§ Mr. Ashleyasked the Secretary of State for Social Services what has been the total cost of the service providing artificial limbs and appliances in each of the last five years; what has been the cost in real terms, after 203 allowing for inflation, in each of these years; and what has been the change in cost in real terms since 1979.
§ Mr. MajorThe total cost (including administration costs) of the limb service are not separately identified but the following is the expenditure incurred on the supply, fitting and repair of artificial limbs in each of the financial years 1979–80 to 1985–86, together with expenditure figures adjusted in line with the annual movement of the retail price index:
Year Actual Expenditure £ Expenditure at Current prices1 £ 1979–80 18,683,752 28,270,061 1980–81 22,714,884 30,521,126 1981–82 26,453,952 32,210,683 1982–83 28,524,780 33,196,267 1983–84 31,905,404 35,279,925 1984–85 33,136,582 34,539,524 1985–86 36,067,562 36,067,562 1Adjusted by reference to the annual movement in the retail price index. The increase in real terms since 1979–80 is therefore £7,797,501.
§ Mr. Ashleyasked the Secretary of State for Social Services in what ways he is proposing to strengthen the management arrangements at the artificial limb and appliance centres; and what progress he has made with his proposals.
§ Mr. MajorProposals are being developed to devolve more responsibility, authority and discretion to management at local level in the artificial limb and appliance service in order to improve the services provided for patients.
§ Mr. Ashleyasked the Secretary of State for Social Services if he will detail the action that has been taken to improve the transport arrangements for patients attending artificial limb centres, indicating the improvements that have already been implemented; and if he will estimate the cost of the planned improvements.
§ Mr. MajorOperational research studies are being undertaken to fully diagnose problems in the movement of patients to, their flow through and return from artificial limb and appliance centres, and to identify possible solutions. Local initiatives to improve transport, in collaboration with local ambulance authorities, are being 109W tested and evaluated at various limb centres with a view to general implementation. As we have not yet completed our research, we are not yet in a position to provide an estimate of any additional costs that may be incurred when improvements are implemented.
§ Mr. Ashleyasked the Secretary of State for Social Services from which organisations and individuals he has received representations regarding the proposal in the McColl report for a management board or special health authority to oversee the artificial limb and appliance centres; if he will indicate which of the representations favoured the proposals and which were opposed; and when he intends to make a decision.
§ Mr. MajorA wide range of organisations and individuals with an interest in the artificial limb and appliance centre (ALAC) services have now let us have their views on the McColl report and its recommendations. During the formal consultation period 87 submissions were received and representations have been made subsequently by about 330 hon. and right hon. Members and others. A large majority accepted the need for changes in the organisation and management arrangements, but there was no concensus on the structure that was most likely to facilitate the improvements in service delivery which everyone wants to see. Opinion amongst the patients' groups that responded to our invitation to comment was divided between those that expressed a clear preference for the independent management board recommended by the working party and those that saw no particular advantage in it.
A number of suppliers and trades unions involved with the ALAC services favoured some strengthening of management arrangements, but argued that the Department should retain its present responsibilities for them. Most professional interests considered integration with other National Health Service services at local level to be the best way of securing better co-ordination of services at the point of delivery to amputees and wheelchair users. We are considering all the comments that we have received together with the recent Royal
110W
Number of infant deaths by month of occurrence, sex and age-group England and Wales, 1981–1985 Month of occurrence Age group Year 1981 1982 1983 1984 1985 Male Female Male Female Male Female Male Female Male Female January Under 1 year 381 257 384 303 336 250 359 265 344 236 Under 1 week 180 105 153 107 147 102 163 105 134 91 1 week–under 1 month 36 30 28 33 37 32 28 23 37 23 1 month–under 1 year 165 122 203 163 152 116 168 137 173 122 February Under 1 year 349 276 324 250 375 254 309 245 257 233 Under 1 week 144 117 139 113 151 98 133 100 103 84 1 week–under 1 month 56 28 34 20 38 33 37 30 25 37 1 month–under 1 year 149 131 151 117 186 123 139 115 129 112 March Under 1 year 402 257 354 270 354 265 379 269 307 230 Under 1 week 195 125 168 115 150 123 153 121 136 109 1 week–under 1 month 41 27 38 42 50 32 43 21 28 26 1 month–under 1 year 166 105 148 113 154 110 183 127 143 95 April Under 1 year 323 224 310 222 298 205 256 214 320 238 Under 1 week 163 95 146 117 133 97 125 97 158 106 1 week–under 1 month 34 25 26 25 39 21 29 36 27 31 1 month–under 1 year 126 104 138 80 126 87 102 81 135 101 College of Physicians' report on physical disability and will take decisions on future organisational arrangements as soon as possible.
§ Mr. Ashleyasked the Secretary of State for Social Services what is his policy towards the level of resources in real terms to be devoted to the artificial limb and appliance service; and if he will make a statement.
§ Mr. MajorSufficient resources will be made available to maintain the artificial limb and appliance service at the appropriate level. Financial provision for the year 1987–88 will be put to Parliament in estimates in the usual way. I refer the right hon. Member to the statement that I made on 26 November 1986 at columns 327–34.