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Mr. Bowis: Decisions on treatment are the responsibility of the doctors concerned, who are required to exercise their clinical judgment, informed by a patient's medical history. Health authorities and trusts are responsible for ensuring that the full range of services is available, taking account of their priorities and resources.
Mr. Battle: To ask the Secretary of State for Health (1) what training is given to medical practitioners and their staff to ensure that there is a minimum of risk to (a) expectant mothers with epilepsy, (b) mothers with epilepsy and (c) children of mothers with epilepsy.
(2) what advice her Department gives to health authorities in respect of carers for children with epilepsy requiring the best possible training; and if she will make a statement.
Mr. Bowis: The education and training of health professionals is a matter for the relevant royal college. However, as part of the programme that I announced on 17 January, we shall be seeking to raise epilepsy awareness among general practitioners and primary care teams.
Mr. Cohen: To ask the Secretary of State for Health what assessment the Chief Medical Officer of Health has made of health dangers associated with asbestos; what new steps her Department proposes to take; and if she will make a statement.
Mr. Sackville: The principal diseases caused by exposure to asbestos are asbestosis, a pneumoconiosis; primary carcinoma of the lung; malignant mesothelioma; and diffuse mesothelioma. Asbestos-related diseases take a long time to develop and are nearly always the result of occupational exposure to asbestos fibres. Asbestos-related diseases are prescribed as industrial diseases. Such diseases occurring now largely reflect past industrial exposure before the introduction of the controls, enforcement of which is the responsibility of my right hon. Friend the Secretary of State for Employment.
Mr. Llwyd: To ask the Secretary of State for Health what was the total amount recouped by her Department through prescription charges in (a) 1992, (b) 1993 and (c) 1994; and if she will make a statement.
Mr. Malone: I refer the hon. Member to the reply that I gave to the right hon. Member for Derby, South (Mrs. Beckett) on 9 December 1994 at column 397 . Prescription charges provide valuable additional income to the national health service at a time of competing demands for resources.
Mr. Fabricant: To ask the Secretary of State for Health in respect of what proportion of prescriptions the patient claims exemption from prescription charges, what checks are made to monitor the accuracy of such claims; and what proportion of such claims are found to be false.
Mr. Malone: In 1993, 82 per cent. of prescription items were dispensed free of charge by community pharmacists and appliance contractors to patients who declared that they were exempt or entitled to remission of charges under the national health service low income scheme. Regular checks of patients declarations carried out by family health services authorities indicate that about 1.5 per cent. are incorrect. I am determined to take action to stamp out this abuse and all other forms of fraud against the NHS.
Year |millions --------------------------- 1990-91 |4.154 1991-92 |4.979 1992-93 |5.528 1993-94 |5.935 The number of private sight tests is not available.
Mr. Alton: To ask the Secretary of State for Health (1) how many yellow card reports of suspected adverse reactions linked to the autumn measles rubella vaccination campaign have been received by the Committee on the Safety of Medicines and Medicines Control Agency since 9 December 1994.
(2) if she will list the complications notified by the yellow card reports linked to the autumn measles rubella vaccination campaign received since 9 December 1994 in respect of (a) the number of individuals affected, (b) the number of signs and symptoms, (c) the number of more serious reactions, (d) the number of allergic reactions, (e) the number of reported convulsions and (f) the number with late neurological damage.
Mr. Sackville: Since 9 December 1994 the Medicines Control Agency has received a further 50 yellow card reports of suspected adverse reactions to measles rubella vaccine. A report for a suspected reaction does not necessarily mean that the vaccine caused the reaction. Signs and symptoms described in these reports have been classified as reactions. One hundred and fifty affected children were reported as having 281 reactions, of which 87--affecting 67 children--were considered to be serious. There were 15 allergic reactions, eight convulsions and seven late-onset neurological conditions, five of whom have recovered and two are recovering. Further information is being sought for some of the reactions to investigate their relationship with immunisation. It is estimated that eight million children have been immunised. Reporting of serious adverse reactions to date is therefore low.
Mr. Malone: The net ingredient cost--that is, the basic cost of drugs, less discount and excluding dispensing fees, container cost on cost allowance, oxygen payments and value added tax--of drugs prescribed and dispensed generically in England in 1993 was £341.6 million. For the first three quarters of 1994 the cost was £345.4 million.
The mortality rates for asthma for the last five years for which data are available are shown in the table:
Mortality rates<1> for asthma (ICD <2> code 493), England and Wales, 1988-92 Year |Rates ------------------ 1988 |4.0 1989 |3.9 1990 |3.6 1991 |3.7 1992 |3.5 <1> Deaths per 100,000 population. <2> International Classification of Diseases, 9th Revision.
Mr. Matthew Taylor: To ask the Secretary of State for Health if she will list the number of cases of asthma reported in each family health service authority for each of the last five years, broken down by ethnic origin.
Mr. Sackville: Data on newly diagnosed episodes of asthma are not available by ethnic origin or family health services authority. Aggregated data from returns submitted to the Birmingham research unit of the Royal College of General Practitioners are available in the Office of Population Censuses and Surveys annual reference volume, "Communicable Diseases-- Series MB2", copies of which are available in the Library. The latest data published are for the year 1992.
Mr. Sackville: This information is not available in the precise form requested. It is estimated that in England 101,000 patients suffering from glaucoma were treated by general practitioners during 1991 92--source: "Morbidity Statistics from General Practice". Comparative figures are not available for the other years requested. For hospital in-patients, the numbers of finished consultant episodes, ordinary admissions and day cases, during the latest available period of five years, were as follows:
Year |Number ---------------------- 1992-93 |22,802 1991-92 |19,826 1990-91 |17,534 1989-90 |17,427 1988-89 |15,373 Source: Hospital Episode Statistics.
Information on numbers of out-patient cases with glaucoma is not available centrally.
Mr. Rooker: To ask the Secretary of State for Health how many full and short version birth certificates are issued each year by the Registrar General; and how many applications are made by a person who is not the individual on the certificate nor related to them.
Mr. Sackville: In 1994 the Registrar General issued 245,961 full birth certificates and 12,469 short birth certificates. The Registrar General does not distinguish between applicants who are the subject of the certificate or their relatives and other applicants.
(2) if she will make a statement on arachnoidits.
Mr. Sackville: We have received a number of representations about Depo-Medrone and arachnoiditis. Depo-Medrone is licensed for use by certain specified routes of administration only and is not recommended for epidural or spinal administration. If a doctor, however, believes that use of a licensed drug in an unlicensed manner is the only suitable treatment for a patient he or she may supply or administer the drug, having obtained informed consent from the patient.
Column 400Family health services authorities can apply for permission to appoint salaried dentists in areas where there are shortages. We have recently given approval for two salaried dentists to be appointed by Devon family health services authority and for one salaried dentist to be appointed by Gloucestershire family health services authority. The Green Paper, "Improving NHS Dentistry", proposes a wider role for the community dental service to treat those who cannot have ready access to general dental services.
Mrs. Beckett: To ask the Secretary of State for Health how many family health services authorities have appointed salaried dentists; how many salaried dentists have been appointed since July 1992; for what additional provision district health authorities have contracted; and if she will make a statement.
Mr. Malone: The number of family health services authorities that have employed salaried dentists and the number employed are shown in the table. In addition to those family health services authorities listed, Berkshire, Devon, Dorset, Hampshire, Hereford and Worcester, Kingston and Richmond, Northamptonshire, Gloucestershire and Solihull have also been granted permission to employ salaried dentists. At 30 September 1992 there were 2,191 whole-time equivalent hospital and community health service staff in England, excluding hospital practitioners and clinical assistants who also work as general and dental practitioners.
Table 1 number of salaried dentists for whom a contract has opened since 31 July 1992 by family health service authority FHSA |Salaried dentists ------------------------------------------------------------------------ Total |137 Cumbria |1 Derbyshire |3 Cambridgeshire |7 Norfolk |3 Kensington, Chelsea and Westminster |14 Essex |2 City and East London |22 Kent |11 Greenwich and Bexley |6 Bromley |1 Lambeth, Southwark and Lewisham |22 Surrey |5 Merton, Sutton and Wandsworth |1 Wiltshire |2 Isle of Wight |2 Buckinghamshire |6 Cornwall and Isles of Scilly |5 Gloucestershire |4 Somerset |6 Staffordshire |2 Cheshire |8 Lancashire |2 Manchester |1 Salford |1 This is the count of the number of salaried dentists who have contracts with FHSAs. This is not the number of salaried dentists employed at the requested dates. (Some salaried dentists have "open contracts" with FHSAs. This means they are ready to work when required but are not actually working).
Mrs. Beckett: To ask the Secretary of State for Health how many letters concerning problems in gaining access to NHS dentistry have been received by her Department from individuals in the last five years; and if she will list those organisations that have written to her on the subject.
Mr. Malone: Since February 1990, the Department of Health has received approximately 350 letters from members of the public which were exclusively concerned with problems in gaining access to national health service general dental services.
The Department has also received a similar number of letters from hon. and right hon. Members, community health councils, local authorities, professional organisations and patient groups. Family health service authorities continue to be the best source of information on the local availability of general dental services, and all authorities report that they are able to help patients to find NHS dentists.
Payments to general dental practitioners working with the national health service in England in each month since April 1991 Month |1991-92 |1992-93 |1993-94 |1994-95 |£ million|£ million|£ million|£ million ------------------------------------------------------------ April |92.3 |118.9 |101.1 |104.3 May |93.4 |118.8 |103.6 |105.2 June |95.8 |114.0 |103.0 |110.7 July |102.1 |117.0 |102.8 |109.9 August |106.8 |115.7 |103.9 |109.9 September |94.1 |103.2 |98.8 |104.0 October |101.4 |100.9 |100.9 |106.6 November |110.7 |104.3 |103.7 |111.10 December |113.3 |104.5 |98.5 |109.8 January |103.1 |108.6 |100.8 |106.6 February |117.3 |101.4 |104.2 |- March |116.7 |97.7 |100.1 |- Notes: 1. The data are for England only and are drawn from monthly cash-based financial information system reports submitted by family health services authorities and the Dental Practice Board. The January data are the latest available for 1994-95. 2. Expenditure figures show the total of all general dental service payments in each month, including payments for salaried dentists and emergency dental service clinics. The figures also include the cost of employers' superannuation contributions.
Mrs. Beckett: To ask the Secretary of State for Health what is the average cost per course of (a) NHS dental treatment, (b) private dental treatment and (c) all dental treatments for an adult patient in 1993 94, 1992 93, and 1991 92.
Average cost per adult course of treatment in the general dental service in England for the financial years 1991-92 to 1993-94 Year |Average cost £ --------------------------------------------- 1991-92 |39.80 1992-93 |39.11 1993-94 |36.18 Source: Dental Practice Board. Note: 1. The information refers to the general dental service only. The cost shown is the fee paid to the dentist.
Mrs. Beckett: To ask the Secretary of State for Health what is the average annual number of courses of dental treatment for an adult patient in England; and what is the average cost to (a) the NHS and (b) the patient.
Information for courses of treatment completed in the year ending 31 March 1994 |£ ---------------------------------------------------------- Average number of courses of treatment per adult patient |1.62 Average annual cost to the NHS of treatment per adult patient |31.34 Average annual cost to the adult patient |£27.27 Notes: 1. The average number of courses of treatment per patient has been estimated from a sample of 70,000 courses of treatment. 2. The costs shown are the costs of adult treatment. Regular continuing care payments are not included. 3. The average to the patient represents the average for all adults, not the average to charge payers alone.
Mr. Malone: "British Social Attitudes: the 11th Report", 1994 95 edition, found that 58 per cent. of respondents surveyed in 1993 were satisfied or very satisfied with national health service dentists. A further 18.6 per cent. were neither satisfied nor dissatisfied. The comparable figures from the 9th report, 1992 93 edition, were 75.3 per cent. and 16.2 per cent.
Family health services authorities report that they can help patients to find national health service dentists. The Government meet over two thirds of the cost of the general dental service. All those under 18 get free treatment and a quarter of treatments are provided free or at reduced cost.
Mrs. Beckett: To ask the Secretary of State for Health by how much payments to dentists have exceeded Government estimates for each year since 1987; and how much was paid by Government and how much by patients.
Overpayment of general dental practitioners fee income, 1987-88 to 1993-94, Great Britain Total payment (to all DRSG principals) |"Gross" payments|"Net" payment |(£ million) |(£ million) |(1) |(2) -------------------------------------------------------------------- 1987-88 |(5.003) |22.722 1988-89 |49.276 |74.494 1989-90 |(13.645) |12.256 1990-91 |54.582 |17.921 1991-92 |192.604 |128.140 1992-93 |65.001 |62.920 1993-94 |(49.354) |4.143 () Denotes a negative amount.
Overpayment of general dental practitioners fee income, 1987-88 to 1993-94, Great Britain: payment by Government Total payment (to all DRSG principals) |"Gross" payments|"Net" payment |(£ million) |(£ million) -------------------------------------------------------------------- 1987-88 |(3.544) |16.095 1988-89 |34.379 |51.974 1989-90 |(8.511) |7.645 1990-91 |35.171 |11.548 1991-92 |131.203 |87.290 1992-93 |45.536 |44.078 1993-94 |(34.609) |2.905
Overpayment of general dental practitioners fee income, 1987-88 to 1993-94, Great Britain: payment by patients Total payment (to all DRSG principals) |"Gross" payments|"Net" payment |(£ million) |(£ million) -------------------------------------------------------------------- 1987-88 |1.459 |6.627 1988-89 |14.896 |22.520 1989-90 |5.134 |4.611 1990-91 |19.410 |6.373 1991-92 |61.400 |40.850 1992-93 |19.466 |18.843 1993-94 |14.745 |1.238 Notes: 1. Column (1) shows the difference between actual gross fee payments made to dentists in the financial year and the estimates made of sums due to GDPs in the Dental Rates Study Group. The estimates include allowances for GDPs expenses. For 1993-94 an expenses allowance was not formally agreed but a notional amount decided upon for administrative and monitoring purposes. 2. Column (2) shows the difference between target net income (after balancing) and the actual net income, allowing for the practice expenses incurred. This is calculated using information from a special exercise carried out by the Inland Revenue. 3. DRSG principals are essentially general dental practitioners who have worked in the GDS for the whole of the financial year in question. 4. The overpayment sums have been allocated to patient and Government by using total net and gross expenditure figures. 5. Payments made under determinations 11-1X of the Statement of Dental Remuneration (eg maternity payments, seniority payments and direct reimbursement of expenses) are not included in the above. 6. The net payment figures for 1987-88 excludes the balancing adjustment for associate dentists (£225 "underpayment" per principal; £3.37 million in total). Subsequent to 1987-88 this adjustment was not required. 7. The figures in columns (2) and (4) for 1993-94 are provisional, and are subject to revision.
Mr. Sackville: The national three-year no-smoking campaign, which was launched in December 1994, is being undertaken by the Health Education Authority on behalf of the Department of Health. It is being evaluated in terms of its effectiveness in changing knowledge, attitudes and behaviour in the general population.
Individual components of the campaign will also be monitored for impact among specific groups.
Mr. Alex Carlile: To ask the Secretary of State for Health what has been the reduction in treatment costs of smoking-related diseases since the beginning of the current no-smoking campaign; and if she will make a statement.
Mr. Sackville: It is not possible to relate recent reductions in smoking prevalence to current levels of smoking-related disease. Many smoking-related diseases have a lengthy development period and most of these manifesting themselves now are related to the smoking habits prevailing some 20 or 30 years ago.
Mr. Alex Carlile: To ask the Secretary of State for Health if she will make a statement on the review of intensive care for children undertaken by regional health authorities and regional branches of the NHS Executive.
Mr. Sackville: The reviews confirm that plans have been made to improve the provision of paediatric intensive care. The Department is consulting on the further work required to guide the implementation of these plans towards achieving an accessible and cost effective service nationally.
Mr. Sackville: 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. Alex Carlile: To ask the Secretary of State for Health if she will list the cardiac diseases researched by her Department and the amount spent on each, for the last year for which figures are available.
Recently completed research
the effects of passive smoking: review and analysis of data on the contribution of passive smoking to coronary heart disease (1 11 93 to 30 4 94--£24,335);
British Regional Heart Study: prediction and prevention of cardiovascular disease (1 10 85 to 31 12 95--£311,807);
Lipids and coronary heart disease (1 1 87 to 31 3 92--£25,000); Coronary heart disease: the role of the GP (1 10 90 to 30 9 92-- £181,232);
Randomised controlled trial of coronary risk factor intervention (1 1 93 to 31 12 93--£299,192);
National Study of Health and Growth: assessing coronary disease risk factors and bronchial reactivity in children (1 12 91 to 31 12 92-- £30,123);
(All the amounts quoted for research are for the entire duration of each project).
Nottingham Heart Attack Register (1 8 88 to 31 3 98--£657,283); Whickham revisited: cardiovascular proposal (1 3 93 to 28 2 95-- £83,000);
Prospective markers of anti-oxidant status in relation to future cardiovascular disease, lung and stomach cancer (1 4 93 to 31 3 95-- £183,972);
CSAG: Waiting times for coronary revascularisation (1 10 94 to 31 1 95; £38,489);
Development and validation of a weight-losing dietary intervention to reduce the risk of diabetes and CHD in South Asians (1 7 94 to 31 12 96-- £176,987).
Figures for on-going projects are estimates.
Mr. Alex Carlile: To ask the Secretary of State for Health what were the numbers and percentage of emergency ambulance calls, in each ambulance service area, which took (a) up to 14 minutes, (b) each subsequent minute up to 60 minutes and (c) over 60 minutes, since April 1994.
Mr. Sackville: Information on calls up to 14 minutes in urban areas can be found in the patients charter, copies of which are available in the Library. The remaining information is not available centrally.
Mrs. Beckett: To ask the Secretary of State for Health what amount of compensation has been paid to members of the public by the London ambulance service due to delays in reaching patients calling the emergency service in each of the last five years.
Column 406targets. The task force's "Eat Well!" programme comprises a number of projects for this purpose. The ministerial Cabinet committee, chaired by my right hon. Friend the Lord President of the Council, and the Chief Medical Officer's health of the nation working group, play a role in ensuring that progress towards targets is being made.
Mr. Madden: To ask the Secretary of State for Health (1) what representations she has received about the information required to be obtained by those in pharmacies from those presenting prescription forms; what assessment she has made of the intrusiveness of the information required; and what arrangements are being made to print prescription forms in larger type and in ethnic minority languages; (2) which professional bodies were consulted about the design and content of the prescription forms to be issued shortly; on which dates such consultation took place; if consultation resulted in favourable reaction to the content; how many prescription forms have been printed to date; how many remain to be printed; what is the total cost of printing and distribution; and if she will make a statement.
Mr. Malone: From 1 April 1995 the already wide-ranging national health service prescription charge exemption and remission arrangements presently covering 81 per cent. of prescription items will be further extended to include all recipients of disabled working allowance who had less than £8,000 capital at the date of their claim. The prescription form FP10 must be amended to reflect that.
I am also taking the opportunity to amend the declaration to make it applicable to all patients. In doing so the Government are responding to concerns of both the Health Select Committee and the Audit Commission, who have suggested that the laxity of the present patient declarations leave the way open for fraudulent claims. By asking all patients to sign the patient declaration we are taking an important first step in stamping out that abuse.
We are currently discussing with the general medical services committee of the British Medical Association and the pharmaceutical services negotiating committee about incorporating these changes into their terms of service. I hope to lay amending regulations in the summer.
There have been no additional printing and distribution costs. The changes were incorporated into the form during a regular print run. It has never been our practice to print prescription forms either in large print or in ethnic minority languages.