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|District health|Family health |Total spend
|authorities |services |per capita
|spend |authorities
|per capita |spend
|per capita
|£ |£ |£
--------------------------------------------------------------------------------
London |460 |124 |584
Birmingham |417 |132 |549
Manchester |654 |137 |791
Liverpool |487 |142 |629
Leeds |381 |140 |521
Newcastle |514 |135 |649
Total England |378 |132 |510
Source:
Expenditure-Annual accounts of health authorities (England).
Population-Mid-year population estimates for 1992 (1991 Census based)
Notes:
1. There is additional hospital and community health services expenditure from
national and regional top-sliced budgets.
2. Figures exclude expenditure by the London Postgraduate Hospitals Special
Health Authorities. London residents are the main users.
Family Health Services Authorities
Mr. Alexander : To ask the Secretary of State for Health, pursuant to her answer to the hon. Member for Eltham (Mr. Bottomley) of 3 March, Official Report, column 851, what was the percentage increase of the (a) FHSA administration costs and (b) FHSA medicine costs in each of the last three years.
Dr. Mawhinney : The percentage increases in family health services authorities' administration expenditure for 1990-91, 1991-92 and 1992-93 over the previous year were 55.2, 30.8 and 19.1 respectively. The percentage increases in family health services drugs expenditure for 1990- 91, 1991-92 and 1992-93 over the previous year were 7.1, 11.4 and 14 respectively.
FHSAs manage the introduction of general practitioner fundholding, the monitoring of general practitioner prescribing, and the development of clinical audit in primary care--all initiatives to improve the effectiveness of patient care and value for money. In 1992-93 administration expenditure represented only 2.5 per cent. of the £6.5 billion of taxpayers' money spent on the FHS.
Internal Market
Ms Primarolo : To ask the Secretary of State for Health if she will make a statement on the principles driving the internal market ; and what plans she has to regulate it.
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Dr. Mawhinney : The internal market enables district health authorities and general practioner fundholders to assess their patient's needs and purchase services more responsively. This means that money for services follows patient care to those hospitals and community units which provide high quality and cost effective care. Hospitals and community units therefore have an incentive to develop their services in an environment which encourages increasing efficiency through competition. We already have mechanisms in place to manage the market and these are constantly updated.
NHS Budget
Ms Primarolo : To ask the Secretary of State for Health what was the management overhead as a percentage of the total budget of the national health service in each year since 1990-91.
Dr. Mawhinney : The gross salary costs of general and senior managers as a percentage of the total hospital and community health services revenue expenditure in 1990-91, 1991-92 and 1992-93 was 1.7, 1.9 and 2.4 respectively. The figures need to be treated with caution. The number of managers has been deliberately increased since the mid 1980s--not just since the reforms--because the service was previously undermanaged. Much of the increase arises from the reclassification of existing staff, including many senior nurses, as managers. General and senior managers account for only 2 per cent. of the total national health service work force in England.
NHS Trusts
Ms Jowell : To ask the Secretary of State for Health what criteria she applies when considering proposals for mergers of NHS trusts.
Dr. Mawhinney : The same criteria area used to assess all applications for national health service trust status, including proposals for trust mergers. They are that the establishment of the trust will give clear benefits and improved quality of service to patients ; that management has the necessary skills and capacity to operate independently ; that senior professional staff, especially consultants, are involved in the management of the unit and that the trust will be financially viable.
Mr. Blunkett : To ask the Secretary of State for Health how many of the chief executives of the fourth wave of NHS trusts will receive remuneration of £80,000 per year or above ; and if she will make a statement.
Dr. Mawhinney : Information about the individual remuneration of trust chief executives is not held centrally. The remuneration of trust chief executives is a matter for trust boards but information about their emoluments is published in annual accounts and annual reports available locally.
Ms Jowell : To ask the Secretary of State for Health how many mergers of hospital trusts have taken place in London and in England since 1990 ; and how many hospital beds have closed as a result.
Dr. Mawhinney : There have been three mergers of national health service trusts since 1990. Information on bed closures is not available centrally.
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Tobacco Advertising
Mr. Barron : To ask the Secretary of State for Health how many shop fronts advertising tobacco products are currently covered by the voluntary agreement with the tobacco manufacturing companies ; and how many she estimates are within (a) three miles, (b) two miles, (c) one mile, (d) three-quarters of a mile, (e) half a mile and (f) one-quarter of a mile of school premises.
Dr. Mawhinney : All cigarette and hand-rolling tobacco brand advertising material displayed on shop fronts is covered by the voluntary agreement, in that the advertising should comply with the cigarette code of the British code of advertising practice. In addition, all such material of 40 sq in or more must carry a health warning. Under the voluntary agreement the total number of external permanent cigarette and hand-rolling tobacco advertisements at retail premises is being reduced by 50 per cent. over five years from July 1991. Priority is being given to reducing the number of signs on shops clearly visible from school. Information on the number of shop fronts advertising tobacco products within different distances of school premises is not held centrally.
Surplus Property
Mr. Gordon Prentice : To ask the Secretary of State for Health, pursuant to her answer of 28 March, Official Report, column 594, when she last had occasion to comment adversely on the time taken to dispose of surplus national health service property.
Mr. Sackville : Regional health authorities have been very successful in disposing of surplus national health service property. In the past 10 years, over £1 billion has been raised which has been reinvested in patient care.
Some properties do prove to be hard to sell given the difficult property market of recent years. I see no reason to comment adversely on the regional health authorities' performance in this area.
Mental Health
Mrs. Dunwoody : To ask the Secretary of State for Health when she will implement the 10-point plan for supervised discharge of mental health patients set out in the report of the mental health nursing review team.
Mr. Bowis : My right hon. Friend the Secretary of State for Health announced our 10-point plan to reinforce community care for mentally ill people on 12 August 1993, following the Department's internal review of legal powers in this area.
We have made substantial progress on the matters covered by the plan. Following wide consultation we shall be introducing legislation as soon as possible to give effect to the review team's proposals for a new power of supervised discharge and for extending the present Mental Health Act provision for leave of absence.
The revised Mental Health Act code of practice was published at the end of August.
Draft guidance on the discharge of psychiatric patients from hospitals, and their continuing care in the community, was issued for consultation on 12 January. We are now considering more than 250 comments received on the draft and will be issuing the definitive guidance shortly.
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Guidance on the development of supervision registers for the most vulnerable patients was issued in February and health authorities were required to introduce these registers from 1 April.As part of our programme to improve training for key workers with mentally ill people, we held a successful conference in London on 3 March, at which I gave the keynote address.
The clinical standards advisory group is on schedule with its review of standards of care for people with schizophrenia, on which it expects to report to Ministers in December.
The mental health task force has been reinforced to carry out a special review of mental health services in the London implementation zone. This work is being jointly led by the head of the task force, Mr. David King, and Dr. Peter Kennedy who has been seconded from his post as chief executive of the York health services trust. The team will be working with district health authorities and other agencies to develop short and long- term action plans, and will be reporting to Ministers on progress against the plans and any issues requiring action in the longer term.
We attach a very high priority to services for mentally ill people and will maintain the vigorous action we have been taking in these and other areas to develop and improve them still further.
Community Care
Ms Jowell : To ask the Secretary of State for Health what advice her Department has given to local authorities and health authorities on consultation with users and carers in producing local purchasing plans for community care ; and if she will make a statement.
Mr. Bowis : I refer the hon. Member to the reply I gave the hon. Member for Wakefield (Mr. Hinchcliffe) on 9 March, Official Report, column 307.
Mentally Ill People (Homicide)
Dr. Lynne Jones : To ask the Secretary of State for Health when the first report of the confidential inquiry into homicides by mentally ill people is expected to be available.
Mr. Bowis : We expect to receive the first report later this year.
Chinese Swabs
Mrs. Mahon : To ask the Secretary of State for Health (1) what representations she has received about Chinese swabs ;
(2) what advice her Department is giving to national health service supplies authorities on the purchasing of Chinese swabs.
Mr. Sackville : Two representations have been received. A defective product was withdrawn from use last year and the contract in question was terminated.
No advice has been given on the purchase of divisions swabs from particular sources. The various purchasing of the National Health Service Supplies Authority are aware of the standards to be applied when purchasing surgical dressings, and that sterile dressings should be purchased from suppliers who operate recognised quality assurance systems.
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Royal Victoria Infirmary, Newcastle
Mr. Cousins : To ask the Secretary of State for Health what response she has given to the request from the Royal Victoria infirmary trust in Newcastle for extra paediatric intensive care provision.
Dr. Mawhinney : The Royal Victoria infirmary and associated hospitals national health service trust has made no request for additional resources for paediatric intensive care provision. The National Health Service Management Executive has asked all regional general managers and district general managers to ensure that levels of paediatric intensive care provision adequately meet the needs of the local population.
Accountants
Mr. Austin Mitchell : To ask the Secretary of State for Health if she will list the contracts currently being worked on for her Department by Coopers and Lybrand, Ernst and Young, Price Waterhouse, KPMG Peat Marwick, Grant Thornton, Robson Rhodes, Levy Gee, Hacker Young, BDO Binder Hamlyn, Pannell Kerr Forster and Stoy Hayward.
Mr. Sackville : The available information is as shown.
KPMG Peat Marwick
Support to Market Test (In-House bid) Prescription Pricing. Local Authority Systems Project.
Support to Market Test (In-House bid) Main frame computer services.
Coopers and Lybrand
Review of Organisations in receipt of Section 64 Grants. Hospital Episode Statistics--Business case for
redevelopment.
BACS Payment system.
Personal Social Services Information Strategy--Mental Illness Project.
Hospital and Community Health Service Information Strategy Statement.
Accruals Based Accounting.
Health Service Indicators Technical Options.
National Health Service Administrative Register--Benefits Evaluation.
Development of Information Systems for Providers-Purchaser progress review.
Investment Scrutiny process.
Michael Buchanan
Dr. Lynne Jones : To ask the Secretary of State for Health, pursuant to her answer of 16 March, Official Report, column 727, if she will increase the membership of the inquiry panel set up by the North West London mental health trust to investigate the care and treatment of Michael Buchanan, convicted of manslaughter after discharge from Shenley psychiatric hospital, to include two members of the public to ensure that it is as independent and objective as possible, as recommended in the Ritchie report.
Mr. Bowis : The panel of inquiry set up by the North West London mental health trust is an independent inquiry and not an internal one of the type referred to in the Ritchie report.
St. Mary's Hospital
Mr. Patchett : To ask the Secretary of State for Health if she will hold an investigation into the use by Neil Goodwin, chief executive of the St. Mary's hospital trust, of a private room in his hospital ; what arrangements were made for payments ; and if she will make a statement.
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Mr. Sackville : No. Mr. Goodwin was treated as a private patient at his own expense.
Psychiatric Wards, London
Mr. Harry Greenway : To ask the Secretary of State for Health what representations she has received about the need to increase the number of beds on psychiatric wards in London.
Dr. Mawhinney : The Department has received a number of representations about mental health services including the number of beds provided on psychiatric wards in London.
IT Consultants
Mr. Matthew Taylor : To ask the Secretary of State for Health what information technology consultants her Department has employed, for what purpose and at what total cost for each of the last five years.
Mr. Sackville : Detailed information could be provided only at disproportionate cost. The total expenditure on information technology consultants by the Department for each year since 1990-91, the earliest year for which figures are available was :
|£ million
------------------------------
1990-91 |10.19
1991-92 |12.50
1992-93 |13.37
1993-94 |12.55
The services covered by this expenditure included advice on procurement and information strategies, the design, development and implementation of the office automation system and user support services. A very wide range of firms is used for this purpose.
Pharmaceutical Investment
Mr. Cousins : To ask the Secretary of State for Health when the initial stage of the strategy to encourage inward pharmaceutical direct investment from the United States and Japan is expected to be completed ; and what input has been given from the Board of Trade.
Dr. Mawhinney : The initial stage of the inward investment strategy is expected to be completed in a few weeks. The Department of Trade and Industry and the Invest in Britain Bureau are represented on the working group set up to develop the strategy.
Anthrax
Mr. Cousins : To ask the Secretary of State for Health what provision she has made for the treatment of, or vaccination against, penicillin-resistant anthrax.
Mr. Sackville : Anthrax vaccine creates protective immunity to the toxin produced by the anthrax bacillus. The vaccine is, therefore, effective against all strains of anthrax, irrespective of their antibiotic sensitivity.
The anthrax bacillus is sensitive to a number of common antibiotics and these would be available for treatment in the rare event of penicillin- resistant strains.
Mr. Cousins : To ask the Secretary of State for Health what assessment her Department has made of the extent to
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which naturally occurring strains of anthrax are resistant to penicillin ; and if she will make a statement on penicillin-resistant anthrax.Mr. Sackville : Only three cases of penicillin-resistant anthrax have been described in the world literature. One of these occurred in 1974 in the United Kingdom and this was verified at the Public Health Laboratory Service's centre for applied microbiology and research. The other two reports were from Bosnia and Japan, but it has been impossible to verify these. With these exceptions, natural strains of anthrax are not resistant to penicillin.
Medical Certificates
Mr. Blunkett : To ask the Secretary of State for Health in what circumstances general practitioners can charge a fee for issuing a medical certificate to a patient.
Dr. Mawhinney : Under paragraph 37 of their terms of service, general practitioners are required to issue a defined list of medical certificates free of charge. They may charge a fee for issuing certificates not included on this list.
Dental Services
Mr. Blunkett : To ask the Secretary of State for Health what guidelines there are to regulate the use of premises, equipment and staff, paid for from public funds, for the development of private dental practice.
Dr. Mawhinney : Fees paid to general dental practitioners do not fund the development of private practice. Fees are set to take account of the average level of expenses incurred in the provision of national health service treatment.
Wythenshawe Hospital
Mr. Alfred Morris : To ask the Secretary of State for Health what discussions her Department has had with the Manchester Health Purchasing Consortium about the major improvements planned for Wythenshawe hospital ; for what reason a new and more limited scheme will now have to be submitted to her Department ; what effect an amended scheme will have on the running down of Withington hospital ; what other hospitals in the city will be affected ; and if she will make a statement.
Dr. Mawhinney : When considering major capital proposals we need to be satisfied that schemes are cost effective and offer the best value for money. Officials support Ministers in this by meeting national health service staff and discussing new schemes in detail. The Wythenshawe hospital development is subject to this process. Further improvements to the scheme will deliver better services for less cost. It is too soon to detail the impact that the current revision will have upon the scheme or on other hospitals in the city, including Withington hospital.
Hospital Consultants
Mr. Milburn : To ask the Secretary of State for Health what representations she has received alleging difficulties in recruiting hospital consultants in (a) anaesthetics, (b) accident and emergency, (c) ophthalmology, (d) paediatrics and (e) other specialties.
Dr. Mawhinney : The Department of Health has received representations regarding recruitment of hospital
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consultants in anaesthetics and paediatrics. No specific concerns have been raised relating to recruitment in the accident and emergency area.In ophthalmology there are a number of senior registrars available to take up consultant appointments, but who, for personal reasons, are not submitting applications for posts.
In paediatrics, concern regarding shortages of suitably qualified doctors available to take up consultant appointments is known to the Department. The British Paediatric Association has met separately with the then chief executive of the national health service management executive and me to express their concerns. Steps are being taken to alleviate these problems. Regions have indicated to the Department that they expect to fund the additional senior registrar posts they were allocated by the Joint Planning Advisory Committee after the 1992 review within the required time scale of March 1995 at the latest. The increased throughput of higher specialist trainees following the implementation of the Report of the Working Group on Specialist Medical Training, "Hospital Doctors : Training for the Future" should also be of assistance in making suitable candidates available to take up consultant appointments. In anaesthetics, a similar situation exists. The Department is fully aware of the Royal College of Anaesthetists' concerns over the availability of suitably trained candidates for consultant posts. Again, positive steps have been taken by the NHS executive to respond to these issues, including the introduction of innovative mechanisms to increase the number of doctors in training in the specialty. As with paediatrics, regions have indicated that they expect to be able to establish all senior registrar posts allocated to them within the required time scale, in this case of March 1996.
Employing bodies may experience difficulties in recruiting consultants for a range of reasons. These include the nature of the post, its geographical location and the facilities offered at the hospital concerned.
Hospital Beds
Mr. Cryer : To ask the Secretary of State for Health what provision is being made to ensure adequate provision of long-term beds in the NHS following the recent decision of the health service ombudsman ; and if she will make a statement.
Mr. Bowis : The recommendations on the specific care instigated by the Commissioner have been accepted by the Leeds health authority. We are considering whether there are any wider implications to the Health Service Commissioner's report.
Recruitment Consultants
Mr. Milburn : To ask the Secretary of State for Health how much the NHS has spent on employing recruitment consultants in the last year for which figures are available.
Dr. Mawhinney : Responsibility for recruitment of staff, and the procedures they use for doing so, are a matter for national health service employers.
Mr. Milburn : To ask the Secretary of State for Health how much her Department has spent on recruitment consultant purposes in the last year.
Mr. Sackville : During 1993-94 the Department of Health, excluding its agencies, spent £259,659 on
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recruitment, of which £204,606 was spent on work carried out by Recruitment and Assessment Services Agency, an executive agency of the Cabinet Office.Home Helps
Mr. Blunkett : To ask the Secretary of State for Health how many home helps were employed by each local authority responsible for community care ; and what was the ratio of home helps to population in each authority, at 30 September 1993.
Mr. Bowis : I refer the hon. Member to the reply I gave the hon. Member for Bristol, South (Ms Primarolo) on 15 July 1993, Official Report, columns 624-26 for data in respect of the position at 30 September 1992. Information about the position at 30 September 1993 should be available shortly.
Computer Systems
Mr. Matthew Taylor : To ask the Secretary of State for Health what computer systems her Department have brought in, for what function and at what cost for each of the last five years ; and in each case whether the computer system is still in use.
Mr. Sackville : The Department has a large number of computer systems mainly for office support and statistics. It would not be possible fully to list these without incurring disproportionate costs.
NHS Management Executive
Mr. Milburn : To ask the Secretary of State for Health what have been the costs associated with redesignating the NHS management executive as the NHS executive.
Dr. Mawhinney : I refer the hon. Member to the reply I gave the hon. Member for Sheffield, Brightside (Mr. Blunkett) on 31 March, Official Report , columns 1049-50.
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