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Lord Lucas asked Her Majesty's Government:

Lord Hunt of Kings Heath: Early clinical symptoms of variant Creutzfeldt-Jakob Disease (vCJD) are non-specific and include psychiatric symptoms such as depression, personality change, irritability, sleep disturbance and personal neglect. In addition, persistent pain and odd sensations may be experienced in the face and limbs. After several weeks or months, more clear-cut neurological symptoms may set in such as unsteadiness in walking, sudden jerky movements and loss of mental function. vCJD is a rare disease. With the vague nature of the early symptoms, general practitioners might initially diagnose a range of much more common psychiatric disorders. However, all healthcare professionals should be aware of the above symptoms and hence the possibility of vCJD through publications in the medical press, the media and the National CJD Surveillance Unit website. Updates on the disease are being sent out to all general practitioners through "CMO's update".

Dental Strategy for England

Lord Colwyn asked Her Majesty's Government:

Lord Hunt of Kings Heath: The NHS Dental Strategy for England will be published this summer,

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building on the section on dentistry which was included in the NHS Plan: A plan for investment; a plan for reform.

Dental Services: Anaesthesia and Sedation

Lord Colwyn asked Her Majesty;s Government:

    Whether they will carry out a survey on the use of general anaesthetics and sedations in general dental practice, both National Health Service and private, reporting on numbers, morbidity and mortality, to update the last such survey, undertaken in 1966.[HL3770]

Lord Hunt of Kings Heath: The recent review of general anaesthesia and sedation for dental treatment led by the Chief Medical Officer and the Chief Dental Officer considered data on National Health Service provision of general anaesthesia and sedation and associated mortality and this is reported in the report A Conscious Decision. No data was available on morbidity or on private sector provision. One of the recommendations in the report was that mortality and morbidity should be monitored and we will be taking this forward. The Department of Health continues to collect data in respect of NHS provision and in 1999-2000, 48,500 general anaesthetics were administered in the general dental services in England and 223,000 sedations.

Lord Colwyn asked Her Majesty's Government:

    Whether they intend to make any new funding available for the provision of sedation techniques in general dental practice; and whether some of this money will be available for the training of dental practitioners in these techniques.[HL3768]

Lord Hunt of Kings Heath: We have accepted the recommendations in the report from the review of general anaesthesia and sedation for dental treatment, which was led by the Chief Medical Officer and the Chief Dental Officer. We will now need to consider what implications accepting the recommendations may have for the provision of treatment under conscious sedation within the general dental services of the National Health Service. Training in sedation is already funded through public funds and we are exploring the need, and ways, for increasing this.

Lord Colwyn asked Her Majesty's Government:

    Whether, in view of the recent General Dental Council guidance on the use of general anaesthesia in dental practices, sufficient facilities are available in hospitals to cope with the extra referrals which will result; and what effect the ban will have on hospital waiting lists.[HL3769]

Lord Hunt of Kings Heath: General anaesthesia for dental treatment will not be restricted to hospitals until 2002, which will allow time for hospitals to prepare for additional pressures. We expect to see a further reduction in the number of general anaesthetics provided between now and 2002 and believe that the

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caseload, which is actually transferred to hospital, should be manageable.

NHS Expenditure on Smokers

Lord Stoddart of Swindon asked Her Majesty's Government:

    Further to the Written Answer to the Lord Laird on 11 July (WA 22), how much of the estimated amount of between £1.4 billion and £1.7 billion spent by the National Health Service on treating smoking-related diseases was expended on people who smoke tobacco.[HL3608]

Lord Hunt of Kings Heath: The estimate of £1.4 billion to £1.7 billion is the expenditure incurred by the National Health Service in respect of smokers because they smoke. Hence all those whose treatment incurred this expenditure are smokers. Expenditure on disease to which smoking makes some contribution (smoking related diseases) is necessarily higher.

NHS Management Structure

Lord Tebbit asked Her Majesty's Government:

    How many layers of management exist in the National Health Service between a staff nurse in a hospital and the Secretary of State.[HL3668]

Lord Hunt of Kings Heath: A staff nurse in a hospital ward in the National Health Service works within a team led by a ward sister or charge nurse. Wards are managed within clinical directorates in NHS trusts, but management structures vary. NHS trusts and health authorities are performance-managed by the NHS Executive whose chief executive reports to the Secretary of State for Health.

NHS Commissioning Arrangements

Earl Howe asked Her Majesty's Government:

    Further to the Written Answer by the Lord Hunt of Kings Heath on 29 February (WA 65-66), what steps they are taking to ensure that their advice on the structure and content of the annual reports on the new regional specialised commissioning arrangements is followed and that performance of these arrangements can be seen to be measured consistently throughout the National Health Service; and [HL3671]

    Whether they will circulate to relevant user organisations and disability charities their advice on the structure and content of (a) the annual reports on the new regional specialised commissioning arrangements; and (b) the annual report of the National Specialist Commissioning Advisory Group; how they propose to disseminate the findings of these reports; and when they expect to place copies of the reports in the Library of the House. [HL3672]

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Lord Hunt of Kings Heath: The annual reports for the new regional specialised commissioning arrangements have all been drawn up in line with a consistent structure and will be published locally in mid-September. The lessons learnt will be summarised in the annual report of the National Specialist Commissioning Advisory Group which is due to be published in early October. Both reports will be widely disseminated locally and copies will be placed in the Library.

Men's Health

Lord Laird asked Her Majesty's Government:

    Whether they will support and encourage a United Kingdom-wide men's health promotion awareness campaign; and [HL3632]

    What plans they have to address the widening mortality difference between social classes among men; and [HL3633]

    Whether they will make an annual report on the state of men's health nationally, listing strategies to address gender health differences. [HL3635]

Lord Hunt of Kings Heath: The Government are working closely with a number of voluntary and statutory organisations across the country to raise the profile of men's health. For example, the Health Development Agency is examining what measures are most effective in engaging men's interest in health issues. By this type of collaborative work, the Government are aiming to address men's particular health needs and tackle the inequalities that exist across social classes.

The widening inequalities between men are due to a variety of factors including the wider determinants of health, lifestyle and access to/willingness to take up services. We are addressing these problems in a number of ways. For example, a cross-departmental ministerial group is looking at issues affecting all young people, including young men. Also, the new National Plan for the National Health Service--building on the Acheson Report on inequalities in health and the White Paper Saving Lives--Our Healthier Nation--sets out a strategy for dealing with inequalities in health that will benefit men in lower social class groups, both directly and indirectly. We shall examine how best to report on progress and developments in men's health and to disseminate examples of good, innovative work in alleviating gender-related differences in health.

Prostate Cancer

Lord Laird asked Her Majesty's Government:

    What plans they have to address the differences in waiting times for men with suspected prostate cancer compared with patients with suspected breast cancer.[HL3634]

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Lord Hunt of Kings Heath: We are determined to improve the detection and treatment of prostate cancer as part of our programme of action to improve prevention and treatment of our cancer services across the National Health Service. In April 1999, we introduced a two-week waiting time standard for patients referred urgently by their general practitioners with suspected breast cancer. This high standard of care is being put in place for all other cases of suspected cancer during 2000 with the standard for prostate cancer being introduced in December 2000. We are also introducing "On the spot" style booking systems for cancer treatment, including prostate cancer, through the Cancer Services Collaborative. This £6 million initiative is significantly improving patient care by streamlining and redesigning care from referral through diagnosis and treatment thus reducing delays at every stage and will be rolled out to the NHS from April 2001.

The NHS Plan (Cm 4818-I) now sets out our commitment that the National Cancer Plan which we shall publish in the autumn will contain referral to diagnosis to treatment waiting times targets, covering all cancers. These targets will be drawn up in discussion with clinicians and patient groups, taking account of the speed at which the workforce can expand.

A Prostate Cancer Action Plan encompassing research, diagnosis, early detection, treatment and care will also be built into the National Cancer Plan. We have also asked the National Institute for Clinical Excellence to commission evidence-based guidance on urological cancers, including prostate, as part of the Improving Outcomes series.


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