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Mr. Sackville : Specialised cancer units receive referrals from general practitioners and from non-specialist units. It is most unlikely that they would accept a woman who refers herself. The Department has not undertaken any research into the possible benefits of self-referral.
Ms Primarolo : To ask the Secretary of State for Health how many specialised breast cancer units there are, by region.
Mr. Sackville : This information is not available centrally. It is for local health authorities in consultation with hospitals and trusts to determine the organisation of cancer services to meet the needs of the local population.
Ms Primarolo : To ask the Secretary of State for Health what research her Department is funding into (a) environmental and (b) social causes of breast cancer.
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Ms Primarolo : To ask the Secretary of State for Health what steps she is taking to ensure that the North West, North East and South West Thames and Mersey regions achieve the target for breast cancer screenings.
Mr. Sackville : The breast screening programme is achieving its national average uptake target rate of 70 per cent., including in Mersey and South West Thames regions. To address under-achieving in specific areas, health authorities are encouraged to set local targets for improvement in contracts.
Dementia
Mr. Llwyd : To ask the Secretary of State for Health what assessment her Department has made of the impact on national health service drug costs of the increasing numbers of people with dementia.
Ambulance Response Times
Mr. Pike : To ask the Secretary of State for Health what changes she proposes in the recommended ambulance response times in the patients charter.
Mr. Pike : To ask the Secretary of State for Health what discussions she has had with the chairman of those ambulance authorities with the lowest attainment of achieving attendance of ambulances within the response times set by the patients charter ; and if she will make a statement.
Mr. Sackville : There have been no formal meetings to discuss response times, although from time to time I meet ambulance service chairmen to discuss perfomance generally. I am pleased to note that the majority of ambulance services are now meeting the charter standard.
Mr. Pike : To ask the Secretary of State for Health what proportion of ambulance authorities are achieving (a) the patients charter standard and (b) the Orcon standard in respect of ambulance response times ; and if she will make a statement.
Mr. Sackville : The Orcon patients charter standard requires an ambulance to arrive at the scene of an incident within 19 minutes of an emergency call in 95 per cent. of cases in rural areas, and within 14 minutes in urban areas. In 1992-93, 28 of the 34 rural authorities met the former standard and three of the nine urban authorities the latter.
Local Government Legislation
Mr. Vaz : To ask the Secretary of State for Health if she will list the Acts of Parliament and Consolidation Acts that affect local government which have been introduced by her Department since 1990.
Mr. Bowis : Since 1990, the Department introduced the following Acts of Parliament that affected Local Government :
--the National Health Service and Community Care Act 1990. --the Community Care (Residential Accommodation) Act 1992.
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Cancer Specialists
Ms Primarolo : To ask the Secretary of State for Health how many cancer specialists worked in the national health service, by region, over each of the last five years.
Dr. Mawhinney : The available information will be placed in the Library. Cancer is treated by doctors in a number of specialties. Consultants in the specialties of medical oncology, radiotherapy, haematology and general surgery all treat cancer patients. However, they are not all involved full time in the treatment of cancer, for example general surgeons and haematologists also work with other patients, while other specialties are also involved in the treatment of cancer.
Independent Living Fund
Mr. Llwyd : To ask the Secretary of State for Health how much of the independent living fund transitional grant money has been spent in each local authority ; how many people have received services under this money ; what is the average cost of services to each individual ; and if she will make a statement.
Mr. Bowis : Some £26.8 million was included in this year's special transitional grant to English local authorities as a consequence of changes to independent living fund arrangements. It will rise to £64.1 million next year. Authorities are free to use this money to provide such services as they consider best to meet local needs. They are not required to account for services provided from this money separately from services provided from other resources. The figures for Wales are a matter for my right hon. Friend the Secretary of State for Wales.
Alzheimer's Disease
Mr. Llwyd : To ask the Secretary of State for Health how much research into the causes and treatment of Alzheimer's disease has been funded by (a) the Government, (b) the private sector and (c) the voluntary sector for each of the last five years.
Mr. Bowis : The main agency through which the Government support biomedical and clinical research is 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. The table shows the level of research into Alzheimer's disease funded by the MRC between 1988-89 and 1992-93--the latest figures available. The level of research undertaken by the private and voluntary sectors is not available centrally.
MRC expenditure on research into Alzheimer's disease Year |(£ million) ------------------------------------ 1988-89 |5.0 1989-90 |4.0 1990-91 |4.5 1991-92 |4.7 1992-93 |4.9
National Continence Awareness Week
Mr. Llwyd : To ask the Secretary of State for Health what evaluation her Department is making of the effectiveness of national continence awareness week ; and if the event will be repeated in 1995.
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Mr. Bowis : National continence week took place from 13-19 March 1994. The campaign generated a substantial amount of media coverage with articles in the national press as well as in women's and general interest magazines. Many radio and television programmes also carried times about the week. Demand for the Department's publicity material exceeded expectations. The posters, leaflets and stickers had to be reprinted three times and nearly 2 million copies have been sent out so far. Calls to the telephone helpline funded by the Department have increased from 15 to around 300 a day. In addition, the Continence Foundation is receiving an average of 200 written requests for information a day.
The Department will continue to monitor the results of the campaign and a decision as to whether to repeat the event in 1995 will be made in the light of this.
Medical Negligence Claims
Dr. Wright : To ask the Secretary of State for Health which NHS body had (a) the highest and (b) the lowest number of medical negligence claims against it in each year since 1990.
Dr. Mawhinney : Information about the number of claims in each financial year is collected from district health authorities, in respect of their directly managed units collectively, and from national health service trusts as they became operational in 1991, 1992 and 1993. This shows national and regional trends. Because details are not supplied for individual directly managed units, most such units have progressively become trusts, and some district health authorities have merged, meaningful comparisons between NHS bodies are not possible.
Dr. Wright : To ask the Secretary of State for Health what are the insurance and indemnity arrangements for NHS trusts in relation to medical negligence claims.
Dr. Mawhinney : Claims for clinical negligence against health care professionals employed by national health service trusts, occurring after the operational date of the trust, are met by the trust and recouped through prices. Arrangements exist for NHS trusts to fund the cost of a substantial settlement through a loan from the Department which has to be repaid, with interest, over several years if necessary. The proposed creation of a central fund in England to help NHS trusts is the subject of a consultative document issued earlier this month, copies of which have been placed in the Library.
Health Reforms
Ms Jowell : To ask the Secretary of State for Health if, in calculating changes in the numbers of patients treated before and after the health reforms, her Department counts individual patients treated or finished consultant episodes.
Mr. Sackville : Information on in-patient activity has been collected on the basis of finished consultant episodes since 1988-89 following the recommendation of the Ko"rner steering group. This was considered to be the most effective way of measuring workload. There has been no change in the collection of data on activity in out-patients clinics and accident and emergency departments which are based on the number of new attendances and the total number of attendances.
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Death Certificates
Mr. Blunkett : To ask the Secretary of State for Health what was the total amount paid to general practitioners for signing death certificates, and the number of death certificates signed, in each year since 1990, for each regional health authority area.
Dr. Mawhinney : The Births and Deaths Registration Act 1953 requires general practitioners to sign death certificates. This duty does not attract a separate fee from the Department of Health. It is not possible to distinguish between death certificates signed by general practitioners and others, such as hospital doctors and coroners. The deaths recorded for each regional health authority from 1990 to 1992 are shown in the table. Figures for 1993 are not yet available.
Persons
|1990 |1991 |1992
--------------------------------------------------
Northern RHA |37,480|37,970|37,072
Yorkshire RHA |41,955|42,044|40,481
Trent RHA |51,717|52,827|52,171
East Anglian RHA |22,296|22,700|22,207
North West Thames RHA |32,894|33,076|31,817
North East Thames RHA |38,574|38,997|38,006
South East Thames RHA |42,353|42,589|42,002
South West Thames RHA |32,630|33,108|32,149
Wessex RHA |34,497|34,756|34,195
Oxford RHA |22,323|22,937|22,806
South Western RHA |38,937|39,234|38,610
West Midlands RHA |56,762|56,980|56,092
Mersey RHA |27,906|28,230|27,460
North Western RHA |48,592|48,524|47,588
The figures relate to deaths registered in each
calendar year, the time: lag between the date of
occurrence and the date of registration being
usually only a day or two.
Mental Health
Ms Primarolo : To ask the Secretary of State for Health, pursuant to her answers of 16 February, Official Report, column 860, and 17 March, Official Report, column 834, whether data collection monitoring mental illness hospitals on the lines of that compiled for the mental health task force is being undertaken to produce figures for 1992-93 and 1993-94.
Mr. Bowis : Data are currently being compiled for 1992-93 and should be available later this year. It is too early to start compiling data for 1993-94.
Dental Services
Mr. Parry : To ask the Secretary of State for Health what response he has made to the university of Liverpool school of dentistry representations regarding the timing of the response to the Bloomfield report and oral health strategy ; and if she will make a statement.
Dr. Mawhinney : The hon. Member for Liverpool, Mossley Hill (Mr. Alton) wrote to my right hon. Friend the
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Secretary of State on 22 February enclosing a letter from a lecturer at the university of Liverpool school of dentistry. I replied on 19 March.Mr. Blunkett : To ask the Secretary of State for Health how many dentists in (a) England and (b) each regional health authority area took on new NHS patients in each year since 1990.
Dr. Mawhinney [holding answer 24 March 1994] : The information available is shown in the table.
Number of dentists who had additions to their
register, by regional
health authority area and year, 1991-93
England
Number of
dentists who
had additions to
their
register in the
year
Region |1991 |1992 |1993
----------------------------------------------
England |15,126|15,295|15,268
Northern |860 |883 |866
Yorkshire |1,133 |1,158 |1,146
Trent |1,268 |1,283 |1,309
East Anglia |620 |619 |625
North West Thames |1,509 |1,511 |1,515
North East Thames |1,296 |1,314 |1,335
South East Thames |1,406 |1,392 |1,394
South West Thames |1,294 |1,298 |1,331
Wessex |1,004 |1,005 |987
Oxford |859 |861 |851
South Western |1,223 |1,248 |1,237
West Midlands |1,400 |1,427 |1,412
Mersey |778 |773 |772
North Western |1,272 |1,289 |1,290
Note:
1. Additions to the register include
instances of patients registering with a
dentist after a break in attendance and
instances of reinstatement of registrations
that have been cancelled in error.
2. Some dentists have contracts in more than
one regional health authority area. These
dentists have, where appropriate, been
included in the count for each regional
health authority area where they are under
contract, but only once in the England total.
Mr. Blunkett : To ask the Secretary of State for Health what proportion of dentists in each family health service authority took on new NHS patients for each year since 1990.
Dr. Mawhinney [holding answer 24 March 1994] : The information will be placed in the Library.
Nursing and Midwifery Staff
Mr. Sims : To ask the Secretary of State for Health if she will publish details of the average gross weekly earnings and make-up of pay by type of pay or allowances for each of the clinical grades for nursing and midwifery staff in (a) 1992 and (b) 1993.
Mr. Sackville : The information is shown in the table.
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Average estimated weekly gross earnings of nursing and midwifery full-time staff in 1992-93 and
1993-94
1992-93<1> 1993-94<2>
Grade |Total |Basic pay |Allowances|Total |Basic pay |Allowances
|£ |£ |£ |£ |£ |£
-------------------------------------------------------------------------------------------------
Clinical Grade A |186.0 |151.3 |34.7 |188.7 |153.4 |35.3
Clinical Grade B |203.8 |163.4 |40.4 |216.1 |174.1 |42.0
Clinical Grade C<3> |256.4 |220.1 |36.3 |249.2 |214.6 |34.6
Clinical Grade D |250.3 |215.0 |35.3 |258.6 |222.2 |36.4
Clinical Grade E |294.2 |250.7 |43.5 |302.0 |257.7 |44.3
Clinical Grade F |340.8 |294.6 |46.2 |349.4 |302.1 |47.3
Clinical Grade G |381.3 |349.3 |32.0 |383.1 |351.6 |31.5
Clinical Grade H |397.9 |378.8 |19.1 |410.4 |389.4 |21.0
Clinical Grade I |459.9 |439.3 |20.6 |466.4 |443.2 |23.2
<1> Source: Earnings-related base of data March 1993 and non-medical manpower census September
1991.
<2> Source: Earnings-related base of data December 1993 and non-medical manpower census
September 1992.
<3> Clinical grade C 1993-94 shows the average going down, this is due to a shift in enrolled
nurses moving to grade D registered nurse, therefore leaving more nurses in grade C on medium to
lower incremental point.
Drugs Review
Mr. Cousins : To ask the Secretary of State for Health whether the results of the Committee on Safety of Medicines review of non-steroidal anti-inflammatory drugs are now available ; and what advice to prescribers on the use, brands, or side-effects of such drugs has been given.
Mr. Sackville : The safety of non-steroidal anti-inflammatory drugs- -NSAIDs--remains under review by the Committee on Safety of Medicines. The findings and recommendations of the CSM will be made public, if appropriate, through relevant channels such as the bulletin "Current Problems in Pharmacovigilance". Advice to prescribers on the use, brands and side-effects of NSAIDs is given in the product data sheets produced by manufacturers and authorised by the Licensing Authority, and in the British national formulary which the Department of Health sends free to all doctors. Articles from the CSM relating to the safety of NSAIDs have also been published in the bulletin "Current Problems", No. 16, issued in 1986 and in the British Medical Journal in March and May 1986. Copies of the bulletin are available in the Library.
Free Prescriptions
Mr. Blunkett : To ask the Secretary of State for Health on what grounds medical conditions are added to the list of conditions that entitle long-term sufferers to free prescriptions.
Dr. Mawhinney : I refer the hon. Member to the reply I gave the hon. Member for Blaenau Gwent (Mr. Smith) on 21 March at column 68.
NHS Expenditure
Sir John Stanley : To ask the Secretary of State for Health what was the expenditure on the national health service in 1978-79 ; what it will be in 1994-95 ; and what percentage increase this represents in real terms.
Mr. Sackville : Government expenditure on the national health service will be a planned £30,669 million in 1994-95 compared with £6,273 million in 1978-79, an increase of 63.9 per cent. in real terms.
Hospital Consultants
Ms Primarolo : To ask the Secretary of State for Health what discussions she has had concerning the self-payment by maximum or part-time hospital consultants of in-service training costs ; and if she will make a statement.
Dr. Mawhinney : None. The chief medical officer has convened a conference on continuing medical education to
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be held on 13 June which will consider the question of the funding of the training and education of hospital consultants.Ms Primarolo : To ask the Secretary of State for Health if the guidelines limiting the proportion of their NHS income which full-time hospital consultants may earn from private practice apply to hospital consultants employed by trusts.
Dr. Mawhinney : The limits on the earnings from private practice of full-time national health service consultants apply to those whose contracts retain national terms--whether they work in trusts or for health authorities. Trusts have freedom to negotiate new terms of employment with their staff.
Ms Primarolo : To ask the Secretary of State for Health what is her Department's estimate of the average time spent by hospital consultants employed as maximum part-timers on private practice and on national health service patients.
Dr. Mawhinney : No such estimate is made.
Ms Primarolo : To ask the Secretary of State for Health what proportion of their working hours maximum part-time hospital consultants are required to spend on national health service patients.
Dr. Mawhinney : National health service hospital consultants with maximum part-time contracts under national terms of service are contractually required to devote substantially the whole of their professional time to duties in the NHS. The actual allocation of time with NHS patients is determined as part of the consultant job plan drawn up in agreement with local management.
Patients Charter
Mr. Tyler : To ask the Secretary of State for Health (1) what is the total annual budget, including all editorial, production and distribution costs, for "The Patient's Charter News", published by the NHS management executive ;
(2) what is the total annual budget for the patient's charter unit of the NHS management executive.
Dr. Mawhinney : The 1993-94 production budget for "The Patient's Charter News" was £44,000. This excludes editorial and distribution costs since both were carried out in-house, and it is not possible to isolate these costs.
The patients charter unit is part of a branch of the department concerned with quality and consumer issues in the national health service and which has an overall budget for several units. Since the breakdown of this budget is not unit based, it is not possible to provide an accurate annual figure for the patients charter unit alone.
Column 1045
NHS Executives
Mr. Blunkett : To ask the Secretary of State for Health whether regional health authorities will adopt the title "NHS Executive" before their geographical names from 1 April.
Mr. Mawhinney : No. Regional health authorities will use the names established by the National Health Service (Regional Health Authorities) Order 1994.
Mr. Blunkett : To ask the Secretary of State for Health what has been the cost of the new corporate look for the NHS management executive in terms of (a) stationery, (b) publications, (c) signage, (d) livery, (e) logo design and (g) in total.
Dr. Mawhinney : The new corporate identity for the NHS executive is based very closely on the design produced four years ago for the NHS management executive. No further costs have been incurred in logo design. There are no plans for expenditure on livery or new signage on the NHS executive headquarters buildings, but existing signs will be replaced as necessary over time.
Application of the new design to NHS publications does not increase costs. The cost of designing and introducing new stationery which is being phased in as existing stocks are exhausted, will be £50,000. This will be more than offset by the very considerable savings expected from the proposals which my right hon. Friend the Secretary of State for Health announced on 21 October 1993 for streamlining central management of the NHS.
Mental Health Act 1983
Ms Primarolo : To ask the Secretary of State for Health if she will require regional health authorities to review their recruitment of doctors for duties under section 12 of the Mental Health Act 1983 to ensure that the numbers are sufficient to respond promptly to requests for assessment under the Act.
Mr. Bowis : We carried out a survey in 1993 of regional health authorities' arrangements for approving doctors under section 12 of the Act. The results indicated that the Department's guidance was being properly implemented and the numbers of doctors approved were sufficient. The Department is also discussing with the Royal College of Psychiatrists the training given to approved doctors about their responsibilities under the Act.
University College Hospital
Ms Primarolo : To ask the Secretary of State for Health how much additional money has been allocated to keep University College hospital open ; to whom the money will be made available ; and if the expenditure will continue in future years.
Dr. Mawhinney : In 1993-94 University College London
Hospitals--UCLH--of which University College hospital is a part, were allocated transitional funding totalling some £10.6 million as part of a management plan for matching their capacity to current and foreseeable demand for services. This funding was made available to UCLH via its host commissioner, Camden and Islington district health authority. The amount of transition funding allocated to UCLH in 1994-95 is yet to be agreed.
Column 1046
Hospitals (Accident and Emergency Departments)
Ms Primarolo : To ask the Secretary of State for Health what increase in patient activity at Unversity College hospital accident and emergency department she expects after St. Bartholomew's accident and emergency department shuts ; and what increase in bed numbers will occur.
Dr. Mawhinney : Based on studies carried out by the London ambulance service, we estimate that the closure of St. Batholomew's accident and emergency department will lead to a 16 per cent. increase in attendances-- around 10,000 per year--at University College London Hospital's accident and emergency department. We anticipate that UCLH will be able to absorb this additional work load within the capacity of its existing facilities.
Staff Guidance
Ms Primarolo : To ask the Secretary of State for Health what assessment she has made of the consistency between paragraph 1 of the nurses', midwives and health visitors' code for professional conduct and paragraphs 8, 27 and 28 of the national health service management executive "Guidance for Staff on Relations with the Public and the Media" ; which document takes precedence ; and if she will make a statement.
Dr. Mawhinney : The national health service management executive's "Guidance for staff on relations with the public and the media", EL(93)51 makes plain--paragraph 2--that it complements the United Kingdom Central Council code of professional conduct.
Ms Primarolo : To ask the Secretary of State for Health how many letters she has received criticising the NHS management executive document on "Guidance for Staff on Relations with the Public and the Media".
Dr. Mawhinney : We have received five letters which, while supporting the aims of the guidance, have offered particular criticism on points of detail.
Ms Primarolo : To ask the Secretary of State for Health if she will renew the NHSME document on "Guidance for Staff on Relations with the Public and the Media" with particular reference to paragraphs 3, 8, 27 and 28.
Dr. Mawhinney : Sir Duncon Nichol, the then chief executive of the national health service management executive, wrote to all NHS managers on 7 September 1993 to clarify paragraph 27 of the guidance. We have no immediate plans to review the guidance.
Misconduct and Mismanagement
Ms Primarolo : To ask the Secretary of State for Health in what circumstances publicising misconduct or mismanagement in the NHS is a dismissible offence ; and if she will make a statement on the considerations underlying the policy on the subject.
Dr. Mawhinney : Decisions about disciplinary matters are entirely for national health service employers.
The NHS management executive's "Guidance for Staff on Relations with the Public and the Media", EL(93)51, sets out the
responsibilities of staff when raising issues of concern about health care matters and indicates how employers may ensure these rights and duties are met. A copy is available in the Library.
Column 1047
Cancelled Operations
Mr. Blunkett : To ask the Secretary of State for Health how many patients are not admitted within a month of their second cancelled operation.
Dr. Mawhinney [holding answer 28 march 1994] : In the quarter ending 31 December 1993, 150 patients failed to be admitted to hospital within one month of their second cancelled operation. The total number of general and acute elective operations performed in the same period was 1,062,000.
Drugs
Ms Primarolo : To ask the Secretary of state for Health what plans she has to expand the list of drugs that cause dependency and to require prescriptions to be written in full by hand.
Mr. Maclean : I have been asked to reply.
Dangerous drugs are controlled under the Misuse of Drugs Act 1971. The list of such drugs is kept constantly under review by the Home Office and the Advisory Council on the Misuse of Drugs. The provisions of the Misuse of Drugs Regulations 1985 include a requirement that prescriptions for certain controlled drugs be written in full by hand. This requirement applies to drugs listed in schedules 2 and 3 to the regulations.
The ACMD has made certain recommendations to tighten the controls on temazepam, including a requirement that prescriptions be written in full by hand. These are under consideration.
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