giving priority this year to tackling hard-pressed on-call posts contracted for more than 72 hours a week. We are determined that junior doctors see real benefits from the new deal.
Dr. Mawhinney : We receive regular reports from regional task forces. Between September 1990 and September 1993 the number of junior doctors and dentists contracted for more than an average 83 hours a week fell from over 13,300 to 91, a reduction of 99 per cent. This is a remarkable achievement.
From August 1992 to September 1993 the number of those working in hard- pressed on-call posts contracted on average for between 73 and 83 hours a week fell from over 10,200 to 7,800, a 24 per cent. reduction. In December 1993 we announced that eliminating the remaining posts in this category will be a priority in 1994.
Mr. Sackville : We attach high importance to the prompt and appropriate treatment of people with asthma. Last July the Department launched the chronic disease management programme, which is an organised programme of care run by general practitioners for people with asthma. And only last month the National Health Service Management Executive asked purchasers to reflect in contracts the professionally developed clinical guidelines produced by the British Thoracic Society on the management of asthma.
Dr. Mawhinney : A list of the directly managed units in England not awaiting a decision on national health service trust status is set out as follows. Information relating to Scotland and Wales are matters for my right hon. Friends the Secretaries of State for Scotland and for Wales.
Directly Managed Units not awaiting a decision on NHS Trust status
Wolverhampton Primary Healthcare
Sandwell Mental Health
Glenfrith Unit (Merger with Fosse Health NHS Trust in the 5th Wave)
Grantham and Kesteven General Hospital
Harlow Wood Orthopaedic Hospital
Charles Clifford Dental Hospital
North East Thames
Essex Herts Acute
Essex Herts Community
City and East London Family and Community Health Services South West Thames
North West Surrey Learning Difficulties
Pathfinder (Wandsworth Mental Health)
Croydon Mental Health Unit (Warlingham Park)
Seacroft, Killingbeck and Wharfedale Hospital
My right hon. Friend the Secretary of State has given permission for these units to submit applications in the fifth wave of NHS trusts.
Dr. Mawhinney : Trusts are not required to hold their board meetings in public. Each trust is required to hold an annual public meeting at which it presents its annual report, audited accounts and any report made on those accounts by the auditor.
Many trusts go beyond the minimum requirements on public access. Detailed information is not held centrally.
Mr. Bowis : The Government are in the process of implementing the range of recommendations from the policy and financial management review of the Central Council for Education and Training in Social Work--CCETSW. This includes proposals for improvements to the management structure of CCETSW and a review of the "Rules and Requirements for the Diploma in Social Work".
(2) what assessment her Department has made on the cost implications arising from shortfalls in service provision for treatment centres for drug and alcohol addiction cases ;
(3) what consultations she has had regarding provision of drug and alcohol addiction treatment centres ; and if she will make a statement ;
(4) what monitoring her Department has done on the impact of the implementation of community care on independent providers of residential services for alcohol and drug misuse ; and if she will make a statement.
Mr. Bowis : The Department has received a number of representations about the funding of residential services for alcohol and drug misusers under the new community care arrangements. The Department consulted both providers and purchasers of services for this vulnerable group on the preparation of guidance to local authorities to ensure that alcohol and drug misusers receive proper attention within community care. This guidance, LAC(93)2, was issued in January 1993 and copies are available in the Library.
We also commissioned Goldsmiths' college to monitor the impact of community care on residential services for alcohol and drug misusers in the first three months of community care and the report "Who Cares Now" was published in July 1993. A copy of this report is in the Library. A three-month follow -up report was commissioned by Alcohol Concern and the Standing Conference on Drug Abuse--SCODA--entitled "Vulnerable Services for Vulnerable People" and published in December 1993, copies of which will be placed in the Library. The Goldsmiths' reports make it clear that the numbers of people receiving care funded by local authorities have increased steadily over the first six months of the community care reforms, and that local authorities had specified budgets in 1993-94 totalling £20.59 million for the purchase of services for alcohol and drug misusers within community care.
We shall continue to monitor the provision of services for drug and alcohol misusers within our general monitoring of community care.
Ms Jowell : To ask the Secretary of State for Health (1) how many districts have a register of the 300 or 400 most severely ill vulnerable people in their area ; and how many have a care programme approach register ;
(2) how many districts have a suicide register to identify potentially vulnerable people.
Mr. Bowis : Guidance to be issued to district health authorities in the next few weeks will require them to ensure that providers of mental health services have in place from 1 April 1994 registers which identify those people with severe mental illness who may be at risk to themselves or to others. The number of mentally ill people to be included on these registers will be determined locally. The terms "suicide register" and "care programme register" are not in general use in the national health service, but all providers of NHS mental health services should already be able to identify all patients subject to the care programme approach.
Mr. Bowis : All district health authorities are developing plans to achieve "The Health of the Nation" target to reduce the suicide rate of severely mentally ill people by at least 33 per cent. by 2000.
Sir Donald Thompson : To ask the Secretary of State for Health (1) what is the policy of the NHS on the use of complementary therapies where they are found to be cost-effective ; and what criteria are in use to enable the medical professionals and the management to choose and judge ;
(2) how the NHS assesses the therapies it considers complementary.
Mr. Sackville : Our policy is that the national health service should assess interventions on the basis of their effectiveness in improving or maintaining health. There are a variety of sources of information on effectiveness, and we are seeking to make such information more readily accessible to managers and clinicians who need it.
Mr. Hinchliffe : To ask the Secretary of State for Health what is the cost to independent sector homes of inspection by local authority arm's -length inspection units (a) per resident and (b) per year in total.
Mr. Bowis : The annual fee payable to local authorities by those running registered independent residential care homes for four or more residents is £41 per resident. Inspection by independent inspection units is among the costs reflected in that fee. Information about the total cost of such fees per year is not available centrally.
Dr. Mawhinney : Checks on eligibility for prescription charge exemption and charge remission under the national health service low income scheme indicate that the incidence of fraud is relatively low. The adequacy and operation of these checks are kept under review.
Mr. Barnes : To ask the Secretary of State for Health if she will list for each district health authority and trust the total number of their continual care beds designated for perons diagnosed with senile dementia.