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386488

	registered interest
	date	30/06/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Innovative Medicines and Medical Technology Review
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government what opportunities will be available to participate in the Accelerated Access Review announced in November 2014 as "The Innovative Medicines and Medical Technology Review" for (1) the public and patient groups, (2) medical charities, (3) academics, (4) researchers, and (5) other interested parties; and when they expect it to report.
	tabling member printed	Baroness Gardner of Parkes
	uin	HL983
	answer	answer is ministerial correction date of answer 09/07/2015 answer text <p>In order to inform his recommendations, the independent chair of the Accelerated Access Review, Sir Hugh Taylor, will be seeking views from a variety of stakeholder groups, including patients and their carers, medical charities, academics and researchers, as well as industry, the National Health Service and key arm’s length bodies such as the National Institute for Health and Care Excellence and NHS England. We have agreed a systematic engagement approach for these groups to ensure they all have the opportunity to input. A workshop involving representation from all these stakeholder groups was held on 2 July, and the review team is asking umbrella organisations and trade bodies to support it in continuing to reach a wide audience by holding a series of engagement events throughout the summer; these events are currently being planned. The review’s website is also being developed to include a crowdsourcing platform to allow these groups, and the wider public, to participate.</p><p> </p><p> </p><p> </p><p>We expect the report of the Accelerated Access review to be submitted by the end of the year.</p><p> </p> answering member printed Lord Prior of Brampton question first answered 09/07/2015 13:00:31 answering member 127 label Biography information for Lord Prior of Brampton
	tabling member	3596 label Biography information for Baroness Gardner of Parkes

386477

	registered interest
	date	30/06/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Hepatitis: Drugs
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government what steps they are taking to ensure that NHS England provides patients with hepatitis C access to new drugs approved by the National Institute for Health and Care Excellence without delay, and to ensure that NHS England continues to assess new technologies based on cost-effectiveness rather than affordability.
	tabling member printed	Baroness Randerson
	uin	HL972
	answer	answer is ministerial correction date of answer 09/07/2015 answer text <p>Commissioners are legally required to fund drugs and treatments recommended in National Institute for Health and Care Excellence (NICE) technology appraisal guidance.</p><p> </p><p> </p><p> </p><p>In the absence of guidance from NICE, it is for commissioners, including NHS England, to make funding decisions based on the available evidence.</p><p> </p><p> </p><p> </p><p>Commissioners are required to have in place clear and transparent arrangements for local decision making and for considering individual funding requests taking into account patients’ clinical circumstances.</p><p> </p> answering member printed Lord Prior of Brampton question first answered 09/07/2015 12:59:51 answering member 127 label Biography information for Lord Prior of Brampton
	tabling member	4230 label Biography information for Baroness Randerson

386476

	registered interest
	date	30/06/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Liver Diseases
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government when Public Health England's programme of work on liver disease will be published.
	tabling member printed	Baroness Randerson
	uin	HL971
	answer	answer is ministerial correction date of answer 09/07/2015 answer text <p>Public Health England’s liver disease framework will be published in autumn 2015.</p><p> </p> answering member printed Lord Prior of Brampton question first answered 09/07/2015 12:59:16 answering member 127 label Biography information for Lord Prior of Brampton
	tabling member	4230 label Biography information for Baroness Randerson

386475

	registered interest
	date	30/06/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Migrants: Infectious Diseases
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government whether records are kept on the proportion of new arrivals at immigration centres who have communicable diseases.
	tabling member printed	Baroness Suttie
	uin	HL970
	answer	answer is ministerial correction date of answer 09/07/2015 answer text <p>Healthcare in Immigration Removal Centres (IRCs) in England is commissioned by NHS England.</p><p> </p><p> </p><p> </p><p>Each of the IRCs has a primary healthcare service provided on site. The range of healthcare provision typically available includes initial health screening and risk assessment, including routine treatment of evident infection and active case finding for diseases commonly found among detainees including pulmonary tuberculosis, blood-borne viruses and sexually transmitted infections (if indicated by the initial assessment).</p><p> </p><p> </p><p> </p><p>IRCs currently operate under the Detention Centre Rules and Operating Standards for the purposes of health screening and access to a general practitioner (GP) targets for initial healthcare screening and assessment which means all detainees to be seen by a nurse for an initial health assessment within 2 hours of admission and to be seen by a GP within 24 hours of admission (which may vary on assessment by competent nurse). Any health problems identified, tests or treatments prescribed and their outcomes are recorded on computerised health informatics systems in IRCs (e.g. SystmOne) and information can be shared between prisons and IRCs.</p><p> </p><p> </p><p> </p><p>IRCs, like prisons, are required to notify Public Heath England Centres’ Health Protection Teams of cases or outbreaks of reportable diseases. This information is collated at national level by the Health &amp; Justice Team.</p><p> </p> answering member printed Lord Prior of Brampton question first answered 09/07/2015 12:59:05 answering member 127 label Biography information for Lord Prior of Brampton
	tabling member	4298 label Biography information for Baroness Suttie

386474

	registered interest
	date	30/06/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Migrants: Tuberculosis
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government whether latent tuberculosis infection screening is incorporated into routine medical checks at immigration centres.
	tabling member printed	Baroness Suttie
	uin	HL969
	answer	answer is ministerial correction date of answer 14/07/2015 answer text <p>People admitted to immigration removal centres (IRCs) are not currently screened for latent tuberculosis infection (LTBI). However, a national partnership agreement between Home Office Immigration Enforcement (HOIE), NHS England and Public Health England (PHE) published in April 2015 committed all three organisations to work together to improve the pro-active detection, surveillance and management of infectious diseases in IRCs and improve capability to detect and respond to outbreaks and incidents. A copy of the ‘Partnership Agreement between Home Office Immigration Enforcement, NHS England &amp; Public Health England’ is available at the following link and is attached.</p><p> </p><p> </p><p> </p><p><a href="http://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/04/hoie-partnership-final.pdf" target="_blank">http://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/04/hoie-partnership-final.pdf</a>.</p><p> </p><p> </p><p> </p><p>A working group on LTBI among detainees in IRCs is being established this summer by PHE (health and justice, travel and migrant health and tuberculosis (TB) sections) to explore these issues. This work will contribute to the overarching joint PHE and NHS five year TB strategy for England which was published in January 2015. A copy of ‘Collaborative Tuberculosis Strategy for England, 2015-2020’ is available at the following link and is attached.</p><p> </p><p> </p><p> </p><p><a href="https://www.gov.uk/government/publications/collaborative-tuberculosis-strategy-for-england" target="_blank">https://www.gov.uk/government/publications/collaborative-tuberculosis-strategy-for-england</a>.</p><p> </p><p> </p><p> </p><p>Included among several identified areas for priority action are: tackling TB in under-served populations (including migrants and those in secure and detained settings) and systematic implementation of new entrant LTBI screening.</p><p> </p><p> </p><p> </p><p>PHE will work to provide expert advice to NHS England and HOIE on how to implement LTBI screening in IRCs once this work has been completed.</p><p> </p> answering member printed Lord Prior of Brampton attachment 1 file name Collaborative_TB_Strategy_for_England_2015_2020_.pdf title Collaborative Tuberculosis Strategy for England 2 file name hoie-partnership-final.pdf title Partnership agreement question first answered 14/07/2015 12:09:30 answering member 127 label Biography information for Lord Prior of Brampton
	tabling member	4298 label Biography information for Baroness Suttie

386473

	registered interest
	date	30/06/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Diabetes: Depressive Illnesses
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government what estimate they have made of the annual cost of diabetes-related depression to the National Health Service.
	tabling member printed	Baroness Suttie
	uin	HL968
	answer	answer is ministerial correction date of answer 14/07/2015 answer text <p>The Department has not made any estimate of the annual cost of diabetes-related depression to the National Health Service.</p><p> </p><p> </p><p> </p><p>The National Institute for Health and Care Excellence (NICE) has estimated that approximately 15–25% of people with chronic physical health problems, such as diabetes, also meet diagnostic criteria for depression. This is reflected in NICE’s <em>Diabetes in adults quality standard, </em>which sets out that people with diabetes should be assessed for psychological problems which should then be managed appropriately. A copy is attached.</p><p> </p> answering member printed Lord Prior of Brampton question first answered 14/07/2015 12:07:31 answering member 127 label Biography information for Lord Prior of Brampton
	tabling member	4298 label Biography information for Baroness Suttie

386472

	registered interest
	date	30/06/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Diabetes: Depressive Illnesses
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government what emotional and psychological support is available for people with both diabetes and depression.
	tabling member printed	Baroness Suttie
	uin	HL967
	answer	answer is ministerial correction date of answer 09/07/2015 answer text <p>The National Institute for Health and Care Excellence guidance, <em>Diabetes in adults quality standard,</em> sets out that people with diabetes should be assessed for psychological problems which should then be managed appropriately.</p><p> </p><p> </p><p> </p><p>Talking therapies, provided through the Improving Access to Psychological Therapies programme, are increasing access to appropriate, evidence based services for people suffering from depression and other mental health problems.</p><p> </p> answering member printed Lord Prior of Brampton question first answered 09/07/2015 12:44:28 answering member 127 label Biography information for Lord Prior of Brampton
	tabling member	4298 label Biography information for Baroness Suttie

386469

	registered interest
	date	30/06/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Pancreatic Cancer: Diagnosis
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government what assessment they have made of (1) the number, and (2) the proportion, of pancreatic cancer patients whose diagnosis is made following an emergency admission; and how those figures compare with patients of other cancer types.
	tabling member printed	Lord Aberdare
	uin	HL964
	answer	answer is ministerial correction date of answer 14/07/2015 answer text <p>The Routes to Diagnosis study defines a methodology by which the route the patient follows to the point of diagnosis can be categorised, in order to examine demographic, organisational, service and personal reasons for delayed diagnosis.</p><p> </p><p> </p><p> </p><p>Administrative Hospital Episode Statistics data are combined with cancer waiting times data, data from the cancer screening programmes and cancer registration data from the National Cancer Data Repository.</p><p> </p><p> </p><p> </p><p>Using these datasets every case of cancer registered in England which was diagnosed in 2006-2010 is categorised into one of eight ‘Routes to Diagnosis’.</p><p> </p><p> </p><p> </p><p>The methodology is described in detail in the British Journal of Cancer article <em>Routes to Diagnosis for cancer - Determining the patient journey using multiple routine datasets</em>, which can be found at the following link and is also attached.</p><p> </p><p> </p><p> </p><p>http://www.nature.com/bjc/journal/v107/n8/full/bjc2012408a.html</p><p> </p><p> </p><p> </p><p>Emergency presentations are defined as “an emergency route via A&amp;E, emergency GP referral, emergency transfer, emergency admission or attendance.” More detail can be found in the attached technical document.</p><p> </p><p> </p><p> </p><p>Data on all malignant neoplasms (excluding non-melanoma skin cancer) and pancreatic cancer was taken from the “Routes to diagnosis 2006-2010 workbook (a)” – this can also be found in the attached article.</p><p> </p><p> </p><p> </p><p>The Emergency Presentation Route is the principle route to diagnosis for patients with pancreatic cancer. This reflects the lack of easily recognisable symptoms of early disease, with advanced disease often presenting with the acute onset of jaundice.</p><p> </p><p> </p><p> </p><p>The percentage of emergency presentations ranges from 3% for melanoma to 63% for acute lymphoblastic leukaemia.</p><p> </p><p> </p><p> </p><p>Table 1: Percentage of diagnoses by emergency presentation route, England, persons, 2006-2010</p><p> </p><table><tbody><tr><td> </td><td><p>Number of cases</p></td><td><p>Number of cases by emergency presentation route</p></td><td><p>Percentage by emergency presentation route</p></td></tr><tr><td><p> </p></td><td><p>a</p></td><td><p>b</p></td><td><p>(b/a)x100</p></td></tr><tr><td><p>All malignant neoplasms</p><p>(excl. non-melanoma skin cancer)</p></td><td><p>1,272,584</p></td><td><p>291,391</p></td><td><p>23%</p></td></tr><tr><td><p>Pancreas</p></td><td><p>34,012</p></td><td><p>16,460</p></td><td><p>48%</p></td></tr></tbody></table><p> </p><p><strong> </strong></p><p> </p><p><strong> </strong></p><p> </p> answering member printed Lord Prior of Brampton question first answered 14/07/2015 13:47:58 answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name Routes to diagnosis for cancer.pdf title Routes to Diagnosis for cancer
	tabling member	3898 label Biography information for Lord Aberdare

386468

	registered interest
	date	30/06/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Pancreatic Cancer: Tomography
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government what plans they have to increase the capacity of imaging services available to pancreatic cancer patients across the National Health Service, including computerised tomography scans.
	tabling member printed	Lord Aberdare
	uin	HL963
	answer	answer is ministerial correction date of answer 09/07/2015 answer text <p>NHS England has a published service specification for pancreatic cancer which clearly defines what it expects to be in place for providers to offer evidence-based, safe and effective pancreatic cancer services. This service specification has been developed by specialised clinicians, commissioners, expert patients and public health representatives to describe core and developmental service standards.</p><p> </p><p> </p><p> </p><p>Patients being treated at cancer units should have access to an upper gastrointestinal cancer nurse. All district general hospitals should have such a person in post. If the patient is transferred to a cancer centre they should then have access to a pancreatic nurse specialist. This person should see every patient and become their key worker.</p><p> </p><p> </p><p> </p><p>Patients with suspected pancreatic cancer are usually first investigated by an ultrasound scan. If this shows biliary dilatation, or anything else suspicious, the patient should then be sent for a pancreas protocol computerised tomography scan which is the best investigation for identifying pancreatic cancer.</p><p> </p><p> </p><p> </p><p>Increasing the capacity of diagnostic and imaging services is clearly recognised as a priority for the National Health Service and it is has been raised as a key issue by the independent Cancer Taskforce, as well as by the Cancer Waiting Times Taskforce. We expect a new cancer strategy to be published this summer which will set out the strategy for the system for the next five years and will include consideration of the whole cancer pathway, including the capacity of diagnostic services.</p><p> </p><p> </p><p> </p><p>In addition, NHS England is testing various approaches to new models of care which could potentially deliver improved access to diagnostic services for cancer patients, including those with pancreatic cancer.</p><p> </p> answering member printed Lord Prior of Brampton grouped question UIN HL962 question first answered 09/07/2015 12:43:47 answering member 127 label Biography information for Lord Prior of Brampton
	tabling member	3898 label Biography information for Lord Aberdare

386467

	registered interest
	date	30/06/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Pancreatic Cancer: Nurses
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty’s Government what steps they are taking to ensure that all pancreatic cancer patients have access to a clinical nurse specialist.
	tabling member printed	Lord Aberdare
	uin	HL962
	answer	answer is ministerial correction date of answer 09/07/2015 answer text <p>NHS England has a published service specification for pancreatic cancer which clearly defines what it expects to be in place for providers to offer evidence-based, safe and effective pancreatic cancer services. This service specification has been developed by specialised clinicians, commissioners, expert patients and public health representatives to describe core and developmental service standards.</p><p> </p><p> </p><p> </p><p>Patients being treated at cancer units should have access to an upper gastrointestinal cancer nurse. All district general hospitals should have such a person in post. If the patient is transferred to a cancer centre they should then have access to a pancreatic nurse specialist. This person should see every patient and become their key worker.</p><p> </p><p> </p><p> </p><p>Patients with suspected pancreatic cancer are usually first investigated by an ultrasound scan. If this shows biliary dilatation, or anything else suspicious, the patient should then be sent for a pancreas protocol computerised tomography scan which is the best investigation for identifying pancreatic cancer.</p><p> </p><p> </p><p> </p><p>Increasing the capacity of diagnostic and imaging services is clearly recognised as a priority for the National Health Service and it is has been raised as a key issue by the independent Cancer Taskforce, as well as by the Cancer Waiting Times Taskforce. We expect a new cancer strategy to be published this summer which will set out the strategy for the system for the next five years and will include consideration of the whole cancer pathway, including the capacity of diagnostic services.</p><p> </p><p> </p><p> </p><p>In addition, NHS England is testing various approaches to new models of care which could potentially deliver improved access to diagnostic services for cancer patients, including those with pancreatic cancer.</p><p> </p> answering member printed Lord Prior of Brampton grouped question UIN HL963 question first answered 09/07/2015 12:43:47 answering member 127 label Biography information for Lord Prior of Brampton
	tabling member	3898 label Biography information for Lord Aberdare