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fertility rates of the calendar year in question throughout their childbearing lives.

Source : OPCS Fertility Statistics Unit.

The 10 family health services authorities with the highest recorded number of new cases of tuberculosis in 1991--this information is not available by district health authority--were :

Birmingham

Brent and Harrow

Bradford

Lambeth, Southwark and Lewisham

Leicestershire

Ealing, Hammersmith and Hounslow

Lancashire

City and East London

Kensington, Chelsea and Westminster

Enfield and Haringey

Redbridge and Waltham Forest

Joint tenth.

Source : OPCS Communicable Diseases HMSO Series MB2 1993.

Nurses

Ms Primarolo : To ask the Secretary of State for Health what representations she has received about the career prospects of nurses from ethnic minorities ; and if she will commission a survey.

Mr. Sackville : None. The Department has commissioned the Policy Studies Institute to undertake a study on the careers of nursing staff in a multiracial society. It is expected that the findings will be published in late 1994.

Mental Health

Mr. Blunkett : To ask the Secretary of State for Health what was the total number of working days lost through problems of mental health in 1993 -94 ; and what is the estimated total cost of that absence from work.

Mr. Bowis : I refer the hon. Member to the reply that I gave him on 4 November 1993 at cols. 453-54.

Ms Jowell : To ask the Secretary of State for Health what is the level of per capita spending on mental health care provided by hospital and community trusts for residents of (a) London, (b) Cornwall, (c) Hertford, (d) Leeds, (e) Newcastle, (f) Liverpool and (g) East Sussex.


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Mr. Bowis : Information on expenditure by national health service trusts on a per capita basis cannot be provided as trusts do not provide services for fixed populations.

Colorectal Cancer

Mr. Sheerman : To ask the Secretary of State for Health what reasons underlay the decision not to refer to deaths caused by colorectal cancer in her paper the "The Health of the Nation" ; and how many deaths occurred in each of the last five years from this form of cancer.

Mr. Sackville : The Government's objective is a reduction in mortality and morbidity caused by all cancers. Although colorectal cancer is a major cause of premature death or avoidable ill health, it has not-- unlike breast, cervical, skin and lung cancer--been possible to identify a procedure which is both effective and measurable. The value of effective screening for colorectal cancer is therefore still uncertain, although the potential of such a programme remains under review.

Deaths occurring in England and Wales from malignant neoplasma of the colon and rectum are shown in the table :


             |Colon       |Rectum,                  

                          |Rectosigmoid             

                          |Junction and             

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

1988         |11,494      |5,756                    

1989         |11,626      |5,756                    

1990         |11,527      |5,696                    

1991         |11,386      |5,685                    

1992         |11,781      |5,622                    

Dentists

Mr. Redmond : To ask the Secretary of State for Health how many dentists have given written notice to have their names removed from dental lists since December 1992.

Dr. Mawhinney : The total number of dentists who have given written notice to have their names removed


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from dental lists between 27 November 1992 and 13 May 1994 is 212. Four hundred and ten dentists were added to the lists in the period 31 December 1992 to 31 December 1993.

Mr. Redmond : To ask the Secretary of State for Health how many patients have contacted each family health services authority asking for help in finding a dentist in the period since December 1992.

Dr. Mawhinney : The information will be placed in the Library.

Elderly People (Treatment)

Ms Jowell : To ask the Secretary of State for Health (1) whether she will conduct a review of health authorities' purchasing policies to identify the extent to which elderly people are being excluded from certain treatment on grounds of their age ;

(2) what action she intends to take to establish whether health authorities are issuing contracts which exclude people from treatment on grounds of their age.

Dr. Mawhinney : There is no need to conduct such a review. The National Health Service Executive, through its monitoring of district health authorities' purchasing plans and its corporate contracts with regional health authorities, already reviews and monitors annually the purchasing intentions of DHAs and general practitioner fundholders.

Recorded Diseases, London

Ms Jowell : To ask the Secretary of State for Health how many cases of (a) rickets, (b) scurvy, (c) tuberculosis, (d) diphtheria and (e) dysentery were recorded in inner London for 1979, 1985 and each year since.

Mr. Sackville : Notifications of tuberculosis, diphtheria and dysentery are shown in the table.

There is no reliable source of data on rickets and scurvy.


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Notifications of selected infectious diseases in Inner London 1979, 1985-1992                                                                      

Inner London     |1979        |1985        |1986        |1987        |1988        |1989        |1990        |1991        |1992                     

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

All tuberculosis |1,203       |887         |810         |717         |751         |831         |879         |922         |1,024                    

Diphtheria       |0           |1           |0           |1           |0           |2           |1           |1           |1                        

Dysentery        |195         |388         |234         |257         |241         |258         |229         |225         |335                      

Source: Office of Population, Censuses and Surveys.                                                                                                

Cancer Treatment Costs

Ms Jowell : To ask the Secretary of State for Health what is the cost of medical oncology, with radiotherapy costs identified separately, per out-patient day case and in-patient episode for patients attending (a) St. Bartholomew's, (b) University College London, (c) Guy's, (d) the Royal Marsden, (e) Queen Elizabeth Hospital, Welwyn, (f) Royal Sussex, (g) Addenbrookes and (h) John Radcliffe.

Mr. Sackville : The available information is shown in the table. It is not possible to separate out radiotherapy costs from medical oncology.


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Costing information for Medical Oncology in 1992-93                                     

                         |Cost per            |Cost per                                 

                         |Finished            |out-patient                              

                         |for patients using a                                          

                         |bed                                                           

                         |£                   |£                                        

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

Barts Group of Hospitals                                                                

Directly Managed Unit                                                                   

(including St.                                                                          

Bartholomews)            |1,025.55            |154.86                                   

Bloomsbury and Islington                                                                

Acute Directly                                                                          

Managed Unit                                                                            

(including University                                                                   

College Hospital)        |1,221.11            |n/a                                      

Guys and Lewisham NHS                                                                   

Trust (including Guys)   |1,640.01            |123.10                                   

Royal Marsden Special                                                                   

Health Authority         |2,005.39            |144.86                                   

East Herts NHS Trust                                                                    

(including Queen                                                                        

Elizabeth Hospital)       see note 3                                                    

Brighton Healthcare                                                                     

Directly Managed Unit                                                                   

(including Royal                                                                        

Sussex Hospital)         |n/a                 |n/a                                      

Addenbrooke's Hospital                                                                  

Directly Managed Unit                                                                   

(including                                                                              

Addenbrooke's                                                                           

Hospital)                |n/a                 |n/a                                      

John Radcliffe Hospital                                                                 

Directly Managed Unit                                                                   

(including John                                                                         

Radcliffe Hospital)      |n/a                 |n/a                                      

Source: Annual financial returns of health authorities and NHS trusts.                  

Notes:                                                                                  

1. All figures are provisional.                                                         

2. n/a=the hospital does not record any expenditure associated with this particular     

specialty.                                                                              

3. East Herts NHS trust (including Queen Elizabeth hospital) does not have a comparable 

medical oncology service with the other named hospitals.                                

Primary Care (Spending)

Ms Jowell : To ask the Secretary of State for Health what is the per capita spending on primary care for residents of (a) London, (b) Cambridge, (c) Hertford, (d) Brighton, (e) Stevenage, (f) Gloucester, (g) Cheltenham, (h) Durham and (i) Truro.

Dr. Mawhinney : Information is not collected in the form requested.

Hospital Waiting Lists

Ms Jowell : To ask the Secretary of State for Health what is the average length of time on the waiting list for (a) hysterectomy, (b) heart by-pass and (c) hip replacement, for patients living in (i) Bloomsbury and Islington, (ii) Redbridge and Waltham Forest, (iii) south-east London, (iv) Hertford, (v) Cambridge, (vi) Manchester, (vii) north Cornwall, (viii) Brighton, (ix) Eastbourne and (x) Leeds.

Dr. Mawhinney : Information on waiting times is collected by specialty, district health authority and national health service trust. This information is given in "Hospital Waiting List Statistics : England", copies of which are available in the Library. Since 1988 the overall average waiting time has fallen from over nine months to less than five.

Purchasing Authorities

Ms Jowell : To ask the Secretary of State for Health whether she will intervene in the decisions of purchasing authorities to ensure that all residents of those areas are guaranteed the elective or emergency treatment that they need.

Mr. Sackville : It is the responsibility of health authorities to assess the health care needs of their local population.


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Bed Availability

Ms Jowell : To ask the Secretary of State for Health (1) how many acute beds were available per head of the population for residents of (a) Newcastle, (b) Birmingham, (c) Manchester, (d) Leeds, (e) Liverpool and (f) London for 1985 and each year since 1989 ; (2) how many NHS continuing care beds were available per head of the population for residents of (a) Newcastle, (b) Birmingham, (c) Manchester, (d) Leeds, (e) Liverpool and (f) London for 1985, 1987 and each year since 1989 ;

(3) how many registered nursing home beds were available per head of the population for residents of (a) Newcastle, (b) Birmingham, (c) Manchester, (d) Leeds, (e) Liverpool and (f) London for 1985, 1987 and each year since 1989.

Mr. Sackville : The information is not available in the form requested.

Adoptions

Ms Jowell : To ask the Secretary of State for Health what steps she intends to take to ensure that both adoptive parents and young people who have been the subjects of trans-racial adoptions are consulted as part of the consultations on her White Paper on the future of adoption.

Mr. Bowis : The White Paper "Adoption : The Future" is not a consultation document but contains the Government proposals for reforming adoption law. Publication of the White Paper followed four years work of reviewing adoption law by an inter-departmental working group during which time several consultative documents were issued. Views on the Government's plans from parents who have adopted children from ethnic minority cultures, as well as the young people themselves, have been made known to the Department through responses received from local authority social services, voluntary adoption agencies and adoption support groups as well as individual correspondents.

In formulating the adoption proposals, the Government have taken account of the responses to the various consultation documents as well as the latest research, thinking and practice on a variety of adoption issues.

GP Fundholders, London

Ms Jowell : To ask the Secretary of State for Health how many general practitioner fundholders are practising in inner London ; and what proportion they represent of all general practitioners in London.

Dr. Mawhinney : There are 278 general practitioner fundholders practising in inner London representing 17 per cent. of all general practitioners in that area.

Inequalities and Health

Mr. Alfred Morris : To ask the Secretary of State for Health what input other Government Departments will have into the new working party on inequalities and health ; and if he will make a statement.

Mr. Sackville : The recently established sub-group of the Chief Medical Officer's "Health of the Nation" working group will be looking at variations in health. The


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sub-group's terms of reference focus on the provision of practical advice to the Department of Health and the national health service but other Government Departments are being kept informed of its work.

Nurse Prescribing

Ms Jowell : To ask the Secretary of State for Health when she will approve the introduction of nurse prescribing to general practitioners' practices which are not fundholders.

Dr. Mawhinney : The extension of nurse prescribing to non- fundholding practices will be considered in the light of experience gained from the eight demonstration projects which are to be introduced in October.

Research Allocation

Ms Jowell : To ask the Secretary of State for Health when she will publish the report on the calculation of the special increment for teaching and research which was commissioned in 1993 by her Department to inform resource allocation.

Dr. Mawhinney : In due course.

London Hospitals

Ms Jowell : To ask the Secretary of State for Health which London hospitals were fined by their purchasers for failing to meet contract specifications for elective treatments in each year since 1991 ; and what was the amount of the fine in each case.

Dr. Mawhinney : Contracts that purchasers have with hospitals may contain clauses which enable financial penalties to be imposed in the event of contract specifications not being met. These contracts are agreed locally and any resulting penalties are not monitored by the national health service executive.

The hon. Member may wish to write to the chairmen of the relevant health authorities for details.

Mouth Cancer

Ms Primarolo : To ask the Secretary of State for Health what assessment her Department has made of links between smoking tobacco and the incidence of mouth cancer.

Mr. Sackville : Available research shows that an increased risk of cancer of the mouth, relative to that in non-smokers, has been found among tobacco smokers. The risk is of similar magnitude for cigarette, cigar and pipe smokers.

Ms Primarolo : To ask the Secretary of State for Health what percentage of the notified cases of mouth cancer were discovered during routine dental check-ups in each of the last five years.

Mr. Sackville : The origin of the diagnosis of oral cancer is not routinely recorded.

Ms Primarolo : To ask the Secretary of State for Health what materials her Department has produced or funded to educate people on the dangers of mouth cancer.

Mr. Sackville : Smoking and excessive alcohol consumption, the main known risks factors for mouth cancer, are addressed through a variety of material produced by the Health Education Authority and others.


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Health Workers (Redundancies)

Ms Primarolo : To ask the Secretary of State for Health, pursuant to her answer of 15 April, Official Report, column 318, what are the total numbers of redundancies in inner London hospitals since April 1993 by each hospital ; and if she will categorise redundancies under the headings (a) ancillary, (b) nursing, (c) doctors, (d) consultants and (e) managers.

Dr. Mawhinney : The previous reply covered only those hospitals in receipt of transitional funding. Information on redundancies across all inner London hospitals is not available centrally.

Operational Mergers

Mr. Blunkett : To ask the Secretary of State for Health how many operational mergers currently exist between district health authorities and family health services authorities in England ; and if she will list those authorities operating on such a basis.

Dr. Mawhinney : None.

Performance Tables

Mr. Blunkett : To ask the Secretary of State for Health, pursuant to her answer of 20 April, Official Report, column 545, what were the initial non-recurring set up costs for the NHS performance tables.

Dr. Mawhinney : I refer the hon. Member to the reply that I gave him on 20 April, Official Report , column 545.

Continuing Care

Mr. David Young : To ask the Secretary of State for Health, pursuant to her answer of 16 May, Official Report, column 323, if it is her policy that in all cases payment rests on public funds when a patient is discharged from hospital because of a lack of long-stay beds and is still in need of continuing care in a nursing home.

Mr. Bowis : Arrangements for continuing care will depend on the assessed needs of the individual.

NHS Trusts

Mr. Milburn : To ask the Secretary of State for Health, pursuant to her answer of 16 May, Official Report, columns 317-18, if she will list the trusts and the amounts involved where approval has been given for trusts to invest in (a) United Kingdom public sector institutions, (b) banks and (c) building societies.

Mr. Sackville : The approval referred to previously is a general approval as to the institutions in which trusts may invest surplus cash. Individual trusts do not require specific approval for their investment arrangements unless they wish to invest surplus cash other than in an approved institution. No trust has applied to use a non-approved institution. Trusts are not required to notify my right hon. Friend the Secretary of State or the national health service executive the details of their investing activities, as the amounts involved will vary in the normal course of business and are in any event subject to independent audit.

Mr. Milburn : To ask the Secretary of State for Health, pursuant to her answer of 17 May Official Report, column 417, which trusts have been investigated by the NHS executive for (a) merger and (b) dissolution.


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Mr. Sackville : The circumstances of each trust that materially failed to meet a financial duty in 1993-94 have been reviewed by the national health service executive to ensure that they take appropriate action in the current year. In the case of two trusts, the Royal Liverpool University hospital NHS trust and Broadgreen Hospital NHS trust, their plans include a proposal to dissolve themselves and form a new trust to run the facilities that are managed separately by them at present. As a result, my right hon. Friend the Secretary of State has given permission to North West regional health authority to consult on this proposal. Consultation, which lasts for three months, commenced on 16 May 1994.

Mr. Blunkett : To ask the Secretary of State for Health if she will place in the Library copies of reports received from practice counsellors in general pratitioner fundholding practices, indicating how they intend to achieve the "The Health of the Nation" targets.

Dr. Mawhinney : Such information is not available centrally.

WALES

Care and Repair Cymru

Mr. Ron Davies : To ask the Secretary of State for Wales when he expects to announce the funding allocations to care and repair schemes in Wales, and Care and Repair Cymru for 1994-95 ; and if he will make a statement.

Mr. Redwood : An offer of grant for the first quarter of 1994-95 has been made both to individual schemes and to Care and Repair Cymru. Decisions on the remainder of the year will follow shortly.

Mr. Ron Davies : To ask the Secretary of State for Wales when his Department's review of care and repair in Wales is expected to be completed ; when the review is completed ; and what plans he has to publish the results and arrange for consultation on the review's proposals.

Mr. Redwood : I expect the review of central funding to care and repair schemes to be completed shortly. My officials will then discuss the future funding of the care and repair movement with Care and Repair Cymru.

Welsh Development Agency

Mr. Jon Owen Jones : To ask the Secretary of State for Wales when the Welsh Office received an answer from the Welsh Development Agency following its letter to the agency on 25 November 1991 concerning the case of Mr. Price.

Mr. Redwood : On 27 November 1991.

Mr. Jon Owen Jones : To ask the Secretary of State for Wales, pursuant to his answer of 12 May, Official Report , column 205 , whether the Welsh Office made any communication with the Welsh Development Agency between 25 November 1991 and 19 February 1992 concerning the redundancy of Mr. Price.

Mr. Redwood : No.


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Energy Efficiency

Mr. Ron Davies : To ask the Secretary of State for Wales how much the Welsh Office has made available in supplementary credit approvals for energy efficiency in local authority administrative buildings in Wales to encourage a 15 per cent. reduction in energy consumption in each year the scheme has been available.

Mr. Redwood [holding answer Friday 20 May 1994] : No supplementary credit approvals have been made specifically for energy efficiency for local authority administrative buildings in Wales. In 1993- 94, 79 projects took place in Wales under the "other environmental services" budget.

SOCIAL SECURITY

Integrated Benefit Information System

Mr. Pike : To ask the Secretary of State for Social Security (1) if he will publish a report on the progress of the integrated benefit information system ; when the transition to the new integrated benefit information system will take place ; and if he will make a statement ;

(2) what is the estimated cost of introducing the integrated benefit information system computer system into all agencies.

Mr. Burt : In September 1993, my right hon. Friend, the Secretary of State announced the introduction of a one-stop service to Benefits Agency offices and that as part of that service, a new computer system, the integrated benefit information system--IBIS--would be available by July 1994.

The IBIS is now available to all Benefits Agency offices. Offices are starting to use it alongside existing systems and other initiatives to support their transition to the business goals of one stop. There are, however, no plans to publish a report on its progress.

Each agency has a different business focus so it would not be appropriate to introduce the same computer system to them all. The IBIS was designed specifically for the Benefits Agency ; however, other agencies are considering using the IBIS concept to deliver systems that will generate greater efficiencies in their own business. Detailed proposals and costings are not currently available.


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