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390599

	registered interest
	date	16/07/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Anaemia
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government what action they are taking to address the problems associated with the late diagnosis of pernicious anaemia, in the light of the results of the survey published in the <i>British Nursing Journal</i> in April 2014.
	tabling member printed	The Countess of Mar
	uin	HL1539
	answer	answer is ministerial correction date of answer 24/07/2015 answer text <p>It is important that patients suffering from pernicious anaemia, the result of a vitamin B12 (cobalamin) deficiency, receive a prompt and appropriate diagnosis. Pernicious anaemia develops gradually, and can cause a range of symptoms, including fatigue, lethargy, feeling faint and headaches, which vary from patient to patient. Because of the gradual progression of the condition, the variety of symptoms, which are shared with a range of other conditions, diagnosis at early onset can be challenging.</p><p>To support the diagnosis of pernicious anaemia, the British Committee for Standards in Haematology (BCSH) has published <em>Guidelines for the diagnosis and treatment of Cobalamin and Folate disorders,</em> which sets out that cobalamin status is the recommended first line diagnostic test. However, the guidance states that there is no gold standard test for the condition and makes it clear that the clinical picture of a patient is the most important factor in assessing the significance of the test results. This means clinicians should take into account all of the symptoms the patent is experiencing, their medical history, age and other relevant factors when considering the implications of a patient’s cobalamin status. The BCSH guidance highlights the risk of neurological impairment if treatment is delayed.</p><p><br /> The BCSH operates independently of Department and NHS England and produces evidence based guidelines for both clinical and laboratory haematologists on the diagnosis and treatment of haematological disease, drawing on the advice of expert consultants and clinical scientists practicing in the United Kingdom. It would be for the BCSH, not the Department, to consider whether any adjustments to current best practice in the diagnosis and treatment of patients with pernicious anaemia were needed, including whether any new or additional tests were appropriate. A copy of the BCSH guidance document <del class="ministerial">has already been placed in the Library and</del> is attached.</p><p><br /> More general clinical guidance on the diagnosis and management of pernicious anaemia can also be found on the National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summaries website. This is a freely accessible online resource that covers the causes, symptoms, diagnosis and treatment of pernicious anaemia, as well as potential complications of the condition. In addition to this, NHS Choices provides similar, though less technical, information on pernicious anaemia for the public.</p> answering member printed Lord Prior of Brampton question first answered 24/07/2015 13:21:19 question first ministerially corrected 14/10/2015 11:21:08 answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name colbalamin and folate disorders.pdf title BCSH Guidelines pernicious anaemia previous answer version 17459 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name colbalamin and folate disorders.pdf title BCSH Guidelines pernicious anaemia
	tabling member	1861 label Biography information for The Countess of Mar

390600

	registered interest
	date	16/07/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Anaemia
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government how they propose to alert medical practitioners to the severe and irreversible nerve damage that can occur when pernicious anaemia is misdiagnosed.
	tabling member printed	The Countess of Mar
	uin	HL1540
	answer	answer is ministerial correction date of answer 24/07/2015 answer text <p>It is important that patients suffering from pernicious anaemia, the result of a vitamin B12 (cobalamin) deficiency, receive a prompt and appropriate diagnosis. Pernicious anaemia develops gradually, and can cause a range of symptoms, including fatigue, lethargy, feeling faint and headaches, which vary from patient to patient. Because of the gradual progression of the condition, the variety of symptoms, which are shared with a range of other conditions, diagnosis at early onset can be challenging.</p><p>To support the diagnosis of pernicious anaemia, the British Committee for Standards in Haematology (BCSH) has published <em>Guidelines for the diagnosis and treatment of Cobalamin and Folate disorders,</em> which sets out that cobalamin status is the recommended first line diagnostic test. However, the guidance states that there is no gold standard test for the condition and makes it clear that the clinical picture of a patient is the most important factor in assessing the significance of the test results. This means clinicians should take into account all of the symptoms the patent is experiencing, their medical history, age and other relevant factors when considering the implications of a patient’s cobalamin status. The BCSH guidance highlights the risk of neurological impairment if treatment is delayed.</p><p><br /> The BCSH operates independently of Department and NHS England and produces evidence based guidelines for both clinical and laboratory haematologists on the diagnosis and treatment of haematological disease, drawing on the advice of expert consultants and clinical scientists practicing in the United Kingdom. It would be for the BCSH, not the Department, to consider whether any adjustments to current best practice in the diagnosis and treatment of patients with pernicious anaemia were needed, including whether any new or additional tests were appropriate. A copy of the BCSH guidance document <del class="ministerial">has already been placed in the Library and</del> is attached.</p><p><br /> More general clinical guidance on the diagnosis and management of pernicious anaemia can also be found on the National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summaries website. This is a freely accessible online resource that covers the causes, symptoms, diagnosis and treatment of pernicious anaemia, as well as potential complications of the condition. In addition to this, NHS Choices provides similar, though less technical, information on pernicious anaemia for the public.</p> answering member printed Lord Prior of Brampton question first answered 24/07/2015 13:21:19 question first ministerially corrected 14/10/2015 11:21:19 answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name colbalamin and folate disorders.pdf title BCSH Guidelines pernicious anaemia previous answer version 17460 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name colbalamin and folate disorders.pdf title BCSH Guidelines pernicious anaemia
	tabling member	1861 label Biography information for The Countess of Mar

347943

	registered interest
	date	02/06/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Human Papillomavirus: Vaccination
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government, to date, how many adverse reactions to (1) Cervarix, (2) Gardasil and (3) generic human papilloma virus vaccines have been reported to the Medicines and Healthcare products Regulatory Agency; for each category, how many of those reports are of serious adverse reactions; and what age-specific rate those figures represent.
	tabling member printed	The Countess of Mar
	uin	HL229
	answer	answer is ministerial correction date of answer 16/06/2015 answer text <p>A total of 8,243 suspected adverse drug reaction (ADR) reports with human papilloma virus (HPV) vaccines have been reported to the Medicines and Healthcare products Regulatory Agency (MHRA), via the Yellow Card Scheme, up to 3 June 2015.</p><p> </p><p> </p><p> </p><p>To date, more than 8 million doses of HPV vaccine have been given across the United Kingdom as part of the routine immunisation programme. The MHRA does not hold data on age-specific vaccine usage, and therefore age-specific reporting rates cannot be calculated.</p><p> </p><p> </p><p> </p><p>It is important to note that a Yellow Card report is not proof of a side effect occurring, but a suspicion by the reporter that the vaccine may have been the cause. Yellow Card data cannot be used as a reliable indicator of the frequency of suspected ADRs to vaccines or medicines. The level of ADR reporting may fluctuate between given years due to a variety of reasons such as a medicine being new (reporting rates are generally higher when a product is first introduced), stimulated interest/publicity and variations in exposure to the medicine.</p><p> </p><p> </p><p> </p><p>The possible known side effects, and the frequency, are listed in the product information which is provided with the vaccines. The vast majority of the 8,243 ADRs relate to the known risks of vaccination that are well-described in the available product information. The proportion of suspected ADRs for HPV vaccines that were reported as serious (32%) is less than the proportion reported as serious for other routinely used vaccines (68% overall) during the same time period. The expected benefits in protecting against HPV-related mortality and disease outweigh the known side effects of HPV vaccine.</p><p> </p><p> </p><p> </p><p>The following table provides a breakdown of UK suspected spontaneous ADRs received via the Yellow Card Scheme in association with the HPV vaccine. The MHRA does not hold data on age-specific vaccine usage, and therefore age-specific reporting rates cannot be calculated.</p><p> </p><p> </p><p> </p><table><tbody><tr><td><p>Vaccine Brand</p></td><td><p>Total number of reports</p></td><td><p>Number of serious reports (% of total)</p></td><td><p>Reporting rate per 1000 doses (serious reporting rates per 1000)</p></td></tr><tr><td><p>Cervarix</p></td><td><p>6,266</p></td><td><p>1,768 (28%)</p></td><td><p><ins class="ministerial">n/a **</ins><del class="ministerial">0.78 (0.22)</del></p></td></tr><tr><td><p>Gardasil</p></td><td><p>1,471</p></td><td><p>504 (34%)</p></td><td><p><ins class="ministerial">n/a **</ins><del class="ministerial">0.18 (0.06)</del></p></td></tr><tr><td><p>HPV Brand unspecified</p></td><td><p>507</p></td><td><p>326 (64%)</p></td><td><p><ins class="ministerial">n/a ** </ins><del class="ministerial">0.06 (0.04)</del></p></td></tr><tr><td><p>Total for Human Papilloma virus vaccines</p></td><td><p>*8,244</p></td><td><p>2,598 (32%)</p></td><td><p>1.03 (0.32)</p></td></tr></tbody></table><p> </p><p><em>Source:</em> MHRA sentinel database for adverse reactions.</p><p> </p><p>* It should be noted that the total number of reports received will not be equal to the totals in the table above as some reports of suspected adverse reactions may have included more than one vaccine.</p><p><ins class="ministerial">**Updated UK-wide brand-specific usage data are not available to MHRA at the time of writing based on a minimum of 8 million combined doses of Cervarix and Gardasil administered across the UK to date.</ins></p><p> </p><p><ins class="ministerial"> <p> </p><p> </p><p> </p></ins></p><p> </p><p> </p><p> </p><p> </p><p> </p><p>The seriousness criteria for ADR reporting were determined by a working group of the Council for International Organizations of Medical Sciences (CIOMS) and are defined as 6 possible categories which are explained on the Yellow Card. The MHRA asks reporters to select one of the following criteria by ticking the appropriate box on the Yellow Card: (1) patient died due to reaction; (2) life threatening; (3) resulted in hospitalisation or prolonged inpatient hospitalisation; (4) congenital abnormality; and (5) involved persistent or significant disability or incapacity; or (6) if the reaction was deemed medically significant. In addition to this, seriousness of reaction terms has also been defined by the MHRA in its medical dictionary. Therefore an ADR report can be serious because the reporter considers the reaction to be serious or because the reaction term itself is considered serious in the MHRA medical dictionary.</p><p> </p> answering member printed Lord Prior of Brampton question first answered 16/06/2015 14:35:02 question first ministerially corrected 03/07/2015 14:01:13 answering member 127 label Biography information for Lord Prior of Brampton previous answer version 5462 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton
	tabling member	1861 label Biography information for The Countess of Mar

105793

	registered interest
	date	03/11/2014
	answering body	Department for Education
	answering dept id	60
	answering dept short name	Education
	answering dept sort name	Education
	hansard heading	Special Educational Needs
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government whether, under the Children and Families Act 2014, a family with a child who has special educational needs may opt out of an Education and Health Care Plan; and, if so, by what mechanism.
	tabling member printed	The Countess of Mar
	uin	HL2605
	answer	answer is ministerial correction date of answer 17/11/2014 answer text <p>Parents can make their own arrangements for their child’s education. These must be suitable for the child’s age, aptitude and any special educational needs they may have.</p><p> </p><p>Under the Children and Families Act 2014 where a local authority maintains an Education, Health and Care (EHC) plan for a child or young person it is under a duty to secure the special educational provision specified in it unless parents have made suitable alternative arrangements.</p><p> </p><p>Where a local authority is satisfied that the parents’ arrangements are suitable it must continue to review the child’s EHC plan annually and assure itself that the plan remains appropriate.</p><p> </p> answering member printed Lord Nash question first answered 17/11/2014 14:20:33 answering member 4270 label Biography information for Lord Nash
	tabling member	1861 label Biography information for The Countess of Mar

105794

	registered interest
	date	03/11/2014
	answering body	Department for Education
	answering dept id	60
	answering dept short name	Education
	answering dept sort name	Education
	hansard heading	Special Educational Needs
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government whether social services investigations into families are automatically triggered if a family chooses an educational method, such as home education, other than those listed in their Education and Health Care Assessment.
	tabling member printed	The Countess of Mar
	uin	HL2606
	answer	answer is ministerial correction date of answer 17/11/2014 answer text <p>Social services investigations into families are not automatically triggered if a family whose child has an Education, Health and Care Needs Assessment chooses to educate their child at home. Under section 7 of the Education Act 1996, parents have the right to educate their child at home. Home education must be suitable to the child’s age, ability, aptitude and special educational needs.</p><p> </p><p>Where local authorities and parents agree that home education is the right provision for a child with an Education, Health and Care (EHC) plan, the plan should make clear that the child will be educated at home. If it does, the local authority must arrange the special educational provision in the plan, working with the parents.</p><p> </p><p>In cases where the local authority names a school or type of school that it considers appropriate in the child’s EHC plan but the parents decided to educate the child at home, the local authority is not under a duty to arrange the special educational provision specified in the plan provided that it is satisfied that the arrangements made by the parents are suitable. Local authorities do not have the right of entry to the family home to check that the provision being made by the parent is suitable and may only enter the home at the invitation of the parents.</p> answering member printed Lord Nash question first answered 17/11/2014 14:19:59 answering member 4270 label Biography information for Lord Nash
	tabling member	1861 label Biography information for The Countess of Mar

156575

	registered interest
	date	19/11/2014
	answering body	Department for Work and Pensions
	answering dept id	29
	answering dept short name	Work and Pensions
	answering dept sort name	Work and Pensions
	hansard heading	Employment and Support Allowance
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government how many claimants for Employment Support Allowance who have degenerative conditions for which there is no possibility of improvement have been placed in the Work-Related Activity Group; how many have found employment; how many have had their benefits reduced for failing to find employment; whether the position of those claimants will be reviewed; and, if so, when.
	tabling member printed	The Countess of Mar
	uin	HL2998
	answer	answer is ministerial correction date of answer 27/11/2014 answer text <p /> <p>The information as requested is not available.</p> answering member printed Lord Freud question first answered 27/11/2014 12:30:03 answering member 3893 label Biography information for Lord Freud
	tabling member	1861 label Biography information for The Countess of Mar

156576

	registered interest
	date	19/11/2014
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Diseases
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government which organisations within the National Health Service or which represent members who provide services to the National Health Service are bound by the World Health Organisation’s International Classification of Diseases (ICD—10).
	tabling member printed	The Countess of Mar
	uin	HL2999
	answer	answer is ministerial correction date of answer 26/11/2014 answer text <p>The United Kingdom as a member state of the World Health Organization (WHO) is expected to comply with the WHO Nomenclature Regulations 1967 and is required to use the most current version of the International Classification of Diseases (ICD-10) for reporting cause of death and disease for compiling and publishing mortality and morbidity statistics. As such all providers of National Health Service funded care are required to submit ICD-10 codes for national reporting.</p><p> </p> answering member printed Earl Howe question first answered 26/11/2014 12:58:45 answering member 2000 label Biography information for Earl Howe
	tabling member	1861 label Biography information for The Countess of Mar

156577

	registered interest
	date	19/11/2014
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Chronic Fatigue Syndrome
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government why they do not record the numbers of people who are diagnosed with chronic fatigue syndrome/myalgic encephalomyelitis, given that current estimates are based on extrapolations from other countries.
	tabling member printed	The Countess of Mar
	uin	HL3000
	answer	answer is ministerial correction date of answer 27/11/2014 answer text <p>With the exception of cancer, there is no comprehensive central record of disease diagnosis for any condition. In 2007, the National Institute for Health and Care Excellence produced the clinical guidance, <em>Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): Diagnosis and management of CFS/ME in adults and children</em> which estimates that the annual prevalence is approximately 4000 cases per million of the population.</p><p> </p> answering member printed Earl Howe question first answered 27/11/2014 12:42:01 answering member 2000 label Biography information for Earl Howe
	tabling member	1861 label Biography information for The Countess of Mar

156578

	registered interest
	date	19/11/2014
	answering body	Department for Business, Innovation and Skills
	answering dept id	26
	answering dept short name	Business, Innovation and Skills
	answering dept sort name	Business, Innovation and Skills
	hansard heading	Artificial Sweeteners: Imports
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government what was the total amount of artificial sweeteners imported into the United Kingdom in 2013.
	tabling member printed	The Countess of Mar
	uin	HL3001
	answer	answer is ministerial correction date of answer 01/12/2014 answer text <p>According to HMRC, UK import figures for ‘artificial sweeteners’ are contained within HMRC Overseas Trade Statistics database code HS 21069092 (‘food preparations’, see full definition below). This captures a range of food preparations; it is not possible to split the data to show the amount (value or volume) of UK imports of artificial sweeteners in 2013 separately. The HMRC data shows that the UK imported £326.8 million (76,388,773 kilograms) worth of ‘food preparations’ in 2013.</p><p> </p><p> </p><p> </p><p><em>Note: definition of HS 21069092</em></p><p> </p><p><em>HS 21069092 - Food preparations, n.e.s., not containing milkfats, sucrose, isoglucose starch or glucose or containing, by weight, &lt; 1,5% milkfat, &lt; 5% sucrose or isoglucose, &lt; 5% glucose or &lt; 5% starch</em></p><p> </p><p><strong><em> </em></strong></p><p> </p> answering member printed Lord Livingston of Parkhead question first answered 01/12/2014 12:11:31 answering member 4278 label Biography information for Lord Livingston of Parkhead
	tabling member	1861 label Biography information for The Countess of Mar

166877

	registered interest
	date	01/12/2014
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Medical Records
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government whether clinical commissioning groups, general practitioner surgeries or any other National Health Service bodies have the legal right to provide insurance companies, or anyone else outside the National Health Service, with patients’ details, including their medical details; if so, which legislation permits such action; and, if any payment is received for supplying such information, to whom it is made.
	tabling member printed	The Countess of Mar
	uin	HL3295
	answer	answer is ministerial correction date of answer 05/12/2014 answer text <p>In the vast majority of cases National Health Service organisations may only provide confidential information about a patient to insurance companies and other third parties such as employers with the explicit consent of the patient. However, there may be a small number of cases where disclosure may take place without seeking consent, for example where there is a court order. Healthcare professionals who supply medical reports to insurance companies and employers may charge a fee for doing so; NHS organisations that supply copies of medical records may charge a fee that covers their costs.</p><p> </p> answering member printed Earl Howe question first answered 05/12/2014 14:32:42 answering member 2000 label Biography information for Earl Howe
	tabling member	1861 label Biography information for The Countess of Mar