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Staff Morale

29. Ms Christine Russell: To ask the Secretary of State for Health what proposals he has for improving staff morale in the NHS. [23444]

Mr. Milburn: I refer my hon. Friend to the oral reply my right hon. Friend gave my hon. Friend the Member for Kettering (Mr. Sawford) today.

Private Medical Insurance

30. Mrs. Roe: To ask the Secretary of State for Health what estimate his Department has made of the impact on the NHS budget of the abolition of tax relief on private medical insurance for over-60-year-olds. [23445]

Mr. Milburn: None.

Referral Invoicing

31. Dr. Brand: To ask the Secretary of State for Health what arrangements will be made to fund patient treatment currently covered by extra-contractual referral invoicing.[23446]

Mr. Milburn: The Government's proposals for funding patient treatment currently covered by extra contractual referral invoicing are set out in paragraph 9.17 of the White Paper, "The New NHS", copies of which have been placed in the Library.

More detailed advice will be issued by summer 1998.

Community Hospitals

32. Mr. Whittingdale: To ask the Secretary of State for Health if he will make a statement on the role of community hospitals. [23447]

Mr. Milburn: I refer the hon. Member to the oral reply I gave the hon. Member for South-East Cornwall (Mr. Breed) today.

Tobacco-related Illness

33. Mr. Canavan: To ask the Secretary of State for Health what steps he intends taking to reduce the incidence of tobacco-related illnesses and deaths. [23448]

Ms Jowell: The Government regard banning tobacco advertising as the essential first step in building an effective strategy to deal with smoking. However, smoking is too complex an issue and too serious a threat to health for us to rely on a single measure. Controlling tobacco consumption, and ultimately tobacco-related illnesses and deaths, requires a wide range of measures as part of a well thought out overall strategy if we are to have a real impact and see a significant and lasting reduction. A White Paper setting out the Government's tobacco control strategy will be published this year.

Clinical Governance

34. Dr. Starkey: To ask the Secretary of State for Health what proposals he has to develop clinical governance in NHS trusts. [23449]

27 Jan 1998 : Column: 200

Mr. Milburn: The New National Health Service White Paper, published last December, outlines our proposals for developing clinical governance in NHS trusts. These proposals will be the subject of consultation later in the year.

Primary Care (Nurses)

35. Dr. Iddon: To ask the Secretary of State for Health what proposals he has for boosting the role of nurses in commissioning primary care. [23450]

Mr. Milburn: From April 1999, teams of local general practitioners and community nurses will work together in new Primary Care Groups to shape services to patients. Primary Care Groups will open up a new leadership and decision making role for community nurses, working in partnership with GPs and others locally to improve health and health care.

Specialist Services

36. Mr. Gareth R. Thomas: To ask the Secretary of State for Health what proposals he has for improving access to specialist services provided from hospitals. [23451]

Mr. Boateng: As we said in the White Paper "The New National Health Service", improved arrangements for commissioning specialised services will be in place by 1 April 1999. Regional offices will be held accountable for ensuring that these arrangements are able to deal with the particular needs of the patients who use each service, including the question of access.

Locality Commissioning

37. Mr. Malcolm Bruce: To ask the Secretary of State for Health what incentives the Government intend to give general practitioners to participate in locality commissioning, with particular reference to existing fundholders. [23452]

Mr. Milburn: In England, primary care-led commissioning will be undertaken by Primary Care Groups, which will allow better co-ordination of primary care and community services, and better healthcare provision to patients in the locality. National Health Service trusts and Primary Care Groups will be able to use savings from longer term agreements to improve services to patients. In addition, there can be practice-level incentive arrangements associated with the groups' budgets, approved by the health authority.

Redeployment of the general practitioner fundholding Practice Fund Management Allowance will provide about £3 per head of population to support the groups' running costs. GPs who take on key responsibilities within Primary Care Groups will have their time appropriately reimbursed from within the group's management support.

Clinical Excellence

Mr. Opik: To ask the Secretary of State for Health if the proposed national institute for clinical excellence will be responsible for (a) assessing the clinical and cost-effectiveness of all technologies and (b) producing guidelines for the NHS. [23422]

27 Jan 1998 : Column: 201

Ms Jowell: The National Institute for Clinical Excellence will give a new coherence and prominence to information about clinical and cost-effectiveness. It will develop and disseminate clinical guidelines based on relevant evidence of clinical and cost-effectiveness. We will be consulting on the Institute's role and responsibilities over the coming months.

Waste Reduction

Mr. Davidson: To ask the Secretary of State for Health what action he is taking to reduce waste in the national health service. [23431]

Mr. Milburn: We are committed to ensuring that the new National Health Service uses its resources both efficiently and effectively to deliver high quality services. The White Paper sets out a programme of action to sweep away the bureaucracy of the internal market. Over the lifetime of this parliament, £1 billion that would otherwise have been spent on bureaucracy will be released for patient care.

Last October we announced that the NHS Efficiency Task Force, set up to consider the scope for making short-term savings, would become a permanent body examining the scope for savings through systems and processes in the NHS, and sharing best practice with the health service.

BSE-linked Deaths

Mr. Kenneth Clarke: To ask the Secretary of State for Health how many deaths have been scientifically established to have been caused by the consumption of beef contaminated by BSE. [24706]

Ms Jowell: There is convincing scientific evidence that the agent which causes new variant Creutzfeldt-Jakob Disease (nvCJD) in humans is the same as that which causes Bovine Spongiform Encephalopathy in cattle. However, research so far has been unable to shed any light on the mechanism through which patients have contracted the disease.

So far, there have been 23 deaths from nvCJD in the United Kingdom. In 22 of these cases, the diagnosis has been definitely established by the examination of brain tissue.

Care in the Community

Mr. Cox: To ask the Secretary of State for Health what is the total amount of money that has been spent in the Greater London area on care in the community in each of the last three years. [24529]

Mr. Boateng: Gross expenditure on care in the community (a) by London Health Authorities on National Health Service Hospital and Community Health Services

27 Jan 1998 : Column: 202

(HCHS) and (b) by London boroughs and the Corporation of the City of London, for the last three years, is given in the table.

£ million
1994-951995-961996-97
(a) Hospital and Community Health Services63,03374,59495,745
(b) Personal Social Services (PSS):
non-residential services475511n/a
residential services472557n/a

PSS expenditure for 1996-97 is not yet available.


Long-term Care

Ms Drown: To ask the Secretary of State for Health what consultation the Government have carried out on the proposal that the nursing costs of long-term care should be met by the NHS. [25918]

Mr. Boateng: We have noted this issue in our initial evidence to the Royal Commission, which will no doubt be considering it in the wider context of its considerations on the funding of long-term care.

Dental Services

Mr. Barnes: To ask the Secretary of State for Health if he will make a statement on dental registration and the availability of NHS dentistry. [23426]

Mr. Milburn: The Government are committed to improving access to National Health Service dentistry and tackling oral health inequalities. We have recently announced a further £10 million to expand our Investing in Dentistry initiative in 1998-99. The registration period for both adult continuing care and child capitation has been harmonised at fifteen months following each course of treatment. This will improve value for money by focusing resources on those patients receiving active care. We shall redeploy any savings to target improvements in oral health.


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