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Contraceptive Advice for Young People
Lord Stoddart of Swindon asked Her Majesty's Government:
- When questions of conscientious objection to abortion referral and contraceptive provision to under-16s were included in local audits of general practice; and who they consulted beforehand.[HL5164]
Lord Hunt of Kings Heath: Best Practice Guidance on the Provision of Effective Contraceptive and Advice Services for Young People was issued to local teenage pregnancy co-ordinators in 2000. The guidance is a specific action point of the Government's Teenage Pregnancy Strategy and sets out the criteria by which contraceptive advice services should be commissioned and provided. This includes the provision of confidential contraceptive advice to under-16s within the established legal framework, the provision of early pregnancy testing and non-judgmental advice, and where abortion is the agreed course, quick referral to NHS funded abortion services in line with the Royal College of Obstetricians and Gynaecologists Evidence Based Guideline 7 (2000).
In 2001 the Teenage Pregnancy Unit provided an audit questionnaire for local areas to review community contraceptive services and general practice against the Best Practice Guidance in order to identify gaps in provision and plan improvements. The majority of areas completed their general practice audits by March 2002.
The guidance and the audit questionnaire were developed in consultation with health professionals, including those representing general practice on the Government's Independent Advisory Group on Teenage Pregnancy.
Lord Stoddart of Swindon asked Her Majesty's Government:
- Whether it is their policy to encourage general practitioners to provide abortions or contraception to under-16s; and, if so, how they propose to do this.[HL5165]
Lord Hunt of Kings Heath: The Government's Teenage Pregnancy Strategy recognises the importance of helping young people resist peer pressure to have early sex while seeking to ensure that those who are sexually active have easy access to high quality contraceptive advice. Under-16s are at particular risk of unprotected sex. Although over a quarter are sexually active, they are less likely than older teenagers to access services and use contraception. Teenagers who become pregnant often delay seeking advice from a health professional and are more likely to have late abortions and miss out on antenatal care.
Improving access to professional advice by sexually active teenagers is a central strand of the Teenage Pregnancy Strategy. General practitioners have a key role to play in this. Best Practice Guidance on the Provision of Effective Contraception and Advice Services was issued in 2000 setting out the criteria against which services should be commissioned and provided. The guidance includes the provision of contraceptive advice to under-16s within the established legal framework and highlights that health professionals' duty of confidentiality to under-16s is the same as that owed to older patients. Services are also expected to provide early pregnancy testing, non-judgmental advice and, where abortion is the agreed option, quick referral to NHS funded abortion in line with the Royal College of Obstetricians and Gynaecologists evidence based guideline The Care of Women Requesting Induced Abortion (2000). General practitioners are expected to work to the principles of the guidance.
Section 4 of the Abortion Act 1967, as amended, which relates to conscientious objection to abortion, does not extend to giving advice or performing the preparatory steps to arrange an abortion where the request meets the legal requirements. Such steps include referral to another doctor, without delay.
Local teenage pregnancy strategy partnerships have been auditing services against the guidance to identify gaps in provision and plan improvements. Each area is developing plans with the relevant PCTs to support general practice in meeting the needs of their teenage patients. The Teenage Pregnancy Unit is also working closely with the Royal College of General Practitioners to develop relevant training materials.
NHS Bodies: Contracts with non-UK Organisations
Baroness Noakes asked Her Majesty's Government:
- Which National Health Service Bodies will enter into contracts with non-United Kingdom organisations to carry out operations on National Health Service patients in England; and, if any of those National Health Service bodies are strategic health authorities, how that will affect the commissioning responsibilities of primary care trusts.[HL5187]
Lord Hunt of Kings Heath: Decisions on which National Health Service bodies will enter into these contracts are likely to depend on the exact nature of the contracts proposed. As the prospectus Growing Capacity, a new role for external healthcare providers in England notes, NHS commissioners will have a key role—working with the Department of Health—in defining their requirements from international establishment initiatives.
Mental Health Bill: Categories of Mental Disorder
Lord Lucas asked Her Majesty's Government:
- In the context of the draft Mental Health Bill, which definitions they prefer for "personality", "personality disorder", "severe personality disorder", "dangerous severe personality disorder" and "dangerous".[HL5311]
Lord Hunt of Kings Heath: The draft Mental Health Bill does not define particular categories of mental disorder. This means that no particular clinical diagnosis will have the effect of limiting the way the powers are used. The same conditions will be used to determine whether an individual falls within the scope of the legislation whatever their diagnosis.
The Government have not attempted to produce new definitions for the terms described, but would accept those in general usage and agreed clinical definitions. There is an internationally recognised classification system for personality disorder and these clinical definitions are accepted in relation to the term personality disorder where it is used in the consultation document attached to the draft Mental Health Act.
The World Health Organisation and the American Psychiatric Association have produced definitions of personality disorder. The International Classification of Mental and Behavioural Disorders (ICD-10) (World Health Organisation 1992), defines a personality disorder as: "a severe disturbance in the characterological condition and behavioural tendencies of the individual, usually involving several areas of the personality, and nearly always associated with considerable personal and social disruption". The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association 1994) defines a personality disorder as: "an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual's culture".
The classification system does not distinguish between "personality disorder" and "severe personality disorder". The term "dangerous and severe personality disorder" is not a recognised clinical classification.
The term "severe personality disorder" is now in general use as a means of identifying, from within the millions of people with a degree of personality disorder in this country, the relatively small number whose condition is so serious as to require specialist interventions.
It is acknowledged that dangerous and severe personality disorder does not exist as a condition in its own right. The DSPD Programme has adopted the term DSPD as a working title and is currently developing—with clinicians and others—a supporting description that will be more meaningful to clinicians, lawyers and the general public. Any definition and description will be considered as part of the evaluation of the pilot projects.
Disability Equipment
Lord Campbell of Croy asked Her Majesty's Government:
- What action they have taken so far on the report of the Audit Commission, published in March 2000, on the quality of artificial limbs, surgical appliances and disability equipment services in the United Kingdom.[HL5320]
Lord Hunt of Kings Heath: The National Health Service Purchasing and Supplies Agency (PASA) is in ongoing consultation with the industry regarding supply of disability equipment in general, which includes discussion regarding research and development. The Department of Health's Medical Devices Agency is responsible for enforcing regulations which cover safety and quality aspects of disability equipment. The agency investigates adverse incidents involving these products in conjunction with the manufacturers. Resultant design or material changes generally improve product quality.
The NHS Plan set targets to integrate health and social care community equipment services and to increase by 50 per cent the number of people who can benefit from such services by 2004. A national implementation support team has been established to help local NHS and social services organisations through the transition from separate to integrated services.
In relation to orthotics, PASA and others are working together to identify and resolve service problems with a view to developing improved patient outcomes and patient focussed service provision. The quality of the finish of artificial limbs has been improved by the introduction of silicone cosmesis covers, funding for which has been increased by £4 million over three years from April 2001: £30.75 million has also been invested in modernisation of hearing aid services, including the provision of high quality digital hearing aids.
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