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Competitive Tendering
19. Mr. Morley : To ask the Secretary of State for Health if he will make a statement on competitive tendering within the National Health Service.
Mr. Mullin : To ask the Secretary of State for Health if he will make a statement on competitive tendering within the National Health Service.
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127. Mr. Morgan : To ask the Secretary of State for Health if he will make a statement on competitive tendering within the National Health Service.139. Mr. Nellist : To ask the Secretary of State for Health if he will make a statement on competitive tendering within the National Health Service.
Mr. Freeman : Over 40 per cent. of support services in the NHS--to a value of £1 billion a year--are now routinely subject to some form of competitive tendering. The White Paper "Working for Patients" provides a framework for further widening the scope for competition. Within that framework it is for each health authority to determine where the most fruitful opportunities arise for using competition to achieve increased effectiveness and value for money at local level.
35. Mr. Illsley : To ask the Secretary of State for Health how many contracts awarded through the competitive tendering process within the National Health Service have not been renewed at the end of the period concerned.
56. Mr. Leadbitter : To ask the Secretary of State for Health how many contracts awarded through the competitive tendering process within the National Health Service have not been renewed at the end of the period concerned.
62. Mr. James Lamond : To ask the Secretary of State for Health how many contracts awarded through the competitive tendering process within the National Health Service have not been renewed at the end of the period concerned.
117. Mr. John Hughes : To ask the Secretary of State for Health how many contracts awarded through the competitive tendering process within the National Health Service have not been renewed at the end of the period concerned.
Mr. Freeman : Information is not held centrally on the results of routine renewal of the wide range of NHS contracts which are subject to competitive tendering. This is a contractual matter for the health authority concerned.
Cervical Cancer Screening
20. Mr. George Howarth : To ask the Secretary of State for Health if he will make a statement on cervical cancer screening.
36. Mrs. Fyfe : To ask the Secretary of State for Health if he will make a statement on cervical cancer screening.
66. Mr. Hood : To ask the Secretary of State for Health if he will make a statement on cervical cancer screening.
Mrs. Virginia Bottomley : I refer the hon. Members to my reply to the hon. Member for Cumbernauld and Kilsyth (Mr. Hogg) earlier today.
Portsmouth and South East Hampshire DHA
21. Mr. Viggers : To ask the Secretary of State for Health if he has any plans to visit Portsmouth and South East Hampshire district health authority.
Mr. Freeman : Not at the present time. I am, however, always willing to consider an invitation.
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Core Services
22. Mr. Hague : To ask the Secretary of State for Health if he will set out his powers in relation to core services provided by National Health Service trusts.
122. Mr. Moss : To ask the Secretary of State for Health what are his powers in respect of specifying the core services.
Mr. Kenneth Clarke : I do not anticipate any need to use powers of compulsion to secure the provision of necessary local services by National Health Service trusts. Nevertheless, as a last resort, paragraph 6(1) of schedule 2 to the National Health Service and Community Care Bill provides me with the necessary powers of direction to secure contractual provision.
Huddersfield Health Authority
23. Mr. Riddick : To ask the Secretary of State for Health what was the total amount of money allocated to the Huddersfield health authority in 1979 and 1989 ; and what was the percentage change in that period.
Mr. Freeman : This information is not held centrally. Only expenditure figures are available to the Department centrally. These can be obtained from annual accounts. My hon. Friend may wish to contact the chairman of the Yorkshire regional health authority for the proper answer.
The Huddersfield health authority was established on 1 April 1982. Total revenue expenditure recorded in the authority's annual accounts for 1982-83 was £36.3 million and in 1988-89 was £52.4 million representing an increase in real terms of 7 per cent. (measured at 1988-89 prices by the use of the gross domestic deflator).
Hospital Medical Staffing
24. Mr. Alan W. Williams : To ask the Secretary of State for Health what representations he has received regarding the contents of the interim report on patterns of hospital medical staffing.
77. Mr. David Young : To ask the Secretary of State for Health what representations he has received regarding the contents of the interim report on patterns of hospital medical staffing.
81. Mr. Watson : To ask the Secretary of State for Health what representations he has received regarding the contents of the interim report on patterns of hospital medical staffing.
Mrs. Virginia Bottomley : No written representations have been received regarding the contents of the interim report on patterns of hospital medical staffing, but reference has been made to it in recent meetings I have had on the subject of junior doctors' hours.
Wessex RHA
25. Mr. Ian Bruce : To ask the Secretary of State for Health what increase there has been in resources to Wessex regional health authority since 1979.
Mr. Freeman : Total revenue expenditure recorded in the annual accounts of the health authorities comprising the Wessex region increased in cash terms from £223.6
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million in 1978-79 to £671 million in 1988-89, representing an increase in real terms of 36.5 per cent. (measured at 1988-89 prices by use of the gross domestic product deflator). The figures exclude expenditure on family practitioner services which is accounted for by family practitioner committees and which cannot strictly be attributed to particular regions.British Medical Association
27. Mr. Strang : To ask the Secretary of State for Health when he last met the British Medical Association ; and what subjects were discussed.
84. Mrs. Ray Michie : To ask the Secretary of State for Health when he last met representatives of the British Medical Association ; and what matters were discussed.
Mr. Kenneth Clarke : I refer the hon. Members to the reply I gave the hon. Members for Kilmarnock and Loudoun (Mr. McKelvey), for Glasgow, Rutherglen (Mr. McAvoy), for Fife, Central (Mr. McLeish) and for Gordon (Mr. Bruce) on 20 February at column 1172.
AIDS
28. Mr. Ian Taylor : To ask the Secretary of State for Health what current action is being taken in the fight against AIDS.
Mrs. Virginia Bottomley : The Government continue to attach great importance to action to prevent the spread of HIV infection. We are supporting a wide range of programmes to achieve this through local authorities and health authorities, voluntary bodies and the Health Education Authority, whose latest mass media campaign was launched on 14 February 1990. Further details of the Government's approach can be found in "AIDS : Response by the Government to the Seventh Report from the Social Services Committee Session 1988-89" (Cm 925), published last November, a copy of which is available in the Library.
NHS Trusts
29. Mr. Dykes : To ask the Secretary of State for Health if he will make a statement on developments in hospital independent trust proposals within the National Health Service.
Mrs. Virginia Bottomley : A total of 191 National Health Service units have, to date, expressed an interest in National Health Service trust status and I understand that some 80 units are currently undertaking preparatory work with a view to submitting applications for National Health Service trust status at an early stage. Subject to the passage of the necessary legislation, we intend to invite formal applications for trust status shortly after Royal Assent. We intend that the first trusts should become fully operational in April 1991.
78. Mr. Patchett : To ask the Secretary of State for Health how may district health authorities have resolved to have a ballot on the question of the formation of self-governing trusts.
120. Ms. Primarolo : To ask the Secretary of State for Health how many district health authorities have resolved to have a ballot on the question of the formation of self-governing trusts.
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138. Mr. Pendry : To ask the Secretary of State for Health how many district health authorities have resolved to have a ballot on the question of the formation of self-governing trusts.
Mr. O'Brien : To ask the Secretary of State for Health how many district health authorities have resolved to have a ballot on the question of the formation of self-governing trusts.
Mrs. Virginia Bottomley : Formal consultation on proposals to establish NHS trusts cannot take place until applications are made ; that is after the necessary legislation has received Royal Assent. I am aware that self-governance and other NHS review issues will have been discussed by health authorities, but the results have not been formally requested or recorded by the Department. When details become available and formal applications are prepared, regional health authorities will ensure that they are given local publicity and will seek the views of all those with an interest including health authorities, staff, patients, GPs, CHCs, and the local community. My right hon. and learned Friend the Secretary of State shall consider these views alongside the application. However, no one group will have a veto.
98. Mr. Burns : To ask the Secretary of State for Health how many units have now expressed interest in becoming National Health Service hospital trusts.
143. Mr. Barry Field : To ask the Secretary of State for Health how many expressions of interest he has now received from hospitals or units wishing to obtain National Health Service hospital trust status.
Mrs. Virginia Bottomley : A total of 191 units have, to date, expressed an interest in NHS trust status.
99. Mr. Ashby : To ask the Secretary of State for Health what will be the status of National Health Service trusts within the National Health Service.
Mrs. Virginia Bottomley : The National Health Service and Community Care Bill provides for NHS trusts to be established as separate bodies corporate. They will remain an integral part of the NHS.
Newcastle DHA
30. Mr. Cousins : To ask the Secretary of State for Health when he next proposes to meet members of the Newcastle district health authority ; and what he proposes to discuss.
Mrs. Virginia Bottomley : My right hon. and learned Friend has no plans at present to meet members of Newcastle district health authority.
Mentally Handicapped People
Mr. Buckley : To ask the Secretary of State for Health what steps he is taking to improve the availability of day care facilities for the mentally handicapped.
31. Mr. Bradley : To ask the Secretary of State for Health what steps he is taking to improve the availability of day care facilities for the mentally handicapped.
105. Mr. Boyes : To ask the Secretary of State for Health what steps he is taking to improve the availability of day care facilities for the mentally handicapped.
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Mr. Caborn : To ask the Secretary of State for Health what steps he is taking to improve the availability of day care facilities for the mentally handicapped.Mr. Freeman : Over the last 10 years there has been a 26 per cent. increase in the number of day centre places for people with a mental handicap. We look to a continued expansion of such places as resources allow and commend to social services authorities the recent social services inspectorate report "Inspection of Day Services for People with a Mental Handicap" as a useful guide to good practice.
48. Mr. Brandon-Bravo : To ask the Secretary of State for Health what progress has been made in the provision of services for the mentally handicapped since 1978-79.
72. Dame Jill Knight : To ask the Secretary of State for Health what progress has been made in the provision of services for the mentally handicapped since 1978-79.
Mr. Caborn : To ask the Secretary of State for Health what steps he is taking to improve the availability of day care facilities for the mentally handicapped.
Mr. Freeman : Considerable progress has been made in developing community-based services for mentally handicapped people. Net expenditure by local authorities on residential accommodation and adult training centres increased by 88 per cent. in real terms to £271 million in 1987-88, and overall the number of places in residential homes, including those provided by the private and voluntary sectors, has doubled over the period (to 28,500), while the number of places in adult training centres and day centres has increased by 26 per cent. (to 53,000). The number of mentally handicapped people in hospital fell from 46,900 in 1978 to 27,700 in 1989 and by that year 11 out of the 14 regions had no mentally handicapped children in long-stay care in hospital. Despite this reduction, expenditure on hospital and community health services had grown by 11 per cent. in real terms (to £497 million) by 1986-87, the last year for which information is readily available, reflecting improved standards.
83. Mr. Robert G. Hughes : To ask the Secretary of State for Health whether any assistance will be given to health authorities for the provision of community services for the mentally ill and handicapped.
Mr. Freeman : Regional health authorities will make provision for community health services for the mentally ill and handicapped from within their main allocations together with any resources made available from the planned run down and closure of long-stay mental hospitals.
NHS Reform
32. Sir Peter Emery : To ask the Secretary of State for Health whether there will be any changes in doctors' rights to refer patients for treatment as a result of the proposals in the National Health Service and Community Care Bill.
115. Mr. Sims : To ask the Secretary of State for Health what effect the provisions of the National Health Service and Community Care Bill will have on general practitioners' freedom to refer patients for the most appropriate treatment.
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Mrs. Virginia Bottomley : The provisions of the National Health Service and Community Care Bill will allow the introduction of contract funding of health care. This will bring GP referrals and the allocation of resources more closely into line. For example it will avoid problems that arise currently where the choices open to GPs may be constrained if the preferred hospital is a victim of its own success and cannot accept additional patients because of budgetary constraint.
In future district health authorities will be expected to let contracts which secure the referral patterns which their local GPs prefer, unless there are compelling reasons for not doing so. In this way resources will be directed to the units which GPs and their patients wish to use.
GPs who take part in the new practice funds scheme will have resources for certain hospital procedures which they can deploy directly.
42. Mr. Tim Smith : To ask the Secretary of State for Health what progress is being made in implementing the National Health Service review changes.
Mrs. Virginia Bottomley : For a detailed explanation of all the progress we have made in putting into action the changes outlined in the White Paper "Working for Patients" I refer my hon. Friend to the reply I gave him and my hon. Friend the Member for Maidstone (Miss Widdecombe) on 20 February at columns 714-15.
Since then, other important steps have been taken towards implementing our proposals. First, on 27 February I announced the funding of a further 65 consultants for the NHS between now and 1992. This fulfils our commitment in the White Paper to the creation of 100 new consultant posts over three years. These posts will help reduce waiting times in districts and specialities with particularly long waiting lists. They will also help reduce the working hours of junior doctors, and improve the career structure in the respective specialities.
On 1 March, further information was published about how the new contracting system will operate.
On 14 March, Duncan Nichol, NHS chief executive, launched a new management development drive for 80,000 NHS managers and professionals, including doctors and nurses, with management responsibilities. The 14 regions are committed to developing their own support programmes with particular emphasis on improving the skills needed to implement the major changes that will be required in the post-reform NHS.
The chief executive also announced the next phase of the management communication programme to improve communications with staff. This is based on the results of a survey of communications carried out among general managers with particular emphasis on those at unit level where most staff ar employed and most patients are treated.
60. Dr. Goodson-Wickes : To ask the Secretary of State for Health what recent representations he has received from the British Medical Association on the implementation of his White Paper.
Mrs. Virginia Bottomley : We have not received recent representations from the British Medical Association on the White Paper "Working for Patients". There is, however, a growing understanding among the medical profession and others of the positive benefits to patients that will flow from these reforms.
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68. Mr. Bidwell : To ask the Secretary of State for Health when he last met representatives of local authority associations to discuss the provisions of the National Health Service and Community Care Bill.102. Mr. Bell : To ask the Secretary of State for Health when he last met representatives of local authority associations to discuss the provisions of the National Health Service and Community Care Bill. 111. Mr. Harry Barnes : To ask the Secretary of State for Health when he last met representatives of local authority associations to discuss the provisions of the National Health Service and Community Care Bill.
129. Mr. Battle : To ask the Secretary of State for Health when he last met representatives of local authority associations to discuss the provisions of the National Health Service and Community Care Bill.
Mrs. Virginia Bottomley : I met with representatives from the Association of Metropolitan Authorities (AMA) and Association of County Councils (ACC) on 5 February to discuss implementation of community care. Officials have also been meeting with officers of the local authority associations over recent months to discuss a range of community care issues. We shall continue to engage in consultation with the local authority associations as we carry forward our plans for implementation.
86. Mr. Matthew Taylor : To ask the Secretary of State for Health how many doctors in Cornwall have indicated their support for the Government's National Health Service reforms.
Mrs. Virginia Bottomley : We have received many comments on the Government's proposals to improve the Health Service from a wide variety of sources. Many ask questions, many support all or some of the proposals, and some only refer to specific points. It is not possible to distinguish them in the way the hon. Member requests.
136. Mr. Neale : To ask the Secretary of State for Health what effect the proposals in the National Health Service and Community Care Bill will have on the distances patients will travel for treatment.
Mrs. Virginia Bottomley : Surveys have shown that a majority of patients are willing to travel to get earlier or better treatment. Under the new funding arrangements for hospital services, the financial problems previously associated with accepting patients from outside the home district will be alleviated because hospitals will be funded directly for the patients they treat, wherever they come from. No patient will be made to travel long distances for treatment against his will.
141. Ms. Walley : To ask the Secretary of State for Health what assessment he has made of the implications the National Health Service and Community Care Bill will have for current prescribing policies by general practitioners.
Mrs. Virginia Bottomley : When the proposals for indicative prescribing budgets contained in the National Health Service and Community Care Bill are implemented, GPs will remain free to prescribe all medicines which are clinically necessary for their patients. Indicative prescribing budgets will encourage GPs to examine their prescribing habits and costs more closely and to prescribe more effectively.
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Regional Chairmen
33. Mr. Rathbone : To ask the Secretary of State for Health when he last met regional chairmen ; what matters he discussed ; and if he will make a statement.
Mr. Kenneth Clarke : I last met regional health authority chairmen on 17 January. I shall be meeting them again tomorrow morning for our regular bimonthly meeting when we shall be discussing a range of Health Service issues, including the ambulance dispute, rehabilitation services, income and expenditure in the NHS and the continuing progress of the NHS reforms.
Prescription Charges
34. Mr. Alex Carlile : To ask the Secretary of State for Health if he will make it his policy to include cancer sufferers within the categories of people exempt from prescription charges.
Mrs. Virginia Bottomley : Over 75 per cent. of prescriptions are now dispensed free. The Government's policy is to direct help with prescription charges to those who are likely to have difficulty in paying charges on financial grounds. To extend the small list of medical conditions which confer exemption from charges would not be making the best use of NHS resources.
58. Mr. Ashley : To ask the Secretary of State for Health if he intends to make any further increases in prescription charges.
Mrs. Virginia Bottomley : I announced on 1 March that the NHS prescription charge will be increased to £3.05 with effect from 1 April. There are no immediate plans for a further increase in the charge.
133. Mr. Fearn : To ask the Secretary of State for Health what representations he has received on the level of prescription charges.
Mr. Freeman : A number have been received from hon. Members and others.
69. Mr. Roy Hughes : To ask the Secretary of State for Health what was the cost of a prescription in 1979 ; how many subsequent increases there have been ; and what has been the percentage increase overall.
Mrs. Virginia Bottomley : Currently over 75 per cent. of all items dispensed in the National Health Service are free from prescription charges. In 1979, the figure was around only 60 per cent. The number of items attracting the standard prescription charge has fallen from around two in every five items to less than one during this time. In 1979, a total of 304.6 million items were dispensed at an ingredient cost of £592.1 million. In 1989, some 352 million items were dispensed at a cost of around £1,883 million. The average cost per item rose during this time from £1.94 to about £5.35.
On 16 July 1979, the National Health Service prescription charge was increased to 45p. Since then the charge has been increased on 10 occasions to its present level of £2.80. This represents an increase of 522 per cent. in cash terms or 209 per cent. in real terms.
Childhood Immunisation
37. Mrs. Maureen Hicks : To ask the Secretary of State for Health what is the current level of childhood immunisation ; and if he will make a statement.
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61. Mr. David Porter : To ask the Secretary of State for Health what is the current level of childhood immunisation ; and if he will make a statement.Mr. Freeman : I refer my hon. Friends to the reply I gave my hon. Friend the Member for Edmonton (Dr. Twinn) on 8 March at columns 825-26.
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