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Column 533
Private income of the national health service
Region, Special |1988-89 |1989-90 |1990-91 |1991-92 |1992-93
Health Authority,
National Health
Service Trust
--------------------------------------------------------------------------------------------------------------------------------------------------------------
Northern regional health authority |1,579,019 |1,801,937 |2,071,309 |1,877,310 |1,332,230
Yorkshire regional health authority |3,837,428 |4,070,335 |5,044,191 |4,541,752 |2,551,178
Trent regional health authority |2,838,649 |3,183,545 |2,877,057 |3,464,673 |2,615,399
East Anglia regional health authority |3,911,425 |4,743,750 |5,278,653 |7,318,941 |6,068,307
North West Thames regional health authority |10,251,108 |11,765,016 |13,377,772 |13,984,258 |11,082,874
North East Thames regional health authority |11,064,093 |14,063,599 |16,267,305 |11,158,170 |9,893,003
South East Thames regional health authority |7,857,124 |8,636,174 |11,023,826 |11,692,162 |12,558,427
South West Thames regional health authority |2,808,233 |3,368,424 |4,150,714 |3,527,592 |2,966,909
Wessex regional health authority |2,233,589 |2,516,311 |3,322,716 |4,383,335 |3,530,475
Oxford regional health authority |5,812,328 |8,138,495 |9,510,480 |9,724,622 |10,803,281
South Western regional health authority |3,192,220 |3,643,156 |4,821,114 |2,111,512 |1,484,225
West Midlands regional health authority |3,704,756 |4,405,253 |5,612,685 |6,326,507 |5,525,374
Mersey regional health authority |2,070,550 |1,706,556 |2,051,833 |2,006,183 |312,253
North Western regional health authority |4,568,630 |5,382,332 |6,644,907 |4,949,840 |4,127,700
Hospitals for Sick Children special health authority2,843,674 3,459,624 3,578,948 5,066,294 4,987,994
National hospitals for nervous diseases special
health authority1,014,771 |1,099,076 |1,234,224 |1,707,059 |1,508,084
Moorfield eye hospital special health authority |636,115 |676,430 |739,885 |884,570 |944,319
Bethlem Royal/Maudsley special health authority |111,959 |128,768 |134,547 |183,815 |155,266
National heart and chest hospitals special health
authority |2,805,264 |3,660,196 |3,636,114 |4,256,510 |4,429,254
Royal Marsden hospital special health authority |2,986,469 |3,883,394 |4,586,605 |6,390,534 |8,159,002
Hammersmith and Queen Charlotte's special
health authority |1,512,684 |2,232,927 |2,753,572 |3,003,772 |3,735,534
Eastman dental hospital special health authority |19,463 |24,097 |13,298 |20,140 |23,321
National health service trusts |n/a |n/a |n/a |32,254,000 |58,520,000
|------- |------- |------- |------- |-------
Total income |77,659,551 |92,589,395 |108,731,755 |140,833,551 |157,314,409
Source: Annual accounts for regional health authorities, district health authorities, London postgraduate special health authorities and NHS trusts.
Notes:
1. The figures in the table include money received from national health service patients paying for accommodation in single rooms or small wards
(section 63 NHS Act 1977), private in-patients (section 65) and private non-resident patients (section 66).
2. Overseas visitors (section 211) not eligible for free treatment have been excluded (as they are charged national health service patients).
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In-patients
Ms Primarolo : To ask the Secretary of State for Health what were the activity figures for in-patients plus day cases in terms of finished consultant episodes for each region and special health authority combined in 1990-91, 1991-92 and 1992-93 for (a) NHS patients and (b) private patients.
Mr. Sackville : The information available is shown in the table. Information on private patients for 1992-93 is not yet available.
England, NHS Hospital activity data, 1990-91-1992-93 (a)
Finished
consultant episodes (in-patient plus day cases)<1>
|1990-91 |1991-92 |1992-93
----------------------------------------------------------
England |8,785,252|9,306,707|9,636,262
Northern |628,583 |655,287 |678,185
Yorkshire |722,130 |751,428 |784,549
Trent |809,186 |858,823 |899,532
East Anglia |360,934 |379,294 |388,343
North West Thames |536,203 |576,714 |600,446
North East Thames |695,279 |746,633 |762,213
South East Thames |629,250 |673,068 |702,475
South West Thames |457,600 |500,588 |522,221
Wessex |526,284 |562,571 |573,834
Oxford |383,333 |404,923 |431,021
South Western |588,049 |617,689 |647,201
West Midlands |959,648 |1,006,699|1,029,052
Mersey |487,107 |523,515 |541,685
North Western |887,029 |927,034 |944,323
SHAs |114,637 |122,441 |131,182
<1> This includes a small number of private patients of
which estimates
are shown in the table (b).
Source: KP70 return.
(b) Private patients in NHS hospitals-Finished
Consultant Episodes
|1990-91 |1991-92<2>
---------------------------------------------------
England<1> |81,366 |89,863
Northern |3,349 |3,178
Yorkshire |4,842 |5,263
Trent |2,797 |3,038
East Anglia |4,504 |4,270
North West Thames |10,345 |9,337
North East Thames |7,402 |9,850
South East Thames |6,648 |8,636
South West Thames |5,081 |6,269
Wessex |2,643 |2,673
Oxford |6,928 |7,244
South Western |5,044 |5,458
West Midlands |6,081 |6,866
Mersey |2,370 |2,249
North Western |6,445 |7,224
SHAs |6,887 |8,306
<1> Total may not add due to rounding.
<2> Provisional estimates.
Source: Hospital Episode Statistics, 1990-91;
1991-92.
Community Care Grants
Mr. Morgan : To ask the Secretary of State for Health, pursuant to her answer of 20 January, Official Report, column 794, if she will specify the aggregate level of special grants and care in the community over the present financial year and each of the next three years.
Mr. Bowis : The special transitional grants for community care are planned to be :
|£ million
------------------------------
1993-94 |565.4
1994-95 |735.9
1995-96 |647.6
In each case, the majority of the resources within the special transitional grant will be incorporated into the following year's local authority revenue support grant, so that the cumulative additional resource available for community care will be :
|£ million
------------------------------
1994-95 |1,274.5
1995-96 |1,838.0
We propose to make available a further £418 million in 1996-97, and will determine nearer the time how much of that will be included within the special transitional grant, and how much within the revenue support grant.
Mr. Hinchliffe : To ask the Secretary of State for Health what proposals she has to require local authorities to spend a specific percentage of special transitional community care grant in the private and voluntary sector during the next financial year.
Mr. Bowis : We shall shortly be announcing the conditions which we propose to apply to the special transitional grant in 1994-95.
NHS Regional Authorities
Mr. Robathan : To ask the Secretary of State for Health if she has reached decisions on the boundaries for the new NHS regional health authorities to be established on 1 April.
Mrs. Virginia Bottomley : Following consultation, I have decided that the number of regional health authorities should be reduced to eight from 1 April 1994. The boundaries for the regions will, with one exception, be as set out in the consultation document "Managing the new NHS : Proposal to determine the new NHS regions and establish new Regional Health Authorities". The exception is the districts of East and West Cumbria which, in response to local representations, will be part of the new Northern and Yorkshire region and not North West region as originally proposed.
I shall be laying statutory instruments before the House early in March to implement the required changes to regional boundaries. The chairmen of the eight regions will be :
Anglia and Oxford -- (originally East Anglian and Oxford) Dr. Stuart Burgess CBE
Northern and Yorkshire -- (originally North East and Yorkshire) Mr. John Greetham CBE
Trent--
Sir Michael Carlisle until end of July 1994 when he will be succeeded by
Mr. Keith Ackroyd
North Thames--
Sir William Staveley GCB
South Thames--
Mr. William Wells
South and West -- (originally South West)
Ms Rennie Fritchie
West Midlands--
Mr. Bryan Baker
North West--
Sir Donald Wilson DL
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Community Nurses
Mr. Donohoe : To ask the Secretary of State for Health if she will make a statement on the consultation exercise undertaken by the United Kingdom Central Council concerning proposals to amend the criteria for community nurse status ; and what action her Department has taken on the conclusions of the consultation exercise.
Mr. Sackville : The United Kingdom Central Council is reviewing its proposal for post-registration education and practice as a consequence of its consultation exercise. We have not received its revised proposals.
NHS Supplies Authority
Mr. Fatchett : To ask the Secretary of State for Health if she will set out the names and the professional background of the current members of the NHS Supplies Authority.
Mr. Sackville : The chairman is Sir Robin Buchanan, who was previously chairman of Wessex regional health authority, and is a chartered accountant and company director. the other non-executive members are :
Mrs. Alison Cook, chairman of Barnsley district health authority, and a company solicitor ; formerly company secretary within ICI. Mr. Eric Greenhalgh, consultant and company chairman ; formerly Director of Trading for the John Lewis Partnership department stores ; Managing Director for David Jones, Australia, and also Selfridges ; Chairman of Owen Owen plc ; President of ACI ; Vice-President and President-designate of the International Association of Department Stores.
Mr. Jim Hammond, Chief Executive, East Gloucestershire National Health Service Trust and a chartered engineer ; formerly director and general manager of several companies in the construction industry. Miss Catherine McLoughlin, Management consultant, and Chairman of Bromley Family Health Services Authority ; formerly District General Manager for Haringey DHA, and Director of Nursing for the NHS Management Executive from 1989 to 1990 with extensive nursing experience.
Mr. Fred Hoult, Chairman of the Freeman Group of Hospitals NHS Trust, and director of a transport and distribution company and three property companies.
The executive directors are :
Mr. Terry Hunt, National Director and former Regional General Manager to North East Thames RHA.
Mr. Evan Sutherland, Deputy National Director and Director of Purchasing ; formerly Regional Supplies Director to North Western RHA and extensive private sector procurement experience.
Mr. Richard Chantler, Director of Finance and Information and former senior manager with TNT Express Worldwide Ltd. ; Fellow of the Institute of Certified Accountants.
Mrs. Roxanne Sutton, Director of Communications ; formerly Director of Communications for North East Thames RHA, and extensive experience in NHS personnel management posts at hospital, district and regional level ; Member of the Institute of Personnel Management.
Mr. Chris Uden, Director of Human Resources ; formerly Director of Management Development with the NHS Procurement Directorate with extensive experience with British Gas in marketing, customer services and management development. Member of the Institute of Training and Development and Associate Member of the Institute of Personnel Management.
Drug Overdoses
Mr. Flynn : To ask the Secretary of State for Health how many people die each year from deliberate or accidental overdoses of prescribed drugs.
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Mr. Sackville : In 1991, 1,783 people were recorded as having died from accidental, self-inflicted or undetermined, whether accidentally or purposely inflicted, poisoning by drugs, medicaments and biological substances. Whether or not these were prescribed is not recorded at death. However, most categories of these substances are only available on prescription. Major exceptions are "analgesics, antipyretics and antirheumatics" which accounted for 753 of the deaths and "other unspecified drugs and medicaments" which accounted for a further 294 of the total.
Detailed data about these deaths and the substances involved are published each year in the Office of Population Censuses and Surveys "Mortality Statistics Series DH2 and DH4", copies of which are available in the Library.
Mr. Flynn : To ask the Secretary of State for Health if she will list the 10 prescribed drugs used in the largest numbers of deliberate or accidental fatal overdoses.
Mr. Sackville : Table 10 in the Office of Population Censuses and Surveys "Series DH4 Mortality" statistics, injury and poisoning, shows the substances involved where deaths were recorded as accidental, self- inflicted or undetermined whether accidentally or purposely inflicted. Whether or not these were prescribed is not recorded at death.
Copies of the relevant OPCS publications are available in the Library.
Cannabis
Mr. Flynn : To ask the Secretary of State for Health what assessment her Department has made of the medical ill-effects of cannabis on users.
Mr. Bowis : Consideration of the short and long-term effects of cannabis use is part of the normal medical assessment of any drug-taking individual who presents for treatment. In general, concentration, short- term memory and manual dexterity tend to be impaired during intoxication. Long-term, regular and heavy cannabis smoking may also cause respiratory diseases such as bronchitis or lung cancer.
Mr. Flynn : To ask the Secretary of State for Health what assessment her Department has made of the medical applications of cannabis in the treatment or prevention of (a) glaucoma, (b) multiple sclerosis and (c) Alzheimer's disease.
Mr. Sackville : Cannabis is known to lower intraocular pressure in glaucoma and to relieve muscle spasms associated with multiple sclerosis, although in neither case is it as effective as other drugs. We are not aware that cannabis has any benefit to patients with Alzheimer's disease.
Drug Prescriptions
Mr. Flynn : To ask the Secretary of State for Health what is the annual cost to the NHS of the medical service provided to those patients addicted to prescribed drugs.
Mr. Bowis : This information is not available centrally in the form requested. However, since 1986-87 top sliced funds have been made available to health authorities for the development of drug misuse services, including services
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for people addicted to prescribed drugs. This allocation, which totals over £24 million in 1993-94 represents a minimum that health authorities will spend on drug misuse services.Heroin
Mr. Flynn : To ask the Secretary of State for Health what is the annual cost to the NHS per prescription, of providing prescribed heroin to a patient.
Dr. Mawhinney : The average net ingredient cost per prescription item for all diamorphine products dispensed in the family health services authorities in England in 1992 was £27.16.
Prescriptions for diamorphine products are issued both to drug addicts and to patients with terminal illness as part of their symptom control.
Mr. Flynn : To ask the Secretary of State for Health what proposals she has to reduce the numbers of deaths resulting from variation in purity of heroin.
Mr. Bowis : On 6 January we launched a £2.6 million media campaign on the dangers of drug and solvent misuse. The campaign is supported by leaflets for young people, parents, professionals and others giving the facts and advice on drug misuse. This includes the fact that the strength of drugs made illegally or without medical supervision is unpredictable and dangerous.
Hospital Waiting Lists
Mr. Burns : To ask the Secretary of State for Health how many people in the Mid Essex area were waiting over one year for hospital admissions in (a) March 1991 and (b) the latest available month.
Dr. Mawhinney : The area covered by Mid Essex and West Essex district health authorities in March 1991 is now covered by Mid Essex hospital services trust and North Essex district health authority. At March 1991 in Mid and West Essex district health authorities 3, 143 patients had waited more than a year for treatment and 1,018 of these had waited more than two years. At September 1993 in the Mid Essex hospital services trust and North Essex district health authority the number waiting over one year had fallen by 56 per cent. to 1,379 and no one had waited more than two years.
Mr. Burns : To ask the Secretary of State for Health (1) what proportion of hospital admissions in the Mid Essex area are (a) immediate, (b) within five weeks, (c) within three months and (d) longer than a year ; and what the figures were in March 1991 ; (2) what was the average waiting time for admission to hospital in the Mid Essex area in (a) 1988, (b) March 1991 and (c) the latest available month.
Dr. Mawhinney : The information requested is available only on a national or regional basis rather than district health authority or trust.
Chelmsford Hospitals
Mr. Burns : To ask the Secretary of State for Health (1) if she will list all those services provided for patient care at Broomfield and St. John's hospitals, Chelmsford that have been enhanced since May 1979 ; and if she will make a statement ;
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(2) if she will list any totally new services for patient care provided by Broomfield hospital, Chelmsford and St. John's hospital, Chelmsford since May 1979.Mr. Sackville : We are aware of a number of new or enhanced services at these hospitals.
My hon. Friend may wish to contact Sir Jeffrey Bowman, chairman of Mid Essex hospital services national health service trust, for full details.
Mr. Burns : To ask the Secretary of State for Health how much money in cash terms at current prices, has been spent on capital projects at Broomfield hospital, Chelmsford and St. John's hospital, Chelmsford, since May 1979.
Mr. Sackville : During the last 15 years, more than £25 million has been spent on various developments and improvements at Chelmsford. My hon. Friend may wish to contact Sir Jeffrey Bowman, chairman of Mid Essex hospital services national health service trust, for details of the schemes.
Mr. Burns : To ask the Secretary of State for Health if she will list all those new services in health care which have been recommended or are being considered for moving to Broomfield hospital, Chelmsford from other hospital sites outside the Chelmsford area.
Mr. Sackville : Statutory consultation is taking place on a proposal to transfer the regional plastic surgery and burns unit from St. Andrew's hospital, Billericay to Broomfield hospital.
Health Spending
Mr. Burns : To ask the Secretary of State for Health how much money was spent on the national health service in pounds sterling per head of the population in Mid Essex in (a) May 1979, (b) April 1991 and (c) the expected spending level in April 1994.
Mr. Sackville : Information is not available centrally in this form. However, Mid Essex's revenue outturn increased from £35,554,483 in 1982-83--1982-83 cash--to £93,892,755 in 1991-92--1991-92 cash. My hon. Friend may wish to contact Mr. Alec Sexton, the chairman of North Essex health authority, for full details.
Patients, Mid-Essex
Mr. Burns : To ask the Secretary of State for Health how many patients in the Mid Essex area have been treated in the latest month available for every 100 patients treated in March 1991.
Mr. Sackville : For every 100 finished consultation
periods--ordinary admissions plus day cases--in the general and acute sector in national health service hospitals in the Mid Essex district in the financial year 1990-91, there were 105 in 1992-93.
Statutory Sick Pay
Mr. Ingram : To ask the Secretary of State for Health if she will provide a figure for the number of staff in her Department covered by statutory sick pay.
Mr. Sackville : As at 31 December 1993 the Department of Health had 5,379 staff entitled to statutory sick pay.
Column 541
Continuing Care
Ms Lynne : To ask the Secretary of State for Health what rights a patient has to receive continuing care in NHS hospitals for (a) dementia and (b) other chronic conditions ; and what regulations and guidance her Department has issued on this matter.
Mr. Bowis : The "Caring for People" White Paper--Cm 849--sets out clearly that all health authorities have a responsibility to secure continuing care for people who require it for reasons of ill-health.
Ms Lynne : To ask the Secretary of State for Health what steps her Department is taking to ensure that there are sufficient long-stay beds for people wishing to receive continuing care in hospital.
Mr. Bowis : The White Paper "Caring for People" made it clear that the national health service has a continuing responsibility to secure long- term care for those who need it for reasons of ill-health. Health authorities as purchasers are encouraged to consider the range of options which may be available for the long-term care needs of their resident populations : whether by placing contracts for services with their own directly managed units or by other district health authorities, NHS trusts, or the independent sector.
Ms Lynne : To ask the Secretary of State for Health what measures her Department has taken to publicise to patients and their relatives the options available to them for continuing care.
Mr. Bowis : The Government have made it clear to health authorities and local authority social services departments that they should explain to all people who may require continuing care the options available to them. Under the National Health Service and Community Care Act 1990 local authorities are expected to publish community care plans in collaboration with health authorities which take into account the needs of the local population. The Department has produced a leaflet, "Community Care changes in April 1993", on community care services, which was made generally available to the public, and an information pack for voluntary and private sector providers explaining the new arrangements. These were also sent to voluntary organisations who represent patients/residents and their relatives.
Hospital Charges
Mr. Rooney : To ask the Secretary of State for Health (1) in what circumstances a person with the right to permanent residence in the United Kingdom is classed as an overseas visitor and liable to charges for treatment in hospital ;
(2) in what circumstances a British citizen is classed as an overseas visitor and liable to charges for treatment in hospital.
Mr. Sackville : The services of the national health service are intended for people ordinarily resident in the
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United Kingdom regardless of nationality or origin. The NHS (Charges to Overseas Visitors) Regulations 1989--1989 SI No. 306--as amended by the NHS (Charges to Overseas Visitors) Amendment Regulations 1991--1991 SI No. 438--apply.Efficiency Savings
Mr. Blunkett : To ask the Secretary of State for Health where she expects to identify efficiency savings in the national health service for 1994-95 in addition to the 2.25 per cent. announced in the budget for spending on direct patient care.
Dr. Mawhinney : Hospital and community health services will be required to demonstrate efficiency improvements of at least 2 per cent. in 1994-95. How these are achieved is a matter for local decision in the light of local circumstances.
NHS Productivity
Mr. Blunkett : To ask the Secretary of State for Health what guidance he has issued or plans to issue to health authorities and trusts about improved productivity in the service.
Dr. Mawhinney : Specific guidance on productivity is not issued by the Department. However, health authorities and national health service trusts are assisted in their efforts to improve productivity by the National Audit Office, the Audit Commission and the value for money unit of the NHS Management Executive, which report on key areas and make appropriate recommendations. The NHS reforms have also given an incentive to improve productivity as providers have to compete for contracts.
NHS Pay
Mr. Blunkett : To ask the Secretary of State for Health what guidance has been given to health authorities and trusts about pay levels for 1994-95.
Dr. Mawhinney : The chief executive of the national health service management executive wrote to general managers of health authorities and chief executives of NHS trusts on 30 November 1993 about the increase in public spending on health in 1994-95. The letter set out the implications for real growth, efficiency targets and pay rises. A copy of the letter EL(93)110 will be placed in the Library.
AIDS
Mr. Peter Shore : To ask the Secretary of State for Health how many cases of AIDS in the age groups (a) 16 to 18, (b) 18 to 21 and (c) over 21 years were notified to the Department in each year since 1987.
Mr. Sackville : The information requested for the United Kingdom is shown in the table.
Column 541
Age (years)Number of cases
reported
diagnosis |1987 |1988 |1989 |1990 |1991 |1992 |1993
------------------------------------------------------------------------------------------
16 |1 |- |- |1 |1 |- |-
17 |- |- |1 |2 |1 |- |-
18 |2 |1 |- |- |- |2 |1
19 |5 |2 |3 |4 |3 |5 |3
20 |- |2 |4 |4 |2 |4 |3
21 |6 |4 |3 |1 |3 |3 |3
22+ |613 |737 |826 |1,232 |1,320 |1,437 |1,577
Not known |- |- |- |1 |1 |- |3
-------
Total |627 |746 |837 |1,245 |1,331 |1,451 |1,590
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