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175861

registered interest
date	27/01/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Fertility: Drugs
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government, further to the Written Answers by the Parliamentary Under-Secretary of State for Public Health, Jane Ellison, on 14 July 2014 (HC Deb, col 448W), by Earl Howe on 2 December 2014 (HL2907) and by the Parliamentary Under-Secretary of State for Business, Innovation and Skills, George Freeman, on 14 January 2015 (HC220047), which body is responsible for regulating the administration of drugs used in fertility treatment; which fertility clinics in the United Kingdom are known to have administered drugs to patients when the corresponding drugs have not yet been licensed by the Medicines and Healthcare products Regulatory Agency (MHRA), regardless of whether or not the clinics concerned have been licensed by the Human Fertilisation and Embryology Authority (HFEA); which clinics in the United Kingdom that have been licensed by the HFEA are known to have administered reagents to permitted gametes or permitted embryos that are then introduced into patients when the reagents concerned have not otherwise been licensed by the MHRA for clinical use; how either the HFEA or the MHRA would be kept aware of all such instances; what the regulatory consequences are in each case; which body is responsible for collecting data regarding the effects of particular dosages on the welfare of the developing child and the health of the mother; and whether such data are collected on a case by case basis or as part of a clinical trial.
tabling member printed	Lord Alton of Liverpool
uin	HL4441
answer	answer is ministerial correction date of answer 10/02/2015 answer text <p>The Medicines and Healthcare products Regulatory Agency (MHRA) is the Government body responsible for the safety and licensing of medicines in the United Kingdom.</p><p> </p><p> </p><p> </p><p>Under their terms of service, general practitioners and hospital doctors are allowed to prescribe any medicinal product, including any unlicensed medicinal product, in order to meet special clinical need (subject to any local funding arrangements). They should always satisfy themselves that the medicinal products, or other substances they consider appropriate for their patients, can be safely prescribed, that patients are adequately monitored and that, where necessary, expert hospital supervision is available.</p><p> </p><p> </p><p> </p><p>The administration of medicinal products to patients undergoing fertility treatment is a matter of clinical judgment by the treating clinician. It is not regulated by the Human Fertilisation and Embryology Authority (HFEA). The National Institute for Health and Care Excellence’s Guideline <em>Fertility, Assessment and treatment for people with fertility</em> problems provides guidance for healthcare professionals on the use of such products, including those used for ovarian stimulation. The HFEA has advised that it does not collect information on the identity of medicinal products used in treatment.</p><p> </p><p> </p><p> </p><p>The HFEA is aware of some clinics that have administered reagents to permitted gametes or permitted embryos that are then introduced into patients when the reagents concerned have not been CE marked. Such instances are identified by sample audits conducted during the course of inspection and documented in the report of the inspection.</p><p> </p><p> </p><p> </p><p>Although the HFEA does not hold information on the effects of particular dosages on the welfare of the developing child and the health of the mother, the HFEA expects clinics to do such monitoring as part of their licensing conditions.</p><p> </p> answering member printed Earl Howe question first answered 10/02/2015 17:27:13 answering member 2000 label Biography information for Earl Howe
tabling member	738 label Biography information for Lord Alton of Liverpool

175862

registered interest
date	27/01/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	IVF
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government, further to the Written Answer by Earl Howe on 26 January 2015 (HL4064), why the Human Fertilisation and Embryology Authority (HFEA) does not consider that discussion of genetic modification, as it might be considered to apply to the creation of human admixed embryos, can usefully add to the debate on the definition of genetic modification in humans; whether the basis for the HFEA’s particular position is legal, scientific, doctrinal, ideological or pecuniary; whether the HFEA is capable of distinguishing between human embryos that have been genetically modified or not; if so, why it is unable to determine whether the generation of any human admixed embryos as defined under section 4A(6)(a) to (c) of the Human Fertilisation and Embryology Act 1990 would constitute genetic modification; and if not, how the HFEA is able to regulate such manipulation of human embryos.
tabling member printed	Lord Alton of Liverpool
uin	HL4442
answer	answer is ministerial correction date of answer 10/02/2015 answer text <p>We are advised that the Human Fertilisation and Embryology Authority (HFEA) does not believe that discussion of genetic modification, as it might be considered to apply to the creation of human admixed embryos, can usefully add to the debate on the definition of genetic modification in humans. This is because the current debate relates to the use of human eggs and embryos, which might be permitted for use in treatment, which would not involve the use of animal DNA, eggs or embryos.</p><p> </p><p> </p><p> </p><p>The HFEA has also advised that the regulatory framework enables the Authority to provide appropriate oversight of all embryos used in treatment and research.</p><p> </p> answering member printed Earl Howe question first answered 10/02/2015 17:25:40 answering member 2000 label Biography information for Earl Howe
tabling member	738 label Biography information for Lord Alton of Liverpool

175863

registered interest
date	27/01/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	IVF
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government, further to the Written Answers by Earl Howe on 26 January 2015 (HL4063 and HL4228), how members of the Expert Panel convened by the Human Fertilisation and Embryology Authority (HFEA) were assured that the children were genetically normal in the absence of any further information when the published abstract only referred to a "normal karyotype" and there was no "data concerned" further to support this; whether each of the mitochondrial diseases listed in Annex D of the Department of Health’s consultation document entitled "Mitochondrial Donation" is associated with an abnormal karyotype; whether they will place in the Library of the House a full copy of the correspondence between the member of the HFEA’s Expert Panel and the Zhang research group; if not, why not; and on what date or dates the correspondence was shared with all other members of the HFEA’s Expert Panel.
tabling member printed	Lord Alton of Liverpool
uin	HL4443
answer	answer is ministerial correction date of answer 10/02/2015 answer text <p>I have nothing further to add to the answers given previously on the subject of the published abstract of the Zhang research group.</p><p> </p><p><strong> </strong></p><p> </p><p>We are advised that all of the mitochondrial diseases listed in the consultation document are due to point mutations or deletions and thus there is a normal karyotype.</p><p> </p> answering member printed Earl Howe question first answered 10/02/2015 17:27:29 answering member 2000 label Biography information for Earl Howe
tabling member	738 label Biography information for Lord Alton of Liverpool

175864

registered interest
date	27/01/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	IVF
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government, further to the Written Answer by Earl Howe on 21 January (HL4011) regarding the challenges facing the National Health Service of tackling obesity, what assessment the Human Fertilisation and Embryology Authority (HFEA) has made of the impact of findings recently reported in the journal <i>Endocrinology</i> (Volume 155, Issue 11, pages 4554–67); and what data is held by the HFEA that would permit follow-up studies of children conceived via in vitro fertilisation, in order to establish whether or not trends observed in mice are similarly apparent in humans.
tabling member printed	Lord Alton of Liverpool
uin	HL4444
answer	answer is ministerial correction date of answer 10/02/2015 answer text <p>The Human Fertilisation and Fertilisation Authority (HFEA) has advised that it has not made an assessment of the impact of findings recently reported in the journal Endocrinology (Volume 155, Issue 11, pages 4554-67). However, the legislative framework allows the HFEA to hold data that can be linked to other databases holding height and weight data (for instance the Clinical Practice Research Datalink). Providing this linkage is performed by researchers at a United Kingdom institution, it would be permissible to carry out follow-up studies of children conceived via in vitro fertilisation, in order to establish whether or not the trend observed in mice is similarly apparent in humans.</p><p> </p> answering member printed Earl Howe question first answered 10/02/2015 15:49:21 answering member 2000 label Biography information for Earl Howe
tabling member	738 label Biography information for Lord Alton of Liverpool

175869

registered interest
date	27/01/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Diabetes
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what progress has been made in reducing the national diabetes-related amputation rate since their commitment to halve the rate two years ago.
tabling member printed	Lord Harrison
uin	HL4449
answer	answer is ministerial correction date of answer 10/02/2015 answer text <p>NHS England and clinical commissioning groups have responsibility for determining the overall approach to improving clinical outcomes from healthcare services for people with diabetes. Nevertheless, there are various actions at a national level which will help to ensure that all patients with diabetes receive good quality care, including foot care, to help improve outcomes and minimise amputation rates.</p><p> </p><p> </p><p> </p><p>The new National Diabetes Foot Care Audit, a module of the National Diabetes Audit, aims to establish the extent to which national guidelines on the management of diabetic foot disease are being met. The audit will provide local teams with the evidence needed to tackle any identified differences in practice which will lead to an overall improvement in management and outcomes for patients. Local and national level results will be available in March 2016. However, we do know that there has been an increase in the proportion of trusts with multidisciplinary diabetic footcare teams, from around 60% in 2011 to over 70% in 2013.</p><p> </p><p> </p><p> </p><p>As part of its focus on the Cardiovascular Disease Outcomes Strategy, NHS Improving Quality is working with the National Clinical Director for Diabetes to identify potential areas of service improvement such as diabetic foot disease. A number of Cardiovascular Strategic Clinical Networks are focussing on this to ensure that appropriate clinical pathways are in place which will deliver improved clinical outcomes for people with diabetes, including minimising amputation rates.</p><p> </p><p> </p><p> </p><p>Within NHS England, the National Clinical Director for Rehabilitation and Recovering in the Community and the Chief Allied Health Professions Officer are leading work to improve rehabilitation services, including collection and dissemination of good practice. This will help to improve outcomes, such as improving/maintaining foot health, by putting the patient at the centre of their care, and a focus on their goals.</p><p> </p> answering member printed Earl Howe question first answered 10/02/2015 15:21:44 answering member 2000 label Biography information for Earl Howe
tabling member	2488 label Biography information for Lord Harrison

175873

registered interest
date	27/01/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	NHS: Temporary Employment
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government, further to the reply by Baroness Jolly on 27 January, when they expect the annual cost of £2.5 billion for National Health Service agency staff appointments to be reduced to £1 billion per annum.
tabling member printed	Lord Mawhinney
uin	HL4453
answer	answer is ministerial correction date of answer 10/02/2015 answer text <p>The Department is not imposing a target nor a timescale for reducing the annual cost of National Health Service agency appointments, because to do so in an arbitrary manner might put patients at risk. However, the Government expects NHS organisations, who are responsible for the recruitment and retention of their staff, to have a firm grip on their workforce planning and management including how much they spend on agency staff. NHS organisations have access to a wide range of advice, guidance and best practice available to help them with this. One of the new conditions we have recently introduced for those trusts receiving financial help under section 42 of the Health and Social Care Act 2012 is to reduce their use of and the amount they spend on agency staff.</p><p> </p> answering member printed Earl Howe question first answered 10/02/2015 15:22:30 answering member 2000 label Biography information for Earl Howe
tabling member	121 label Biography information for Lord Mawhinney

175888

registered interest
date	27/01/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Hospitals: Hygiene
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what steps they are taking to increase the standard of hygiene in hospitals.
tabling member printed	Lord Taylor of Warwick
uin	HL4468
answer	answer is ministerial correction date of answer 04/02/2015 answer text <p>Good infection prevention and control, prudent antimicrobial use and cleanliness are essential to ensure that people who use health and social care services receive safe and effective care. A clean healthcare environment promotes patient confidence and demonstrates a positive safety culture. The Government has taken a number of steps to secure this, as set out below.</p><p> </p><p> </p><p> </p><p>Firstly, all hospital trusts are required by law to be registered with the Care Quality Commission (CQC) against a range of safety and quality standards. From April 2015, a new set of fundamental standards will come into force that reflect the recommendations made by Sir Robert Francis following his inquiry into care at Mid-Staffordshire NHS Foundation Trust.</p><p> </p><p>The new requirement for cleanliness will be that all premises and equipment used by service providers must be:</p><p> </p><p>- clean;</p><p> </p><p>- secure;</p><p> </p><p>- suitable for the purpose for which they are being used;</p><p> </p><p>- properly used;</p><p> </p><p>- properly maintained; and</p><p> </p><p>- appropriately located for the purpose for which they are being used.</p><p> </p><p> </p><p> </p><p>Secondly, the Department of Health is currently consulting on a revised <em>Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance </em>that will provide guidance for hospital trusts on how they might meet the CQC’s registration requirements in relation to hygiene.</p><p> </p><p> </p><p> </p><p>Thirdly, the Department has recently sponsored the British Standards Institution’s revision of a cleaning specification that can be used to assess the risks of poor cleanliness on patient confidence and the incidence of infection. The document is attached.</p><p> </p><p> </p><p> </p><p>By all current measures, standards of hospital cleanliness are very high. The most recent CQC survey results (of both in-patients and accident and emergency departments) show the highest ever levels of patient satisfaction with the cleanliness of wards and toilets.</p><p> </p><p> </p><p> </p><p>These improved levels of cleanliness have gone hand in hand with a continuing reduction in the number of healthcare associated infections such as Meticillin-resistant staphylococcus aureus.</p><p> </p> answering member printed Earl Howe question first answered 04/02/2015 13:52:43 answering member 2000 label Biography information for Earl Howe attachment 1 file name PAS5748 Specification for the planning, application, measurement and review of cleanliness services in hospitals.pdf title Hospital cleanliness review specification
tabling member	1796 label Biography information for Lord Taylor of Warwick

175889

registered interest
date	27/01/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Accident and Emergency Departments
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government whether they consider that accident and emergency units in England have a sufficient complement of doctors; and if not, what they consider to be the reasons for any shortfall.
tabling member printed	Lord Taylor of Warwick
uin	HL4469
answer	answer is ministerial correction date of answer 05/02/2015 answer text <p>It is not for the Government but for local National Health Service organisations to decide whether they have a sufficient complement of doctors, and they are best placed to do this based on the needs of their patients, demand for services and the best skill mix to serve their local community.</p><p> </p><p> </p><p> </p><p>The latest monthly workforce statistics published by the Health and Social Care Information Centre show that as at October 2014 there were 6,098 accident and emergency (A&amp;E) doctors in the NHS in England, an increase of 1,236 since May 2010.</p><p> </p><p> </p><p> </p><p>In addition to the increasing numbers of doctors working in A&amp;E units, in order to increase the pool of supply, last year Health Education England (HEE) worked with the College of Emergency Medicine to expand the emergency medicine branch of the Acute Care Common Stem programme and established a ‘run through’ pilot for speciality training. HEE developed a mechanism whereby doctors working in other clinical areas can transfer into emergency medicine with their skills recognised and progress more quickly through the early years of emergency medicine training. These actions are now having a positive impact on the system, and there is now a 98% fill rate.</p><p> </p> answering member printed Earl Howe question first answered 05/02/2015 13:20:58 answering member 2000 label Biography information for Earl Howe
tabling member	1796 label Biography information for Lord Taylor of Warwick

175890

registered interest
date	27/01/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Tobacco: Packaging
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what assessment they have made of the likely impact on the illicit tobacco market of their announcement to proceed with standardised packaging for tobacco products.
tabling member printed	Lord Palmer
uin	HL4470
answer	answer is ministerial correction date of answer 10/02/2015 answer text <p>The Government has considered carefully all aspects relevant to standardised packaging of tobacco products, including potential impacts on illicit trade. HM Revenue &amp; Customs has prepared an assessment of the potential impact of standardised packaging on illicit tobacco, which will be published in due course.</p><p> </p> answering member printed Earl Howe question first answered 10/02/2015 15:22:55 answering member 2000 label Biography information for Earl Howe
tabling member	3192 label Biography information for Lord Palmer

175891

registered interest
date	27/01/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Action on Smoking and Health
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government whether they will place in the Library of the House all correspondence including emails between Ministers and officials of the Department of Health and Action on Smoking and Health between 1 January 2012 and 27 January 2015.
tabling member printed	Lord Palmer
uin	HL4471
answer	answer is ministerial correction date of answer 10/02/2015 answer text <p>The Department of Health holds regular meetings with ASH to monitor delivery according to the terms of the grant awarded under Section 64 of the Health and Social Care Act.</p><p> </p><p> </p><p> </p><p>Ministers and officials meet a range of organisations on a regular basis to discuss tobacco control.</p><p> </p><p> </p><p> </p><p>Details of Ministerial meetings with external stakeholders are published quarterly in arrears on the Gov.UK website:</p><p> </p><p> </p><p> </p><p><a href="https://www.gov.uk/government/collections/ministerial-gifts-hospitality-overseas-travel-and-meetings" target="_blank">https://www.gov.uk/government/collections/ministerial-gifts-hospitality-overseas-travel-and-meetings</a></p><p> </p><p> </p><p> </p><p>Copies have been placed in the Library.</p><p> </p><p> </p><p> </p><p>Searching for and preparing the correspondence requested for release could only be provided at disproportionate cost.</p><p> </p> answering member printed Earl Howe grouped question UIN HL4473 question first answered 10/02/2015 16:11:54 answering member 2000 label Biography information for Earl Howe
tabling member	3192 label Biography information for Lord Palmer