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Mr. Redmond : To ask the Secretary of State for Health if she will make a statement on the proposal to allow pharmacists to substitute cheaper non-branded drugs for the drug prescribed by the general practitioner ; whether the general practitioner would be consulted ; and how patients would be protected from fake and substandard drugs.
Dr. Mawhinney : The Department has opened discussions with the medical and pharmaceutical professions about generic substitution. We are seeking a way forward which would leave the clinical decision about whether a generic substitute was appropriate, to the prescribing doctor.
All medicines, whether branded or generic, have to meet the standards of safety, quality and efficacy required by the licensing authority.
Mr. Milburn : To ask the Secretary of State for Health how many staff were employed by trusts in each region in each year since 1991-92 ; and what are these figures as a percentage of the total number of NHS provider staff.
Dr. Mawhinney : The number of staff employed by trusts in each region is shown in the table. The total number of national health service provider staff cannot be separated from aggregated figures including all staff in regional and district health authorities. The growth in numbers of trust staff between 1991 and 1992 reflects the 57 trusts created on 1 April 1991 and a further 99 which came into being on 1 April 1992--replacing units formerly directly-managed by health authorities. Figures for September 1993 will not be available until later this year.
NHS staff numbers in trusts by region in England as at 30 September 1991 |1991 |1992 ------------------------------------------ Northern |4,090 |12,910 Yorkshire |11,060 |23,500 Trent |5,790 |20,570 East Anglia |1,600 |5,220 North West Thames |5,380 |23,410 North East Thames |11,850 |16,930 South East Thames |5,860 |18,750 South West Thames |7,600 |13,910 Wessex |2,760 |13,360 Oxford |550 |5,980 South Western |19,740 |35,480 West Midlands |3,660 |11,020 Mersey |15,570 |25,310 North Western |5,460 |16,590 |---- |---- Total |100,970|242,950 Source: DoH non-Medical Workforce Census, Medical Workforce Census and form KM 49. Note: All figures are rounded to the nearest ten whole-time equivalents.
Mr. Ainger : To ask the Secretary of State for Health what inquiries her Department has made into the use of the financial assets of NHS trusts (a) generally and (b) with particular reference to currency speculation.
Mr. Sackville : National health service trusts must present their audited accounts at a public meeting. For accounts covering the financial year 1993-94 onward it is a mandatory requirement that this meeting, and the availability of copies of the accounts, must be advertised in the media local to the NHS trust no less than 14 days prior to the date of the meeting. Previously this was regarded as good practice and the procedure was followed by most trusts. NHS trusts are required to distribute a copy of the audited accounts to any member of the public who requests one. A reasonable fee to cover copying costs may be charged. It is a matter for trusts themselves who they distribute copies of the accounts to without such a request having been received.
Mr. Sackville : No specific advice has been given to trust board members regarding the use of national health service resources for purposes other than healthcare provision. Trusts are expected to use resources effectively, efficiently and economically whatever authorised purpose they are applied to. Advice on the use of resources generally is contained in the trust finance and capital charges manuals which are issued to trusts and are available to board members. Copies of these manuals are available in the Library.
Mr. Ainger : To ask the Secretary of State for Health what statutory provisions govern the use by NHS trusts of resources for purposes other than those related to health care provision ; and if she will make a statement.
Mr. Sackville : Paragraph 15 of part II of schedule 2 to the National Health Service and Community Care Act 1990 specifies that trusts shall have the powers specified in section 7(2) of the Health and Medicines Act 1988. These powers enable trusts to engage in activities, some of which may not be directly healthcare related, for the purpose of generating additional income to enable them better to perform their healthcare functions.
Mr. Sackville : The statutory provisions relating to the use of financial assets by national health service trusts are contained in schedule 3 to the National Health Service and Commuity Care Act 1990. Paragraph 1(3) of the schedule prohibits trusts from borrowing in any currency other than sterling except with the consent of my right hon. Friend the Secretary of State and the approval of my right hon. and learned Friend the Chancellor of the Exchequer. No such consent has been given. Paragraph 7 of the schedule limits the manner in which trusts can invest any money held to securities of the Government of the United Kingdom or such other manner as my right hon. Friend the Secretary of State may, with the consent of the Treasury, approve. Approval has been given for investment in certain United Kingdom public sector institutions, banks which are authorised under part 1 of the Banking Act 1987, and building societies authorised under the Building Societies Act 1986.
Mr. Sackville : The principal legislative provision relating to the financial assets of trusts is in schedule 3 to the National Health Service and Community Care Act 1990 : paragraphs 1 and 2 of the schedule govern trust borrowing, including the provision that a trust may not use its assets as security for loans, and paragraph 7 governs investment.
Paragraph 6(2)d of schedule 2 to the Act provides for the Secretary of State to make directions restricting or prohibiting the disposal of an asset worth in excess of a value specified in trust establishment orders. All trusts have £1 million as the specified amount in their establishment order.
Mrs. Golding : To ask the Secretary of State for Health what is the estimate of the annual cost of providing publicly funded residential care for people in England who have been returned to, or retained within, the community under the community care policy ; and if she will make a statement.
Mr. Bowis : This year in England we estimate that between them local authorities and the Department of Social Security will incur net expenditure in the region of £3.5 billion supporting people in residential care and nursing homes. It is not possible to say how much of this is supporting people who have been resettled from long-stay hospitals or who might, under other circumstances, have entered such hospitals.
Mr. Sackville : In 1992-93, the latest year for which figures are available, family health services authority administration amounted to £161,881,000. Expenditure on drugs by the family health services was £2,641,332,000.
FHSAs manage the introduction of general practitioner fundholding, the monitoring of GP prescribing, and the development of clinical audit in primary care--all initiatives aimed at improving the effectiveness of patient care and value for money.
Column 852In 1992-93 FHSA administration expenditure represented only 2.5 per cent. of the £6.5 billion of taxpayers' money spent on the FHS.
Mrs. Bridget Prentice : To ask the Secretary of State for Health what assessment she has made of the impact of dentists deregistering their patients on the level of dental health in (a) London and (b) England.
Dr. Mawhinney : Dental treatment under the national health service is available throughout England. Over the period July 1992 to December 1993 there was a net increase in the number of patients registered with dentists and in the number of dentists in contract with family health services authorities, in both London and England.
Mrs. Bridget Prentice : To ask the Secretary of State for Health how many people have been deregistered by their dentists in each of the London health authority areas during each of the last five years ; and how many dentists in each of the London health authority areas have been involved in the deregistration.
Dr. Mawhinney : The available information is shown in the table. In the London area 338 dentists deregistered 39,127 adult patients and 15 dentists deregistered 85 child patients between July 1992 and February 1994. Some dentists will appear in both counts. Over the period July 1992 to December 1993, in the London area there was a net increase of 168,000 registrations and a net increase of 21 dentists contracted to family health services authorities.
Number of dentists deregistering patients and number of patients deregistered July 1992 to February 1994 |Number of dentists|Number of adult |Number of dentists|Number of child |deregistering |patients |deregistering |patients |adults |deregistered |children |deregistered ----------------------------------------------------------------------------------------------------------------------------------- London FHSAs |338 |39,127 |15 |85 Barnet |42 |4,858 |2 |8 Brent and Harrow |7 |1,542 |2 |2 Ealing, Hammersmith and Houslow |1 |35 |- |- Hillingdon |- |- |- |- Kensington, Westminster and Chelsea |15 |2,256 |- |32 Barking and Havering |13 |3,842 |3 |7 Camden and Islington |12 |295 |- |2 City and East London |31 |546 |3 |11 Enfield and Haringey |3 |978 |2 |3 Redbridge and Waltham Forest |9 |2,192 |1 |14 Greenwich and Bexley |23 |4,355 |- |- Bromley |39 |13,175 |1 |2 Lambeth, Southwark and Lewisham |29 |446 |- |- Croydon |69 |1,889 |- |- Kingston and Richmond |9 |972 |- |- Merton, Sutton and Wandsworth |36 |1,746 |1 |4
Mrs. Bridget Prentice : To ask the Secretary of State for Health what assessment she has made of increases in the costs of dental treatment in (a) London and (b) England as a result of the Government's changes in the payment framework for dentists treating NHS patients.
Dr. Mawhinney : There have been no changes to the system for paying dentists since October 1990, when continuing care and capitation payments were introduced. The consequences of these changes, and other relevant factors, were considered at the time by the dental rates study group and were reflected in its recommended dental fee scale.
(2) if she will publish the Government's response to the Bloomfield report on dental services ; and if she will make a statement.
Mrs. Bridget Prentice : To ask the Secretary of State for Health what evidence has been presented to her Department about the incidence of asthma and other respiratory illnesses in the London borough of Lewisham.
Mr. Sackville : Whilst no specific initiative is proposed for London, last July the Department of Health launched the chronic disease management programme, which is an organised programme of care run by general practitioners for people with asthma. The national health service management executive wrote to health authorities, GP purchasers and hospital providers last December, EL(93)115, asking them to work towards providing services based on the British Thoracic Society's "Guidelines on the Management of Asthma". Copies are available in the Library.
In 1992-93 the Medical Research Council, which receives its grant-in-aid from the office of my right hon. Friend the Chancellor of the Duchy of Lancaster, spent £1.5 million on research into asthma and areas which may be relevant to the condition. Moreover, we attach high importance to the prompt and appropriate treatment of people with asthma.
Mrs. Bridget Prentice : To ask the Secretary of State for Health what is her policy concerning the allocation of resources to the treatment and prevention of asthma ; and what studies her Department has made of its incidence in childhood.
It is for individual health authorities to determine the level of service provision required to meet the needs of people with asthma in their area. Priorities are determined in the light of local circumstances.
Mr. Spellar : To ask the Secretary of State for Health what monitoring her Department is undertaking of the current performance of the West Midlands regional health authority ; and what oversight is being conducted of its attempts to clear up past problems identified by the Committee of Public Accounts.
executive--NHSME--through a process of continuous review, including quarterly meetings and an annual review by the chief executive of the NHSME. Performance is measured against progress being made on objectives agreed each year between the NHSME and each regional health authority set out in their regional corporate contracts. With regard to the past problems in west midlands identified by the Public Accounts Committee, actions have been taken by the RHA to resolve these problems and these actions have been closely monitored by the NHSME.
Mr. Gunnell : To ask the Secretary of State for Health what were the combined administrative costs of the Leeds East and Leeds West health authorities in 1988-89 ; and what is the administrative cost of Leeds healthcare in 1992-93.
Dr. Mawhinney : The combined total administrative costs of Leeds East and Leeds West health authorities in 1988-89 were £5,907,495. The administrative cost of Leeds health authority in 1992-93 was £4, 308,416. The 1992-93 figures are provisional and are not comparable to those of 1988-89.
Ms Jowell : To ask the Secretary of State for Health, pursuant to her answer of 18 February, Official Report, column 1048, if she can now supply the figures for press and public relations officers employed by the NHS in 1991, 1992 and 1993.
Dr. Mawhinney : Information is not available centrally on the numbers of press and public relations officers. After 1990 the method of collecting staffing figures changed and it was no longer possible to disaggregate staff engaged in particular areas of work.
Number of deaths from hypertrophic obstructive cardiomyopathy (ICD 425.1)<1> in the United Kingdom 1988 to 1992 |Total -------------------- 1988 |79 1989 |76 1990 |64 1991 |77 1992<2> |78 <1> International Classification of Diseases 9th revision. <2> Data for 1992 are provisional.
Ms Coffey : To ask the Secretary of State for Health (1) if she will give details of the guidelines issued by her Department to local health authorities on their responsibilities to provide long-term care for people who need it for reasons of ill-health ; and what monitoring is done by her Department on provisions ;
(2) what guidelines have been issued by her Department to local health authorities defining their responsibilities to
Column 855provide long-term care for people who need it for reasons of ill-health ; and what monitoring is done by her Department on availability of provision.
Mr. Bowis : The "Caring for People" White Paper makes it clear that the provision of continuing care for those who need it for reasons of ill health remains the responsibility of the national health service. It is a matter for district health authorities to determine in consultation with local social services authorities the level and type of care required. As part of the new community care arrangements we have required health and local authorities to agree their respective responsibilities for long-term care. This was a pre-condition of the 1993-94 and 1994-95 special transitional grant and covered by guidance in executive letters EL(92)82 and EL(93)97, copies of which are in the Library. There has been an extensive programme of monitoring of the new community care arrangements including the operation of agreements on continuing care responsibilities.
Dr. Mawhinney : An optician who carries out a sight test is required, by regulations, to perform (i) an examination of the external surface of the eye and its immediate vicinity, (ii) an intra-ocular examination, and (iii) such additional examinations as the optician considers clinically necessary.
Mr. Ashton : To ask the Secretary of State for Health (1) what was the nature of the recent incidents which resulted in (a) the calling of an inquiry at Bassetlaw hospital, Worksop, and (b) the calling in of the Nottinghamshire police ;
(2) how many (a) members of the public and (b) members of the staff and of the latter in which grades, and which departments, were involved in the inquiry at Bassetlaw hospital ;
(3) what consultations will take place between trade unions at Bassetlaw hospital and the hospital trust and the North Nottinghamshire regional health authority following the recent inquiry.
Mr. Sackville : This is a matter for the Bassetlaw hospital and community services national health service trust. The hon. Member may wish to contact the chairman, Mrs. Valerie Dickinson, for details.
Mr. Ashton : To ask the Secretary of State for Health when her Department first learned that an inquiry into the security and tampering of equipment in the intensive therapy unit at Bassetlaw hospital was taking place.
Mr. Brandreth : To ask the Secretary of State for Health whether she has received a report from the South West Thames regional health authority showing the progress made in implementing the recommendations of the 1993 inquiry report into the failure of the computer-aided dispatch system at the London ambulance service.
Mr. Sackville : I understand that the South West Thames regional health authority--RHA--is today publishing a report of progress by the London ambulance service--LAS--in implementing the inquiry team's recommendations. The report, a copy of which has been placed in the Library, will be considered at a public meeting of the RHA next week.
As the Government announced in December, a further £14.8 million is being invested in the LAS in 1994-95 to help it improve its services. This money will enable the LAS to buy 120 new accident and emergency vehicles and recruit 240 additional staff. The extra money is being tied to specific targets for improving ambulance performance against national patients charter standards.
(2) what resources are available to NHS trusts and district health authorities to improve the security of hospitals ;
(3) what guidelines she will issue to health authorities and NHS trusts following the recent abduction of a baby from the Royal United hospital in Bath.
Mr. Sackville : I refer the hon. Member to the reply I gave my hon. Friend the Member for Dartford (Mr. Dunn) on 26 May 1993 at columns 577-78. Security arrangements at all health service premises, for the protection of patients and the staff who care for them, rests with local managers. They are in the best position to decide what is needed to cope with the local situation and what proportion of their resources should be directed to security matters.
To help them in this task, in March 1992 the National Association of Health Authorities and Trusts--NAHAT--published, with financial assistance from the Department, a revised edition of the "National Health Service Security Manual". The Department provided copies for each unit and commended it to them as an excellent source of advice and guidance, copies of which are available in the Library. National health service managers have a difficult balance to strike between allowing access to visitors, families and staff, while ensuring that there are satisfactory arrangements for the security of all those who use the hospital for lawful purposes.
Ms Primarolo : To ask the Secretary of State for Health to what extent general practitioner fundholders may vary national terms and conditions of employment for directly employed staff ; and whether such conditions of employment or any applicable professional code of practice take precedence in the event of conflict.
Ms Primarolo : To ask the Secretary of State for Health (1) what steps have been taken to ensure that primary care staff are aware of the guidance on staff relations with the public and media ; (2) if the guidance for staff on relations with the public and media is applicable to staff directly employed by general practitioner fundholding general practitioners.
Ms Primarolo : To ask the Secretary of State for Health what discussions she has had in the last 12 months with the Chancellor of the Exchequer of (a) extending tax relief on private health insurance to those aged under 60 years or (b) abolishing tax relief for those aged over 60 years ; and if she will make a statement.
Mr. Sackville : None. The tax relief on private medical insurance enables those with insurance to retain cover at a time when income falls and premiums rise and also reduces pressure on the national health service.
Ms Primarolo : To ask the Secretary of State for Health if she will recommend that the schedule for the 1995 general household survey contain questions on private medical insurance in British households.
Mr. Sackville : An extensive survey of customers was carried out by national health service Supplies last summer covering a wide cross-section of almost 2,000 people within the customer base, ranging from chief executives to ward sisters. The results were communicated to staff, customers and the media.