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176783

	registered interest
	date	29/01/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Health Services
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, when NHS England will publish details of the co-commissioning of specialised services.
	tabling member constituency	Walsall South
	tabling member printed	Valerie Vaz
	uin	222693
	answer	answer is ministerial correction date of answer 03/02/2015 answer text <p>NHS England is the accountable commissioner and budget holder for all specialised services as set out in The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012, with the Manual for prescribed specialised services providing further detail.</p><p> </p><p> </p><p> </p><p>NHS England has achieved significant progress in developing a set of nationally consistent service standards and commissioning policies, which ensure equity of access to high quality services across the board. Those standards and policies will continue to apply for those specialised services which are to be collaboratively commissioned by NHS England and clinical commissioning groups.</p><p> </p><p> </p><p> </p><p>NHS England is currently in the process of agreeing the guidance on the collaborative commissioning arrangements which will be in place from 1 April 2015.</p><p> </p><p> </p><p> </p><p>NHS England has clarified that where there are collaboratively commissioned services, NHS England will retain the full financial risk for these services for 2015/16. NHS England has advised us that there will be further work conducted over the next year to advise on the range of specialised services for which NHS England should remain the accountable commissioner and budget holder for 2016/17 and future years.</p><p> </p><p> </p><p> </p><p>Copies of The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 and the Manual for prescribed specialised services are attached.</p><p> </p> answering member constituency Battersea answering member printed Jane Ellison attachment 1 file name nhs-england-and-ccg-regulations.pdf title Regulations NHS Commissioning Board & CCGs 2 file name pss-manual.pdf title Manual prescribed specialised services question first answered 03/02/2015 15:09:14 question first ministerially corrected 03/02/2015 15:21:10 answering member 3918 label Biography information for Jane Ellison previous answer version 42620 answering member constituency Battersea answering member printed Jane Ellison answering member 3918 label Biography information for Jane Ellison
	tabling member	4076 label Biography information for Valerie Vaz

176784

	registered interest
	date	29/01/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Health Services
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, whether NHS England will remain the sole budget-holder and accountable commissioner for all specialised services.
	tabling member constituency	Walsall South
	tabling member printed	Valerie Vaz
	uin	222694
	answer	answer is ministerial correction date of answer 03/02/2015 answer text <p>NHS England is the accountable commissioner and budget holder for all specialised services as set out in The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012, with the Manual for prescribed specialised services providing further detail.</p><p> </p><p> </p><p> </p><p>NHS England has achieved significant progress in developing a set of nationally consistent service standards and commissioning policies, which ensure equity of access to high quality services across the board. Those standards and policies will continue to apply for those specialised services which are to be collaboratively commissioned by NHS England and clinical commissioning groups.</p><p> </p><p> </p><p> </p><p>NHS England is currently in the process of agreeing the guidance on the collaborative commissioning arrangements which will be in place from 1 April 2015.</p><p> </p><p> </p><p> </p><p>NHS England has clarified that where there are collaboratively commissioned services, NHS England will retain the full financial risk for these services for 2015/16. NHS England has advised us that there will be further work conducted over the next year to advise on the range of specialised services for which NHS England should remain the accountable commissioner and budget holder for 2016/17 and future years.</p><p> </p><p> </p><p> </p><p>Copies of The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 and the Manual for prescribed specialised services are attached.</p><p> </p> answering member constituency Battersea answering member printed Jane Ellison attachment 1 file name nhs-england-and-ccg-regulations.pdf title Regulations NHS Commissioning Board & CCGs 2 file name pss-manual.pdf title Manual prescribed specialised services question first answered 03/02/2015 15:09:14 question first ministerially corrected 03/02/2015 15:23:29 answering member 3918 label Biography information for Jane Ellison previous answer version 42621 answering member constituency Battersea answering member printed Jane Ellison answering member 3918 label Biography information for Jane Ellison
	tabling member	4076 label Biography information for Valerie Vaz

178160

	registered interest
	date	05/02/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Heart Diseases
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, how many admissions to hospital with a (a) primary and (b) secondary diagnosis of coronary heart disease per head of population there were in (i) each clinical commissioning group and its predecessor organisation and (ii) England in each of the last 10 years.
	tabling member constituency	Sutton and Cheam
	tabling member printed	Paul Burstow
	uin	223598
	answer	answer is ministerial correction date of answer 12/02/2015 answer text <p>The following tables show the number of admissions to hospital with a primary and secondary diagnosis of coronary heart disease by primary care trust of treatment for the years 2004/05 to 2012/13; by clinical commissioning group of treatment for 2013/14 and for England as a whole.</p><p> </p> answering member constituency Battersea answering member printed Jane Ellison question first answered 12/02/2015 15:52:16 question first ministerially corrected 12/02/2015 16:09:16 answering member 3918 label Biography information for Jane Ellison attachment 1 file name Hospital Admissions data.xlsx title No. of adnissions - CHD previous answer version 45133 answering member constituency Battersea answering member printed Jane Ellison answering member 3918 label Biography information for Jane Ellison
	tabling member	204 label Biography information for Paul Burstow

416385

	registered interest
	date	04/09/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Accident and Emergency Departments
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, by what indicators he plans to use to assess the improvement of Trusts receiving support from the Emergency Care Improvement Programme.
	tabling member constituency	Copeland
	tabling member printed	Mr Jamie Reed
	uin	8995
	answer	answer is ministerial correction date of answer 14/09/2015 answer text <p><del class="ministerial">Public Health England has developed a campaign to raise awareness of the symptom of breathlessness which ran as a local pilot in Oldham and Rochdale from 24 February – 23 March 2014 and as a regional pilot in the East of England 2 February – 1 March 2015.</del></p><p> </p><p> </p><p> </p><p><del class="ministerial">The Breathlessness campaign aims to encourage those with inappropriate breathlessness (breathlessness that is disproportionate to the level of activity undertaken i.e. at rest or on minimal exertion) to go and see their general practitioner (GP). It is primarily aimed at earlier diagnosis of heart and lung disease, including chronic obstructive pulmonary disease, with scope to reduce premature mortality and to improve the quality of life of those living with these conditions. The key message of the campaign is “If you get out of breath doing things that you used to be able to do, see your GP. Getting out of breath could be a sign of heart or lung disease. Finding it early makes it more treatable, so don’t ignore it, tell your doctor”.</del></p><p> </p><p> </p><p> </p><p><del class="ministerial">Evaluation of the regional pilot is still underway, although early findings from follow-up in-depth interviews with a sample of local GPs and pharmacists and pre and post awareness tracking research among the public, are positive.</del></p><p> </p><p> </p><p><ins class="ministerial"> <p> </p><p><ins class="ministerial">The Emergency Care Improvement Programme (ECIP) is a clinically led programme that will offer practical help and support to the 27 urgent and emergency care systems across England that are under the most pressure. </ins></p><p> </p><p><ins class="ministerial"> </ins></p><p> </p><p><ins class="ministerial">The progress of trusts taking part in ECIP will be measured by monitoring improvements in their accident and emergency (A&amp;E) four hour waiting time standard, along with patient outcome and experience indicators. The urgent and emergency care systems taking part in this programme were selected based on performance against the A&amp;E four hour standard in 2014/15 and Q1 of 2015/16 alongside discussions with regional teams from NHS England, Monitor and the Trust Development Authority.</ins></p><p><ins class="ministerial"> </ins></p></ins></p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p> answering member constituency Battersea answering member printed Jane Ellison question first answered 14/09/2015 15:55:26 question first ministerially corrected 14/09/2015 17:19:34 answering member 3918 label Biography information for Jane Ellison previous answer version 21204 answering member constituency Battersea answering member printed Jane Ellison answering member 3918 label Biography information for Jane Ellison
	tabling member	1503 label Biography information for Mr Jamie Reed

175097

	registered interest
	date	21/01/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Hospital Beds: North West
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, how many delayed discharges there were from (a) St Helens and Knowsley Hospitals Trust and (b) Warrington and Halton Hospitals NHS Foundation Trust in each month since January 2014.
	tabling member constituency	Halton
	tabling member printed	Derek Twigg
	uin	221512
	answer	answer is ministerial correction date of answer 26/01/2015 answer text <p>Information is not available in the format requested. The data that is available is shown in the following tables.</p><p> </p><p> </p><p> </p><p>Table 1: St Helens and Knowsley Hospitals NHS Trust</p><p> </p><p> </p><p> </p><table><tbody><tr><td><p>Month</p></td><td><p>Patients</p></td><td><p>Days</p></td><td> </td></tr><tr><td><p>January 2014</p></td><td><p>8</p></td><td><p>282</p></td><td> </td></tr><tr><td><p>February 2014</p></td><td><p>5</p></td><td><p>233</p></td><td> </td></tr><tr><td><p>March 2014</p></td><td><p>5</p></td><td><p>253</p></td><td> </td></tr><tr><td><p>April 2014</p></td><td><p>3</p></td><td><p>186</p></td><td> </td></tr><tr><td><p>May 2014</p></td><td><p>7</p></td><td><p>188</p></td><td> </td></tr><tr><td><p>June 2014</p></td><td><p>7</p></td><td><p>158</p></td><td> </td></tr><tr><td><p>July 2014</p></td><td><p>4</p></td><td><p>227</p></td><td> </td></tr><tr><td><p>August 2014</p></td><td><p>4</p></td><td><p>155</p></td><td> </td></tr><tr><td><p>September 2014</p></td><td><p>3</p></td><td><p>166</p></td><td> </td></tr><tr><td><p>October 2014</p></td><td><p>5</p></td><td><p>186</p></td><td> </td></tr><tr><td><p>November 2014</p></td><td><p>3</p></td><td><p>143</p></td><td> </td></tr><tr><td><p>December 2014</p></td><td><p>3</p></td><td><p>149</p></td><td> </td></tr><tr><td> </td><td colspan="3"> </td></tr></tbody></table><p> </p><p><em>Source</em>: NHS England</p><p> </p><p> </p><p> </p><p><em>Notes:</em></p><p> </p><ol start="1" type="1"><li>Patients: The number of patients whose transfer is delayed at midnight on the last Thursday of the month.</li><li>Days: The number of days delayed within the month for all patients delayed throughout the month.</li></ol><p> </p><p> </p><p> </p><p> </p><p> </p><p>Table 2: Warrington and Halton Hospitals NHS Foundation Trust</p><p> </p><table><tbody><tr><td colspan="3"> </td></tr><tr><td><p>Month</p></td><td><p>Patients</p></td><td><p>Days</p></td></tr><tr><td><p>January 2014</p></td><td><p>20</p></td><td><p>407</p></td></tr><tr><td><p>February 2014</p></td><td><p>19</p></td><td><p>591</p></td></tr><tr><td><p>March 2014</p></td><td><p>16</p></td><td><p>535</p></td></tr><tr><td><p>April 2014</p></td><td><p>26</p></td><td><p>513</p></td></tr><tr><td><p>May 2014</p></td><td><p>24</p></td><td><p>548</p></td></tr><tr><td><p>June 2014</p></td><td><p>14</p></td><td><p>537</p></td></tr><tr><td><p>July 2014</p></td><td><p>20</p></td><td><p>688</p></td></tr><tr><td><p>August 2014</p></td><td><p>26</p></td><td><p>880</p></td></tr><tr><td><p>September 2014</p></td><td><p>24</p></td><td><p>576</p></td></tr><tr><td><p>October 2014</p></td><td><p>20</p></td><td><p>458</p></td></tr><tr><td><p>November 2014</p></td><td><p>9</p></td><td><p>425</p></td></tr><tr><td><p>December 2014</p></td><td><p>11</p></td><td><p>222</p></td></tr><tr><td> </td><td colspan="2"> </td></tr></tbody></table><p> </p><p><em>Source</em>: NHS England</p><p> </p><p> </p><p> </p><p><em>Notes:</em></p><p> </p><ol start="1" type="1"><li>Patients: The number of patients whose transfer is delayed at midnight on the last Thursday of the month.</li><li>Days: The number of days delayed within the month for all patients delayed throughout the month.</li></ol><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p> answering member constituency North Norfolk answering member printed Norman Lamb question first answered 26/01/2015 16:57:42 question first ministerially corrected 26/01/2015 17:14:04 answering member 1439 label Biography information for Norman Lamb previous answer version 41239 answering member constituency Battersea answering member printed Jane Ellison answering member 3918 label Biography information for Jane Ellison
	tabling member	429 label Biography information for Derek Twigg

420822

	registered interest
	date	17/09/2015
	answering body	Department of Health
	answering dept id	17
	answering dept short name	Health
	answering dept sort name	Health
	hansard heading	Department of Health: Legal Costs
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health, what proportion of his Department's budget is spent on legal fees and damages.
	tabling member constituency	Warrington South
	tabling member printed	David Mowat
	uin	901477
	answer	answer is ministerial correction date of answer 13/10/2015 answer text <p>The Departmental Group spend on legal fees is captured in the Annual Report and Accounts for 2014-15. The Departmental Group spend on legal fees is separately identified under Legal Fees in Other Administration Costs,<del class="ministerial"> £61,159k</del> <ins class="ministerial">£61.159 million </ins>and Programme Costs <del class="ministerial">£128,642k,</del> <ins class="ministerial">£128,642 million </ins>totalling <del class="ministerial">£189,801k.</del><ins class="ministerial">£189,801 million.</ins></p><p>The majority of the Core Department’s spend on legal fees is captured as part of ‘Other’ spend under ‘Other Administration Costs’, ‘Programme Costs’ and in “Consultancy services”. The Annual Report and Accounts is available at:</p><p><a href="https://www.gov.uk/government/publications/department-of-health-annual-report-and-accounts-2014-to-2015" target="_blank">https://www.gov.uk/government/publications/department-of-health-annual-report-and-accounts-2014-to-2015</a></p><p>It is intended that from the 2015-16 financial year, spend on legal fees for the core Department will be discussed separately in the accounts.</p> answering member constituency Battersea answering member printed Jane Ellison question first answered 13/10/2015 16:48:38 question first ministerially corrected 14/10/2015 14:55:18 answering member 3918 label Biography information for Jane Ellison previous answer version 23237 answering member constituency Battersea answering member printed Jane Ellison answering member 3918 label Biography information for Jane Ellison
	tabling member	4080 label Biography information for David Mowat

347943

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

390599

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

390600

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

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