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Pergau Project

Mr. Alan Williams : To ask the Prime Minister when he was first informed that the Foreign Secretary intended to issue a direction to the accounting officer in respect of the Pergau project.

The Prime Minister [holding answer 10 February 1994] : In February 1991.

Malaysia

Mr. Rogers : To ask the Prime Minister on how many occasions Tan Sri Arumugam, joint managing director, GEC-Malaysia, has visited his office in the past three years ; and if he will list the occasions.

The Prime Minister [holding answer 17 February 1994] : Once, in 1992, on the occasion of an official dinner for the Prime Minister of Malaysia.

President Yeltsin

Mr. Wareing : To ask the Prime Minister what views he received from President Yeltsin on the NATO ultimatum to the Bosnian Serbs during his discussion with him on Tuesday 15 February ; and if he will make a statement.

The Prime Minister [holding answer 18 February 1994] : I described the specific terms of the North Atlantic Council's response to the United Nations Secretary General's request for NATO assistance at Sarajevo. I agreed with President Yeltsin that our objectives were the same. Both the United Kingdom and Russia wanted to see an effective ceasefire implemented in Sarajevo, with heavy weapons brought under United Nations control. We both strongly supported the negotiations for a peaceful settlement.

We discussed President Yeltsin's decision to send a personal emissary to Belgrade. He told me that he was considering sending additional Russian troops to assist UNPROFOR in maintaining control over heavy weapons. I welcomed this, and agreed with President Yeltsin that it was important for Russia and her western partners in the European Union and the United States to use their channels of influence to promote a ceasefire in Sarajevo and an overall settlement. President Yeltsin stressed that Russia wished to be a full participant in this process, and I welcome his Government's announcement on 17 February that the additional forces will be made available to UNPROFOR.

Regional Offices

Mr. Rendel : To ask the Prime Minister which of Her Majesty's Government's Departments have been incorporated into integrated regional offices since 1992.

The Prime Minister [holding answer 18 February 1994] : New Government offices for the regions will come


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into being in April, combining the existing regional offices of the Departments of the Environment, of Employment, of Trade and Industry and of Transport.

HEALTH

Nurses and Carers

Mrs. Bridget Prentice : To ask the Secretary of State for Health what was the ratio of trained nurses to carers working in (a) London's and (b) England's national health service hospitals in (i) 1992 and (ii) 1993.

Mr. Sackville : The available information for 1992-93 is shown in the table.

The number of in-patients is not collected centrally. The table shows the number of ordinary admissions, which is the term used for in-patient consultant episodes.


                     |Ordinary admissions,|Nursing and mid-                         

                     |(includes midwifery |wifery staff (WTE)                       

                     |admissions)                                                   

------------------------------------------------------------------------------------

London               |1,158,449           |61,570                                   

England              |7,829,403           |378,790                                  

Notes:                                                                              

Admission figures are for the year 1 April 1992 to 31 March 1993.                   

Nursing figures are taken at 30 September 1992 and are for nursing and              

midwifery, including traditional learners but exclude Project 2000                  

nursing students who are supernumerary, and those nurses who have                   

transferred to senior management terms and who cannot be identified                 

separately from other senior managers.                                              

Primary Health Care

Mr. Bayley : To ask the Secretary of State for Health what was the level of net NHS current expenditure on primary health care excluding hospital and community health service expenditure for each year since 1973- 74 ; and what was the net expenditure each year on (i) administration including executive council, family practitioner committee or family health service authority administration and general practitioner practice administration, (ii) prescription items and (iii) other items including the remuneration of primary health care professionals, expressed in 1993-94 prices adjusted by (a) the gross domestic product deflator and (b) changes in input unit costs.

Mr. Sackville : Primary health care consists of the community health and family health services. The information available, excluding expenditure on the community health services, is shown in the table. Indices are not available to adjust drugs bill, other FHS, and family health services authorities' expenditure for changes in input unit costs.


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Family health services net expenditure                                                                                                                   

England                                                                                                                                                  

£ million                                                                                                                                                

Year             |<1>Family health|<2>Drugs bill   |<3>Drugs bill   |<4>Other family |<3>Other family |<5>FHSA         |<3>FHSA                          

                 |services        |expenditure     |expenditure at  |health services |health services |administrative  |administrative                   

                 |expenditure                      |1993-94 prices  |expenditure     |expenditure at  |expenditure     |expenditure at                   

                                                                                     |1993-94 prices                   |1993-94 prices                   

---------------------------------------------------------------------------------------------------------------------------------------------------------

1973-74          |522             |n/a             |n/a             |n/a             |n/a             |13              |83                               

1974-75          |630             |n/a             |n/a             |n/a             |n/a             |n/a             |n/a                              

1975-76          |854             |277             |1,141           |577             |2,371           |n/a             |n/a                              

1976-77          |993             |361             |1,308           |632             |2,291           |n/a             |n/a                              

1977-78          |1,123           |461             |1,470           |662             |2,111           |n/a             |n/a                              

1978-79          |1,329           |554             |1,589           |775             |2,224           |n/a             |n/a                              

1979-80          |1,549           |633             |1,555           |916             |2,251           |n/a             |n/a                              

1980-81          |1,923           |766             |1,592           |1,157           |2,403           |n/a             |n/a                              

1981-82          |2,208           |876             |1,660           |1,331           |2,522           |n/a             |n/a                              

1982-83          |2,547           |1,009           |1,784           |1,538           |2,719           |n/a             |n/a                              

1983-84          |2,730           |1,130           |1,909           |1,600           |2,704           |n/a             |n/a                              

1984-85          |3,010           |1,192           |1,917           |1,818           |2,925           |n/a             |n/a                              

1985-86          |3,188           |1,275           |1,943           |1,914           |2,917           |45              |69                               

1986-87          |3,419           |1,378           |2,040           |2,041           |3,022           |47              |69                               

1987-88          |3,802           |1,536           |2,160           |2,265           |3,185           |49              |69                               

1988-89          |4,293           |1,744           |2,298           |2,549           |3,358           |55              |72                               

1989-90          |4,531           |1,942           |2,393           |2,589           |3,189           |67              |82                               

1990-91          |5,156           |2,080           |2,371           |3,076           |3,507           |104             |118                              

1991-92          |5,944           |2,317           |2,484           |3,627           |3,889           |136             |146                              

1992-93          |6,593           |2,641           |2,727           |3,952           |4,081           |162             |167                              

<1>Net expenditure, after taking account of patient charges and other receipts, on the General Medical, General Dental, General Ophthalmic and           

Pharmaceutical Services. Excludes administrative costs of FHSAs and other bodies and GP Fundholders budgets for purchasing secondary care                

services. Information is based on the relevant year's Appropriation Account.                                                                             

<2>Represents the cost of items prescribed by GPs. Dispensing fees are not included. Costs are not separately identifiable in 1973-74 and 1974-75.       

<3>Converted to 1993-94 prices using GDP deflator.                                                                                                       

<4>Balance of net FHS expenditure minus the cost of the drugs bill. Consists mainly of the cost of remuneration and practice expenses of FHS             

contractors.                                                                                                                                             

<5>Net administrative expenditure of Family Health Services Authorities (known as Family Practitioner Committees before September 1990, and as           

Executive Councils before April 1974). The administrative functions of FHSAs and their predecessors have changed over time as their management           

responsibilities have been developed. Expenditure was not separately identifiable in the period 1974-75 to 1984-85. Excludes expenditure on              

national administrative bodies such as the Prescription Pricing Authority and the Dental Practice Board. Information is based on FHSAs' income           

and expenditure accounts.                                                                                                                                

Barnsley FSHA

Mr. Illsley : To ask the Secretary of State for Health if she will list the amount, recipient and date of all the grants made by Barnsley family health services authority since 1990.


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Mr. Sackville : Detailed information is not held centrally. The information in the annual accounts of Barnsley family health services authority is shown in the table.


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Year                  |Grants to general    |Grants to supervisors|Practice teams and   |Practice teams and                         

                      |medical service      |of ophthalmic        |premises             |premises                                   

                      |trainers             |optician trainees    |improvements-        |improvements-                              

                                                                  |Revenue              |Capital                                    

                      |£                    |£                    |£                    |£                                          

------------------------------------------------------------------------------------------------------------------------------------

1990-91               |29,294               |1,250                |-<1>                 |<1>9,897                                   

1991-92               |30,935               |750                  |0                    |216,699                                    

1992-93               |19,714               |1,500                |0                    |139,498                                    

<1>In 1990-91 the expenditure was reported on a different basis to that in subsequent years i.e. as "improvement grants", not       

analysed between                                                                                                                    

revenue and capital.                                                                                                                

Source:                                                                                                                             

Barnsley Family Health Services Authority's annual accounts.                                                                        

Consultants

Mr. Meacher : To ask the Secretary of State for Health if she will state the value of consultancy contracts awarded by her Department each year since 1988, both in current prices and at constant 1994 prices.

Mr. Sackville : Expenditure on fees and expenses for contracts awarded by the Department of Health paid under the general management consultancy budget for the financial years 1989-90 to 1992-93 was :


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<

Financial year |Expenditure at|Expenditure at               

               |current prices|constant                     

                              |1993-94                      

                              |prices                       

               |(£ million)   |(£ million)                  

------------------------------------------------------------

1989-90        |4.870         |5.999                        

1990-91        |2.870         |3.272                        

1991-92        |2.806         |3.008                        

1992-93        |3.526         |3.641                        

Prior to 1989-90 management consultants were funded from a joint health- social security budget and it is not possible to identify expenditure solely on health. Expenditure figures for the current 1993-94 year will not be available until after the end of the financial year. The


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Department also employs specialist consultants, particularly on information technology projects, and other consultants on specific projects which are funded from other budgets.

NHS (Fraud)

Mr. Redmond : To ask the Secretary of State for Health how many cases of fraud against health service managers are currently pending.

Mr. Sackville : We do not routinely monitor the progress of fraud investigation in the national health service.

Mr. Redmond : To ask the Secretary of State for Health what plans she has to surcharge national health service directors in respect of fraud or incompetence.

Mr. Sackville : We have no such plans.

Mr. Redmond : To ask the Secretary of State for Health what plans she has to issue revised advice to NHS authorities and trusts on the action to be taken in cases of corruption and fraud.

Mr. Sackville : Guidance on action to be taken in the case of fraud is currently being routinely updated and will be issued in due course.

NHS Trading Undertakings

Ms Primarolo : To ask the Secretary of State for Health if she will make a statement on the Government's policy on the privatisation of national health service trading undertakings.

Mr. Sackville : The Government are committed to a publicly funded health service with national health service units, both trusts and directly managed units, firmly within the public sector. However, our policy is to encourage health service bodies to concentrate their management skills on the core activities of the NHS and to use their expertise, where possible, to seek better value for money and improved quality in the provision of non -core activities. If trading undertakings prove to be commercially viable, we would expect that they would ultimately become independent businesses.

Geriatric Care

Mr. French : To ask the Secretary of State for Health (1) what is her estimate of the cost of geriatric care in (a) 2004 and (b) 2014 ;

(2) what is her estimate of the percentage increase in the cost of geriatric health care between (a) 1980 and 1990, (b) 1990 and 2000 and (c) 2000 and 2010.

Mr. Bowis : Hospital and community health service spending on non- acute services for elderly people between 1980-81 and 1990-91 increased by 21 per cent. in real terms, as measured by the gross domestic product deflator. The costs of future service provision will depend on a number of complex factors including social and demographic change, advances in medical technology and care skills, and the success of our long-term strategy for health promotion and sickness prevention in later life.

Dental Treatment

Mr. Wigley : To ask the Secretary of State for Health in what way dental patients who are registered with dentists on the NHS are to be notified that if they do not have dental


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treatment over a two-year period, the obligations of the dentist towards that patient lapses ; and if he will clarify this position.

Dr. Mawhinney : There is no requirement for patients to be notified. Patients who register for national health service treatment with a dentist receive continuing care over a two-year period normally requiring their attendance at the dental surgery during that period, at which point the arrangement can be rolled on for a further two years. The dentist receives a monthly fee for every patient registered and many operate systems to recall patients.

Mr. Wigley : To ask the Secretary of State for Health (1) what is the greatest distance or greatest journey time which the NHS in England regards as reasonable for a patient to have to travel in order to secure dental treatment on the NHS ; and what guidance his Department has issued in order to ensure that such targets are achieved locally ;

(2) what action she has taken to ensure that every citizen who wishes to receive dental treatment on the NHS can do so expeditiously and conveniently in every area ; and if she will make a statement.

Dr. Mawhinney : Dental treatment under the national health service is available throughout England. Patients who experience difficulty in obtaining treatment should contact their local family health services authority who will help them find treatment.

Private Health Care

Mr. French : To ask the Secretary of State for Health (1) what percentage of the United Kingdom population is currently covered by private health care plans ;

(2) what is her estimate of the current savings to the NHS budget as a result of patients covered by private health care plans.

Mr. Sackville : About 12 per cent. of the population are covered by private health care. It is for the individual to decide whether or not to seek private health care. The national health service will remain available to all on the basis of clinical need, not the ability to pay. It is not possible to quantify the saving to the NHS.

Adoption

Miss Lestor : To ask the Secretary of State for Health how much was allocated to funding post-adoption services for the current financial year, for 1991 and for 1985.

Mr. Bowis : This information is not held centrally.

Clothier Report

Mr. Ieuan Wyn Jones : To ask the Secretary of State for Health what additional resources she will provide to the NHS for the discharge of the additional duties recommended by the Clothier report ; and if she will make a statement.

Dr. Mawhinny : The recommendations contained in the Allitt inquiry report represent good practice, which we expect national health service authorities and trusts to follow within existing resources.


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Tuberculosis

Mr. Spearing : To ask the Secretary of State for Health what steps she is taking to monitor the incidence of tuberculosis ; what are the current trends ; and what variations appear in its distribution.

Mr. Sackville : The incidence of tuberculosis is monitored by examination of routinely obtained information and the results of special surveys. Deaths from and notifications of cases of tuberculosis are collated by the Office of Population Censuses and Surveys and published regularly. Special detailed surveys of tuberculosis notifications have been carried out at approximately five-yearly intervals in order to study the occurrence of the disease in population subgroups. The most recent survey, which is being conducted as a collaboration between the Public Health Laboratory Service, the British Thoracic Society and the Department of Health, will be reporting its results by the end of this year.

Variations in the incidence of tuberculosis are apparent between different age-sex groups, and in different ethnic groups. For instance, the incidence of tuberculosis increases with increasing age as a result of reactivation of infection acquired many years previously. In recent decades tuberculosis notifications have continued to decline. However, in the mid to late 1980s, in common with a number of other European countries, notifications stopped declining and small increases have been seen in most recent years.

Private Treatment

Ms Lynne : To ask the Secretary of State for Health what representations she has received alleging that staff at certain hospitals are advising patients to pay for operations rather than wait for them ; and if she will make a statement.

Mr. Sackville : None.

Dental Decay

Mr. Wigley : To ask the Secretary of State for Health (1) what percentage of five-year-old children in England and Wales had dental decay (a) in 1990 and (b) in 1993 ;

(2) if she will publish a table indicating for five-year-old children for (a) 1991 and (b) the most recent date for which information is available, the average number of teeth suffering from dental decay, analysed by region for England.

Dr. Mawhinney : The Department has commissioned the Office of Population Censuses and Surveys to conduct surveys of the dental health of children at 10-year intervals. The most recent survey was carried out in 1993 and the report will be published later this year. Copies of previous survey reports are available in the Library. Information on dental decay among five-year-old children is available from surveys by the British Association for the Study of Community Dentistry. Copies of the latest published report, which relates to a survey conducted in 1989-90, are available in the Library.

Regional Health Authorities

Mr. Lewis : To ask the Secretary of State for Health what is the formula for compensating for loss of office as a consequence of re- organisation of the chairs of regional health authorities.


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Dr. Mawhinney : There are no plans to compensate the chairmen who will be standing down from 1 April.

Walsgrove Hospital Trust

Mr. Robert Ainsworth : To ask the Secretary of State for Health how much money has been spent by the Walsgrove hospital trust in Coventry on office accommodation re-organisation in the financial year 1992-93 and so far in the current financial year.

Mr. Sackville : This is a matter for Walsgrave Hospital trust. The hon. Member may wish to contact Mr. Robert Jordan, the chairman, for details.

Mental Health

Mr. Alex Carlile : To ask the Secretary of State for Health if she will make it her policy to heighten awareness among mental health professionals that people from culturally different communities have different mental health needs ; and if she will make a statement.

Mr. Bowis : It is already our policy to heighten awareness among mental health professionals by issuing publications, such as the "Health of the Nation, Mental Illness Key Area Handbook" and "Health of the Nation, Ethnicity and Health--A Guide for the National Health Service" and "Mental Health and Britain's Black Communities". The mental health task force is holding a series of regional conferences for black service users and health service professionals aimed at improving understanding by all of the mental health needs of black people and how they might be met. The Royal College of Psychiatrists has been funded by the Department to mount a conference on 1 March on "The Provision of Mental Health Services for Minority Ethnic Patients in Britain".

Cancer

Mr. Alex Carlile : To ask the Secretary of State for Health what plans she has to undertake or sponsor research on the possible link between electromagnetic fields and cancer, especially in children ; and if she will make a statement.

Mr. Sackville : I refer the hon. Member to the reply I gave the hon. Member for Blaenau Gwent (Mr. Smith) on 9 February at column 325 .

Mr. Alex Carlile : To ask the Secretary of State for Health if she will make it her policy to encourage the enactment of a prudent avoidance policy with regard to electrical powerline work, which ensures that all future powerlines will be sited away from schools and houses until the possible link between electromagnetic fields and cancer is disproved ; and if she will make a statement.

Mr. Sackville : The National Radiological Protection Board and Committee on Medical Aspects of Radiation in the Environment have considered this question and concluded that the available information does not establish that electromagnetic fields cause cancer. The significance of an epidemiological study depends, among other things, on the strength of the association, the presence of a dose-response relationship, supporting experimental evidence and a credible biological explanation. These tests for causality are not satisfied for the link between electromagnetic fields and cancer. On the basis of present


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evidence, the two bodies have not recommended the adoption of a policy of prudent avoidance. The position is being kept under review.

Private Medical Services

Mr. Blunkett : To ask the Secretary of State for Health what discussions she has had with the President of the Board of Trade following the Monopolies and Mergers Commission report on private medical services.

Mr. Sackville : None.

Mr. Blunkett : To ask the Secretary of State for Health what measures exist to regulate the advertising by consultants within the private medical market ; and what amendments she is considering to the regulations.

Dr. Mawhinney : Under the Medical Act 1983 the General Medical Council has statutory responsibility for the regulation and registration of all doctors, including those offering private medical services. The GMC's "Blue Book"--"Professional Conduct and Discipline : Fitness to Practise" contains guidance to doctors on the advertising of medical services. Failure to abide by the council's guidance may call a doctor's professional conduct into question. The GMC keeps its policy on advertising under constant review, but we understand there are no plans to amend the guidance at present.

Community Care

Mr. Matthew Banks : To ask the Secretary of State for Health if she will list for (a) the shire counties and (b) metropolitan areas, the amount each district authority received in special transitional grants for care in the community for (a) 1993-94 and (b) 1994-95 ; and what was the percentage increase or decrease for 1994-95 in each case.

Mr. Bowis : The figures for individual local authorities will be placed in the Library.

Mr. Matthew Banks : To ask the Secretary of State for Health (1) how much money was made available in 1993-94 for care in the community in the form of special transitional grant ;

(2) how much money is available in the form of special transitional grant for care in the community in 1994-95 ;

(3) what is the percentage increase in the amount of money available for care in the community in the special transitional grant scheme for 1994-95 compared with 1993-94.

Mr. Bowis : A special transitional grant of £565.4 million was made available in 1993-94 to local authorities in England for their new community care responsibilities.

The grant will be £735.9 million in 1994-95, an increase of 30 per cent. on the 1993-94 figure. In addition, £538.6 million from the 1993 -94 grant will be rolled into local authorities' 1994-95 baseline funding, making a total of over £1.2 billion available. These figures are in addition to the personal social services standard spending assessment, which contributes to the cost of community care as well as other social services areas of spending.


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Children (Limb Defects)

Mr. Tyler : To ask the Secretary of State for Health what steps she is taking to investigate the significance of the reported clusters of children born with limb defects in coastal areas ; and what advice is being issued to pregnant women in those areas.

Mr. Sackville : Investigations of suspected or reported clusters of limb reduction defects have been initiated by district health authorities, in concert with the Office of Population Censuses and Surveys. OPCS has, for the last 30 years, maintained a national monitoring system for collecting data on malformations among newborn babies. The significance of reported clusters is currently being assessed by comparative analyses with the national data. This work is expected to be completed shortly.

Discussions have also been held between the Department of Health, OPCS and the environmental epidemiology unit, London school of hygiene and tropical medicine, which incorporates the small area statistics unit, to identify and make the necessary provisions for any additional expertise that may be required.

Decisions about any further action necessary will be taken as quickly as possible, once the results of these investigations are known.

Oral Health

Mr. Blunkett : To ask the Secretary of State for Health (1) when she will publish the oral health strategy ;

(2) when she will publish her response to the Bloomfield report.

Dr. Mawhinney : I refer the hon. Member to the reply I gave the hon. Member for Gower (Mr. Wardell) on 18 February at col. 1042.

Mr. Blunkett : To ask the Secretary of State for Health if she will publish for each year since 1990, by region, the incidence of dental decay in (a) children and (b) adults.

Dr. Mawhinney : This information is not available centrally in the form requested. The Department commissions the Office of Population Censuses and Surveys to conduct surveys of the dental health of adults and children at 10-year intervals. The report of the last adult dental health survey carried out in 1988 was published in 1991 and copies are available in the Library. The most recent survey of children was carried out in 1993 and the report will be published later this year.

Information on dental decay among children is available from surveys by the British Association for the Study of Community Dentistry. Copies of the latest report published will be placed in the Library.

Personal Social Services

Mr. Hinchliffe : To ask the Secretary of State for Health what is her policy with regard to charging for personal social services other than residential care for users or carers in receipt of (a) income support payments, (b) disabled living allowance and (c) attendance allowance ; and if she will make a statement.

Mr. Bowis : It is for each local authority to decide what charges to make for day and domiciliary services. Local authorities should have regard to individual service users'


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income and overall financial circumstances in assessing their ability to pay. They may take into account all types of income, except the mobility component of disability living allowance.

SOCIAL SECURITY

Incapacity Benefit

Mr. Flynn : To ask the Secretary of State for Social Security what is the expected saving resulting from making incapacity benefit payable in respect of any day at one seventh rather than one sixth of the weekly rate.

Mr. Scott : This measure will produce both gainers and losers, depending on whether a Sunday is included in a part-week payment, or in the waiting days at the start of a claim. We estimate that the overall expenditure consequences of this change will be minimal.


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Pensioners (Benefits)

Mr. Simon Hughes : To ask the Secretary of State for Social Security what are the most accurate up-to-date figures he has of the number of pensioners on benefit in (a) Southwark, (b) London, (c) England and (d) the United Kingdom.


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