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Community Dental Service
364. Mr. Blunkett : To ask the Secretary of State for Health how she proposes the community dental service being funded if responsibility for the community dental service is transferred to health authorities.
Mr. Sackville : District health authorities are already responsible for purchasing community dental services. DHAs are funded for this purpose through their general allocations.
Column 594
Hospital Water
Ms Primarolo : To ask the Secretary of State for Health (1) how many hospitals do not meet the current legal limit of lead in water ;
(2) how many times in each of the last five years sub-standard drinking water has been reported from hospitals.
Mr. Sackville : I am not aware of any hospitals which do not meet the current legal limit of lead in water nor of any reports of sub-standard drinking water in the national health service.
Ambulances
Ms Primarolo : To ask the Secretary of State for Health (1) what percentage of ambulances used unleaded fuel in each of the last five years ;
(2) what percentage of ambulances have catalytic converters.
Mr. Sackville : This information is not available centrally.
Hospital Information Support Systems
Mrs. Fyfe : To ask the Secretary of State for Health if it is her policy that the national health service as a whole adopt hospital information support systems ; what progress has been made to date ; on what criteria that or any other system is selected ; and if cost comparisons can now be made between similar units.
Mr. Sackville : The national health service executive's information management and technology strategy encourages hospitals to move towards the implementation of integrated information systems. Around 50 sites in England are implementing hospital information support systems.
It is for each hospital to determine, locally, whether it can justify spending on such systems. If so, then each is expected, where relevant, to run a competitive procurement under European Community rules.
Costs of many contracts have been published in the Official Journal of European Communities , from which comparisons may be made. Copies of the journal are available in the Library.
Prisoner Referrals
Mr. McCartney : To ask the Secretary of State for Health if she will give a breakdown of the referrals for psychiatric treatment of prisoners broken down by category for each year since 1984.
Mr. Sackville : The available information is shown in the table :
Estimated number of cases of hospital admissions, including day
cases,
recorded as being referred from penal institutions,
courts, or police stations
|1989-90 |1990-91 |<1>1991-92
----------------------------------------------------------------
Acute sector |1,560 |1,496 |1,548
Geriatric |40 |16 |20
Maternity |24 |20 |44
Mental illness |4,720 |5,024 |4,996
Learning disability |88 |44 |76
Not known |- |- |4
|------- |------- |-------
Total |6,432 |6,600 |6,688
Source: Hospital Episode Statistics.
<1>Provisional.
Advertising
Ms Primarolo : To ask the Secretary of State for Health, pursuant to her answer of 11 July, Official Report , column 422, what proportion of expenditure on advertising by the health service concerned health education information and how much concerned information related to health reforms.
Mr. Sackville : I will write to the hon. Member.
Tobacco
Ms Primarolo : To ask the Secretary of State for Health how many shops there are on national health service premises selling cigarettes otherwise than to long-stay patients who are smokers.
Mr. Sackville : Surveys carried out by regional health authorities showed that six outlets were still offering tobacco products for general sale at the end of May 1993. Three of these outlets have since ceased such general sale. The Department will continue to keep the matter under review.
Energy
Ms Primarolo : To ask the Secretary of State for Health how many energy consultants were employed by the national health service in each of the last five years ; and what was the energy bill for the national health service in each of the last five years.
Mr. Sackville : Information on the number of energy consultants employed in the national health service is not available centrally. I understand that individual national health service trusts and health authorities have made appointments of this kind.
Expenditure on energy by national health service trusts and health authorities is shown in the table.
Total expenditure on energy by national health service trusts and health authorities Year |£ thousands ------------------------------------ 1988-89 |210,374 1989-90 |219,615 1990-91 |233,884 1991-92 |270,141 1992-93 |278,750 Source: 1. Annual accounts and financial returns of district, regional and special health authorities. 2. Annual financial returns of national health service trusts, 1991-92 and 1992-93.
Ms Primarolo : To ask the Secretary of State for Health what progress has been made towards her target for reducing energy consumption in the national health service over the five years from 1991-92.
Mr. Sackville : The target for reducing energy consumption in the national health service applies to the five years from April 1991. In the first two years, the national health service achieved a reduction in energy consumption of 7.1 per cent. which is the latest period for
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which information is available. Plans for the subsequent three years indicate that the national health service will meet the overall reduction of 15 per cent.Publicity
Ms Primarolo : To ask the Secretary of State for Health, pursuant to her answer of 20 June, Official Report, column 22, what amount of money spent on publicity by the information division is expended on (a) information or publicity about or as a result of the reforms and (b) health education matters for the public.
Mr. Sackville : The information could be provided only at disproportionate cost.
Military District Hospital Units
Mr. Blunkett : To ask the Secretary of State for the Health Department how the extra military district hospital units to be established in national health service hospitals will be accommodated ; and what extra funding will be available for the hospitals in which they are placed.
Mr. Sackville : Service personnel in military district hospital units will be integrated within national health service hospitals. How they and service patients are accommodated will be a matter to be discussed directly between the hospital and the Ministry of Defence. Any agreed extra costs to a hospital from establishing a unit or from treating service patients will be met from the Defence budget.
Mr. Blunkett : To ask the Secretary of State for Health what discussions she has had with the Secretary of State for Defence regarding his plans to close the Army's Cambridge military hospital at Aldershot and the Princess Alexandra hospital at Wroughton and to set up regional military district hospital units at NHS hospitals.
Mr. Sackville : In common with other Cabinet colleagues my right hon. Friend the Secretary of State has been kept fully appraised of my right hon. and learned Friend the Secretary of State for Defence's proposals.
Mortality Statistics
Dr. Wright : To ask the Secretary of State for Health (1) if she will list the figures for stroke mortality by gender in each district health authority for the last two years ;
(2) if she will list the figures for breast cancer mortality in each district health authority in each of the last two years ; (3) if she will list the figures for lung cancer by gender at district health authority level for the last two years ;
(4) if she will give the figures for skin cancer mortality by gender by district health authority for the last two years ; (5) if she will give the figures for coronary heart disease mortality by gender by district health authority for the last two years ;
(6) if she will list the figures for cervical cancer mortality by district health authority for the last two years.
Mr. Sackville : This information will be placed in the Library.
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Health Service Indicators
Dr. Wright : To ask the Secretary of State for Health (1) if she will list the preliminary set of outcome indicators produced by the population health outcome indicators feasibility study ; and if she will make a statement ;
(2) if she will publish the criteria used by the Faculty of Public Health in confirming the suitability of outcome indicators for the health service indicators set ;
(3) if she will list the outcome indicators recommended by the Chief Medical Officer's working party on outcome indicators ; and if she will also list which of those indicators were confirmed by the Faculty of Public Health to be included in the latest set of health service indicators ;
(4) what outcome indicators will be included in the 1992-93 health service indicator set ;
(5) if she will make a statement on the population health outcome indicators for the national health service feasibility study.
Mr. Sackville : The Chief Medical Officer's working party on population health outcome indicators did not recommend specific outcome indicators. It identified a number of potential indicators which could be produced using data currently available. The Department of Health subsequently commissioned the Faculty of Public Health Medicine to undertake a feasibility study of suggested indicators against a set of criteria. The faculty made some recommendations as part of the first phase of this study, following which the Department of Health commissioned analysis of those indicators recommended. This resulted in the production of the two documents Population Health Outcome Indicators for the NHS--A Consultation Document' and Population Health Outcome Indicators for the NHS --A Feasibility Study' copies of which are available in the Library. These documents list the population health outcome indicators suggested by the study.
The criteria adopted in determining the suitability of particular indicators were set out in some detail in the documents but one overriding criterion was that the indicators should be based on routinely collected data.
Following a positive consultation, which showed that this initiative was favourably received, the central health outcomes unit of the Department will shortly be commissioning work within the health service to test the practicality and effectiveness of the indicators suggested in a working environment. Updated indicators will, in future, be included within the "Public Health Common Data Set" which is distributed to the NHS annually. The information will not, necessarily, be duplicated within the health service indicators.
Work is also starting on a further phase of development of population health outcomes measures. This will build on the work which has taken place and specifically will look to the future information needs of the health service and the data which will require to be collected to assess health outcomes.
Dr. Wright : To ask the Secretary of State for Health if she will place in the Library, indicator numerators, denominators and values and rankings, as mentioned on page 24 of the 1991-92 health service indicators discussion paper.
Mr. Sackville : Arrangements are being made for the numerators and denominator values used in the health
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service indicators to be placed in the Library when available. These should be used with care since the timetable for the publication often requires the use of provisional and unvalidated data which may be corrected in published values of statistics.Dr. Wright : To ask the Secretary of State for Health of what the purchaser mortality ML61, as used in the health service indicators set, consists.
Mr. Sackville : An explanation of the purchaser mortality ML61, as used in the health service indicators set, is contained in the health service handbook, copies of which are available in the Library.
Clinical Effectiveness Indicators
Dr. Wright : To ask the Secretary of State for Health (1) if she will list all information sources, including databases, detailing clinical effectiveness indicators which are (a) maintained and (b) used by the Department of Health, its public bodies and other advisory bodies ; and if she will also list the forms in which those databases are maintained ;
(2) which clinical effectiveness indicator datasets refer (a) to individual episodes and (b) to individual patients ;
(3) what clinical effectiveness indicators are collated at the level of (a) district health authorities and (b) individual units.
Mr. Sackville : The assessment of clinical effectiveness is complex and does not readily lend itself to the production of indicators. However, there are a number of national confidential inquiries based on systems reporting individual episodes and individual patients whose anonymised reports assist clinicians to improve clinical effectiveness.
The main confidential enquiries are :
National Confidential Enquiry into Peri-Operative Deaths Confidential Enquiry into Stillbirths and Deaths in Infancy Confidential Enquiry into Maternal Deaths
National Confidential Enquiry into Quality of Genetic Counselling In addition, the national network of cancer registries which are computerised, provide a database of cancer cases and the outcome of those cases.
Dr. Wright : To ask the Secretary of State for Health what guidelines there are to ensure that collated clinical effectiveness data are seen by surgeons in each individual hospital.
Mr. Sackville : It is a professional responsibility of all doctors, including surgeons, to keep in touch with relevant professional developments. This includes information about clinical effectiveness.
Dr. Wright : To ask the Secretary of State for Health if she will list the changes which have been made in the collation of clinical effectiveness indicators as a result of the 1991-92 health service indicators discussion paper.
Mr. Sackville : As a result of the 1991-92 health service indicator discussion paper the indicator set was increased to include the "Population Health Outcome Indicators for the NHS". Copies of the revised indicators are available in the Library.
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Clinical Guidelines
Dr. Wright : To ask the Secretary of State for Health if she will make a statement on the progress of the national health service executive initiative involving the use of clinical guidelines to inform the contracting process.
Mr. Sackville : The clinical outcomes group has established a sub- group on clinical guidelines which will guide the future development of the national health service executive's work. A series of five workshops have been held to gain feedback from the national health service on the development work initiated in December.
Ambulance Response Times
Mr. Pike : To ask the Secretary of State for Health if she will list the criteria for defining rural and urban areas in compiling ambulance response times ; and if she will make a statement.
Mr. Sackville : The formula for classification of national health service ambulance services as urban or rural was introduced following the acceptance of a recommendation made in an independent consultants report in 1990. Those ambulance services serving an area with an overall population density of greater than 2.5 people per acre were classified as urban. Others were classified as rural. The population density formula acknowledges the higher number of longer distance journeys travelled by ambulance services in less densely populated rural areas.
Out-patients
Mr. Pike : To ask the Secretary of State for Health what figures are available to indicate how many patients are discharged from a hospital out- patient unit after three consultations ; how many of these are subsequently referred back to the out-patient unit ; and what figures are available specifically for Burnley health care trust.
Mr. Sackville : The information available centrally on out-patient attendances is published in "Outpatients and ward attenders for England, Financial Year 1992-93" copies of which are available in the Library.
Mr. Pike : To ask the Secretary of State for Health (1) what figures are available for general practitioner referral times for a patient's initial appointment at Burnley health care trust's out-patient unit, and the numbers of patients involved ; and if she will make a statement ;
(2) what monitoring she has done of general practitioner referral times from initial letters to a patient's initial appointment at a hospital out- patient unit ; and if she will make a statement.
Mr. Sackville : A system of monitoring the length of time a patient waits from general practitioner referral to first consultant out-patient appointment is being introduced. Data collection is in the early stages and the information collected is not yet sufficiently comprehensive to enable publication.
Operation Cancellations
Mr. Pike : To ask the Secretary of State for Health what figures are available for operations cancelled within one week of the appointment date ; and if she will make a statement.
Column 600
Mr. Sackville : This information is not available centrally.
Infertility
Mr. Hinchliffe : To ask the Secretary of State for Health (1) what information she has available to show the level of NHS expenditure for infertility within each English region ;
(2) how many persons have received infertility treatment within the NHS in each year since 1983 ; on how many occasions this has led to pregnancy ; and what figures she has available for successful pregnancy form NHS in- vitro fertilisation treatment, annually, for each NHS region in England.
Mr. Sackville : Information is available for three years on the numbers of finished consultant episodes for cases with a diagnosis of female infertility. Figures for ordinary admissions and day cases in England are shown in the table :
|Number
------------------------------
1989-90 |25,510
1990-91 |25,145
1991-92 |<1>27,276
<1>Provisional.
These figures include only those patients who are admitted to hospital to use a bed.
Comparable information for earlier years is not available. Information is not available centrally on the numbers of successful treatments or the level of national health service expenditure on infertility in each English region.
Source : Hospital Episode Statistics.
Day Care Surgery
Mr. Pike : To ask the Secretary of State for Health if she will list the criteria set down to define treatment suitable for day surgical care ; and if she will make a statement about the future of day care surgery.
Mr. Sackville : Hospital consultants are responsible for making clinical judgments about the suitability of individual patients for day surgery treatments. In 1992 the Royal College of Surgeons produced guidelines which stated that day surgery is now considered the best option for 50 per cent. of all patients undergoing elective surgical procedures. The introduction of new surgical techniques, and developments in anaesthesia, are increasing the range of operations which can be carried out on a day care basis.
Waiting Times
Mr. Pike : To ask the Secretary of State for Health which hospitals have been reported by the Audit Commission as using inadequate systems for compiling waiting times ; and if she will make a statement.
Mr. Sackville : The systems in place to compile the waiting times statistics published in the 1993-94 hospital and ambulance services comparative performance guide were reviewed by the Audit Commission's auditors. Hospitals or trusts whose waiting times result in the comparative performance guide have no star ratings are those where the auditors had reservations about the systems in place. Copies of the comparative performance guide are available in the Library.
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Staff (Consultation)
Mr. Spearing : To ask the Secretary of State for Health if she will give the current arrangements for a standing procedure for consultations with staff concerning the operation and administration of the service.
Mr. Sackville : Long established consultation arrangements with the staff sides of the Whitley councils ensure that all staff interests have the opportunity to comment on major departmental developments likely to affect them.
Porton Down
Mr. Llew Smith : To ask the Secretary of State for Health how many consultancy contracts have been secured by the new centre for applied microbiology and research at Porton Down ; what other Government Department's have placed contracts at the centre ; what is the total value of those contracts ; and if she will make a statement on the operation of the Microbiological Research Authority since 1 April.
Mr. Sackville : The Centre for Applied Microbiology and Research-- CAMR--provides a range of services including consultancy advice, research, development and production. Many contracts involve some or all of these services. Since 1 April 1994, CAMR has secured 26 consultancy-only contracts at a total value of £72,000 and 11 contracts involving consultancy and other services with a value of £2 million in 1994-95. In addition CAMR is providing similar services under pre-existing contracts to the value of £5.5 million. Three contracts have been placed by other Government Departments with a total value of £387,000 in 1994- 95.
Since 1 April the authority has completed a major reorganisation of the centre to give a better focus to its operations and has created a business development unit to seek additional external income. I look forward to meeting the staff and reviewing progress when I visit the centre in September.
Dental Services (Lewisham, Deptford)
Ms Ruddock : To ask the Secretary of State for Health if she will list the dentists in the constituency of Lewisham, Deptford, which will accept NHS patients ; of those listed, which dentists have said that their lists for NHS patients are currently closed ; and if she will make a statement.
Mr. Sackville : This information is not available centrally. The Lambeth, Southwark and Lewisham family health services authority advises that it can help a patient in the area find a national health service dentist. The hon. Member may wish to contact Mr. Ian Mills, the chairman, for details.
Bradford Community Health Council
Mr. Madden : To ask the Secretary of State for Health if she will list the names and organisations represented of those serving currently on Bradford community health council ; how many vacancies currently exist ; how many public meetings community health councils are required to hold annually ; and if she will make a statement.
Mr. Sackville : Information about the names, vacancies and organisations represented on individual community health councils is not available centrally. Regional health authorities, as the establishing body, have these details.
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Community health councils are required to hold meetings once every three months and these meetings would normally be open to the public.Private Consultant Episodes
Ms Primarolo : To ask the Secretary of State for Health how many finished consultant episodes on private patients in NHS hospitals occurred by (a) region and (b) district health authority in (i) 1990-91, (ii) 1991- 92 and (iii) 1992-93.
Mr. Sackville : The most recent information available at regional level is shown in the table.
Region |1990-91 |<1>1991-92
------------------------------------------------------------
England |81,366 |89,863
Northern |3,349 |3,178
Yorkshire |4,842 |5,263
Trent |2,797 |3,038
East Anglia |4,504 |4,270
North West Thames |10,345 |9,337
North East Thames |7,402 |9,850
South East Thames |6,648 |8,636
South West Thames |5,081 |6,269
Wessex |2,643 |2,673
Oxford |6,928 |7,244
South Western |5,044 |5,458
West Midlands |6,081 |6,866
Mersey |2,370 |2,249
North Western |6,445 |7,224
Special health authorities |6,887 |8,306
<1> Provisional.
Source: SD2A, Hospital Episode Statistics.
Reliable information at district level could be provided only at disproportionate cost.
Wheelchairs
Mr. Alfred Morris : To ask the Secretary of State for Health what developments there have been in regard to the provision of indoor/outdoor powered wheelchairs for all permanently disabled children and adults requiring them for independent mobility on the basis recommended by the Government's working party chaired by Professor--now Lord--McColl in 1986, further to the Adjournment debate on this subject on 1 July ; and if she will make a statement.
Mr. Bowis : I reiterate the remarks I made during the constructive debate on 1 July at columns 1124-28. I made it clear that the issue of wheelchairs, including powered indoor/outdoor wheelchairs, is a matter for health authorities and national health service hospital and community care units--trusts--in the light of their resources and priorities, but I have set up a departmental working group to look at all aspects of such a scheme and it will take evidence from experts. I have asked for a report to be made to me by the end of October.
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