9.5.02

Questions to the Minister for Health 9.5.02

 

Doctors Surgeries in Delyn


Alison Halford:

What action has/will the Minister taken to refurbish/improve the quality of doctors’ surgeries in Delyn? (WAQ17571)Alison Halford: What action is the Minister taking to ensure local health boards are aware of the need to refurbish and improve the quality of doctors’ surgeries in Delyn? (WAQ17572)

 

Jane Hutt:

The Assembly issued guidance on 12 July 2001 outlining new flexibilities in arrangements for funding and developing primary care premises which will assist local health groups in this work.
A pilot study to develop a primary care estates strategy is underway in Rhondda Cynon Taff local health group. This project is drawing to a close and we hope to learn much to support future work in this area. These lessons will inform future guidance and support to local health boards in tackling premises issues.
 

Complaints Advocacy in North Wales

 

Alison Halford:

Will the Minister establish and finance a complaints advocacy pathfinder scheme anywhere in north Wales to compliment the two Assembly-funded complaints advocacy pathfinder schemes recently established in south Wales? (WAQ17573)

Jane Hutt:

The Gwent and Cardiff complaints advocacy schemes are pilot projects which are being funded by the Assembly for 12 months, after which they will be evaluated by an independent organisation. Lessons learned will be shared throughout the NHS in Wales, and the results of the independent evaluation will be used to inform the way forward.
 

Complaints Advocacy System

 

Alison Halford:

Is the Minister committed to a centrally financed complaints advocacy system whereby patients, wherever they are in Wales, can expect the same standard and quality of support, while preserving existing patient advocacy services that have a history of success? (WAQ17574)

Jane Hutt:

I am committed to ensuring that people in Wales have access to independent advocacy services. This is why we are piloting two pathfinder schemes in Cardiff and Gwent community health councils to see what works in practice. Existing patient advocacy services provided by some community health councils in Wales will be looked at in the light of the evaluation of these pathfinders. The results of the independent evaluation will be used to inform decisions about the way forward and possible wider application in other parts of Wales.
 

An Adequate Patients Complaints System


Alison Halford:

Will the Minister consider a patients complaints system adequate if it were limited only to sign-posting and self-help advice? (WAQ17575)

Jane Hutt:

Patients require different methods of support to suit their needs. A comprehensive complaints system will offer sign-posting and self-help advice alongside other advocacy and support services. The NHS complaints system in Wales is currently under review in order to make it easier to access and to use for people who wish to complain about NHS services.
Pilot projects for complaints advocacy and patient support are being tested at eight locations across Wales. A key element of these projects is to provide help for patients and the public to sort out any concerns or problems on the spot, or to refer them to other specialist agencies for further help. The results of an independent evaluation of these projects will be used to inform decisions about the way forward and possible wider application in other parts of Wales.
 

Recording of Disciplinary Findings

 

Alison Halford:

As the Welsh Assembly Government has already accepted the need to implement recommendation 136 of the Carlile report, will the Minister now see how it can be used to reform the rest of the NHS to ensure that the majority of adverse disciplinary findings are recorded centrally and made available to AMs/the wider public? (WAQ17576)

Jane Hutt:

I agree with recommendation 136 of the Carlile report that regulatory bodies must make recommendations concerning disciplinary findings widely available. All professional regulatory bodies have a duty to ensure that there is appropriate registration of healthcare professionals and that any adverse disciplinary findings are accessible to employers and other relevant parties.
While professional regulation is a UK-wide issue, the Welsh Assembly Government will work closely with the regulatory bodies to ensure that processes of recording disciplinary findings are implemented across Wales.
 

Effect of Health Funding

 

Alison Halford:

Following the excellent news of more money for health in the budget announcement by the Chancellor of the Exchequer, which was welcomed by the Minster on 18 April, would the Minister make a statement on how many more doctors/nurses/ancillary staff and directly employed general practitioners are to be employed in the next few years as a consequence of the extra funding? (WAQ17577)

Alison Halford:

Following the announcement of extra health funding on 18 April, how much will the extra training needed to increase number of doctors/specialists/nurses cost the NHS in Wales? (WAQ17580)
Jane Hutt: Edwina Hart has confirmed that the Chancellor’s budget announcement means that there will be additional money for new and better ways of improving health for the people of Wales. The Welsh Assembly Government will be setting priorities for allocating the Assembly’s budget and will be consulting on these next month as part of the annual budget planning round. I will then identify priorities for the allocation of any additional resources to ensure that core health and social services are properly funded across Wales.NHS Wales already directly employs 2,300 more staff now than in 2000 and 8,400 more than in 1997.
From the results of this year’s workforce planning process, which has collected data in respect of all healthcare professionals, and in conjunction with locally prepared recruitment and retention strategies, we will be able to produce realistic, planned numbers for the future. I expect to be able to set overall workforce targets this summer.Since the Assembly came into being, one of its major priorities has been to put more money into the education of the health professionals of tomorrow. We have increased the service increment for teaching allocation paid to NHS trusts in Wales for additional medical student places and have also increased the allocation paid to the University of Wales College of Medicine for postgraduate education. In 1997-98, £37 million was spent on commissioning non-medical training courses in Wales. That was increased by 49 per cent to £55 million in 2001-02, and provision has been made for £62 million to be spent in 2002-03. The results of the workforce planning process will inform the training commissions for future years.
 

NHS Administrative Staff

 

Alison Halford:

Will the Minister confirm that the extra funding for health announced on 18 April will not be used to employ more managers and administrative staff? (WAQ17578)

Jane Hutt:

It is important to recognise that both administrative staff and managers play a key role in ensuring that frontline clinical services are delivered efficiently and effectively, and although I shall be seeking to keep overall management costs under control, I would not wish to place arbitrary constraints on the numbers employed.
 

NHS Audit


Alison Halford:

 Will more auditing be necessary as a result of the recent budget increase for health spending and, if so, how much will this cost? (WAQ17579)

Jane Hutt:

Audit within the NHS in Wales in undertaken primarily by the Audit Commission, which is responsible for financial and value for money work, and by the Commission for Health Improvement, which scrutinises clinical governance arrangements.
On 18 April, the Secretary of State for Health in England announced the creation of a new commission for healthcare audit and inspection, which will replace the Commission for Health Improvement and also undertake some of the work of the Audit Commission.
We are in discussions with the Department of Health about the implications of its announcement for Wales. We have a number of options open to us in securing suitable audit and inspection arrangements for Wales, and we are considering these carefully. Whatever option we choose will need to reflect the policies, intentions and ethos of the health service in Wales, and satisfy value for money criteria.
 

Holywell Hospital

 

Alison Halford:

As a result of the recent announcement on health spending on 18 April, will the Minster be reconsidering using the private finance initiative to build Holywell hospital and use only public funds instead? (WAQ17581)

Jane Hutt:

Edwina Hart has confirmed that the Chancellor’s budget announcement means there will be additional money for new and better ways of improving health for the people of Wales. The Welsh Assembly Government will be setting priorities for allocating the Assembly’s budget and will be consulting on these next month as part of the annual budget planning round. I will then identify priorities for the allocation of any additional resources to ensure that core health and social services are properly funded across Wales.There are many requirements for capital funding within NHS Wales, including replacing equipment and addressing health and safety requirements, as well as building new hospitals. Any decision relating to Holywell hospital will be made when the trust has produced the necessary outline business case. As previously stated, we will continue to use a mix of public and private capital funding.
 

Purpose-built Surgeries for Delyn

 

Alison Halford:

As a result of the recent announcement on health spending, what plans does the Minister have to allocate some of it to build purpose-built surgeries for Delyn? (WAQ17582)

Jane Hutt:

Edwina Hart has confirmed that the Chancellor’s budget announcement means that there will be additional money for new and better ways of improving health for the people of Wales. The Welsh Assembly Government will be setting priorities for allocating the Assembly’s budget and will be consulting on these next month as part of the annual budget planning round. I will then identify priorities for the allocation of any additional resources to ensure that core health and social services are properly funded across Wales.Prior to the budget announcements, the Welsh Assembly Government had already agreed to provide £1 million from 2002-03 to 2004-05 to Flintshire local health group to develop a primary care resource centre for the patients of Flintshire. The development of this centre is under discussion but is likely to include a mix of primary care, community, social care and voluntary services.
 

Dentists in Delyn


Alison Halford:

As a result of the increase in the health budget announced on 18 April, how many more dentists will be working for the NHS in Delyn in the next few years? (WAQ17583)

Jane Hutt:

Edwina Hart has confirmed that the Chancellor’s budget announcement means there will be additional money for new and better ways of improving health for the people of Wales. The Welsh Assembly Government will be setting priorities for allocating the Assembly’s budget and will be consulting on these next month as part of the annual budget planning round. I will then identify priorities for the allocation of any additional resources to ensure that core health and social services are properly funded across Wales.I remain committed to a comprehensive, high quality NHS dental service for the people of Wales. I will continue to assist the Welsh health authorities to ensure the availability of that service through the Welsh dental initiative, which I was pleased to announce in my written statement to Assembly Members on 19 March.
However, general dental practitioners are independent contractors and are not directly employed by the health authority. As such, they are free to decide the level of work they undertake on behalf of the NHS. The Assembly has no power to compel them to work in any particular area, or to accept patients for NHS treatment if they are either unable or unwilling to do so.
 

Spending on Mental Health Services in Delyn


Alison Halford:

As a result of the increase in the health budget announced on 18 April, how much more money is to be spent on mental health services in Delyn? (WAQ17584)

Jane Hutt:

Edwina Hart, the Minister for Finance, Local Government and Communities, has confirmed that the Chancellor’s budget announcement means that there will be additional money for new and better ways of improving health for the people of Wales. The Welsh Assembly Government will be setting priorities for allocating the Assembly’s budget and will be consulting on these next month, as part of the annual budget planning round. I will then identify priorities for the allocation of any additional resources to ensure that core health and social services are properly funded across Wales.It is worth noting that of its £391.6 million discretionary allocation, North Wales Health Authority spent £40.245 million on mental health services in 2000-01—the latest year for which figures are available*. Expenditure figures for constituencies are not collected centrally.* Source: annual accounts of North East Wales NHS Trust 2000-01
 

Health Expenditure in North Wales


Alison Halford:

As a result of the increase in the health budget, how much extra money is to be spent on health services in north Wales and Delyn in the next few years? (WAQ17585)

Alison Halford:

 Following from the increase in spending announced on 18 April, will north Wales see a greater, lesser or equal increase in spending than south Wales? (WAQ17593)

Jane Hutt:

Although Edwina Hart has already confirmed that the Chancellor’s budget announcement means there will be additional money for new and better ways of improving health for the people of Wales, the Welsh Assembly Government will be setting its own priorities for allocating the Assembly’s budget. Final decisions on local health board allocations for 2002-03 will be made once the Assembly’s budget is finalised. The allocations will also need to take account of the outcome of Professor Peter Townsend’s resource allocation review and current levels of health spending in different areas. While final figures are not yet available, north Wales local health boards are expected to receive a lower increase in their overall levels of health expenditure than those where current levels of health expenditure are furthest from the Townsend target share. However, I remain committed to ensuring that all areas of Wales receive sufficient levels of uplift to enable them to sustain ongoing improvements in health services. 


Tonsil Sterilisation Equipment

 

Alison Halford:

What urgent action is being taken to upgrade tonsil sterilisation standards/equipment throughout Wales so that tonsil operation waiting lists can be reduced in Delyn and the rest of Wales? (WAQ17586)

Jane Hutt:

In 2001, an audit of the decontamination and sterilisation procedures in Wales at NHS trusts and general medical and dental practitioners highlighted a number of deficiencies in a number of areas. Following this, in March 2001, grant aid of £8 million was allocated over a three-year period (£2 million in 2001-02, £4 million in 2002-03 and £2 million in 2003-04) to improve the decontamination service for healthcare providers and upgrade all hospital sterilisation and decontamination units across Wales. A project board was set up to ensure fair allocation of the grant aid. In December 2001, the project board met to agree the allocation of £2 million. It was agreed that non-accredited departments would take precedence over compliant departments and that equipment priority would be washers and sterlisers.
Trusts have been invited to resubmit their bids with regard to the allocation of grant aid in 2002-03 and 2003-04. It is anticipated that this aid will fund tracking/tracing systems, autoclaves and other services such as endoscopy and podiatry. In addition, volunteers are being sought for pilot projects to investigate the feasibility of hospital sterilisation and decontamination units offering services to general medical and general dental practices. The next meeting of the project board will be in June 2002 when the allocation of this year’s funding will be agreed.It is the aim of the project board to get all hospital sterilisation and decontamination units up to accredited standard by 2004.
 

Quality of Single-use Tonsil Instruments

Alison Halford:

What discussions has the Minster or her department had regarding concerns over the quality and safety of single-use tonsil instruments and what urgent action has she taken to ensure patient safety is protected? (WAQ17587)

Jane Hutt:

 The first batch of single use instruments for tonsillectomy operations arrived in Wales in July 2001 and was distributed forthwith. Surgeons started performing tonsillectomy and adenoidectomy operations straight away. Unfortunately some surgeons were unhappy with the instruments. Similar problems were being experienced elsewhere in the UK and in December 2001 the Department of Health advised surgeons in England that they might revert to reusable instruments.
This stance was considered in Wales. Guidance issued in December 2001 from the Chief Medical Officer for Wales, Dr Ruth Hall, is that, if surgeons are confident about using single-use instruments, they may continue to operate. Others may wish to wait until the outcome of a review. Reusable instruments are not being used in Wales.
A meeting between Dr Hall, her professional advisers, and representatives of the ear, nose and throat surgeons in Wales, took place on 13 March when it was agreed that the above guidance stood.
At a second meeting on 4 April, Dr Hall was presented with audit data collected from the patient episode database Wales for the past six years. This data will be reviewed internally by the Welsh Assembly Government and presented to a meeting of the Welsh Otorhinolaryngology Association for peer review. At the meeting it was also agreed that the guidance remain unchanged. If, in an emergency situation, a reusable set is used, following the operation this must be discarded or quarantined until the long-term position is established.
A further meeting is scheduled to take place on 16 May 2002.
 

Cost of Better Single-use Tonsil Instruments

 

Alison Halford:

What discussions has the Minster or her department had regarding the acquiring and cost implications of higher standard single-use tonsil instruments for the health service in Wales? (WAQ17588)

Jane Hutt:

A representative from Welsh Health Supplies was invited to the meetings between the Chief Medical Officer and representatives from the ear, nose and throat surgeons in Wales (WAQ17587), to discuss policy issues surrounding use of disposable tonsillectomy instruments in Wales. The Chief Medical Officer for Wales and her professional advisers are being advised of the situation with regard to the status of the purchasing and supply agency’s contract for single-use instruments and of the current stock levels at their warehouses in Bridgend and Denbigh.Welsh Health Supplies, in association with a number of ear, nose and throat surgeons, have been asked to investigate alternative sources of supply instruments and meetings between the ear, nose and throat surgeons and manufacturers have taken place.
Funding of £1.07 million has been set aside in 2002-03 for single-use instruments.
 

Use of Single-use Tonsil Instruments


Alison Halford:

Why, if the Secretary of State for Health in England has allowed a return to reusable instruments for tonsil operations, has the Minister decided not to allow the use of reusable instruments and instead allowed the use of single-use instruments only? (WAQ17589)

Jane Hutt:

Following reports of poor quality instruments and incidents of secondary haemorrhaging, in December 2001 the Department of Health advised trusts in England to revert to reusable instruments. The argument for this was that their decontamination units were now of a high enough standard to be in a position to sterilise and decontaminate instruments used in tonsillectomy and adenoidectomy operations. This line was not taken in Wales (or Scotland or Northern Ireland). The Chief Medical Officer for Wales, Dr Ruth Hall, and her professional advisers have discussed the evidential basis for the introduction of single-use instruments to combat the possibility of associated variant CJD contamination and the clinical risk associated with the use of single-use instruments. It was felt that before a decision could be made objectively in Wales, more information was needed from the trusts. Data on tonsillectomy and adenoidectomy operations is currently being analysed.
 
‘Substandard’ Single-use Tonsil InstrumentsAlison Halford: What help is the Minister giving to local health trusts to ensure they get the full support of the Assembly so that a quick and ultimately safe solution can be found as quickly as possible to the concerns some surgeons have raised over using ‘substandard’ single-use tonsil instruments? (WAQ17590)Jane Hutt: Following meetings with representatives of ear, nose and throat surgeons in Wales, the Chief Medical Officer for Wales has written to each NHS trust to advise them of the outcome of these discussions and issue guidance on policy regarding use of disposable instruments for tonsillectomy operations. In her letter of 11 April 2002, Dr Hall advised trusts that the policy in Wales remained unchanged. She also advised them of the data presented to the meeting, which is currently being analysed, and the role of Welsh Health Supplies.
Trusts which have already identified alternative sources of instruments for single use may purchase these rather than use those instruments identified last year as part of the NHS Purchasing and Supply Agency’s contract. Further funding of £1.07 million, for single-use instruments, has been allocated and trusts will shortly be notified as to budget allocations. 


Neuroscience Services

Alison Halford:

What discussions has the Minister had with North Wales Health Authority over the funding of its neuroscience services? (WAQ17591)

Jane Hutt:

Decisions on funding and commissioning of services are at present the responsibility of health authorities. The authorities, with their local knowledge, are best placed to priorities the services people need after weighing up the many pressing needs in the area.
It is up to local commissioners and the voluntary organisations to negotiate on provision of services, and it is for the statutory authorities to ensure that a proper range of services is provided to people in their area.
 

Epilepsy Services

Alison Halford:

 What plans does the Minister have to ask the Audit Commission to review epilepsy services across Wales? (WAQ17592)

Jane Hutt:

We have no plans to ask the Audit Commission to review epilepsy services across Wales.
 

Safety of Single-use Tonsil Instruments

 

Alison Halford:

Is the Minister confident that the single-use tonsil instruments currently in use are safe to use? (WAQ17594)

Jane Hutt:

The evidence currently before the Chief Medical Officer, taken from a retrospective audit of 18,000 cases performed over the last five to six years, suggests that there may be a problem with just one or two instruments currently in practice in some hands.
In order to resolve this situation the Chief Medical Officer has met and continues to meet with her professional advisers and representatives from ear, nose and throat surgeons across Wales and from Welsh Health Supplies. The data, which has been gathered, is currently being analysed and meetings have also been held with the manufacturers of these instruments with a view to improving quality and design.
Current guidance issued by Dr Hall is that ‘single use tonsillectomy should continue in Wales where surgeons are confident in their use of these instruments and confident in the validity of their data.’ 

 

Reduction in Epilepsy Services

Alison Halford:

 

Will the Minister agree that with no expansion in neuroscience services on the part of the North Wales Health Authority next year, and the expected demise of Epilepsy Wales, that epileptic patients in north Wales are seeing a possibly life-changing reduction in services for this serious condition? (WAQ17595)

Jane Hutt:

Decisions on funding and commissioning of services are at present the responsibility of health authorities.
The position on funding for Epilepsy Wales has been clearly explained in numerous pieces of correspondence and in answers to earlier Assembly questions. I value the services provided by Epilepsy Wales and other epilepsy voluntary organisations, but the Welsh Assembly Government cannot step into the breach each time short-term lottery funding comes to an end. It is up to local commissioners and the voluntary organisations to negotiate on provision of services, and it is for the statutory authorities to ensure that a proper range of services is provided to people in their area.
As well as the services provided by Epilepsy Wales, epilepsy services are provided in south Wales by the Gwent Epilepsy Group and in north Wales by the epilepsy support group in Bangor. None of those groups receive central funding.
 

Additional Funding for Health Spending in Wales

Alison Halford:

Will the Minister confirm that the extra budget money she welcomed on 18 April will amount to £4.676 billion in extra money above the existing baselines available for health spending in Wales by 2007-08, or is the total figure by 2007-08 expected to be £1.8 billion? (WAQ17706)

Jane Hutt:

The additional funding for health spending in Wales, arising from the Chancellor’s budget on 17 April, represents annual increases to existing baselines for the period 2003-04 to 2007-08 as set out below:2003-04
2004-05
2005-06
2006-07
2007-08
£128 million
£493 million
£907 million
£1348 million
£1844 million
By 2007-08, £1.8 billion will be available for health spending in Wales over existing baselines. That additional funding will enable the Welsh Assembly Government to continue improving the quality of healthcare in Wales. Decisions on how the funding should be allocated for the period 2003-06 will be taken during the forthcoming budget planning round.

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