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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

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

432083

	registered interest
	date	24/11/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Atrial Fibrillation: Diagnosis
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government what action they are taking to improve the diagnosis of atrial fibrillation.
	tabling member printed	Baroness Masham of Ilton
	uin	HL3856
	answer	answer is ministerial correction date of answer 08/12/2015 answer text <p>NHS England is encouraging clinical commissioning groups to work with local practices to target people at risk of atrial fibrillation (AF). Innovative approaches such as pulse testing at flu clinics and by some dentists are being used to identify AF in older people. The NHS Health Check programme’s best practice guidance also recommends a pulse check is carried out as part of the process of taking a blood pressure reading. People found to have an irregular pulse rhythm should be referred to the general practitioner for further investigation.</p><br /><p>The National Institute for Health and Care Excellence (NICE) published an updated guideline on AF in June 2014. This offers evidence-based advice on the care and treatment of people with AF and includes recommendations on diagnosis. In July 2015 NICE also published a quality standard on AF.</p><br /><p>In addition to its clinical guideline on AF, NICE has published technology appraisal guidance on a number of new oral anticoagulants (NOACs), approving them for certain patients.</p><br /><p>There is a legal requirement on commissioners to provide funding for treatments and drugs recommended in NICE technology appraisal guidance within three months of the guidance being published.This is enshrined in the NHS Constitution as a right to NICE-approved drugs.</p><br /><p>A <a href="https://www.nice.org.uk/resource/CG180/pdf/c/cg180-atrial-fibrillation-nic-consensus-statement-on-the-use-of-noacs?id=gvyb3hjdqrcjtn6ytpwx3ydb64" target="_blank">consensus statement</a> by the <a href="https://www.nice.org.uk/News/Article/new-collaborative-aims-to-increase-nice-guidance-uptake" target="_blank">NICE Implementation Collaborative</a> was published alongside NICE’s updated guideline in June 2014. This addresses some of the barriers to implementing NICE’s recommendations on prescribing NOACs.</p><br /><p>The need to reduce variation and strengthen compliance of the uptake of NICE technology appraisals was identified in <em>Innovation Health and Wealth</em>, published in December 2011. In response, NHS England and the Health and Social Care Information Centre now publishes on a quarterly basis an Innovation Scorecard to enable commissioners to benchmark their own position and increase transparency to patients and the public. This assists the NHS in the identification of variation and the adoption of treatments such as NOACs that are recommended in NICE technology appraisals. In addition, NHS England advises that it expects practitioners to consider anticoagulant treatments in line with NICE guidelines.</p><p>Some progress is being made. The uptake of NOACs across England has doubled in recent years from 45,708 per 100,000 of the resident population in 2013-14 to 126,845 in 2014-15.</p><br /><p><del class="ministerial">No assessment has been made of the number of strokes related to AF could be prevented each year through the roll-out of Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation in primary care. However, in 2014, an economic analysis estimated that if all eligible patients at high risk were managed according to the NICE AF guidelines, an additional 11,600 AF related strokes per year could be avoided.</del></p><br /><p><del class="ministerial">Copies of the guidance referred to have been placed in the Library.</del></p><p><ins class="ministerial">No assessment has been made of the number of strokes related to AF could be prevented each year through the roll-out of Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation (GRASP-AF) in primary care. However, in 2014, an economic analysis estimated that if all eligible patients at high risk were managed according to the NICE AF guidelines, an additional 11,600 AF related strokes per year could be avoided.</ins></p><p><ins class="ministerial"></ins></p><p><ins class="ministerial">Copies of the guidance referred to, excluding GRASP-AF have been placed in the Library.</ins></p> answering member printed Lord Prior of Brampton question first answered 08/12/2015 12:43:31 question first ministerially corrected 09/12/2015 13:43:14 answering member 127 label Biography information for Lord Prior of Brampton previous answer version 34228 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton
	tabling member	1850 label Biography information for Baroness Masham of Ilton

432082

	registered interest
	date	24/11/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Atrial Fibrillation: Screening
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government what action they are taking to promote opportunistic screening for atrial fibrillation.
	tabling member printed	Baroness Masham of Ilton
	uin	HL3855
	answer	answer is ministerial correction date of answer 08/12/2015 answer text <br /><p>NHS England is encouraging clinical commissioning groups to work with local practices to target people at risk of atrial fibrillation (AF). Innovative approaches such as pulse testing at flu clinics and by some dentists are being used to identify AF in older people. The NHS Health Check programme’s best practice guidance also recommends a pulse check is carried out as part of the process of taking a blood pressure reading. People found to have an irregular pulse rhythm should be referred to the general practitioner for further investigation.</p><br /><p>The National Institute for Health and Care Excellence (NICE) published an updated guideline on AF in June 2014. This offers evidence-based advice on the care and treatment of people with AF and includes recommendations on diagnosis. In July 2015 NICE also published a quality standard on AF.</p><br /><p>In addition to its clinical guideline on AF, NICE has published technology appraisal guidance on a number of new oral anticoagulants (NOACs), approving them for certain patients.</p><br /><p>There is a legal requirement on commissioners to provide funding for treatments and drugs recommended in NICE technology appraisal guidance within three months of the guidance being published.This is enshrined in the NHS Constitution as a right to NICE-approved drugs.</p><br /><p>A <a href="https://www.nice.org.uk/resource/CG180/pdf/c/cg180-atrial-fibrillation-nic-consensus-statement-on-the-use-of-noacs?id=gvyb3hjdqrcjtn6ytpwx3ydb64" target="_blank">consensus statement</a> by the <a href="https://www.nice.org.uk/News/Article/new-collaborative-aims-to-increase-nice-guidance-uptake" target="_blank">NICE Implementation Collaborative</a> was published alongside NICE’s updated guideline in June 2014. This addresses some of the barriers to implementing NICE’s recommendations on prescribing NOACs.</p><br /><p>The need to reduce variation and strengthen compliance of the uptake of NICE technology appraisals was identified in <em>Innovation Health and Wealth</em>, published in December 2011. In response, NHS England and the Health and Social Care Information Centre now publishes on a quarterly basis an Innovation Scorecard to enable commissioners to benchmark their own position and increase transparency to patients and the public. This assists the NHS in the identification of variation and the adoption of treatments such as NOACs that are recommended in NICE technology appraisals. In addition, NHS England advises that it expects practitioners to consider anticoagulant treatments in line with NICE guidelines.</p><p>Some progress is being made. The uptake of NOACs across England has doubled in recent years from 45,708 per 100,000 of the resident population in 2013-14 to 126,845 in 2014-15.</p><br /><p><del class="ministerial">No assessment has been made of the number of strokes related to AF could be prevented each year through the roll-out of Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation in primary care. However, in 2014, an economic analysis estimated that if all eligible patients at high risk were managed according to the NICE AF guidelines, an additional 11,600 AF related strokes per year could be avoided.</del></p><br /><p><del class="ministerial">Copies of the guidance referred to have been placed in the Library.</del></p><p><ins class="ministerial"></ins></p><p><ins class="ministerial">No assessment has been made of the number of strokes related to AF could be prevented each year through the roll-out of Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation (GRASP-AF) in primary care. However, in 2014, an economic analysis estimated that if all eligible patients at high risk were managed according to the NICE AF guidelines, an additional 11,600 AF related strokes per year could be avoided.</ins></p><p><ins class="ministerial"></ins></p><p><ins class="ministerial">Copies of the guidance referred to, excluding GRASP-AF have been placed in the Library.</ins></p> answering member printed Lord Prior of Brampton question first answered 08/12/2015 12:43:31 question first ministerially corrected 09/12/2015 13:42:42 answering member 127 label Biography information for Lord Prior of Brampton previous answer version 34227 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton
	tabling member	1850 label Biography information for Baroness Masham of Ilton

432085

	registered interest
	date	24/11/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Atrial Fibrillation: Strokes
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government what action they are taking to promote the implementation of NICE guidance on prescribing anticoagulants for the prevention of strokes related to atrial fibrillation.
	tabling member printed	Baroness Masham of Ilton
	uin	HL3858
	answer	answer is ministerial correction date of answer 08/12/2015 answer text <p>NHS England is encouraging clinical commissioning groups to work with local practices to target people at risk of atrial fibrillation (AF). Innovative approaches such as pulse testing at flu clinics and by some dentists are being used to identify AF in older people. The NHS Health Check programme’s best practice guidance also recommends a pulse check is carried out as part of the process of taking a blood pressure reading. People found to have an irregular pulse rhythm should be referred to the general practitioner for further investigation.</p><br /><p>The National Institute for Health and Care Excellence (NICE) published an updated guideline on AF in June 2014. This offers evidence-based advice on the care and treatment of people with AF and includes recommendations on diagnosis. In July 2015 NICE also published a quality standard on AF.</p><br /><p>In addition to its clinical guideline on AF, NICE has published technology appraisal guidance on a number of new oral anticoagulants (NOACs), approving them for certain patients.</p><br /><p>There is a legal requirement on commissioners to provide funding for treatments and drugs recommended in NICE technology appraisal guidance within three months of the guidance being published.This is enshrined in the NHS Constitution as a right to NICE-approved drugs.</p><br /><p>A <a href="https://www.nice.org.uk/resource/CG180/pdf/c/cg180-atrial-fibrillation-nic-consensus-statement-on-the-use-of-noacs?id=gvyb3hjdqrcjtn6ytpwx3ydb64" target="_blank">consensus statement</a> by the <a href="https://www.nice.org.uk/News/Article/new-collaborative-aims-to-increase-nice-guidance-uptake" target="_blank">NICE Implementation Collaborative</a> was published alongside NICE’s updated guideline in June 2014. This addresses some of the barriers to implementing NICE’s recommendations on prescribing NOACs.</p><br /><p>The need to reduce variation and strengthen compliance of the uptake of NICE technology appraisals was identified in <em>Innovation Health and Wealth</em>, published in December 2011. In response, NHS England and the Health and Social Care Information Centre now publishes on a quarterly basis an Innovation Scorecard to enable commissioners to benchmark their own position and increase transparency to patients and the public. This assists the NHS in the identification of variation and the adoption of treatments such as NOACs that are recommended in NICE technology appraisals. In addition, NHS England advises that it expects practitioners to consider anticoagulant treatments in line with NICE guidelines.</p><p>Some progress is being made. The uptake of NOACs across England has doubled in recent years from 45,708 per 100,000 of the resident population in 2013-14 to 126,845 in 2014-15.</p><br /><p><del class="ministerial">No assessment has been made of the number of strokes related to AF could be prevented each year through the roll-out of Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation in primary care. However, in 2014, an economic analysis estimated that if all eligible patients at high risk were managed according to the NICE AF guidelines, an additional 11,600 AF related strokes per year could be avoided.</del></p><br /><p><del class="ministerial">Copies of the guidance referred to have been placed in the Library.</del></p><p><ins class="ministerial">No assessment has been made of the number of strokes related to AF could be prevented each year through the roll-out of Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation (GRASP-AF) in primary care. However, in 2014, an economic analysis estimated that if all eligible patients at high risk were managed according to the NICE AF guidelines, an additional 11,600 AF related strokes per year could be avoided.</ins></p><p><ins class="ministerial"></ins></p><p><ins class="ministerial">Copies of the guidance referred to, excluding GRASP-AF have been placed in the Library.</ins></p> answering member printed Lord Prior of Brampton question first answered 08/12/2015 12:43:31 question first ministerially corrected 09/12/2015 13:43:51 answering member 127 label Biography information for Lord Prior of Brampton previous answer version 34230 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton
	tabling member	1850 label Biography information for Baroness Masham of Ilton

432084

	registered interest
	date	24/11/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Atrial Fibrillation: Strokes
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government what assessment they have made of how many strokes related to atrial fibrillation could be prevented each year through the roll-out of GRASP-AF in primary care.
	tabling member printed	Baroness Masham of Ilton
	uin	HL3857
	answer	answer is ministerial correction date of answer 08/12/2015 answer text <p>NHS England is encouraging clinical commissioning groups to work with local practices to target people at risk of atrial fibrillation (AF). Innovative approaches such as pulse testing at flu clinics and by some dentists are being used to identify AF in older people. The NHS Health Check programme’s best practice guidance also recommends a pulse check is carried out as part of the process of taking a blood pressure reading. People found to have an irregular pulse rhythm should be referred to the general practitioner for further investigation.</p><br /><p>The National Institute for Health and Care Excellence (NICE) published an updated guideline on AF in June 2014. This offers evidence-based advice on the care and treatment of people with AF and includes recommendations on diagnosis. In July 2015 NICE also published a quality standard on AF.</p><br /><p>In addition to its clinical guideline on AF, NICE has published technology appraisal guidance on a number of new oral anticoagulants (NOACs), approving them for certain patients.</p><br /><p>There is a legal requirement on commissioners to provide funding for treatments and drugs recommended in NICE technology appraisal guidance within three months of the guidance being published.This is enshrined in the NHS Constitution as a right to NICE-approved drugs.</p><br /><p>A <a href="https://www.nice.org.uk/resource/CG180/pdf/c/cg180-atrial-fibrillation-nic-consensus-statement-on-the-use-of-noacs?id=gvyb3hjdqrcjtn6ytpwx3ydb64" target="_blank">consensus statement</a> by the <a href="https://www.nice.org.uk/News/Article/new-collaborative-aims-to-increase-nice-guidance-uptake" target="_blank">NICE Implementation Collaborative</a> was published alongside NICE’s updated guideline in June 2014. This addresses some of the barriers to implementing NICE’s recommendations on prescribing NOACs.</p><br /><p>The need to reduce variation and strengthen compliance of the uptake of NICE technology appraisals was identified in <em>Innovation Health and Wealth</em>, published in December 2011. In response, NHS England and the Health and Social Care Information Centre now publishes on a quarterly basis an Innovation Scorecard to enable commissioners to benchmark their own position and increase transparency to patients and the public. This assists the NHS in the identification of variation and the adoption of treatments such as NOACs that are recommended in NICE technology appraisals. In addition, NHS England advises that it expects practitioners to consider anticoagulant treatments in line with NICE guidelines.</p><p>Some progress is being made. The uptake of NOACs across England has doubled in recent years from 45,708 per 100,000 of the resident population in 2013-14 to 126,845 in 2014-15.</p><br /><p><del class="ministerial">No assessment has been made of the number of strokes related to AF could be prevented each year through the roll-out of Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation in primary care. However, in 2014, an economic analysis estimated that if all eligible patients at high risk were managed according to the NICE AF guidelines, an additional 11,600 AF related strokes per year could be avoided.</del></p><br /><p><del class="ministerial">Copies of the guidance referred to have been placed in the Library.</del></p><p><ins class="ministerial">No assessment has been made of the number of strokes related to AF could be prevented each year through the roll-out of Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation (GRASP-AF) in primary care. However, in 2014, an economic analysis estimated that if all eligible patients at high risk were managed according to the NICE AF guidelines, an additional 11,600 AF related strokes per year could be avoided.</ins></p><p><ins class="ministerial"></ins></p><p><ins class="ministerial">Copies of the guidance referred to, excluding GRASP-AF have been placed in the Library.</ins></p> answering member printed Lord Prior of Brampton question first answered 08/12/2015 12:43:31 question first ministerially corrected 09/12/2015 13:43:28 answering member 127 label Biography information for Lord Prior of Brampton previous answer version 34229 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton
	tabling member	1850 label Biography information for Baroness Masham of Ilton

348423

	registered interest
	date	03/06/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	General Practitioners
	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 results of a survey on behalf of Monitor, which found that one in ten people are dissatisfied with their general practitioner surgery.
	tabling member printed	Lord Taylor of Warwick
	uin	HL235
	answer	answer is ministerial correction date of answer 17/06/2015 answer text <p>On 1 June 2015, Monitor published <em>Improving GP Services: Commissioners and Patient Choice</em>, which included the findings of a nationally representative survey conducted by Ipsos Mori.</p><p> </p><p> </p><p> </p><p>The report noted a high level of satisfaction with general practice overall. It found that 81% of patients were satisfied with their general practitioner (GP) practice, while only 10% were dissatisfied.</p><p> </p><p> </p><p> </p><p>Monitor’s report found that, after location, patients most value the ease of getting an appointment when choosing a GP practice. In order to improve access for patients, the Government has invested £175 million over two years through the Prime Minister’s GP Access Fund. This is testing improved and innovative access to GP services through longer opening hours, such as at evenings and weekends, but also different ways of accessing services, for example the use of Skype consultations. Altogether, there are now 57 schemes covering over 2,500 practices, meaning that over 18 million patients are expected to benefit from improved access and transformational change at local level by March 2016.</p><p>Additionally, the Primary Care Infrastructure Fund is investing £1 billion<ins class="ministerial">, including</ins> <del class="ministerial">and</del> £25 million as part of the Prime Minister’s GP Access Fund, over four years to improve premises and information technology, which will also improve access.</p><p> </p> answering member printed Lord Prior of Brampton question first answered 17/06/2015 13:19:17 question first ministerially corrected 19/06/2015 11:00:07 answering member 127 label Biography information for Lord Prior of Brampton previous answer version 5697 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton
	tabling member	1796 label Biography information for Lord Taylor of Warwick

628245

	registered interest
	date	03/11/2016
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	General Practitioners: Greater London
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government what was the ratio of GPs to patients in each Clinical Commissioning Group in London in each of the last five years.
	tabling member printed	Baroness Kramer
	uin	HL2980
	answer	answer is ministerial correction date of answer 16/11/2016 answer text <p>Due to the size of the data, the information requested is shown in the attached table.</p> answering member printed Lord Prior of Brampton question first answered 16/11/2016 16:34:05 question first ministerially corrected 21/12/2016 11:49:39 answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name Copy of 161129 HL2980 amended PQ data.xlsx title GP to Patient ratio table amended previous answer version 20761 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name 161107 GP to patient ratio HL2980_Final.xls title GP to Patient ratio table
	tabling member	1557 label Biography information for Baroness Kramer

451765

	registered interest
	date	09/02/2016
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Incontinence
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government whether Clinical Commissioning Groups and NHS trusts are responsible for the funding or provision of incontinence pads to residents of (1) care homes for personal care, and (2) care homes with nursing care.
	tabling member printed	Baroness Greengross
	uin	HL6040
	answer	answer is ministerial correction date of answer 23/02/2016 answer text <p><ins class="ministerial">The legislation under which NHS England and clinical commissioning groups (CCGs) commission services requires them to arrange for the provision of services for which they are responsible, to such extent as they consider necessary to meet all reasonable requirements.</ins></p><p><ins class="ministerial">For CCGs, this includes offering continence services as part of their obligation to provide community health. Although CCGs often focus on prevention and treatment, it is expected any standard continence service should include access to products. </ins><del class="ministerial">There is no legal requirement to supply these products.</del> The criteria for the provisioning of continence products are set by individual <del class="ministerial">clinical commissioning groups (</del>CCGs<del class="ministerial">)</del>. To support CCGs, NHS England has recently published new guidance to help improve the care and experience of children and adults with continence issues. This encourages much greater collaboration between health and social care.</p><p> </p><p>A copy of the guidance <em>Excellence in continence care</em> is attached.</p><p> </p> answering member printed Lord Prior of Brampton question first answered 23/02/2016 12:41:19 question first ministerially corrected 22/03/2016 11:59:02 answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name Excellence in continence care guidance.pdf title Excellence in continence care previous answer version 46599 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name Excellence in continence care guidance.pdf title Excellence in continence care
	tabling member	2518 label Biography information for Baroness Greengross

385301

	registered interest
	date	24/06/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Hepatitis
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government why the national waiting time criterion for referral to hepatitis C treatment is 18 weeks whereas the national waiting time criterion for referral to specialist services for HIV treatment is two weeks.
	tabling member printed	Baroness Masham of Ilton
	uin	HL784
	answer	answer is ministerial correction date of answer 08/07/2015 answer text <p><del class="ministerial">NHS England and Public Health England (PHE) are working alongside a coalition of other organisations and patient groups to draft a framework for hepatitis C improvement. This hepatitis C improvement framework will set high level aims for the public health system towards elimination of hepatitis C related liver disease as a significant public health concern.</del></p><p> </p><p> </p><p> </p><p><del class="ministerial">The hepatitis C improvement framework will be referred to in PHE’s liver disease framework.</del></p><p> </p><p><ins class="ministerial">Timing for access to care or treatments for all NHS England service specifications or policies is based on an assessment of the evidence for clinical effectiveness, cost effectiveness and affordability.</ins></p><p> </p><p> </p> answering member printed Lord Prior of Brampton question first answered 08/07/2015 13:53:15 question first ministerially corrected 08/07/2015 14:59:37 answering member 127 label Biography information for Lord Prior of Brampton previous answer version 12907 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton
	tabling member	1850 label Biography information for Baroness Masham of Ilton