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HEALTH

General Practitioners

Mr. Spearing: To ask the Secretary of State for Health which bodies are responsible for ensuring adequate minimum standards of establishment and functions of deputising services for general practitioners. [10901]

Mr. Malone: Health authorities are responsible for ensuring that general practitioners only use deputising services which are of a satisfactory standard.

NHS Trusts (Patients' Cash)

Mr. Chris Smith: To ask the Secretary of State for Health what guidance is given to NHS trusts about cash handed over for safekeeping on admission to the care of the trust. [11243]

Mr. Horam: Guidance on safeguarding patients' property formed part of the national health service executive's model standing financial instructions issued to all NHS trusts in 1994. The guidance sets out the trust's responsibility to provide safe custody for money and other personal property handed in by patients.

Meningitis

Mr. Cohen: To ask the Secretary of State for Health what estimate he has made of the number of cases of meningitis in the last three months of 1996; and if he will make a statement. [11064]

Mr. Horam: There were 368 laboratory confirmed reports of meningococcal infection by the Public Health Laboratory Service's meningococcal reference laboratory in the last three months of 1996. The latest mid-year to mid-year data show the number of cases in 1996 are currently running very slightly lower than in 1995:

	PHLS confirmed laboratory reports of meningococcal infection
1 July-22 December 1995	654
1 July-22 December 1996	585

Meningitis remains a rare, but serious, disease with a peak in the number of cases in children under one year and a second smaller peak in late teenagers. High awareness of the disease and parental alertness remain the best general protection which is why information on meningitis is targeted in these areas. Health visitors provide new parents with the Health Education Authority's leaflet, "A Guide to Childhood Immunisations", which includes advice on recognising the signs and symptoms of meningitis. The Department of Health and the National Meningitis Trust collaborated in providing an information leaflet for parents of small children and teenagers. The HEA also produced a leaflet, "Look out for your mate", targeted at students, which has been very widely distributed to colleges and universities. The Chief Medical Officer recently wrote to all doctors giving up-to-date advice on the early diagnosis of suspected cases of meningococcal infection and on the need for antibiotic treatment and urgent referral to hospital.

17 Jan 1997 : Column: 411

Tuberculosis and Rickets

Ms Walley: To ask the Secretary of State for Health what was the incidence of (a) tuberculosis and (b) rickets among those aged 0 to 19 years in each health authority area in each of the last five years; and if he will make a statement. [11604]

Mr. Horam: Information on the numbers of notifications of tuberculosis is not available in the form requested. The number of notifications to the Office for National Statistics under the Public Health (Infectious Diseases) Regulations 1988 are published by local authority district or by age in the publications, "MB2 Communicable Disease Statistics" annually and "MB2 Infectious Disease Statistics" quarterly. Copies are available in the Library. Total notifications for 0 to 19-year-olds for the last five years are:

Numbers of tuberculosis notifications, excluding chemoprophylaxis, England and Wales, 0 to 19-year-olds

	Tuberculosis notifications
1992	730
1993	785
1994	615
1995	631
1996 (first 39 weeks)	(3)429

(3) Provisional.

The United Kingdom has an excellent record of tuberculosis control and we are determined that this should remain the case through the BCG immunisation programme, treatment of identified cases and screening of their close contacts, screening and treatment for immigrants and active surveillance of tuberculosis.

Rickets is not a notifiable disease and data are not collected centrally. There are anecdotal reports of rickets in the medical literature, but these tend to be associated with extreme diets and insufficient exposure to sunlight. There is no reliable evidence that rickets is on the increase, and some evidence that rickets which used to be prevalent among Asian communities is now rare. The Committee on Medical Aspects of Food and Nutrition Policy has established an expert sub-group which is considering the nutritional aspects of bone health in the UK population.

17 Jan 1997 : Column: 412

Child Malnutrition

Ms Walley: To ask the Secretary of State for Health what monitoring he has undertaken of the incidence of (a) anaemia, (b) calcium deficiency and (c) vitamin D deficiency among those aged 0 to 19 years. [11605]

Mr. Horam: The nutritional status of 0 to 19-year-olds has been monitored by the Government's programme of nutrition and health surveys.

(a) Anaemia: The prevalence of anaemia has been monitored among young children by the "National Diet and Nutrition Survey of Children Aged 1½-4½ years" published by Her Majesty's Stationery Office in 1995; among those aged 18 to 24 years by the "National Diet and Nutrition Survey of British adults" published by HMSO in 1990, and among 16 to 24 year olds by the 1994 Health Survey for England published by HMSO in 1996. No survey has been analysed in respect of the specific age range 0 to 19 years. The results were as follows:
Prevalence of anaemia (haemoglobin below 11.0g/dl)

	Males(4) Percentage	Females(5) Percentage
NDNS 1½ to 4½ years	7	9
NDNS British Adults 18-24 years	1	6
Health Survey for England 16-24 years	0.2	2.1




(4) 1.0 per cent. below 13g/dl.

(5) 7.7 per cent. below 12g/dl.

(b) Calcium deficiency: There is no clinical condition which can be ascribed to dietary calcium deficiency.


(c) Vitamin D deficiency: The NDNS of Children aged 1½ to 4½ years found adequate vitamin D status in the general population. A review of reports of rickets, prepared for the panel on maternal and child nutrition of the Committee on Medical Aspects of Food and Nutrition Policy, found sporadic cases of rickets among specific groups who follow inappropriately rigid diets, but no evidence of rickets among the general population.

Vitamin D status has also been measured in the survey, "Asian infant feeding practice". The report is expected to be published later this year. Both the occurrence of anaemia and vitamin D status will be measured in the "National Diet and Nutrition Survey of Young People aged 4 to 18 years", the report of which is expected in 1999. The prevalence of anaemia among 11 to 15 year olds was measured in the "1995 Health Survey for England" which is expected to be published next month.

Care for the Elderly

Mr. Alan Howarth: To ask the Secretary of State for Health if he will update the estimates set out on 22 May 1995, Official Report, column 406, relating to the average cost of keeping an elderly infirm person in a (a) hospital bed, (b) nursing home and (c) residential care home. [10210]

Mr. Burns: The Department does not collect information on the average cost for the elderly and infirm of a place in a hospital, residential care home or a nursing home, but the Laing and Buisson market survey estimates, on the basis of the latest survey of independent sector homes, the average fees were £333 and £239 per week at August 1995 for nursing homes and residential care homes, respectively. These figures do not include contributions from individuals' income or from public sources.

17 Jan 1997 : Column: 413

The average cost of keeping an elderly infirm person in a hospital bed has been estimated by the personal social services research unit in "The Unit Cost of Health and Social Care", 1996, to be £114 per in-patient day, or £798 per week at 1995-96 prices.

In addition, figures on gross expenditure per week by local authorities for each supported resident in residential and nursing homes for the elderly in 1994-95, the latest year for which figures are available are given as item UCO2 and UCO3 in table U1 of "Key Indicators of Local Authority Social Services 1996", copies of which are available in the Library.

17 Jan 1997 : Column: 414

District Nurses

Mr. Kirkwood: To ask the Secretary of State for Health (1) how many district nurses there were per 5,000 people in each year since 1979; and if he will make a statement; [9774]

(2) how many district nurses there were in each year since 1979 (a) nationally and (b) by region; and if he will make a statement. [9773]

Mr. Horam: The information requested is shown in the tables.

17 Jan 1997 : Column: 413

NHS hospital and community health services nurses(6)(7) by regional health authority in England as at September 1979 to 1995whole-time equivalents

	1979(8)	1980	1981	1982	1983	1984	1985	1986	1987
England(9)	10,700	10,470	10,300	10,120	10,030	9,770	9,930	9,990	9,500
(per 5,000 head of population)	(1.15)	(1.13)	(1.10)	(1.08)	(1.07)	(1.04)	(1.05)	(1.06)	(1.00)
Northern	n/a	n/a	n/a	n/a	n/a	n/a	n/a	820	820
Yorkshire	n/a	n/a	n/a	n/a	n/a	n/a	n/a	720	740
Trent	n/a	n/a	n/a	n/a	n/a	n/a	n/a	1,000	1,000
East Anglia	n/a	n/a	n/a	n/a	n/a	n/a	n/a	390	360
North-west Thames	n/a	n/a	n/a	n/a	n/a	n/a	n/a	650	590
North-east Thames	n/a	n/a	n/a	n/a	n/a	n/a	n/a	650	630
South-east Thames(9)	n/a	n/a	n/a	n/a	n/a	n/a	n/a	720	480
South-west Thames	n/a	n/a	n/a	n/a	n/a	n/a	n/a	660	620
Wessex	n/a	n/a	n/a	n/a	n/a	n/a	n/a	650	620
Oxford	n/a	n/a	n/a	n/a	n/a	n/a	n/a	510	510
South Western	n/a	n/a	n/a	n/a	n/a	n/a	n/a	620	620
West Midlands	n/a	n/a	n/a	n/a	n/a	n/a	n/a	1,060	1,040
Mersey	n/a	n/a	n/a	n/a	n/a	n/a	n/a	520	530
North Western	n/a	n/a	n/a	n/a	n/a	n/a	n/a	1,000	920
SHAs and others	n/a	n/a	n/a	n/a	n/a	n/a	n/a	20	10
Not included in the figures above:
General Medical Service Practice nurses(10)	990	1,070	1,240	1,450	1,660	1,920	2,210	2,500	2,770

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17 Jan 1997 : Column: 413

whole-time equivalents

	1988	1989	1990	1991	1992	1993	1994	1995
England(9)	9,390	10,160	10,390	9,900	9,650	9,460	8,680	11,360
(per 5,000 head of population)	(0.99)	(1.06)	(1.08)	(1.03)	(1.00)	(1.00)	(0.98)	(1.16)
Northern	810	850	850	820	900	880	640	740
Yorkshire	710	790	780	660	630	630	620	750
Trent	1,030	1,040	1,010	980	930	850	820	1,010
East Anglia	370	370	350	350	330	320	300	610
North-west Thames	570	720	700	660	590	620	610	540
North-east Thames	610	710	730	710	710	680	620	890
South-east Thames(9)	410	350	790	680	670	620	530	1,070
South-west Thames	510	660	620	630	570	610	610	660
Wessex	620	640	630	620	630	660	570	630
Oxford	500	570	580	580	550	600	500	610
South Western	630	750	710	640	620	590	580	800
West Midlands	1,020	1,100	1,080	1,070	1,060	1,020	960	1,210
Mersey	510	570	550	520	490	480	460	380
North Western	980	1,030	1,010	990	950	890	800	1,250
SHAs and others	10	10	--	--	(11)--	(11)--	--	(11)--
Not included in the figures above:
General Medical Service Practice nurses(10)	3,480	4,630	7,740	8,780	9,120	9,600	9,100	9,740

Notes:

(6) Between 1979 and 1994 district nurses exclude seniors 1-5. Included are senior nurses 6-8 in district nursing, district nurses, district nurse practical work teachers, holders of dual post (DN/Midwife), bank district nurses and clinical grades C to I in district nursing.

(7) A new classification for non-medical staff was introduced in 1995. Information based on this classification is not directly comparable with earlier years.

(8) Figures for 1979 are not directly comparable with those for later years because of the change in nurses standard working hours in 1980-81 from 40 to 37.5 hours a week.

(9) Figures for south-east Thames, and subsequently to a lesser extent the England totals, should be treated with caution. There was evidence of considerable under recording of occupation codes used to allocate staff to a particular area of work in the South-east Thames region in 1989 and several years prior to this.

(10) The decrease in practice nurses in 1994 is due to a non-submission of complete data relating to fundholding practices for certain FHSAs.

(11) Greater than zero but less than five.

-- = Zero.

n/a = not available.

Figures are rounded to the nearest 10, consequently, totals may not equal sum of components.

Sources:

Department of Health non-medical work force census.

Department of Health general medical service census.

Office for National Statistics.

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17 Jan 1997 : Column: 415

NHS hospital and community health services district nurses, as defined by new occupation codes, by regional health authority, England, as at 30 September 1995

	1995
England	11,380
(per 5,000 head of population)	(1.16)
Northern	740
Yorkshire	750
Trent	1,010
East Anglia	610
North-west Thames	540
North-east Thames	890
South-east Thames	1,070
South-west Thames	660
Wessex	630
Oxford	610
South Western	800
West Midlands	1,210
Mersey	380
North Western	1,250
SHAs and others	(12)--

Notes:

A new classification for non-medical staff was introduced in 1995. Information based on this classification is not directly comparable with earlier years.

Figures are rounded to the nearest 10; consequently, totals may not equal sum of components.

(12) Greater than zero but less than five.

Source:

Department of Health annual non-medical work force census Office for National Statistics.

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