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Mr. Bowis : Parkinson's disease is associated with a deficiency of a substance called dopamine which is essential for the transmission of nerve impulses. In recent years there have been developments in new variants of "dopamine agonist" drugs which assist in the maintenance
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of the body's level of dopamine. The use of self-administered injections of apomorphine, the usual drug prescribed for the condition, is becoming widespread. The use of brain tissue transplants remains experimental and is not currently being carried out in the United Kingdom.Safe Sex
Mr. Hayes : To ask the Secretary of State for Health if she will make a statement on the role of the Health Education Authority in providing national public education campaigns to promote condom use following recent research into sexual attitudes and lifestyles.
Mr. Sackville : Since 1987, the Health Education Authority has had a continuing role in providing public education on HIV/AIDS and sexual health by delivering information about responsible sexual behaviour. The national survey of sexual attitudes and lifestyles showed the impact of public education, providing evidence of considerable awareness of HIV/AIDS among those reporting behaviour which carried a higher risk of infection, and of increased condom use both by those with more partners and by people under 24. It is important that the HEA and other agencies continue their national and local efforts to promote sexual health.
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Local Authorities (Charging Guidance)
Mr. Cohen : To ask the Secretary of State for Health what recent guidance she has issued to local authorities regarding charging for home helps, day care and community alarms ; what are the financial implications of this guidance ; and if she will make a statement.
Mr. Bowis : Guidance about charging for non-residential social services for adults was sent to local social services authorities in January, and copies of the circular (LAC(94)1) are available in the Library. Powers to charge are discretionary and so it is not possible to quantify precisely the financial implications of this guidance.
Car Parking Charges
Mr. Redmond : To ask the Secretary of State for Health what is her policy towards the charging of nurses to park their cars on NHS premises.
Mr. Sackville : Charges for car parking on national health service premises are a matter for local determination in the light of local circumstances, including the needs of patients, visitors and staff and the availability and cost of providing such facilities.
Emergency Fees (Collection by NHS Trusts)
Mr. Redmond : To ask the Secretary of State for Health whether NHS trusts are required to collect emergency fees under the Road Traffic Acts.
Mr. Sackville : Health service hospitals, including those managed by national health service trusts, are empowered to collect the emergency treatment fee under section 158 of the Road Traffic Act 1988 and it is Government policy that it should be collected. The fee, which must be covered by motor vehicle insurance policies, is payable by vehicle users in respect of each person given immediate treatment or examination arising from a road traffic accident.
Bed Allocations
Mr. Bowden : To ask the Secretary of State for Health (1) what evidence she has that health authorities use age as a criterion for allocating acute patients to different hospitals within their area ; (2) what is her Department's policy on the use by health authorities of age as a criterion by which patients are allocated beds in specific hospitals.
Mr. Sackville : Health authorities are responsible for purchasing appropriate services for all age groups in their resident populations. Children and young people in hospital should be provided with accommodation, facilities and staffing appropriate to their age and development. Depending on local circumstances, hospitals may elect to admit people over the age of 75 to specifically designated wards to ensure they receive the most appropriate care.
Reports (Costs)
Mr. Redmond : To ask the Secretary of State for Health what plans she has to advise all health authorities and trusts to review the costs of producing, publishing, printing and distributing reports in order to maximise the proportion of funds spent on direct health care.
Dr. Mawhinney : Communications about the services being purchased on behalf of patients and the way they are
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provided are an essential part of serving the public. National Health Service trusts are required to publish, as a minimum, an annual report, annual accounts, a summary business plan and a strategic direction document ; health authorities are required to provide a range of information as part of their publicaccountability. We expect them to make the best, most cost-effective use of their resources.
Paediatric Intensive Care
Mrs. Bridget Prentice : To ask the Secretary of State for Health if she will detail by region the (a) recommended and (b) actual number levels of paediatric intensive care beds ; and if she will make a statement.
Dr. Mawhinney : There are no nationally agreed levels for paediatric intensive care bed provision. The British Paediatric Association has recently published a report "The Care of Critically Ill Children" which recommends that there should be one bed per 48, 000 children. The report, which is available in the Library, shows the regional distribution of paediatric intensive care beds. The National Health Service Management Executive, in its executive letter of 27 January 1994 has asked district health authorities to review the current level of paediatric intensive care beds in order to develop in collaboration with other district health authorities and hospitals, a strategic plan for the purchasing of paediatric intensive care which takes into account local needs and resources. Copies of the letter are available in the Library.
Alternative and Complementary Medicine
Mr. Tredinnick : To ask the Secretary of State for Health what analysis has been made of potential cost savings to public funds if alternative and complementary medical treatments, with particular reference to osteopathy, chiropractic and homoeopathy, were more widely available on the national health service ; and if she will make a statement.
Mr. Sackville : The Department has commissioned a study by the medical care research unit of Sheffield university which will examine the impact complementary therapists--such as osteopaths, chiropractors, and homoeopaths--have on the prescribing patterns, cost of drugs, hospital referral practices, patient satisfaction and repeat attendances, within general practice. The study started last December and will take two years to complete.
Ambulance Service, London
Mrs. Bridget Prentice : To ask the Secretary of State for Health what were the response times by the London ambulance service to 999 calls for each of the last five years ; and what were the target times in each of those years.
Mr. Sackville : The target response time for emergency calls in each year was 95 per cent. responded to within 14 minutes. The percentage of calls responded to in the target time is shown in the table.
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Year |Percentage of
|ambulances
|responding
|within 14
|minutes
------------------------------------------
1988-89 |82.8
1989-90 |78.8
1990-91 |73.7
1991-92 |64.0
1992-93 |58.5
The London ambulance service's performance against the patients charter standard of a 95 per cent. response within 14 minutes has been unacceptable. In December 1993 the Government announced £14.8 million additional investment for the London ambulance service in 1994-95. The additional funding will be used to replace 40 per cent. of the vehicle fleet ; recruit and train 240 additional ambulance personnel ; accelerate the paramedic training programme and improve their communications systems.
In response to this investment, the London ambulance service has agreed with its managing agency, South West Thames regional health authority, interim targets of achieving an 80 per cent. response rate within 14 minutes by September 1994 and 85 per cent. by April 1995. When these targets have been met, the Government will expect the London ambulance service to establish an early date for the full achievement of the patients charter standard.
South Yorkshire Ambulance Trust
Mr. Redmond : To ask the Secretary of State for Health what assessment she has made as to whether the south Yorkshire ambulance trust meets patients charter standards ; and if she will make a statement.
Dr. Mawhinney : It is for local purchasers to ensure that contracts and actual performance meet patient's charter standards.
Accident and Emergency Services, London
Mr. Simon Hughes : To ask the Secretary of State for Health what progress has been made with regard to the review of accident and emergency services in London ; and if she will make a statement.
Dr. Mawhinney : There has been no special review of London's accident and emergency services. I refer the hon. Member to the reply I gave the hon. Member for Sheffield, Brightside (Mr. Blunkett) on 21 October 1993 at column 316 .
Mentally Disturbed Children
Mrs. Golding : To ask the Secretary of State for Health how many mentally disturbed children were in adult wards in the last year for which figures are available.
Mr. Bowis : It is a matter for health authorities to determine what arrangements are made locally about admission of children to hospital. However, our advice to purchasers contained in the guidance the "Health of the Nation Key Area Handbook : Mental Illness", a copy of which is in the Library, refers to a range of services which they need to consider so as to meet the needs of children and adolescents and this includes designated in- patient and day patient facilities.
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Bovine Spongiform Encephalopathy
Mr. Redmond : To ask the Secretary of State for Health if she will make a statement on the risks to humans of bovine spongiform encephalopathy.
Mr. Sackville : The Government receive advice on all matters relating to spongiform encephalopathies in humans and animals from an independent, expert committee, the Spongiform Encephalopathy Advisory Committee (SEAC), chaired by Dr. David Tyrrell FRS.
The Government, on advice from SEAC, are satisfied that all the necessary safeguards are in place to minimise further spread of spongiform encephalopathies in animals and to prevent any risk of transmission to humans.
Scientific evidence has not revealed any link between bovine spongiform encephalopathy in cattle and incidence of
Creutzfeldt-Jakob disease, a human spongiform encephalopathy.
Public Relations
Mr. Milburn : To ask the Secretary of State for Health which agencies are employed by each (a) regional health authority, (b) district health authority and (c) trust to deal with public relations ; and what are the estimated costs involved.
Mr. Sackville : This is a matter for the individual health authorities or trusts. The hon. Member may wish to contact the chairmen for details.
Agency Nurses, Wandsworth
Mr. Cox : To ask the Secretary of State for Health what was the number of agency nurses who were employed by the Wandsworth health authority for the period 1 to 31 January.
Mr. Sackville : This is a matter for Wandsworth health authority. The hon. Member may wish to contact Dr. Enid Vincent, the chairman, for details.
Sir James Ackers
Mr. Redmond : To ask the Secretary of State for Health (1) what plans she has to ask Sir James Ackers to repay the sum paid to him on his resignation as chairman of the West Midlands regional health authority ;
(2) if Sir James Ackers has repaid or offered to repay the sum paid to him on his resignation as chairman of the West Midlands regional health authority.
Dr. Mawhinney : Sir James Ackers has not repaid or offered to repay the sum paid to him on his resignation and we have no plans to ask him to do so.
Mr. John Hoare
Mr. Redmond : To ask the Secretary of State for Health if she will set out the detailed make-up of the £111,940 severance pay made to Mr. John Hoare, former Wessex regional health authority general manager.
Dr. Mawhinney : Mr. Hoare received a compensationary payment of £119,940 calculated on the basis of his final salary of £53,970 multiplied by the period remaining on his contract (26.67 months). He was allowed to purchase his lease car at a cost of £8,000, leaving a payment of £111,940.
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NHS (Meetings)
Mr. Redmond : To ask the Secretary of State for Health if she will require all NHS authorities to publish the agendas of all meetings whether or not open to the public.
Dr. Mawhinney : No. All national health service authorities are required by the Public Bodies (Admission to Meetings) Act 1960 to supply the press, on request, with a copy of the agenda for all full meetings at which approval for specific action is required.
Hospital Trusts
Mr. Loyden : To ask the Secretary of State for Health if she will make it her policy to ensure that persons appointed to be chairmen of hospital trusts record their financial and professional interests in a register of interest a copy of which should be placed in the Library.
Dr. Mawhinney : We are currently consulting on draft codes of conduct and accountability for national health service boards. In these we propose that where there is a potential for private interests to be material and relevant to NHS business, the relevant interests should be declared and recorded in the board minutes. We also propose that directorships and other significant interests held by NHS board members should be declared on appointment, kept up to date and set out in the annual report. The codes are to be implemented in all NHS trusts and authorities, subject to consultation, from 1 April 1994.
Health Authorities
Mr. Redmond : To ask the Secretary of State for Health who will be chairman on 1 April of (a) Trent regional health authority and (b) Sheffield community health trust.
Dr. Mawhinney : Sir Michael Carlisle and Mrs. Kathryn Riddle respectively.
Steroids
Mr. Jim Cunningham : To ask the Secretary of State for Health what plans she has to introduce tests for diabetes before steroids are used on patients.
Mr. Sackville : We have no plans to issue prescriptive guidance on such tests which are a matter for the clinical judgement of individual doctors.
Steroids, which are powerful drugs, may cause side effects especially in high doses. Doctors are fully aware of this possibility and to minimise the risk the dose is reduced as quickly as possible to the lowest maintenance level. During this period the patient is monitored for side effects.
Mr. Jim Cunningham : To ask the Secretary of State for Health how many patients died in (a) 1992-93 and (b) 1991-92 from the use of steroids in (i) England, (ii) the west midlands and (iii) Coventry.
Mr. Sackville : The information is shown in the table.
Number of deaths from the use of
steroids, <1>ICD E932.0, in
England,
West Midlands regional health
authority and Coventry in 1991
and
1992.
|1991|1992
---------------------------------
England |1 |0
West Midlands RHA |0 |0
Coventry |0 |0
<1> International Classification
of Disease 9th revision.
Coventry and Warwickshire Hospital
Mr. Jim Cunningham : To ask the Secretary of State for Health when she will announce her decision regarding the future of Coventry and Warwickshire hospital.
Dr. Mawhinney : This is a local matter for Coventry health authority. Coventry health authority has recently completed a consultation on the transfer of services from the Coventry and Warwickshire Hospital to the Walsgrave Hospital. As the local community health council agreed the health authority's proposals, the authority is free to begin implementing its plans. The hon. Member may wish to contact the chairman of the authority, Mr. A Guy, for details.
West Midlands Health Authority
Mr. Jim Cunningham : To ask the Secretary of State for Health what steps she is taking to satisfy herself (a) regarding the proper financial management of the West Midlands health authority and (b) that proper accountability procedures are in place.
Dr. Mawhinney : We have proposed, and are consulting on, the introduction of a code of conduct for the NHS which will make explicit the standards of conduct expected of those in the most senior positions in the NHS and provide a basis for setting standards for their staff. The NHS Management Executive, which is responsible for ensuring that there is a strong accountability and management framework at all levels of the NHS, has taken a number of steps to strengthen financial management across the NHS. These include guidance on the role of the director of finance ; revisions to standing orders, standing financial instructions and financial directions. Measures are also being taken to strengthen internal audit.
In West Midlands regional health authority the new board has taken a range of measures to strengthen financial management and accountability procedures within the region. These actions have been closely monitored by the NHS Management Executive.
Drug and Alcohol Dependence
Mr. Hinchliffe : To ask the Secretary of State for Health what guidance has been issued to local authorities and health authorities regarding responsibility for funding detoxification during the treatment and care of drug or alcohol dependence.
Mr. Bowis : Our guidance circular "Alcohol and Drug Services within Community Care" (LAC(93)2), which was sent to local authorities and health authorities in January 1993, makes it clear that health authorities continue to be responsible for the funding of the health care element of alcohol and drug services, this would include detoxification facilities. Copies of this guidance are available in the Library.
Mr. Hinchliffe : To ask the Secretary of State for Health what is her policy on the imposition of time limits on the funding of residential care for the treatment of drug or alcohol dependence.
Mr. Bowis : It is for the local authority to decide, in the light of the assessed community care needs of the client
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concerned and the programmes offered by treatment providers, how long to fund residential care for the treatment of drug and alcohol dependence.Health Expenditure (Southend)
Mr. Channon : To ask the Secretary of State for Health what progress she is making in increasing the health funds available in areas which are underfunded ; and what are her proposals for improving the situation in Southend during the next three years.
Mr. Sackville : One of the most important aspects of the reforms of the national health service is the progress we have made in distributing resources fairly to regional health authorities who have previously been underfunded. It is for them to do the same for district health authorities who have not had a fair share of NHS funds taking account of their resident populations and particular local characteristics and circumstances.
The allocation of funds to South Essex health authority is the responsibility of North East Thames regional health authority, and the hon. Member may wish to contact Sir William Staveley, the chairman, for details.
Bexley Health Authority
Mr. Evennett : To ask the Secretary of State for Health (1) what representations she has received in respect of the funding of Bexley health authority ;
(2) what representations she has received about thefunding of Queen Mary's hospital, Sidcup ; and if she will make a statement.
Mr. Sackville : We have received representations from a number of people, including my hon. Friend in respect of the funding of Bexley health authority and Queen Mary's hospital, Sidcup.
Mr. Evennett : To ask the Secretary of State for Health when she expects to announce the appointment of a chairman for the new merged Bexley and Greenwich health authority.
Dr. Mawhinney : We expect to make a decision on the chairmanship of the new merged Bexley and Greenwich health authority shortly.
Agency Services
Mr. Blunkett : To ask the Secretary of State for Health (1) if she will list the expenditure on agency services for each year since 1990 for (a) regions, (b) districts and (c) NHS trusts ; (2) if she will list for each year since 1990 the expenditure on external contract staffing and consultancy service for (a) regions, (b) districts and (c) trusts.
Mr. Sackville [holding answer 14 December 1993] : Since 1991- 92 expenditure for agency services is defined as expenditure on external contract staffing and consultancy services which includes non-patient services provided by non-national health service bodies. Information for 1991-92 and 1992-93 is shown in the table. The figures are not comparable with those for earlier years but confirm the effectiveness of the government's policy of encouraging overall value for money in the NHS by using alternative sources to supply a range of services.
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Expenditure on external contract staffing and
consultancy services
£ thousands
|1991-92|1992-93
----------------------------------------------------
Regional Health Authorities |25,813 |26,372
District Health Authorities |34,591 |39,788
NHS Trusts |13,184 |38,957
Source: Annual financial returns of regional health
authorities, district health authorities and
National Health Service trusts in England.
Notes:
1. Figures for 1992-93 are provisional.
2. The number of NHS trusts increased from 57 in
1991-92 to 156 in 1992-93.
Task Forces
Mr. Blunkett : To ask the Secretary of State for Health how many task forces she has set up since becoming Secretary of State ; if she will list them ; and if she will provide a breakdown of their cost.
Dr. Mawhinney [holding answer 24 January 1994] : Task forces on the following have been set up since April 1992. Information on expenditure could be provided only at disproportionate cost. Task Forces
1. Health of the Nation' Accidents
2. Health of the Nation' Workplace
3. Health of the Nation' Physical Activity
4. Review of Clinical Input into Contracts
5. Mental Health Task Force
6. Interdepartmental Task Force on Smoking
7. Corporate Governance
8. Community Care Support Force
9. Norwich II
10. Black and Ethnic Minority Health
11. NHS Research
12. A Strategy for Nursing Midwifery and Health Visiting Research 13. Nutrition
14. Chiropody
15. St. Vincent's Task Force for Diabetes
(Joint Department of Health and British Diabetic Association Task Force)
16. Data Quality
17. Day Surgery
Child Abuse
Mrs. Golding : To ask the Secretary of State for Health how many prosecutions of child abuse cases have been sent directly to the Crown court since October 1992.
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