§ Lord Juddasked Her Majesty's Government:
What analysis they have made of published statistics and of the information held by the Oxford Regional Health Authority on the direct and indirect administrative costs of the fund-holding scheme and on the funds used to purchase capital assets owned by general practitioners; on the average Indicative Prescribing Amount per head of registered population for (a) fund-holding practices, and (b) non-fund holding practices; on the average staff reimbursement per head of registered population for (a) fund-holding practices, and (b) non-fund holding practices; on the expenditure by the Primary Care Department on the development of (a) fund-holding practices, and (b) non-fund holding practices; on the waiting time for first outpatient appointments and for hip replacements, cataract removals, coronary artery by-pass grafting and general surgery for (a) patients of fund-holding practices, and (b) patients of non-fund holding practices; what conclusions they have drawn and what specific action they are now taking to avoid the development of a two-tier service.
§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)Regional health authorities are responsible for managing the fund-holding scheme in their areas and for setting appropriate budgets for both fund-holding practices and district health authorities. In the case of hospital services, the fund-holding scheme must be managed in accordance with the national agreement that hospitals may not offer contracts to one provider which would disadvantage the patients of another. In Oxford region, as elsewhere, general practitioner fund-holders have been at the forefront of quality improvements in both primary care and secondary care. The improvements made by GP fund-holders are having the effect of improving the quality of service for all patients.
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§ Baroness Masham of Iltonasked Her Majesty's Government:
How many cases of tuberculosis have been notified in the United Kingdom in each of the past five years (or the latest period for which figures are available) and how many of these cases have been drug-resistant; and
Whether they have held any discussions with their Community partners about the increase of tuberculosis in the United Kingdom and other Community countries; and
(i) whether they have identified the causes of the recent increase in cases of tuberculosis in the United Kingdom and (ii) what steps they are taking to stop the further spread of this disease.
§ Baroness CumberlegeThe Government are aware of the continued increase in notifications of tuberculosis (TB) in the United Kingdom. Notifications for the past five years were as follows:
Number 1988 5,778 1989 6,059 1990 5,898 1991 6,078 1992 16,442 1Provisional A collaborative study of notifications of TB in England and Wales is under way and will report next year. The results will help us determine the links between TB and a range of contributory factors including HIV infection and immigration and establish what further preventive measures may be needed. This country has an excellent record in combating the scourge of tuberculosis, one of a range of public health issues which we discuss with our European Community partners. We will continue to strengthen our policies to protect the population including by immunisation programmes.
Between 1982 and 1991 9.8 per cent. of isolates of Mycobacterium tuberculosis submitted to the Public Health Laboratory Service Regional Tuberculosis Centres in England and Wales were resistant to one or more anti-tuberculosis drugs. The percentage varied between 8.0 per cent. and 10.9 per cent. between 1982 and 1990, and was 14.2 per cent. in 1991. The incidence of multiple drug resistance remained very low throughout the period.