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Mr. Lennox-Boyd : Some key appointments still remain to be made by the new Administration, which itself lacks administrative experience. Assistance with institution-building is a priority for the international community. In particular, the World bank has helped the Palestinians draw up a priority investment programme, and is providing technical assistance and feasibility studies through a special fund to which Britain contributed $2 million. The World bank is also administering a separate fund set up as a channel for bilateral contributions to the running costs of the Palestinian central administration. Discussions are taking place among donors aimed at the rapid establishment of a similar mechanism for funding police running costs.
Both Britain and the EC are providing direct help in the development of administrative capacity and are contributing towards the Palestinians' immediate budgetary needs.
Mr. Harry Greenway : To ask the Secretary of State for Foreign and Commonwealth Affairs how much aid is currently being given to Rwanda by (a) the European Union and (b) the United Kingdom ; and if he will make a statement.
Mr. Lennox-Boyd : Since the start of the crisis the British Government have committed over £11 million bilaterally in emergency aid to Rwandans, both inside Rwanda and as refugees in neighbouring countries. The European Union has committed over £34 million. Details of the substantial amounts provided bilaterally by other member states are not immediately available.
Mr. Jim Cunningham : To ask the Secretary of State for Foreign and Commonwealth Affairs if he will make a statement on the 1994 United Nations Children's Fund report, "The Progress of Nations" ; and to what extent he considers the report to be an accurate assessment of the objectives set out in the 1990 summit for the world's children and the progress made in achieving those objectives.
Mr. Lennox-Boyd : "The Progress of Nations" is an interesting and encouraging account of real achievements by developing countries. It also highlights, however, those areas, such as the elimination of neonatal tetanus and improvements in child rights, where more work remains to be done.
An assessment of progress towards achievement of the summit's goals is expected to be made in the mid-decade review next year.
Mr. Jim Cunningham : To ask the Secretary of State for Foreign and Commonwealth Affairs what plans he has (a) to increase contributions to UNICEF and (b) to press for a greater proportion of UNICEF's expenditure to be spent on meeting the objectives set out in the 1990 summit for the world's children.
Mr. Lennox-Boyd : Our core contribution to UNICEF in 1994-95 will be £8.5 million. In addition, we will continue to consider each UNICEF appeal for supplementary and other funding on its merits. A mid-decade review of progress on the world summit for children will be made to the United Nations Secretary-General. Progress on the summit's goals is a matter not simply of asking UNICEF to devote more resources but of ensuring a concerted effort by donors, non-governmental organisations, the private sector and, above all, national Governments, to achieve the goals.
Mr. Jim Cunningham : To ask the Secretary of State for Foreign and Commonwealth Affairs what are the procedures for monitoring the achieving of the objectives set out at the summit for the world's children in 1990.
Mr. Lennox-Boyd : Agencies of the United Nations take the lead in monitoring performance in respect of the goals established at the 1990 world summit for children. These agencies produce regular reports which measure progress in such areas as child health, basic education and child protection.
Mr. Lennox-Boyd : The United Kingdom actively supports the increased emphasis placed by the donor community, including the International Monetary Fund and the World bank, in their relations with developing countries on the implications for economic and social development of an excessive level of military expenditure. We have made it clear that we consider the setting of an appropriate level of military expenditure to be an important part of good government. It is one of the factors we take into account when deciding our allocations of bilateral aid.
Mr. Jim Cunningham : To ask the Secretary of State for Foreign and Commonwealth Affairs what plans he has for analysing contributions to overseas aid in terms of allocation to (a) basic education, (b) primary health care, (c) safe drinking water, (d) adequate sanitation, (e) family planning aid and (f) fair distribution of resources between different groups.
Mr. Lennox-Boyd : The ODA has recently introduced a computerised policy information marker system which records both expenditure and future commitments against the seven priority objectives of the aid programme outlined in the ODA's 1994 departmental report. Spending commitments in the areas listed in the question will not be shown separately under the PIMS system but will score against some of ODA's seven objectives, such as human development, including better education and health and children by choice and direct poverty reduction. PIMS data will be drawn upon in the series of biennial monitors' reports which will assess performance, including spending performance, against each of the objectives, and consider what lessons this may have for future strategy and allocation of resources.
Mr. Milburn : To ask the Secretary of State for Health if she will give a table showing those district health authorities that are (a) over and (b) under their capitation targets indicating for 1994-95 (i) the percentage by which they diverge from their capitation and (ii) the cash amount that this represents of current budgets.
Mrs. Wise : To ask the Secretary of State for Health if she will list for each of the 14 former NHS regions and for special health authorities for each financial year from 1992-93 onwards (a) the total number of maternities, (b) the total number of birth episodes in the maternity hospital episode system and (c) the total number of birth episodes in the maternity hospital episode system which had a maternity tail.
Mr. Sackville : The data are contained in the tables, the latest available being those for the year 1992-93. Maternities occurring in hospitals are shown for calendar year 1992 ; financial year data are not available.
Table 1 Maternities in hospitals, 1992 Regional health authority of occurrence |Number ------------------------------------------- Northern |39,450 Yorkshire |49,051 Trent |57,461 East Anglian |27,572 North West Thames |41,282 North East Thames |59,574 South East Thames |49,738 South West Thames |37,994 Wessex |36,609 Oxford |35,328 South Western |38,720 West Midlands |72,370 Mersey |30,729 North Western |56,890 Special Health Authorities |5,130 |------- England |637,898 Source: Office of Population, Censuses and Surveys.
Table 2 Maternity hospital episode statistics, 1992-93 Estimated numbers of birth records and birth records with maternity tails containing data RHA of treatment |Birth records |Birth records with |maternity tails |containing data ------------------------------------------------------------------------------------ Northern |39,168 |35,960 Yorkshire |49,768 |25,852 Trent |52,652 |52,552 East Anglian |27,680 |21,308 North West Thames |31,460 |25,252 North East Thames |51,736 |51,736 South East Thames |49,528 |17,084 South West Thames |34,920 |34,732 Wessex |36,620 |36,620 Oxford |34,624 |32,484 South Western |38,556 |24,872 West Midlands |57,956 |57,956 Mersey |19,264 |15,752 North Western |53,900 |53,900 Special Health Authorities |5,132 |5,132 |------- |------- England |582,964 |491,192 Source: DH 25 per cent. births file.
Mr. Gareth Wardell : To ask the Secretary of State for Health what is the number of active registrations of capitation patients for dental treatment in (a) Trafford family health services authority and (b) City and East London family health services authority in the age categories (i) nought to two years, (ii) three to five years, (iii) six to nine years, (iv) 10 to 14 years, (v) 15 to 17 years and (vi) under 18 years for the period January to March ; and what was the take-up rate for each age group per 100 local population.
Dr. Mawhinney : The available information is shown in the table. Figures are available on a quarterly basis. Patients are free to register with a dentist outside the family health services area where they live. The take-up rates
Column 13shown in the table therefore reflect registrations with dentists in each family health services area and not registrations of each area's residents. Our recent publications, "Improving NHS Dentistry" and "An Oral Health Strategy for England" aim further to improve children's oral health and address regional variations. Copies of these documents are available in the Library.
Number of capitation patients registered and take-up rate per 100 local population<1> at 31 March 1994 Trafford and City and East London family health services authorities Trafford family City and East health services London family authority health services authority Age group |Number |<2>Take-up rate|Number |<2>Take-up rate |registered |per 100 local |registered |per 100 local |population |population ------------------------------------------------------------------------------------------------ 0 to 2 |3,284 |37 |1,980 |6 3 to 5 |7,107 |82 |9,059 |31 6 to 9 |10,620 |95 |16,343 |45 10 to 14 |12,550 |94 |17,224 |45 15 to 17 |5,873 |80 |7,854 |39 Under 18 |39,434 |80 |52,460 |34 Source: Dental Practice Board. <1>Take-up rate per 100 local population is calculated using Office of Population Censuses and Surveys estimated resident population at mid-1992. The take-up rate per 100 local population is the number of children registered with a dentist in the FHSA area expressed as a percentage of the population. This is not a measure of the population of children in an FHSA area registering with a dentist because there is no restriction on patients registered with a dentist outside their FHSA area. <2>Of the relevant age group.
Mrs. Roche : To ask the Secretary of State for Health, pursuant to her answer of 7 July, Official Report, column 318, what research her Department intends to commission to discover the proportion of the population who visit a dentist every six months.
Mr. Spellar : To ask the Secretary of State for Health how many national health service staff took early retirement in each of the last three years ; and what was the total cost to the national health service.
Early retirement Year |Number ---------------------- 1991-92 |3,108 1992-93 |4,033 1993-94 |6,318
National health service employers meet the full cost of paying these retirement benefits early. The total costs in each of the last three years are :
Early retirement Year |£ --------------------------------- 1991-92 |19,222,371 1992-93 |27,065,579 1993-94 |42,522,384
The cost of ill health retirement is not charged to NHS employers. The number of people taking ill health retirement in each of the last three years is :
Year |Number ---------------------- 1991-92 |7,387 1992-93 |8,381 1993-94 |8,613
The figure relates to regional, district and special health authorities and family health services authorities. Figures for national health service trusts are not collected on a comparable basis.
Reported losses to RHA, DHA and FHSA property Year |£ thousands ------------------------------------ 1988-89 |2,482 1989-90 |2,667 1990-91 |3,138 1991-92 |4,995 1992-93 |2,111 Source: Annual receipts and payments returns of regional, district and special health authorities and family health services authorities.
Mr. Bayley : To ask the Secretary of State for Health what proportion of patients discharged from hospital in (a) England, (b) each regional health authority and (c) each hospital or trust between January and March had a community care plan for their continuing health and social care needs agreed with them prior to discharge.
Mr. Bowis : The patients charter states that before a patient is discharged from hospital a decision should be made about any continuing health or social care needed. Local authorities and health authorities should work together to assess and respond to the needs of people who may need long term care and should agree local arrangements for monitoring hospital discharge.
Mr. Sackville : I am advised that there is under-registration of skin cancers other than melanomas. Registration varies widely depending on the registry's access to out-patient records and general practitioners. The steering committee on cancer registration has recommended that the implications of improving registration of these cancers should be examined in a cost-benefit analysis. This is under consideration.
Mr. Sackville : Research is being undertaken by or commissioned by this Department, 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 and the National Radiological Protection Board. Current and recent research has looked at the knowledge, attitudes and behaviour of the public in relation to the risks of over-exposure to sun, underlying mechanisms of ultraviolet-induced skin damage and the benefits of screening for skin cancer.
Mr. Worthington : To ask the Secretary of State for Health what representations she has made to the World Health Organisation about the quality of its work in emergency situations in developing countries.
Dr. Mawhinney : I refer the hon. Member to the reply that the Parliamentary Under-Secretary of State for Foreign and Commonwealth Afairs, my hon. Friend the Member for Morecambe and Lunesdale (Mr. Lennox-Boyd), gave him on 13 July at column 636.
Mr. Worthington : To ask the Secretary of State for Health what information she has about the quality of the work of the World Health Organisation in emergency situations in sub-Saharan Africa ; and what proposals she has to improve the quality of her monitoring of the activities of the World Health Organisation in developing countries.
Dr. Mawhinney : I refer the hon. Member to the reply that the Parliamentary Under-Secretary of State for Foreign and Commonwealth Affairs, my hon. Friend the Member for Morecambe and Lunesdale (Mr. Lennox- Boyd), gave him on 4 July at column 77.
Mr. Hunter : To ask the Secretary of State for Health if she will make a statement on the instructions which are given to national health service trusts for calculating hospital charges to private patients ; and what surpluses these are expected to achieve.
Mr. Sackville : I refer my hon. Friend to the reply that I gave to my hon. Friend the Member for Rugby and Kenilworth (Mr. Pawsey) on 29 June at col 587 . No targets have been set for the amounts to be raised from treating private patients.
(2) what controls and reporting mechanisms there are within national health service trusts to ensure that the treatment of national health service patients is not adversely affected by the use of staff and resources for private patient treatment.
Mr. Sackville : National health service trusts may make accommodation and services available for private patients providing there is no significant interference with the performance of the trust of its obligations under NHS contracts. This statutory requirement prevents NHS patients from being disadvantaged by private practice within the health service. It is for local management to ensure that these statutory obligations are met.
Ms Lynne : To ask the Secretary of State for Health (1) what measures the Government are taking to ensure that all patients with breast cancer are treated and cared for by expert and experienced staff with specific skills in the management of breast cancer ; (2) what steps she is taking to define what constitutes a critical mass of patients to be seen and cared for in breast clinics ; (3) what plans she has to ensure that patients suffering from breast cancer are seen only by specialist surgeons experienced in the management and treatment of breast cancer.
Mr. Sackville : The expert advisory group on cancer consultative document entitled "A Policy Framework for Commissioning Cancer Services", copies of which are available in the Library, recommends that professional bodies should urgently develop guidelines on the level of expertise and support required to manage the commoner cancers including breast cancer. Professional bodies are currently being consulted on the group's recommendations.
Ms Lynne : To ask the Secretary of State for Health what plans she has to increase the current number of specialist breast care nurses to ensure that all patients have access to their skills and support in the physical and psychological effects of the disease and treatment.
Mr. Sackville : The expert advisory group on cancer's consultative document entitled "A policy Framework for Commissioning Cancer Services", copies of which are available in the Library, recommends that the benefits of specialised care are available to all cancer patients. It is for individual health authorities to decide what staff to employ in the light of local needs and priorities.
Mr. Sackville : The expert advisory group on cancer's consultative document entitled "A Policy Framework for Commissioning Cancer Services", copies of which are available in the Library, makes a number of proposals to improve cancer care. In particular it recommends that all patients should have access to a uniformly high quality of care wherever they may live to ensure the maximum possible cure rates and best quality of life. Decisions on the group's proposals will be made when the consultation exercise has been completed.
Ms Lynne : To ask the Secretary of State for Health what measures she is taking to expand services to care for the number of patients with breast disease in whom curative treatment is not appropriate and who require continuing care and support.
Mr. Sackville : The Government are continuing to encourage the development of palliative care in all settings to ensure that patients receive sensitive care and relief from pain and other distressing symptoms. Regional health authorities have been asked to ensure that an appropriate level of palliative care services for terminally ill people is commissioned through service contracts.
Mr. Sackville : The arrangements for the supply of breast prostheses to women who have suffered a mastectomy are through the hospital service. Where they are prescribed through the hospital consultant they are supplied and fitted free. The Department of Health is providing section 64 project funds for a survey, conducted by the charity Breast Cancer Care, into the experience of women fitted with a prosthesis. Their findings will be studied by the Department.
Mr. Corbyn : To ask the Secretary of State for Health how the family health services appeal unit uses the information it receives through identifying practitioners who have persistently been found to be in breach of the terms of service to monitor and improve services.
Dr. Mawhinney : Decisions of the director of the family health services appeal unit are notified to family health services authorities who are responsible for monitoring and improving family health services in their localities. The director may also inform the relevant professional regulatory body of his decision in a particularly serious case.
Mr. Corbyn : To ask the Secretary of State for Health what is the average time since 1 April 1992 taken by the family health services appeal unit (a) from the time of appeal to reach a decision concerning a breach of the terms of service, (b) from the time of the receipt of the request to reach a decision concerning waiving of time limits, (c) to arrange an appeal hearing from the time of receipt of appeal, when the appeal is made by the complainant, (d) to
Column 18arrange an appeal hearing, from the time of receipt of appeal, when a practitioner has appealed against a withholding and (e) to notify the result of an appeal hearing, after the date of the hearing.
Mr. Sackville : We have recently asked the United Kingdom Transplant Support Services Authority to commission a review of the current arrangements for the retrieval, storage and use of tissue, including skin, in the United Kingdom. Once the findings are complete we will give careful consideration to what tissue banking arrangements will be needed for the future.
Ms Lynne : To ask the Secretary of State for Health what plans she has to increase the current number of non-surgical oncologists in line with the Expert Advisory Group on Cancer consultative document entitled "A Policy Framework for Commissioning Cancer Services".
Mr. Sackville : We are currently consulting on the proposals contained within the consultation document ; final decisions are still some months away. We will be looking at manpower issues, but any changes required will be phased gradually over a number of years to allow for the required training of any additional staff and necessary changes to the organisation of cancer provision.
Ms Lynne : To ask the Secretary of State for Health what plans she has to ensure that patients will receive a firm diagnosis within a minimun of four weeks of a referral by their general practitioner to a hospital providing on-site comprehensive histology, cytology and radiography services.
Mr. Sackville : We recognise the fears and anxiety of patients who are concerned that they may have cancer and we consider it unacceptable for patients to wait an undue period for their results. In many places patients are already seen promptly. The expert advisory group on cancer's consultative document entitled "A Policy Framework for Commissioning Cancer Services", copies of which are available in the Library, identifies the need to ensure appropriate referral from general practitioners and for patients to be seen by appropriately trained multi-disciplinary teams which should ensure patients are seen
Column 19more quickly. Commissioning authorities, hospitals and general practitioners are being consulted on the group's recommendations.
Ms Jowell : To ask the Secretary of State for Health what was (a) the share of the revenue resource allocation 1994-95, based on population adjusted for age and standardised mortality ratio and the weighted capitation target, (b) the actual allocation of the revenue resource allocation 1994-95 made, in pound sterling, as of April 1994, (c) the amounts in pound sterling, for London weighting market forces factors and Thames factor and other sums specivically allocated, (d) the amounts for additional moneys included in the actual allocations to region and the district health authorities, which are not weighted capitation target funded and (e) the contigency sums held back by the region or other top- sliced amounts not included in the allocation budgets to district health authorities for (i) each of the four Thames regional health authorities, (ii) each district health authorities in Greater London and (iii) England ; and what was the method of sub-regional allocation of the four Thames regional health authorities.
Mr. Bowis : We have been consulting on the need to amend section 18 of the Act relating to the return to hospital of detained patients who are absent without leave. We have also put forward proposals to amend the Act on extended leave and supervised discharge and will do so when parliamentary time permits.
Dr. Mawhinney : Ministers will be reviewing the options for expanding and developing the fundholding scheme. Revisions to the scope of the list of goods and services for fundholding would not require primary legislation.
Mr. Burns : To ask the Secretary of State for Health, pursuant to the answer of 20 June, Official Report , column 28 , if she is now in a position to announce when she will make a decision on the proposal to move the burns unit from Billericay to Broomfield hospital, Chelmsford ; and if she will make a statement.
Mr. Sackville : The St. Vincent joint task force for diabetes is expected to offer initial advice to the Department of Health and the British Diabetic Association later this year on the implementation of the St. Vincent declaration. Further discussions are then expected to take place to identify possible courses of action and priorities.
Mr. Bowis : The Department has been provided with information about the circumstances surrounding the death of Mr. John Sheppard. I understand that Brent social services and housing departments have already taken steps to improve procedures to check on people who have social services discontinued or who accumulate large rent arrears.
Mr. Sackville : The National Health Service Executive quarterly monitoring system collects information by region on their actual spend on extra contractual referrals compared with planned levels of spend. This information is not audited and is only suitable for management purposes.
Mr. Sackville : The hon. Member tabled an early day motion on 13 July, and the Department has received one letter from the North West Friends of Homoeopathy. North Mersey Community national health service trust is temporarily closing its homoeopathy in-patient unit ; the hon. Member may wish to contact Mr. R. James, chairman of the trust, for further details.