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Mr. Sackville: Whether to carry out a test for, and subsequently treat, helicobacter pylori infection is primarily a clinical decision to be made by the doctor concerned.

Mr. Nicholas Winterton: To ask the Secretary of State for Health whether Zantac, Cimetidine and Tagamet are branded or generic products; by whom they are manufactured; whether the antibiotics used for the treatment of helicobacter stomach infections are branded or generic products; and what would be the effect upon the national health service drugs budget of a substantial switch from treatment by the former to the latter.

Mr. Sackville: Zantac is the brand name used by Glaxo for drug preparations of the chemical ranitidine hydrochloride. Tagamet is the brand name used by SmithKline Beecham for cimetidine preparations. Cimetidine is also available in other branded and generic versions. All the antibiotics commonly used in the eradication of helicobacter pylori are available as generic versions, except Clarithromycin, which is available only in the proprietary form. It is not possible to calculate the effects on the national health service drugs bill of a switch from H2-antagonists to antibiotic drugs for the treatment


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of ulcers as not all prescribing of acid suppressants is for the treatment of ulcers.

Mr. Nicholas Winterton: To ask the Secretary of State for Health what information her Department holds relating to the incidence of helicobacter or similar infections in patients suffering from heart disease; what research it is funding in this area; and if she will make a statement.

Mr. Sackville: The Department has no information at present. However, we are aware that research into this subject is taking place.

The Department of Health has not funded any research into this subject. The main agency through which the Government support biomedical and clinical research is the Medical Research Council, which receives its grant-in-aid from the office of my right hon. Friend the Chancellor of the Duchy of Lancaster.

Mr. Nicholas Winterton: To ask the Secretary of State of Health what (a) research projects, (b) publications and (c) meetings, conferences or seminars her Department has funded to promote a greater awareness of the benefits deriving from antibiotic treatment of helicobacter stomach infections in cases of stomach ulcers compared to treatment by a protracted course of acid blockers; and if she will make a statement.

Mr. Sackville: The medicines resource centre, which is funded by the Department, has made available to all general practitioners and family health services authorities prescribing advisers detailed information on the success rates achievable with the various regimes, their relative costs versus maintenance therapy and the appropriate selection of patients for this intervention. The medical advisers support centre, which also is departmentally funded, has recently promoted a series of local workshops and educational meetings for FHSA prescribing advisers on this subject and more are planned for 1995 96. The MASC is also co-operating in a practice- based GP endoscopy research project which aims to speed up the rate at which patients are given a specific diagnosis and appropriate treatment, including eradication therapy. The drug and therapeutics bulletin, published by the Consumers Association and distributed to all GPs at the Department's expense, covered this topic in its February 1993 edition. Copies of the relevant D and TB and MeReC publications have been placed in the Library.

Further research into the most efficacious and economic treatment regimes should commence later this year as part of the national health service health technology assessment research and development programme.

Mr. Nicholas Winterton: To ask the Secretary of State for Health when her Department first became aware of the developments in the treatment of stomach ulcers associated with the use of antibiotics whether or not in conjunction with acid blockers in preference to the use of such acid blockers alone; when her Department first took steps to ensure that these developments were drawn to the attention of general practitioners; how she accounts for the period between the two dates; how many operations were performed during that period for the removal of all or part of a stomach as a result of stomach ulcers; and what claims for compensation her Department is either facing or accepting.

Mr. Sackville: The use of antibiotics in the treatment of peptic ulcers has been reported and discussed in academic and professional journals for over a decade. Eradication therapy continues to be debated and medical


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opinion is still divided. These are matters for the profession and the royal colleges, in particular, to lead and inform clinical opinion. Information on the number of gastrectomy and partial gastrectomy operations performed where a gastric ulcer was diagnosed is shown in the table. We are not aware of any claims for compensation against the Department.


Number of gastrectomy 

and partial           

gastrectomy           

operations            

performed where a     

gastric ulcer was     

diagnosed:            

finished consultant   

episodes              

        |Number       

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

1989-90 |749          

1990-91 |753          

1991-92 |556          

1992-93 |504          

Source:               

Hospital Episodes     

System, Department of 

Health.               

The above figures are 100 per cent. estimates from a 25 per cent. sample database. A finished consultant episode is defined as a period of health care under one consultant in one health care provider.

Generic Products

Mr. Nicholas Winterton: To ask the Secretary of State for Health what assistance is provided by her Department to enable the development of new regimes of medical treatment in situations where the medication involved in the new regime would be a low-cost generic product, compared with an existing regime of treatment by a highly profitable branded product; and if she will make a statement.

Mr. Sackville: The choice of medical treatment is a matter for the professional judgment of the doctor concerned and will be determined primarily by the clinical needs of the particular patient. Only if there is a choice between two or more equally appropriate and effective medications would the doctor be expected to exercise a decision based on cost. General practitioners are kept informed of developments in treatment regimes, and comparative costs of treatment, by the British National Formulary, medicines resource centre bulletins and the drugs and therapeutic bulletin, all of which are supported financially by the Department of Health. All GPs are also routinely provided with an analysis of their own prescribing patterns and costs by the prescription pricing authority using prescribing analysis and cost data.

Stomach Cancer

Mr. Nicholas Winterton: To ask the Secretary of State for Health (1) what information she has concerning the percentage of cases in which an individual has been identified as being of greater than average risk of developing stomach cancer and in which antibiotics for helicobacter are prescribed; if it is her policy to encourage general practitioners to make greater use of such antibiotics in such cases; and if she will make a statement;

(2) what information she has concerning the percentage of cases of stomach ulcers in which antibiotics for helicobacter are prescribed; whether it is her policy to encourage general practitioners to make greater use of such antibiotics whether or not in conjunction with acid blockers in preference to the use of such acid blockers alone; and if she will make a statement.


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Mr. Sackville: Such information is not available centrally. All general practitioners are encouraged to prescribe in a clinically effective and cost-effective manner. The decision on which drug, if any, to prescribe for a particular patient is, however, solely a matter for the clinical judgment of the doctor.

Mr. Nicholas Winterton: To ask the Secretary of State for Health when her Department first became aware of the developments in the treatment of those at greater than average risk of stomach cancer associated with the use of antibiotics for helicobacter; when her Department first took steps to ensure that these developments were drawn to the attention of general practitioners; and how she accounts for the period between the two dates.

Mr. Sackville: Suggestions of a possible link between stomach cancer and infection with helicobacter pylori emerged around 1990. Research is still in its early stages. Dissemination of the results of such work when completed will initially be by publication in academic and professional medical journals.

Camden and Islington Health Authority

Mr. Corbyn: To ask the Secretary of State for Health what meetings have been held by Ministers or officials of her Department with Camden and Islington health authority concerning the resources available for health care in Camden and Islington; and if she will make a statement.

Mr. Sackville: There have been no such meetings. The allocation of resources to this health authority is the responsibility of North Thames regional health authority.

Health Education Authority

Mr. Kevin Hughes: To ask the Secretary of State for Health (1) if she will outline the new funding mechanism for the Health Education Authority;

(2) what plans she has to put out to tender in the private sector the work now being carried out by the Health Education Authority; (3) what was the budget for the Health Education Authority for each of the last four years; what will be the level of funding for 1995 96; and what estimate her Department has made of the core funding for the Health Education Authority in 1996 97;

(4) what assessment she has made of the number of job losses that may result from the Government's announcement on the Health Education Authority's future.

Mr. Malone: Total funding to the Health Education Authority in the last four years has been as follows:


                  |£                    

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

1991-92           |31,427,000           

1992-93           |33,955,000           

1993-94           |36,194,000           

1994-95 (to date) |36,984,000           

In 1995 96, the authority will receive direct from the Department a sum similar to that for 1994 95. Thereafter, the authority's income will be derived from departmental contracts for services it wishes the authority to provide.

The staffing of the authority will be for the authority to determine in the light of contracts awarded. Both the


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Department and the authority believe that the authority is well placed to maintain, if not increase, its current income, by better marketing of its products and an increased ability to respond to the needs of its customers.

Breast Implants

Mr. Byers: To ask the Secretary of State for Health if she will ask general practioners and health service trusts to contact women who have had breast implants to inform them of the extension of the deadline to register potential claims arising from breast implants with the United States legal authorities; and if her Department will take steps to advertise the new deadline.

Mr. Sackville: The Department of Health is investigating reports that the deadline has been extended to 1 March 1995. When confirmation is received the Department will consider whether any further publicity is needed in addition to that provided from the United States.

Lynfield Mount Special Care Unit

Mr. Madden: To ask the Secretary of State for Health if she has received the report and recommendations of the external review team who inquired into the escape by Mr. Raymond Pemberton from Lynfield Mount special care unit in Bradford last June; if she will place a copy of the report in the Library; if she will arrange for a copy of the report to be provided to those individuals and organisations who gave oral and written evidence to the inquiry; and if she will make a statement outlining what action she is taking in the light of recommendations of the external review team.

Mr. Bowis: Ministers have received a copy of the external review team's recommendations which are a matter for Bradford Community Health national health service trust. The hon. Member may wish to contact the trust for details of the action it plans to take.

Imported Blood Samples

Mr. Foulkes: To ask the Secretary of State for Health what quantities of amniotic fluid blood samples and human tissues were imported from Hong Kong through Heathrow airport to private laboratories in the United Kingdom in 1994; what tests are carried out on such samples for the AIDS virus, hepatitis and other infectious diseases; and if she will make a statement.

Mr. Sackville: Information is not available centrally on the quantity of blood and tissue samples sent to the United Kingdom from abroad. The transport of potentially infectious pathology samples is subject to detailed national and international guidelines directed at ensuring safety. Laboratories receiving such material will be aware of the procedures which they, and the sender, should follow.

London Ambulance Service

Mr. Harry Greenway: To ask the Secretary of State for Health when she expects to receive the report of the review of the London ambulance service carried out by Mr. William Wells; and if she will make a statement.

Mrs. Virginia Bottomley: I have today received this report, copies of which are available in the Library. I am grateful to Mr. Wells and his colleagues for undertaking


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this review and for producing speedily such a thorough report. The review, which looked at the management, working practices and performance of the London Ambulance Service, was established following the unacceptable delays in providing an ambulance for Nasima Begum on the night of 19 June. The report sets out clearly both the progress which the LAS has made since the report of the independent inquiry in February 1993 and the substantial agenda of further work which is needed to improve its performance to the standard achieved by other ambulance services.

I welcome the report's analysis and the key recommendations arising from it. Most of these are for the LAS and the South Thames regional health authority to implement and I look to it to do this vigorously to the challenging timetable set out in the report. Achieving these changes will require all staff in the LAS and the LAS management, to work together. I have asked Mr. Wells, as chairman of the South Thames RHA, to report regularly on progress to Ministers in addition to producing the quarterly public reports proposed in the report. The report recommends that the LAS should seek trust status and that it should remain as a single unit for providing emergency ambulance services for London. I welcome the conclusion about trust status for the LAS. This would, in principle, clarify and strengthen management and accountability for the LAS and I agree that preparatory work should begin now. I also agree that the LAS should remain as a single unit but with the very important proviso that this can be justified only if the LAS improves its performance to the standards achieved by other services.

Finally, the report recommends that there should be a review of national standards for ambulance response times. My Department has already set action in hand for such a review this year and will take into account the points made in the review report.

Public Bodies

Dr. Wright: To ask the Secretary of State for Health which of the advisory non-departmental public bodies sponsored by her Department (a) hold open meetings, (b) conduct public consultation exercises, (c) conduct consultation exercises with outside commercial interests, (d) publish a register of members' interests, (e) publish agendas for meetings and (f) publish the minutes of meetings; and whether this is in each case (i) under a statutory requirement or (ii) voluntary.

Mr. Sackville [holding answer 16 December 1994]: The information is as follows:

(a) hold open meetings: None

(b) conduct public consultation exercises: British Pharmacopoeia Commission; Nutrition Task Force;

(c) conduct consultation exercises with outside commercial interests: British Pharmacopoeia Commission; Nutrition Task Force;

(d) Publish a register of members' interests: Committee on Safety of Medicines (on a voluntary basis); Medicines Commission (on a


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voluntary basis); The advisory Committee on the Microbiological Safety of Food; Committee on the Toxicity of Chemicals in Food, Consumer Products and the Environment; Committee on the Mutagenicity of Chemicals in Food, Consumer Products and the Environment; Committee on the Carcinogenicity of Chemicals in Food, Consumer Products and the Environment; Committee on the Medical Aspects of Food Policy; Committee on Dental and Surgical Materials; Advisory Board on the Registration of Homeopathic Products;

(e) publish agendas for meetings: None

(f) publish the minutes of meetings:

(i) under a statutory requirement: None

(ii) voluntarily: Committee on the Medical Aspects of Food Policy.

GPs and Dentists

Mr. Bayley: To ask the Secretary of State for Health what proportion of the population in each family health service authority area is registered currently with (a) a general practitioner and (b) a general dental practitioner.

Mr. Malone [holding answer 20 December 1994]: Information on the proportion of patients registered with a general medical practitioner is shown in the table. Available information on registration with a dental practitioner is in the Dental Practice Board publication "Registrations: GDS Quarterly Statistics", copies of which are available in the Library.


Proportion of people resident in each FHSA who were registered                 

with a GP 1993-94                                                              

                   |Estimated                                                  

                   |total resident|Registered                                  

                   |population at |patients at                                 

FHSA               |mid 1993      |1 Oct. 1993   |Per cent.                    

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

Northern RHA                                                                   

Cleveland          |557,286       |573,355       |102.9                        

Cumbria            |491,874       |494,210       |100.5                        

Durham             |604,131       |610,182       |101.0                        

Northumberland     |309,019       |307,994       |99.7                         

Gateshead          |202,787       |211,773       |104.4                        

Newcastle          |275,217       |290,477       |105.5                        

North Tyneside     |193,495       |191,635       |99.0                         

South Tyneside     |156,281       |160,444       |102.7                        

Sunderland         |295,951       |298,783       |101.0                        

                                                                               

                   |3,086.041     |3,138.853     |101.7                        

                                                                               

Yorkshire RHA                                                                  

Humberside         |882,733       |892,995       |101.2                        

North Yorkshire    |733,981       |726,107       |98.9                         

Bradford           |478,871       |498,894       |104.2                        

Calderdale         |194,357       |199,496       |102.6                        

Kirklees           |380,732       |385,272       |101.2                        

Leeds              |719,880       |731,043       |101.6                        

Wakefield          |317,943       |330,172       |103.8                        

                                                                               

                   |3,708,497     |3,763,979     |101.5                        

                                                                               

Trent RHA                                                                      

Derbyshire         |949,702       |953,764       |100.4                        

Leicestershire     |907,576       |931,810       |102.7                        

Lincolnshire       |602,722       |605,103       |100.4                        

Nottinghamshire    |1,027,600     |1,015,682     |98.8                         

Barnsley           |224,198       |231,908       |103.4                        

Doncaster          |294,394       |296,615       |100.8                        

Rotherham          |256,493       |252,026       |98.3                         

Sheffield          |525,387       |530,608       |101.0                        

                                                                               

                   |4,788,072     |4,817,516     |100.6                        

East Anglia RHA                                                                

Cambridgeshire     |688,395       |659,863       |95.9                         

Norfolk            |768,759       |735,056       |95.6                         

Suffolk            |665,062       |638,939       |96.1                         

                                                                               

                   |2,122,216     |2,033,858     |95.8                         

North West Thames                                                              

  RHA                                                                          

Bedfordshire       |539,737       |571,500       |105.9                        

Hertfordshire      |995,681       |1,036,258     |104.1                        

Barnet             |306,691       |361,439       |117.9                        

Brent and Harrow   |450,807       |560,106       |124.2                        

Ealing,                                                                        

  Hammersmith and                                                              

  Hounslow         |647,164       |825,644       |127.6                        

Hillingdon         |240,156       |244,042       |101.6                        

Kensington Chelsea                                                             

  and Westminster  |339,330       |413,167       |121.8                        

                                                                               

                   |3,519,566     |4,012,156     |114.0                        

North East Thames                                                              

  RHA                                                                          

Essex              |1,564,673     |1,582,637     |101.1                        

Barking and                                                                    

  Havering         |373,998       |391,552       |104.7                        

Camden and                                                                     

  Islington        |356,223       |443,531       |124.5                        

City and East                                                                  

  London           |590,117       |697,054       |118.1                        

Enfield and                                                                    

  Haringey         |466,444       |542,419       |116.3                        

Redbridge and                                                                  

  Waltham Forest   |447,799       |464,654       |103.8                        

                                                                               

                   |3,799,254     |4,121,847     |108.5                        

South East Thames                                                              

  RHA                                                                          

East Sussex        |723,252       |731,975       |101.2                        

Kent               |1,551,464     |1,583,583     |102.1                        

Greenwich and                                                                  

  Bexley           |436,818       |441,546       |101.1                        

Bromley            |300,271       |301,464       |100.4                        

Lambeth Southwark                                                              

  and Lewisham     |723,696       |869,658       |120.2                        

                                                                               

                   |3,735,501     |2,928,226     |105.2                        

South West Thames                                                              

  RHA                                                                          

Surrey             |1,033,462     |1,061,272     |102.7                        

West Sussex        |723,637       |745,978       |103.1                        

Croydon            |320,881       |338,277       |105.4                        

Kingston and                                                                   

  Richmond         |309,028       |322,917       |104.5                        

Merton, Sutton and                                                             

  Wandsworth       |601,405       |645,079       |107.3                        

                                                                               

                   |2,988,413     |3,113,523     |104.2                        

Wessex RHA                                                                     

Dorset             |671,181       |677,774       |101.0                        

Hampshire          |1,595,950     |1,602,384     |100.4                        

Wiltshire          |587,895       |561,942       |95.6                         

Isle of Wight      |126,656       |126,474       |99.9                         

                                                                               

                   |2,981,682     |2,968,574     |99.6                         

Oxford RHA                                                                     

Berkshire          |764,097       |802,031       |105.0                        

Buckinghamshire    |659,288       |662,442       |100.5                        

Northamptonshire   |599,634       |596,526       |99.5                         

Oxfordshire        |588,051       |597,611       |101.6                        

                                                                               

                   |2,611,070     |2,658,610     |101.8                        

South Western RHA                                                              

Avon               |966,489       |994,668       |102.9                        

Cornwall and Isles                                                             

  of Scilly        |483,114       |478,040       |98.9                         

Devon              |1,052,488     |1,031,592     |98,0                         

Gloucestershire    |544,449       |552,682       |101.5                        

Somerset           |476,153       |469,561       |98.6                         

                                                                               

                   |3,522,693     |3,526,543     |100.1                        

West Midlands RHA                                                              

Hereford and                                                                   

  Worcester        |694,411       |682,018       |98.2                         

Shropshire         |417,005       |407,434       |97.7                         

Staffordshire      |1,059,474     |1,023,646     |96,6                         

Warwickshire       |492,357       |502,370       |102.0                        

Birmingham         |1,004,258     |1,068,805     |106.4                        

Coventry           |300,515       |325,178       |108.2                        

Dudley             |310,663       |319,786       |102.9                        

Sandwell           |292,431       |316,347       |108.2                        

Solihull           |203,364       |221,756       |109.0                        

Walsall            |263,261       |267,984       |101.8                        

Wolverhampton      |245,742       |258,337       |105.1                        

                                                                               

                   |5,283,481     |5,393,661     |102.1                        

Mersey RHA                                                                     

Cheshire           |976.735       |992,462       |101.6                        

Liverpool          |466,864       |493,005       |105.6                        

St. Helens and                                                                 

  Knowsley         |335,232       |354,729       |105.8                        

Sefton             |295,501       |289,070       |97.8                         

Wirral             |335,943       |341,934       |101.8                        

                                                                               

                   |2,410,275     |2,471,200     |102.5                        

North Western RHA                                                              

Lancashire         |1,419,625     |1,423,984     |100.3                        

Bolton             |265,692       |272,058       |102.4                        

Bury               |180,969       |183,415       |101.4                        

Manchester         |433,706       |476,980       |110.0                        

Oldham             |221,185       |213,580       |96.6                         

Rochdale           |207,033       |213,858       |103.3                        

Salford            |227,161       |245,733       |108.2                        

Stockport          |290,594       |295,034       |101.5                        

Tameside           |220,406       |216,056       |98.0                         

Trafford           |214,979       |221,441       |103.0                        

Wigan              |311,688       |292,774       |93.9                         

                                                                               

England            |48,549,799    |50,003,459    |103.0                        

The resident population includes members of Her Majesty's forces in England    

but the population registered with a General Practitioner excludes Her         

Majesty's Forces patients who move from one family health services authority   

area to another do not automatically change general practitioners at the same  

time.                                                                          

This will influence the percentage outcomes shown in the table.                

Capital Projects

Mr. Kevin Hughes: To ask the Secretary of State for Health if she will list (a) NHS trusts and (b) directly managed units which have received funding from (i) the Department of Health and (ii) the private sector for capital projects in each of the last four years, showing in each case the amount of funding involved.

Mr. Sackville [holding answer 15 December 1994]: Information is not available in the form requested. Capital funding for directly managed units is a matter for their parent district health authorities and information about individual units is not available centrally. National health


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service trusts are not funded directly for capital expenditure. Projects are financed by a combination of internally generated resources from trading, principally depreciation and retained surpluses, and loans. The NHS Executive controls the total expenditure of NHS trusts through external financing limits which allow for capital expenditure up to a certain approved level. The actual amount of capital expenditure is for each trust to determine provided expenditure is contained within its external financing limit. A table will be placed in the Library showing actual expenditure on capital assets, excluding donated assets, by each NHS trust. Information is provided for the financial years 1991 92, 1992 93 and 1993 94. There were no NHS trusts prior to 1991 92. NHS trusts do not normally use private sector funds for capital expenditure since loans are available to them from the NHS Executive at Treasury rates. NHS trusts principally use the private sector to obtain overdrafts to fund working capital requirements.

Termination Payments

Mr. Gordon Prentice: To ask the Secretary of State for Health how many termination payments have been made by national health service trusts to chief executives and general and senior managers; and what is the total amount for each trust to date.

Mr. Malone [pursuant to his reply, 9 December 1994, column 395]: I regret that my previous reply contained the following clerical errors:

i) the overall number of termination payments to National Health Service chief executives, senior and general managers notified to the NHS Executive was 54 rather than 48. The total failed to include some late notifications, although these are in the amounts shown for individual trusts;

ii) the total amount for Broadgreen Hospital NHS Trust was £42, 888 not £81,838. The figure was incorrectly shown against Burton Hospitals NHS Trust; and

iii) The total amount for Burton Hospital NHS Trust was £7,053 not £42,888.

Prescription Costs

Mr. Cann: To ask the Secretary of State for Health what percentage of prescription drugs cost less than £5.

Mrs. Beckett: To ask the Secretary of State for Health what percentage of prescriptions cost less than £5; what is the (a) average and (b) median cost of a prescription item; how many prescriptions were issued by doctors in the last year; how many prescriptions items were dispensed by pharmacists last year, in total, and by the family health service authority area; and what has been the total revenue generated by charging for prescriptions in each of the last 15 years.

Mr. Malone [pursuant to his reply, 9 December 1994, column 397]: I regret that some of the figures in the table " Percentage distribution by total cost of prescription items dispensed by community pharmacists, appliance contractors and dispensing doctors and prescription items personally administered by prescribing doctors in England in 1993, and the average total cost of such items " placed in the Library are incorrect. A correct table has been placed in the Library.


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