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NHS Treatment Costs

Barbara Follett: To ask the Secretary of State for Health what the average cost of each NHS treatment with a patient by (a) a GP, (b) a nurse, (c) a consultant and (d) a chiropodist or podiatrist was in the last three years. [38223]

Mr. Hutton: The cost information that we hold centrally is not based on the individual staff categories that perform given treatments and procedures, but is linked to the procedures/treatments themselves. We hold annual information on unit costs and activity for services provided by NHS Trusts, Primary Care Trusts and Personal Medical Services plus element.

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For chiropody/podiatry the majority of services are provided through clinics in various settings. For example in Reference Costs 2001, which was recently published, the national average cost of a chiropody/podiatry attendance was £18 in a NHS Trust. Chiropody/podiatry attendances in Primary Care Trusts and Personal Medical Service Pilots have an average cost per attendance of £18 and £10 respectively.

This information on chiropody/podiatry services has been collected for the first time for the 2000–01 publication and therefore historic information for these services is not available. The cost of a range of inpatient and day case procedures undertaken by consultants is also available.

£

	Foot procedures
	Category 1	Category 2
Elective inpatient	913	1,104
Non-elective inpatient	1,163	1,443
Day case	527	534

The full range of reference cost information 2001 can be found on the Department's website at www.doh.gov.uk/ nhsexec/refcosts.htm. The site holds reference cost information from 1998 onwards. Details in hard copy are also held in the Library.

HIV/AIDS

Mr. Borrow: To ask the Secretary of State for Health what proportion of the HIV prevention moneys allocated to health authorities for 1999–2000 was used for targeted prevention work with (a) people with family links to sub-Sarahan Africa, (b) injecting drug users, (c) women having sex with people in at-risk groups and (d) gay and bisexual men based on AIDS Control Act reports submitted to the Department. [38476]

Yvette Cooper: £53.4 million was allocated to health authorities in 1999–2000 for HIV prevention. Approximately 6 per cent. was targeted at people with links to sub-Saharan Africa, 14 per cent. at injecting drug users, 3 per cent. at women partners of men in high risk groups, and 21 per cent. at gay and bisexual men.

General Practitioner

Mr. Burstow: To ask the Secretary of State for Health what measures he has taken to reduce the prevalence of HIV infections in heterosexual males; and if he will make a statement. [37801]

Yvette Cooper: The national strategy for sexual health and HIV prioritises the HIV prevention needs of groups most affected by HIV, including people from, or with links to, high prevalence countries (currently in Africa), injecting drug misusers and men who have sex with men. The strategy also proposes a target to reduce by 50 per cent. the number of previously undiagnosed HIV infected people attending genito-urinary clinics who remain unaware of their infection by the end of 2007.

Latest estimates of the number of adults living in the United Kingdom with HIV infection indicate that nearly half of all infections in male heterosexuals are

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undiagnosed. These men are therefore unable to benefit from HIV treatment services and health promotion to reduce the likelihood of infecting their partners.

Figures from the Public Health Laboratory Service show that, to date, a total of 5,813 men and 7,630 women diagnosed in the UK are presumed to have acquired HIV through heterosexual sex. This compares to almost 27,000 diagnoses in gay and bisexual men. The majority of heterosexuals with HIV are of African origin and acquired their infection abroad.

In line with the strategy, the Department will launch later this year a new information campaign for the general population on safer-sex, which will cover the prevention of sexually transmitted infections including HIV.

Bob Spink: To ask the Secretary of State for Health what appeal procedures will be open to general practitioners who disagree with the conclusions of the proposed annual appraisals. [38435]

Mr. Hutton: Primary care trusts will be responsible locally for organising and supporting the appraisal of each of their general practitioners (GPs). The GP appraisal framework, issued by the Department, makes clear that in discharging this function, each PCT will be expected to establish effective procedures to deal with worries or concerns from individual GPs about the process or outcomes of appraisal.

Bob Spink: To ask the Secretary of State for Health what the estimated cost is of the proposed annual appraisal of general practitioners. [38436]

Mr. Hutton: Research commissioned by the Department suggests that the average time commitment for the appraisee will be between 4½ to 6½ hours. However this will vary between different GPs. In addition, the appraisal process will in some cases systemise existing arrangements in GP practices or Personal Medical Services pilots for monitoring and reviewing professional development. The GP appraisal framework makes clear that primary care trusts (PCTs) are responsible locally for organising and resourcing the new appraisal system. The 2002–03 health authority revenue resource limits circular (HSC 2001/024) made clear that PCTs should identify resources to support the new system and that they should have a funded policy on the provision of locum cover.

Bob Spink: To ask the Secretary of State for Health what opportunity there will be for patients to make representations about their general practitioners for use in annual appraisals. [38434]

Mr. Hutton: The appraisal documentation requires the general practitioner being appraised to include consideration of his or her relationships with patients. Examples of documentation which may be used to inform this aspect of the appraisal includes patient survey data; significant event reports; any complaints or other representations received from patients, including any appreciative feedback.

Bob Spink: To ask the Secretary of State for Health what standards will be used against which GPs can be measured in making annual appraisals. [38433]

Mr. Hutton: The general practitioner appraisal framework issued by the Department explains that the annual appraisal of a GP will be based on the core

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headings set out in the "Good Medical Practice" document, published by the General Medical Council. These comprise:

Good clinical care


Maintaining good medical practice


Relationships with patients


Working with colleagues


Teaching and training


Probity


Health.

Bob Spink: To ask the Secretary of State for Health what sanctions will be available for use against general practitioners who fail the proposed annual appraisal. [38442]

Ms Abbott: The primary aim of appraisal is to help general practitioners consolidate and improve on good performance. Appraisal will support the continuing personal and professional development of GPs.

The appraisal will not result in a pass or fail. It should conclude by setting down, as an action plan, the agreements that have been reached about what each party is committed to doing. This should include the essentials of the personal development plan (PDP). The appraisal should identify individual needs that will be addressed through the PDP. The appraiser and appraisee should review progress against the PDP and these actions during the course of the year and at the next appraisal discussion.

It should be exceptional for serious concerns about performance to be first raised in an appraisal. However, where it becomes apparent, during the appraisal process, that there is a potentially serious performance issue, which requires further discussion, the appraiser must refer the matter immediately to the PCT clinical governance lead or PCT Chief Executive to take appropriate action. This may for example include referral to any support arrangements that may be in place.

Public Health (Municipal Incinerators)

Mr. Peter Ainsworth: To ask the Secretary of State for Health what evidence he has evaluated concerning the impact on children's health of the proximity of municipal incinerators. [38830]

Jacqui Smith [holding answer 28 February 2002]: The Department is aware of relevant epidemiological studies of childhood cancers, birth defects, and respiratory health, chromosomal aberrations, thyroid hormone levels, and pollutant levels in children, in relation to incinerators. Nearly all of these studies were conducted in countries other than the United Kingdom and are of an older generation of incinerators which would fail to meet current requirements for pollution control and emission standards for municipal incinerators in this country. The studies fail to provide convincing evidence that municipal incinerators affect children's health.

A report on "Health Effects of Waste Combustion Products", published in 1997 by the Medical Research Council Institute for Environment and Health, concluded that

"Epidemiological studies of people who work at or live near incinerators have shown no consistent excess incidence of any specific disease."

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Similarly, a report on "Waste Incineration and Public Health", published in 1999 from the US National Research Council, concluded that "Few epidemiological studies have attempted to assess whether adverse health effects have actually occurred near individual incinerators, and most of them have been unable to detect any effects. The studies of which the committee is aware that did report finding health effects had shortcomings and failed to provide convincing evidence."

A 1997 study by Knox and Gilman EA on "Hazard proximities of childhood cancers in Great Britain from 1953–80" claimed that childhood cancers were associated with industrial atmospheric effluents. It was considered by independent expert advisory Committee on Carcinogenicity of Chemicals in Food, Consumer Products and the Environment, which

"noted a number of major limitations in the methodology used which we believe prevent any conclusions being drawn from these data", and advised that


"we do not consider that any further work is warranted".

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A later paper by Knox published in 2000 developed the same methodology and claimed an increased incidence of childhood cancer in children born near incinerators, but was based on the same methodology, and related to exposures from over two decades ago.

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