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motor vehicle insurance policies and is payable by vehicle users, in respect of each person given immediate treatment or examination arising from a road traffic accident.Overseas Health Care Companies
Mr. Nicholas Brown: To ask the Secretary of State for Health what representations her Department has received from health care firms from abroad seeking to expand into the United Kingdom health sector. [16889]
Mr. Sackville: Ministers and officials receive representations from health care firms from abroad on a regular basis. As such representations can take the form of visits, telephone calls or letters and can be made at ministerial or official level no figure on the number of representations is kept or can be estimated.
Lindane
Mr. Mackinlay: To ask the Secretary of State for Health what evidence or research is available from (a) within the United Kingdom, (b) the USA and (c) other countries in respect of any correlation between aplastic anaemia and bone marrow failure with the use of lindane, gamma HCH or gamma BHC; and if she will make a statement. [15497]
Mr. Sackville: In 1992 the Advisory Committee on Pesticides reviewed the substantial number of worldwide reports, published in the open literature as well as unpublished reports, on lindane exposure and aplastic anaemia. The ACP review focused particularly on cases of people in the United Kingdom who had been diagnosed as having aplastic anaemia and who had been exposed to lindane in pesticidal products. The committee concluded that the weight of evidence suggested that lindane does not cause aplastic anaemia in man. On the basis of the information available, the ACP recommended that no regulatory action on this aspect was justified.
Mr. Mackinlay: To ask the Secretary of State for Health what evidence she has of skin complaints being caused by lindane, gamma HCH or gamma BHC; and if she will make a statement. [15496]
Mr. Sackville: In the United Kingdom lindane is used mainly as an agricultural pesticide. Its only other use in the UK is in some products licensed under the Medicines Act 1986 for the treatment of scabies and crablice, and available only from pharmacies. There are no veterinary uses of lindane in the UK.
The London poisons unit undertook a review of suspected cases of lindane poisoning reported to the unit between 1969 and 1988. The results were submitted to the Advisory Committee on Pesticides for evaluation during its review of lindane in 1991 92. Data were available on 110 cases, in six of which skin irritation was reported. Details of this review were published in December 1992 in the document "Evaluation on Gamma HCH (Lindane 2," copies of which are available in the Library.
Dermatoses can be caused by an allergic reaction to any chemical, whether naturally occurring or manufactured, and some people may be especially sensitive to ingredients of pesticides or medicines. Apart from these very rare cases, no adverse effects should be expected in the short, medium or long term if the product is used in strict accordance with the recommendations on the label and accompanying literature, which give dose and safety precautions.
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Mr. Mackinlay: To ask the Secretary of State for Health what evidence is available from the World Health Organisation regarding the rates of breast cancer in countries where the use of lindane or gamma hexachlorocyclohexane is banned or restricted. [15502]
Mr. Sackville: Lindane is used in many countries. In developed countries, the use of pesticides is regulated by the conditions of approval, and is to that extent restricted. Conditions of approval vary from country to country. Since 1984 lindane, or gamma hexachlorocyclohexane, has been withdrawn from use as a pesticide in Indonesia, Kuwait, Morocco, New Zealand, St. Lucia and two European Union countries, Sweden and Finland.
There are several known risk factors involved in the development of breast cancer but no convincing evidence that exposure to lindane is one. Breast cancer rates alone, in countries in which lindane is banned, give no indication of whether or not there might be a causal relationship.
Mr. Mackinlay: To ask the Secretary of State for Health what assessment she has made of the effect of exposure to lindane gamma HCH or gamma BHC on pregnant women and their foetuses. [15493]
Mr. Sackville: The information on humans is very limited. Adverse effects have been reported in spray operators or workers involved in the manufacture of gamma HCH. These include an increased incidence of spontaneous abortions and stillbirths. However, in all cases exposure to other pesticides or chemicals involved in the manufacture of gamma HCH occurred, therefore it is not possible to conclude that these effects are related to exposure to gamma HCH.
The Advisory Committee on Pesticides has reviewed both published and unpublished data on the effects of lindane on human and animal reproduction and fertility. It did not conclude that, used under the terms of approval, there is a risk from lindane to pregnant women or their foetus.
Full details were given in the document "Evaluation of Gamma HCH (Lindane 2)", December 1992, copies of which are available in the Library.
Mr. Mackinlay: To ask the Secretary of State for Health in which EU countries lindane, gamma HCH and gamma BHC are banned or restricted; and if she will make a statement [15506]
Mr. Sackville: The use of lindane is restricted in the United Kingdom and all other European Union countries. Approval for the use of lindane as a pesticide has been withdrawn in Sweden and Finland.
Mr. Mackinlay: To ask the Secretary of State for Health what evidence she has that lindane, gamma HCH or gamma BHC causes or contributes to CHARGE syndrome; and if she will make a statement. [15494]
Mr. Sackville: In 1994 the subcommittee on pesticides reviewed data from the CHARGE Association family support group, and cases of CHARGE syndrome linked with pesticide exposure which had been reported to the Health and Safety Executive. The SCP agreed that no conclusions could be drawn from the reports available, but that the situation be reviewed on a periodic basis.
Mr. Mackinlay: To ask the Secretary of State for Health which products designed to kill lice on children
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contain lindane, gamma HCH or gamma BHC; and if she will make a statement. [15495]Mr. Sackville: Medicines Control Agency records show that quellada application is the only product currently licensed in the United Kingdom containing lindane--alternatively known as gamma HCH or gamma BHC--which is indicated to kill lice on children.
The Medicines Control Agency ensures that all medicines on the UK market meet acceptable standards of safety, quality and efficacy.
Organochlorines
Mr. Mackinlay: To ask the Secretary of State for Health what evidence she has that organochlorines may be a contributory factor in the cause of breast cancer; and if she will make a statement. [15510]
Mr. Sackville: The Department of Health's independent expert advisory committee on the carcinogenicity of chemicals in food, consumer products and the environment reviewed the available epidemiology data on breast cancer in women and levels of lindane in serum and breast fat tissue at its meeting on the 16 March 1995. The committee concluded that there was no clear evidence of an association between serum and fat levels of lindane and breast cancer at the present time, and recommended that the matter be kept under review.
Well Woman Centres
Mr. Hinchliffe: To ask the Secretary of State for Health if she will list each well woman centre and indicate which are currently part-funded by individual health authorities.
Mr. Sackville: This information is not available centrally.
Mr. Hinchliffe: To ask the Secretary of State for Health what guidance she has given to fundholding general practitioners regarding purchasing from well woman centres. [15754]
It is for national health service purchasers, both fundholding general practitioners and health authorities, to decide whether, and to what extent, they purchase services from well woman centres. Not all services which are provided by well woman centres are included in the fundholding scheme.
Handle with Care" Leaflet
Mr. Hinchliffe: To ask the Secretary of State for Health what age of child is dealt with in the "Handle with Care" leaflet, sponsored by her Department. [15752]
Mr. Bowis: Babies and toddlers.
Clinical Negligence
Mr. Milburn: To ask the Secretary of State for Health, pursuant to her answer of 6 March, Official Report, columns 41 42, if the figures for clinical negligence include legal costs; and if she will itemise those costs. [15750]
Mr. Malone: All the figures include legal costs. The new method of estimating total costs of clinical negligence is not broken down between legal costs and damages paid.
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NHS Trusts
Mr. Milburn: To ask the Secretary of State for Health which management consultants have been employed by her Department to assist in the assessment of applications for NHS units for trust status; how much each was paid; and how many assessments they undertook in each wave. [15846]
Mr. Malone: I refer the hon. Member to the replies the then Minister for Health, my right hon. Friend the Member for Peterborough (Dr. Mawhinney), gave him on 3 November 1993, Official Report, column 225, and on 12 July 1994, Official Report, column 528. The information for the fifth wave of national health service trusts is as shown.
|Number of |Cost
Lead management |assessments |£
consultants
------------------------------------------------------------------
BDO Consulting |17 |15,139
KPMG Peat Marwick |52,139
Deregulation
Mr. Steen: To ask the Secretary of State for Health if she will ensure that her ministerial management information system for establishing objectives for her Department, includes deregulation objectives (a) for her and (b) for each of the Ministers within her Department. [15564]
Mr. Sackville: The need to avoid unnecessary regulatory burdens on business and on others is identified as an objective in my right hon. Friend the Secretary of State's statement of aims, goals, priorities and key challenges for the Department of Health for 1994 95, and subsequent years, which was published on 18 April 1994 and placed in the Library. Each Minister has to pursue this objective in the policy areas for which he or she is responsible. There is also a Minister with particular responsibility for promoting deregulation in the Department.
Mr. Steen: To ask the Secretary of State for Health what targets she has for withdrawing regulations within her Department. [15545]
Mr. Sackville: I refer the hon. Member to the reply given by my hon. Friend the Under-Secretary of State for Corporate Affairs today.
Special Advisers
Mr. Campbell-Savours: To ask the Secretary of State for Health what facilities in terms of (a) access to telephones, (b) use of equipment, (c) use of offices, (d) access to ministerial meetings, (e) sight of correspondence, (f) attendance at interdepartmental meetings and (g) access to civil servants are available to specialist advisers in her Department. [15624]
Mr. Sackville: Special advisers are members of the civil service, have the same conditions of service as civil servants and are subject to the same rules of conduct as other civil servants, with certain limited exceptions. They have facilities appropriate to their duties.
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Mr. Campbell-Savours: To ask the Secretary of State for Health if she will list the names of those persons appointed as political advisers to her Department since May 1992. [15625]
Mr. Sackville: The Department has not appointed a special adviser since May 1992.
Children's Homes (Lay Assessors)
Mr. Hinchliffe: To ask the Secretary of State for Health what steps she is taking to ensure that appropriate police checks are undertaken in respect of lay assessors who have access to children's homes. [16043]
Mr. Bowis: Police checks are generally available for those who have substantial unsupervised access to children in children's homes. Lay assessors do not fall into this category. It is the responsibility of local authorities to satisfy themselves about the suitability of people they engage as lay assessors, for example by checking CVs and taking up references.
Hepatitis
Mr. Alex Carlile: To ask the Secretary of State for Health how many died as a result of infection with the hepatitis C virus in the NHS for (a) 1992, (b) 1993, and (c) 1994. [16583]
Mr. Sackville: The current international classification of diseases, 9th revision, does not allow us separately to identify the hepatitis C virus.
Mr. Alex Carlile: To ask the Secretary of State for Health how many people currently have the hepatitis C virus in the United Kingdom. [16585]
Mr. Sackville: There have been no large population seroprevalence studies in the United Kingdom which could give precise estimates of the numbers infected.
Small studies in transfusion centres at the time of introducing HCV testing estimated the prevalence in blood donors to be 0.06 per cent. This would be an underestimate of the numbers in the United Kingdom population as a whole because the group at most risk of infection, those who have injected drugs, are asked to self-defer from blood donation. There is evidence to suggest that perhaps between 50 and 80 per cent. of intravenous drug users have been infected with hepatitis C. Rates vary with geographical area.
Mr. Alex Carlile: To ask the Secretary of State for Health how many people with haemophilia died as a result of infection with the hepatitis C virus in the NHS in (a) 1992, (b) 1993 and (c) 1994. [16630]
Mr. Sackville: We understand from the United Kingdom haemophilia directors that, of 119 haemophilia patients known to have died in 1992, 10 showed the cause of death as liver disease of which hepatitis C may have been the cause. In respect of the 1993 figures, I refer the hon. and learned Member to the reply I gave the hon. Member for Liverpool, Mossley Hill (Mr. Alton) on 1 December 1994, column 830 . I understand that figures for 1994 are not yet available.
Haemophilia
Mr. Alex Carlile: To ask the Secretary of State for Health what research her Department carried out since 1989 on haemophilia; and if she will make a statement. [16582]
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Mr. Sackville: The Department has not carried out any such research. The main agency that the Government support for 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.
Breast Cancer
Mr. Alex Carlile: To ask the Secretary of State for Health what is the current mortality rate for women with breast cancer in England, for each health authority. [16580]
Mr. Sackville: The latest available data on incidence to mortality ratios are published in table 15 of cancer statistics, registration, 1989, series MB1, No. 22, HMSO, 1994, copies of which are available in the Library.
Mr. Alex Carlile: To ask the Secretary of State for Health how many women have died from breast cancer in the United Kingdom in each year since 1989. [16581]
Mr. Sackville: The information is shown in the table.
Number of women who
have died from
breast cancer-ICD<1>
174-in the United
Kingdom, 1989-1992.
---------------------
1989 |15,667
1990 |15,179
1991 |15,403
1992 |15,221
Mr. Alex Carlile: To ask the Secretary of State for Health how many men were diagnosed with breast cancer in the NHS for (a) 1992, (b) 1993 and (c) 1994 respectively; and if she will make a statement. [16579]
Mr. Sackville: The latest available data on male breast cancer registrations are published in table 2 of cancer statistics, registrations, 1989, series MB1 No. 22, HMSO, 1994, copies of which are available in the Library.
Asthma
Mr. Alex Carlile: To ask the Secretary of State for Health what was the cost to the NHS of asthma, and asthma-related disorders for (a) 1992, (b) 1993, and (c) 1994. [16584]
Mr. Sackville: The net ingredient cost of national health service prescriptions for asthma medication was £305.2 million in 1992, £348.6 million in 1993 and £381 million in 1994. The net ingredient cost is the basic price of a drug before discounts and the addition of dispensing costs or fees. Information on the cost of other NHS services for asthma is not available for the years requested. In 1989 90, excluding community health services, they cost an estimated £72 million.
Wakefield Health Authority
Mr. Hinchliffe: To ask the Secretary of State for Health what role is played by the chair of the Yorkshire and Northern health region in the strategic planning of health care within the area covered by Wakefield health authority. [16350]
Mr. Sackville: District health authorities are directly accountable to regional health authorities. The regional health authority provides the strategic framework for regulating the relationship between purchasers and providers and ensures that local services are developed within the context of national guidelines. The authority
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also seeks to ensure that the most comprehensive and cost-effective balance of primary and secondary services is secured at a local level.Strategic Decisions
Mr. Hinchliffe: To ask the Secretary of State for Health what mechanisms exist to resolve disagreements on strategic decisions at local level between purchasers and providers and community health councils. [16348]
Mr. Malone: Health authorities are expected to consult health care providers about local health strategies and to make every endeavour to resolve differences locally. Disagreement between health authorities and providers can be referred to the regional health authority for arbitration as set out in EL(91)11, "NHS Contracts: Guidance on Resolving Disputes." Health Authorities are required, under regulation 19 of the Community Health Council Regulations, as amended, to consult the community health council on proposals for substantial developments or variations in the provision of health services in the district. Copies of EL(91)11 are available in the Library.
Mr. Hinchliffe: To ask the Secretary of State for Health what is her policy on the extent to which the strategic planning of health provision at local level may be affected by the decisions of private investors of capital. [16351]
Mr. Sackville: The strategic planning of health provision is undertaken by the national health service. It is not affected by the decisions of private investors of capital.
Chorionic Villus Sampling
Mr. Alton: To ask the Secretary of State for Health (1) what information she has on the link between chorionic villus sampling intrauterine tests and subsequent deformities in babies subjected to the test; [16341]
(2) if she will launch an investigation into the links between chorionic villus sampling and deformities in babies; [16343] (3) what follow- up of mothers and babies who have been subjected to chorionic villus sampling tests her Department undertakes; [16342] (4) how many cases of deformities in babies subjected to the chorionic villus sampling test her Department knows of. [16344]
Mr. Sackville: I refer the hon. Member to the reply I gave the hon. Member for Cunninghame, North (Mr. Wilson) on 22 March, columns 207 208.
A further article in The Lancet in 1994 considered the risks associated with chorionic villus sampling undertaken between 56 and 72 days' gestation.
The follow-up of mothers and babies is a matter for local clinical decision. The continuing surveillance and monitoring of babies' health to detect any deviation from normal health is accepted as good clinical practice in the national health service. The recent report of the Advisory Group on Congential Limb Reduction Defects published in February 1995 drew attention to the need for a hypothesis-driven study of the putative causal link between chorionic villus sampling and limb reduction deformity. The Department is awaiting the results of a major study carried out in the United States before taking
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this forward. It seems most likely that this study will address many of these questions.Firth Boyd, Chamberlain, Mackenzie and Huson, analysis of limb reduction defects in babies exposed to chorionic villus sampling, The Lancet, Vol 343, 30 April 1994.
Newchurch and Company Database
Mr. Hinchliffe: To ask the Secretary of State for Health what is the cost to the NHS executive of setting up the private finance database run by Newchurch and Company. [16522]
Ms Sackville: The cost to the Department of Health national health service executive of setting up the private finance database run by Newchurch and Company and operating it to date has been £70,000 plus £12,250 value added tax.
Internal Market
Mr. Hinchliffe: To ask the Secretary of State for Health what objective assessment of the operation of the internal market in health in any particular locality is undertaken on her behalf. [16352]
Mr. Sackville: The main way in which the operation of the internal market is assessed is through the monitoring of the performance of trusts and district health authorities against targets and objectives which are set to ensure the national health service delivers good-quality, responsive services in an efficient manner. These include: performance against the patients charter standards which have recently been expanded; position on waiting times; extent of efficiency gains measured through the efficiency index; and progress towards achievement of "The Health of the Nation" targets. These are available at a district level.
Waiting Times
Mr. Morgan: To ask the Secretary of State for Health (1) what information she has on requests by general practices to hospitals to delay to come in--TCI--dates for non-urgent patients until the commencement of the new financial year for financial reasons; [16680]
(2) what guidelines she has given to general practices concerning the information to be supplied to patients, whose non-urgent TCI dates have been delayed as the request of their general practice until the commencement of the new financial year for exclusively financial reasons; and if she will make a statement. [16676]
Mr. Malone: Fundholding general practitioners, like other national health service purchasers of health care, are required to assess the needs of their population and establish contracts for services accordingly. All emergency cases will be seen immediately and urgent cases are placed on a common waiting list. For non-urgent cases, national or local patients charter standards apply. The patients charter makes it clear that health authorities and general practitioners should give detailed information to patients on local health services, including quality standards and maximum waiting times.
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Pinderfields Hospital
Mr. Hinchliffe: To ask the Secretary of State for Health if she will make it her policy to ensure that Pinderfields hospital, Wakefield, remains open as a district general hospital maintaining regional specialisms. [16349]
Mr. Sackville: This is a matter for the Northern and Yorkshire regional health authority. The hon. Member may wish to contact Mr. John Greetham CBE, chairman of the authority, for details.
Local Health Provision
Mr. Hincliffe: To ask the Secretary of State for Health what factors determine whether she would intervene in the proposals of an individual health authority with regard to future health provision at local level. [16347]
Mr. Malone: It is for health authorities to determine health provision for their area taking account of local needs. Normally, Ministers are involved only in cases where, following consultation by the health authority, plans to close or significantly change the use of health service facilities are contested by the community health council.
WALES
European Union Funding
Mr. Alan W. Williams: To ask the Secretary of State for Wales if he will publish a table giving the total amount of European Community money that has been awarded in grants for each financial year from 1986 87 to the present to (a) each local authority in Wales, (b) the Welsh Development Agency and (c) other organisations, giving the total annually of all such EC grants to Wales. [15346]
Mr. Redwood [holding answer 22 March 1995]: The information requested could be provided only at disproportionate cost.
Special Advisers
Mr. Campbell-Savours: To ask the Secretary of State for Wales what facilities in terms of (a) access to telephones, (b) use of equipment, (c) use of offices, (d) access to ministerial meetings (e) sight of correspondence, (f) attendance at interdepartmental meetings and (g) access to civil servants are available to specialist advisers in his Department. [15602]
Mr. Redwood: Special advisers are members of the civil service, have the same conditions of service as civil servants and are subject to the same rules of conduct as other civil servants, with certain limited exceptions. They have facilities appropriate to their duties.
Deregulation
Mr. Steen: To ask the Secretary of State for Wales what targets he has for withdrawing regulations within his Department. [15548]
Mr. Redwood: I refer the hon. Member to the answer given today by the Under-Secretary of State for Corporate Affairs.
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