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61553

	registered interest
	date	12/06/2014
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Learning Disability: Health Services
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty's Government what plans they have to ensure that people with learning disabilities are not excluded from NHS England's five-year strategic plan for National Health Service commissioners to improve quality of and access to health care, outlined in Everyone Counts: Planning for Patients 2014/15–2018/19.
	tabling member printed	Baroness Hollins
	uin	HL322
	answer	answer is ministerial correction date of answer 26/06/2014 answer text <p>The Government's Mandate to NHS England, sets out our ambitions for the health service, which include an objective that NHS England ensures clinical commissioning groups work with local authorities to ensure that vulnerable people, particularly those with learning disabilities and autism, receive safe, appropriate, high quality care. NHS England sets out how it will achieve the objectives in the Mandate in its 2014-15 – 2016-17 business plan. The Government will hold NHS England to account for its achievement.</p><p> </p><p><em>Everyone Counts: Planning for Patients 2014/15 to 2018/19</em>sets out a framework within which commissioners will need to work with providers and partners in local government to develop five year plans to secure the continuity of sustainable high quality care for all. Building on <em>Everyone Counts</em>, NHS England is beginning a programme of work to consider how to improve quality of and access to health care for people with learning disabilities. Within the framework there is specific reference to <em>Transforming Care: A national response to Winterbourne View Hospital. </em>This is a non-negotiable item that NHS England expects to be part of every relationship between commissioners and providers. As part of this, clinical commissioning groups, local authorities and specialised commissioners should work together to implement the core specification which describes the core principles that must be present in all education, health and social care services for children, young people, adults and older people with learning disabilities and/or autism who either display, or are at risk of displaying, behaviour that challenges.</p><p> </p><p>NHS England is committed to work to reduce premature mortality amongst people with learning disability, including actions in response to the Confidential Inquiry into Premature Deaths of People with Learning Disabilities.</p><p> </p> answering member printed Earl Howe question first answered 26/06/2014 14:01:36 question first ministerially corrected 26/06/2014 15:34:49 answering member 2000 label Biography information for Earl Howe previous answer version 6304 answering member printed Earl Baldwin of Bewdley answering member 3446
	tabling member	4190 label Biography information for Baroness Hollins

164499

	registered interest
	date	24/11/2014
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	NHS: Negligence
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government by how much the provision for clinical negligence claims against the National Health Service has grown in the last year; why it has grown; and what strategy is in place for reducing that amount.
	tabling member printed	Lord Sharkey
	uin	HL3092
	answer	answer is ministerial correction date of answer 04/12/2014 answer text <p>As at 31 March 2014, the National Health Service Litigation Authority (NHS LA) estimates that it has potential liabilities of £26.1 billion, of which £25.7 billion relates to clinical negligence. This is an increase of £3.1 billion from 31 March 201<del class="ministerial">4<ins class="ministerial">3</ins></del>, which can mainly be attributed to a continual rise in clinical negligence claims over recent years. There are a number of factors driving this increase, including the rise in the number of patients cared for and in the complexity of their care; and the general rise in litigation across a number of sectors including the NHS, driven in part by ‘no win, no fee’ agreements. It is anticipated that the effect of the latter is likely to diminish as a result of the Government’s Legal Aid Sentencing and Punishment of Offenders Act of 2012.</p><p> </p><p>The Department believes the best way to reduce negligence claims is to improve patient care and safety. In March 2014, the Secretary of State for Health issued a call to action to make the NHS the safest healthcare system in the world and achieve a three-year goal to halve avoidable harm and save 6,000 lives. The Sign up to Safety campaign embodies the ambition of the NHS to build a culture of safety, bringing together individuals and organisations with a contribution to make towards the patient safety goal. Elements of this campaign will focus on a reduction in avoidable harm that can lead to compensation claims. Organisations that sign up are setting out what they will do to strengthen patient safety, including a safety improvement plan which shows how their organisation intends to save lives and reduce harm for patients over the next three years. The NHS Litigation Authority, which already provides a “safety and learning service” to trusts<strong>,</strong> will support those organisations which have patient safety improvement plans that show a likely reduction in their higher volume, higher value claims.</p><p> </p> answering member printed Earl Howe question first answered 04/12/2014 16:04:05 question first ministerially corrected 13/01/2015 14:37:59 answering member 2000 label Biography information for Earl Howe previous answer version 31769 answering member printed Earl Howe answering member 2000 label Biography information for Earl Howe
	tabling member	4196 label Biography information for Lord Sharkey

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

177981

	registered interest
	date	04/02/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Passive Smoking
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government what is their estimate of the number of people who died as a result of passive smoking in each of the last five years.
	tabling member printed	Lord Laird
	uin	HL4692
	answer	answer is ministerial correction date of answer 17/02/2015 answer text <p>Exposure to secondhand smoke is a serious health hazard. More than 50 carcinogens have been identified in secondhand smoke.</p><p> </p><p> </p><p> </p><p>The report of the United States Surgeon General titled “<em>The health consequences of involuntary exposure to tobacco smoke”</em> concluded that secondhand smoke causes premature death and disease in children and adults who do not smoke. The scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke. Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome, acute respiratory infections, ear problems and more severe asthma. Smoking by parents causes respiratory symptoms and slows lung growth in children. Exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer. Legislation to stop smoking in vehicles carrying children will come into force in England on 1 October 2015.</p><p> </p><p><br /> The report of the Royal College of <ins class="ministerial">Physicians </ins><del class="ministerial">Surgeons</del> titled “<em>Going smoke-free: The medical case for clean air in the home, at work and in public places”</em> included estimates that secondhand smoke exposure caused approximately 12<del class="ministerial">2</del>,200 deaths in the United Kingdom in 2003, and that the majority of these deaths occurred as a result of exposure to secondhand smoke in the home. These estimates were made prior to the introduction of smokefree legislation in England in 2007. Over the past decade, the proportion of smokers who say that they do not smoke in the home has increased.</p><p> </p><p> </p><p> </p><p>The evidence is clear that smokefree legislation in England has had beneficial effects on health, as set out in the report “<em>The Impact of smokefree legislation in England: evidence review”</em> which was published alongside the Government’s <em>“Tobacco Control Plan for England”</em> in March 2011.</p><p> </p><p> </p><p> </p><p>The reports referred to have been placed in the Library.</p><p> </p> answering member printed Earl Howe question first answered 17/02/2015 16:08:25 question first ministerially corrected 12/03/2015 12:34:25 answering member 2000 label Biography information for Earl Howe previous answer version 45462 answering member printed Earl Howe answering member 2000 label Biography information for Earl Howe
	tabling member	2479 label Biography information for Lord Laird