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662068

registered interest
date	19/12/2016
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Health Services: Per Capita Costs
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what is the ranking of spending on healthcare per capita amongst EU member states.
tabling member printed	Lord Moonie
uin	HL4236
answer	answer is ministerial correction date of answer 21/12/2016 answer text <p>The latest Organisation for Economic Co-operation and Development (OECD) figures for total, per capita expenditure on healthcare that have been provided by the countries themselves are for 2014. These figures are only available for the 22 European Union member states that are also members of the OECD. They indicate that the United Kingdom ranked 10<sup>th</sup> out of 22 for total, per capita expenditure on healthcare in 2014. Rankings for all 22 EU member states that are also members of the OECD can be found in Table 1.</p><p> </p><p>OECD estimates for 2015 from their ‘Health at a Glance: Europe 2016’ report suggest that the United Kingdom’s ranking remains unchanged at 10<sup>th</sup> out of all 28 EU member states and that total, per capita expenditure on healthcare is slightly above the EU28 average. However, these figures are yet to be verified by the United Kingdom and a further 19 countries in the report.</p><p> </p><p> </p><p> </p><p>Table 1: Per capita expenditure on healthcare by the 22 EU member states that are also members of the OECD in 2014 - all functions, all financing schemes and all providers (current prices and current purchasing power parity)</p><table><tbody><tr><td><p>Country</p></td><td><p>Rank - 2014</p></td></tr><tr><td><p>Austria</p></td><td><p>6</p></td></tr><tr><td><p>Belgium</p></td><td><p>8</p></td></tr><tr><td><p>Czech Republic</p></td><td><p>16</p></td></tr><tr><td><p>Denmark</p></td><td><p>7</p></td></tr><tr><td><p>Estonia</p></td><td><p>20</p></td></tr><tr><td><p>Finland</p></td><td><p>11</p></td></tr><tr><td><p>France</p></td><td><p>9</p></td></tr><tr><td><p>Germany</p></td><td><p>3</p></td></tr><tr><td><p>Greece</p></td><td><p>17</p></td></tr><tr><td><p>Hungary</p></td><td><p>19</p></td></tr><tr><td><p>Ireland</p></td><td><p>5</p></td></tr><tr><td><p>Italy</p></td><td><p>12</p></td></tr><tr><td><p>Latvia</p></td><td><p>22</p></td></tr><tr><td><p>Luxembourg</p></td><td><p>1</p></td></tr><tr><td><p>Netherlands</p></td><td><p>2</p></td></tr><tr><td><p>Poland</p></td><td><p>21</p></td></tr><tr><td><p>Portugal</p></td><td><p>15</p></td></tr><tr><td><p>Slovak Republic</p></td><td><p>18</p></td></tr><tr><td><p>Slovenia</p></td><td><p>14</p></td></tr><tr><td><p>Spain</p></td><td><p>13</p></td></tr><tr><td><p>Sweden</p></td><td><p>4</p></td></tr><tr><td><p>United Kingdom</p></td><td><p>10</p></td></tr></tbody></table><p> </p><p>Source: OECD.Stat, Health Expenditure and Financing, 2014.</p> answering member printed Lord Prior of Brampton question first answered 21/12/2016 13:57:47 answering member 127 label Biography information for Lord Prior of Brampton
tabling member	621 label Biography information for Lord Moonie

662093

registered interest
date	19/12/2016
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Neuroblastoma
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government whether they plan to uphold the verdict of the National Institute for Health and Clinical Excellence with regard to dinutuximab for children with neuroblastoma.
tabling member printed	Baroness Masham of Ilton
uin	HL4261
answer	answer is ministerial correction date of answer 21/12/2016 answer text <p>The National Institute for Health and Care Excellence (NICE) has not yet published its final guidance on dinutuximab (Unituxin) as a maintenance treatment after therapy for high-risk neuroblastoma. NICE’s Appraisal Committee is currently considering its draft guidance in light of the Appeal Panel’s decision to uphold an appeal against its final appraisal determination.</p><p> </p><p>Dinutuximab was referred to NICE under the single technology appraisal programme following its consideration through the established topic selection process including a public consultation and a scoping workshop with stakeholders.</p><p> </p><p>NICE is also currently appraising another anti-GD2 antibody product, APN311, for use in the treatment of high-risk neuroblastoma. APN311 is not yet licensed for use in the United Kingdom and has only been available in the UK in clinical trials.</p><p> </p><p>Neither treatment has been routinely commissioned for National Health Service patients in England.</p> answering member printed Lord Prior of Brampton grouped question UIN HL4262 HL4263 question first answered 21/12/2016 13:55:28 answering member 127 label Biography information for Lord Prior of Brampton
tabling member	1850 label Biography information for Baroness Masham of Ilton

662094

registered interest
date	19/12/2016
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Neuroblastoma
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government why dinutuximab was referred to the National Institute for Health and Clinical Excellence under the Single Technology Appraisal methodology and not the Highly Specialised Technology programme.
tabling member printed	Baroness Masham of Ilton
uin	HL4262
answer	answer is ministerial correction date of answer 21/12/2016 answer text <p>The National Institute for Health and Care Excellence (NICE) has not yet published its final guidance on dinutuximab (Unituxin) as a maintenance treatment after therapy for high-risk neuroblastoma. NICE’s Appraisal Committee is currently considering its draft guidance in light of the Appeal Panel’s decision to uphold an appeal against its final appraisal determination.</p><p> </p><p>Dinutuximab was referred to NICE under the single technology appraisal programme following its consideration through the established topic selection process including a public consultation and a scoping workshop with stakeholders.</p><p> </p><p>NICE is also currently appraising another anti-GD2 antibody product, APN311, for use in the treatment of high-risk neuroblastoma. APN311 is not yet licensed for use in the United Kingdom and has only been available in the UK in clinical trials.</p><p> </p><p>Neither treatment has been routinely commissioned for National Health Service patients in England.</p> answering member printed Lord Prior of Brampton grouped question UIN HL4261 HL4263 question first answered 21/12/2016 13:55:28 answering member 127 label Biography information for Lord Prior of Brampton
tabling member	1850 label Biography information for Baroness Masham of Ilton

662095

registered interest
date	19/12/2016
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Neuroblastoma
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what steps they are taking to restore the availability of, and access to, the anti-GD2 antibody which had previously been approved.
tabling member printed	Baroness Masham of Ilton
uin	HL4263
answer	answer is ministerial correction date of answer 21/12/2016 answer text <p>The National Institute for Health and Care Excellence (NICE) has not yet published its final guidance on dinutuximab (Unituxin) as a maintenance treatment after therapy for high-risk neuroblastoma. NICE’s Appraisal Committee is currently considering its draft guidance in light of the Appeal Panel’s decision to uphold an appeal against its final appraisal determination.</p><p> </p><p>Dinutuximab was referred to NICE under the single technology appraisal programme following its consideration through the established topic selection process including a public consultation and a scoping workshop with stakeholders.</p><p> </p><p>NICE is also currently appraising another anti-GD2 antibody product, APN311, for use in the treatment of high-risk neuroblastoma. APN311 is not yet licensed for use in the United Kingdom and has only been available in the UK in clinical trials.</p><p> </p><p>Neither treatment has been routinely commissioned for National Health Service patients in England.</p> answering member printed Lord Prior of Brampton grouped question UIN HL4261 HL4262 question first answered 21/12/2016 13:55:28 answering member 127 label Biography information for Lord Prior of Brampton
tabling member	1850 label Biography information for Baroness Masham of Ilton

658696

registered interest
date	14/12/2016
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Hepatitis
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government, further to the Written Answer by Lord Bates on 6 December (HL3698), whether they are committed to eliminating hepatitis C as a public health threat in the UK by 2030; and if so, what strategy they have adopted to achieve this.
tabling member printed	Lord Black of Brentwood
uin	HL4114
answer	answer is ministerial correction date of answer 20/12/2016 answer text <p>The Government is committed to eliminating hepatitis C as a major public health threat.</p><p>The United Kingdom has a comprehensive surveillance system in place combining laboratory diagnoses data, risk/behaviour data, outcome data, statistical modelling and service evaluation to monitor the cascade of care, detect outbreaks, and generate burden estimates. Prevention efforts in minimising harm in people who inject drugs is focused on access to opiate substitution therapies and needle syringe exchange programmes, and disinfection tablets in prisons. NHS England leads on treatment and continues to support National Health Service-led Operational Delivery Networks to provide National Institute for Health and Care Excellence approved treatments for hepatitis C.</p><p>Public Health England supports the Government’s efforts by publishing hepatitis C metrics which are available in the report <em>Hepatitis C in the UK 2016 report: Working towards its elimination as a major public health threat</em>. A copy of the report is attached.</p> answering member printed Lord Prior of Brampton question first answered 20/12/2016 15:27:44 answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name Hepatitis_C_in_the_UK_2016_report.pdf title HEPATITIS C IN THE UK
tabling member	4171 label Biography information for Lord Black of Brentwood

658697

registered interest
date	14/12/2016
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Child Tax Credit
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 impact of reducing public health funding for contraception on the proposal to limit child tax credits to the first two children in a household.
tabling member printed	Baroness Gould of Potternewton
uin	HL4115
answer	answer is ministerial correction date of answer 20/12/2016 answer text <p>No assessment has been made. Local areas decide how to spend public health funding. Contraception is widely available from general practices, and sexual and reproductive health services and is free to all.</p> answering member printed Lord Prior of Brampton question first answered 20/12/2016 15:27:01 answering member 127 label Biography information for Lord Prior of Brampton
tabling member	3573 label Biography information for Baroness Gould of Potternewton

658698

registered interest
date	14/12/2016
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Genito-urinary Medicine
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government how many patients resident in the devolved administrations accessed sexual health services in England in the last three years for which figures are available; and what was the estimated cost to NHS England of the provision of those services in each of those years.
tabling member printed	Baroness Gould of Potternewton
uin	HL4116
answer	answer is ministerial correction date of answer 20/12/2016 answer text <p>Data have been provided on the number of contacts with Sexual and Reproductive Health Services in England, from residents of Scotland, Wales and Northern Ireland for the last two years (2014-15 and 2015-16). Data are not available prior to this, as location of patient residence was not submitted by all providers.</p><p> </p><p>NHS England does not hold data on the costs associated with these contacts. Attendances at genito-urinary medicine (GUM) services is collected separately through the GUMCAD data set. Data are not published in the format requested.</p><p> </p><p>Contacts with Sexual and Reproductive Health Services in England, from residents of Scotland, Wales and Northern Ireland.<sup>1</sup></p><p><sup> </sup></p><p>2014-2015 and 2015-2016</p><table><tbody><tr><td><p><table><tbody><tr><td><p>Country of residence</p></td><td colspan="2"><p>Year</p></td></tr><tr><td><p> </p></td><td><p>2014-15</p></td><td><p>2015-16</p></td></tr><tr><td><p>Northern Ireland</p></td><td><p>3</p></td><td><p>43</p></td></tr><tr><td><p>Scotland</p></td><td><p>152</p></td><td><p>254</p></td></tr><tr><td><p>Wales</p></td><td><p>2,362</p></td><td><p>2,049</p></td></tr><tr><td><p>Total</p></td><td><p>2,517</p></td><td><p>2,346</p></td></tr></tbody></table></p></td></tr></tbody></table><p> </p><p>1. The quality of this data is dependent on the location of residence submitted by providers.</p><p>Source: Sexual and Reproductive Health Activity Dataset, NHS Digital.</p> answering member printed Lord Prior of Brampton question first answered 20/12/2016 15:17:44 answering member 127 label Biography information for Lord Prior of Brampton
tabling member	3573 label Biography information for Baroness Gould of Potternewton

658700

registered interest
date	14/12/2016
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Chronic Illnesses
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 impact of the proposed £100,000 quality-assured life year threshold for evaluating highly specialised technologies on access to, and the uptake of, new medicines for patients with rare and complex diseases.
tabling member printed	Lord Hunt of Kings Heath
uin	HL4118
answer	answer is ministerial correction date of answer 19/12/2016 answer text <p>We are committed to ensuring that patients with rare and ultra-rare diseases in England are able to access effective treatments.</p><p> </p><p>The National Institute for Health and Care Excellence (NICE) has advised that the proposed arrangements are intended to provide clarity about the level of cost effectiveness below which funding will be made available, automatically and without delay, for highly specialised technologies that receive positive recommendations from NICE.</p><p> </p><p>Subject to the outcome of the current consultation exercise, those products that have a value proposition of more than £100,000 per quality-adjusted life year will be provided with a further opportunity to be considered for use in the National Health Service, through NHS England’s annual process for deciding which new treatments and services will be routinely commissioned.</p><p> </p><p>Furthermore, the proposed changes are intended to clarify NICE’s existing responsibility to determine the period within which funding for recommended products needs to be made available by commissioners of services. This clarity should allow companies and commissioners to work on commercial arrangements, in advance of, and in parallel with, the development of NICE technology appraisal and highly specialised technology guidance. In circumstances where this may not be possible, specific requests from commissioners to vary the timescale for the funding requirement will be considered by NICE.</p><p> </p><p>As these proposals are still subject to possible change, no assessment has been made of the number of patients who may be affected or of any effect on uptake and equity of access to medicines for very rare diseases.</p> answering member printed Lord Prior of Brampton grouped question UIN HL4119 question first answered 19/12/2016 15:43:12 answering member 127 label Biography information for Lord Prior of Brampton
tabling member	2024 label Biography information for Lord Hunt of Kings Heath

658701

registered interest
date	14/12/2016
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Medical Treatments
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 number of patients who will be affected by the proposed £100,000 quality-assured life year threshold for evaluating highly specialised technologies.
tabling member printed	Lord Hunt of Kings Heath
uin	HL4119
answer	answer is ministerial correction date of answer 19/12/2016 answer text <p>We are committed to ensuring that patients with rare and ultra-rare diseases in England are able to access effective treatments.</p><p> </p><p>The National Institute for Health and Care Excellence (NICE) has advised that the proposed arrangements are intended to provide clarity about the level of cost effectiveness below which funding will be made available, automatically and without delay, for highly specialised technologies that receive positive recommendations from NICE.</p><p> </p><p>Subject to the outcome of the current consultation exercise, those products that have a value proposition of more than £100,000 per quality-adjusted life year will be provided with a further opportunity to be considered for use in the National Health Service, through NHS England’s annual process for deciding which new treatments and services will be routinely commissioned.</p><p> </p><p>Furthermore, the proposed changes are intended to clarify NICE’s existing responsibility to determine the period within which funding for recommended products needs to be made available by commissioners of services. This clarity should allow companies and commissioners to work on commercial arrangements, in advance of, and in parallel with, the development of NICE technology appraisal and highly specialised technology guidance. In circumstances where this may not be possible, specific requests from commissioners to vary the timescale for the funding requirement will be considered by NICE.</p><p> </p><p>As these proposals are still subject to possible change, no assessment has been made of the number of patients who may be affected or of any effect on uptake and equity of access to medicines for very rare diseases.</p> answering member printed Lord Prior of Brampton grouped question UIN HL4118 question first answered 19/12/2016 15:43:12 answering member 127 label Biography information for Lord Prior of Brampton
tabling member	2024 label Biography information for Lord Hunt of Kings Heath

658702

registered interest
date	14/12/2016
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Medical Treatments
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 patient groups and patients are consulted on decisions made regarding new treatments as part of NHS England's prioritisation process for investing in specialised services.
tabling member printed	Lord Hunt of Kings Heath
uin	HL4120
answer	answer is ministerial correction date of answer 19/12/2016 answer text <p>NHS England involves patients, patient groups and the public at numerous stages of the process for developing clinical commissioning policies and service specifications that may be subject to a process of relative prioritisation.</p><p> </p><p>Clinical policies and service specifications are developed by Clinical Reference Groups (CRGs), which are advisory groups and include patients and patient representatives in their membership. Draft clinical policies and service specifications undergo a process of testing with registered stakeholders before they are submitted for a full public consultation. The CRG will consider the outcome of stakeholder testing and public consultation before submitting the final proposed document to NHS England for the purpose of relative prioritisation.</p><p> </p><p>Recommendations on the relative prioritisation of new investments in specialised services are made by the Clinical Priorities Advisory Group, which is independently chaired and which includes patient and public voice representatives in its membership. ​</p><p><em> </em></p><p>NHS England held a public consultation on <em>Developing a method to assist investment decisions in specialised commissioning </em>between April and May 2016. NHS England’s response to the consultation can be found attached.</p> answering member printed Lord Prior of Brampton question first answered 19/12/2016 15:53:58 answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name prioritisation-method-cons-response.pdf title CONSULTATION RESPONSE
tabling member	2024 label Biography information for Lord Hunt of Kings Heath