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78847

registered interest
date	17/07/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Dementia
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what measures they have put in place to address the need for training for health professionals concerning Parkinson's-related dementias.
tabling member printed	Baroness Gale
uin	HL1237
answer	answer is ministerial correction date of answer 24/07/2014 answer text <p>We are working closely with a wide range of organisations on the implementation of the Challenge, including the Dementia Action Alliance; the Alliance includes organisations representing people with Parkinson’s such asParkinson’s UK.</p><p> </p><p>By October 2013, 108,000 National Health Service staff had received Tier 1 training on dementia, enabling them to spot the early symptoms of dementia, know how to interact with people with dementia and ensure that patients receive the most appropriate care. The Government’s refreshed Mandate to Health Education England, published on 1 May 2014, builds on this by setting an ambition for a further 250,000 NHS staff to receive Tier 1 training on dementia by March 2015, with the tools and training opportunities being made available to all staff by the end of 2018.</p><p> </p><p>Over 100,000 social care workers have received some form of dementia awareness training through workforce development funding from local authorities and care providers.</p><p> </p> answering member printed Earl Howe grouped question UIN HL1238 question first answered 24/07/2014 14:16:50 answering member 2000 label Biography information for Earl Howe
tabling member	2503 label Biography information for Baroness Gale

78848

registered interest
date	17/07/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Dementia
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government how they are involving people with Parkinson's in the Department of Health's Dementia Challenge.
tabling member printed	Baroness Gale
uin	HL1238
answer	answer is ministerial correction date of answer 24/07/2014 answer text <p>We are working closely with a wide range of organisations on the implementation of the Challenge, including the Dementia Action Alliance; the Alliance includes organisations representing people with Parkinson’s such asParkinson’s UK.</p><p> </p><p>By October 2013, 108,000 National Health Service staff had received Tier 1 training on dementia, enabling them to spot the early symptoms of dementia, know how to interact with people with dementia and ensure that patients receive the most appropriate care. The Government’s refreshed Mandate to Health Education England, published on 1 May 2014, builds on this by setting an ambition for a further 250,000 NHS staff to receive Tier 1 training on dementia by March 2015, with the tools and training opportunities being made available to all staff by the end of 2018.</p><p> </p><p>Over 100,000 social care workers have received some form of dementia awareness training through workforce development funding from local authorities and care providers.</p><p> </p> answering member printed Earl Howe grouped question UIN HL1237 question first answered 24/07/2014 14:16:50 answering member 2000 label Biography information for Earl Howe
tabling member	2503 label Biography information for Baroness Gale

78244

registered interest
date	15/07/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Dementia
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what steps they are taking to support research into (1) Parkinson’s dementia, and (2) dementia with Lewy bodies.
tabling member printed	Baroness Finlay of Llandaff
uin	HL1139
answer	answer is ministerial correction date of answer 24/07/2014 answer text <p>At the G8 dementia summit in December 2013, the G8 countries agreed to work together to tackle and defeat dementia. The declaration, built on the Prime Minister’s Dementia Challenge, announced the G8’s ambition to identify a cure or a disease-modifying therapy by 2025 and to increase collectively and significantly the amount of funding for dementia research.</p><p> </p><p>Investment in dementia research by the National Institute for Health Research (NIHR) has increased from £12.6 million in 2009-10 to £26.8 million in 2013-14.</p><p> </p><p>The NIHR Newcastle Dementia Biomedical Research Unit focuses on Lewy body dementia, including Parkinson’s disease patients who later develop dementia. This unit is receiving £4.5 million NIHR funding over the period 2012-17. Other current NIHR investment in this specific disease area includes a £2.1 million multicentre study of the acetylcholinesterase inhibitor donepezil in early dementia associated with Parkinson’s disease, and a £1.9 million programme grant for research on improving the diagnosis and management of Lewy body dementia in the National Health Service.</p><p> </p><p>Investment in dementia research by the Medical Research Council (MRC) has increased from £14.8 million in 2009-10 to £25.3 million in 2012-13 (the latest available figure).</p><p> </p><p>In July 2014, the MRC launched the UK Dementias Research Platform (UKDP), <strong>a multi-million pound public-private partnership,</strong><strong> </strong><strong>developed and led by MRC to accelerate progress in, and open up, dementias research.</strong><strong> </strong><strong>The UKDP’s aims are early detection, improved treatment and ultimately, prevention, of dementias. The </strong>MRC is providing £12 million funding for UKDP for an initial period of five years. This is supplemented by a further £4 million from six partner companies, a mixture of cash contributions and valuable company resources such as research tools, analytical capabilities and expertise.</p><p> </p><p><strong> </strong></p><p><strong> </strong></p><p>The UKDP is creating the world’s largest population for study for dementias research, bringing together two million participants aged 50 and over, from 22 existing study groups within the United Kingdom. Included are people from the general population, people known to be at-risk of developing dementia, and people diagnosed with early-stage dementia. Plans are for the UKDP to be used for all types of neurodegenerative diseases research and this would include Parkinson’s disease and Lewy body dementia.</p><p> </p><p>Within the MRC dementias portfolio, spend on projects with a specific focus on Lewy body dementia was £1.7 million in 2012-13.</p><p> </p> answering member printed Earl Howe question first answered 24/07/2014 14:18:57 answering member 2000 label Biography information for Earl Howe
tabling member	3609 label Biography information for Baroness Finlay of Llandaff

77786

registered interest
date	14/07/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Osteoarthritis
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 advice given by healthcare practitioners to patients with knee osteoarthritis.
tabling member printed	Lord Taylor of Warwick
uin	HL1083
answer	answer is ministerial correction date of answer 24/07/2014 answer text <p>No assessment has been made of the advice given by healthcare practitioners to patients with knee osteoarthritis. In 2008, the National Institute for Health and Care Excellence (NICE) published ‘<em>Osteoarthritis: the care and management in adults’,</em> which sets out best practice on the diagnosis treatment, care and support of patients with this condition, including patients suffering from osteoarthritis of the knee.</p><p> </p><p>Healthcare practitioners in the National Health Service are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not replace the knowledge and expertise of practitioners, who should make decisions on a case by case basis, taking into account the individual circumstances of each patient.</p><p> </p><p>The NICE Osteoarthritis clinical guideline was updated and replaced in February 2014 and can be found on the NICE website at the following link:</p><p> </p><p>www.nice.org.uk/guidance/cg177/resources/guidance-osteoarthritis-pdf.</p> answering member printed Earl Howe question first answered 24/07/2014 14:19:51 answering member 2000 label Biography information for Earl Howe
tabling member	1796 label Biography information for Lord Taylor of Warwick

77264

registered interest
date	10/07/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Lyme Disease
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government when the testing of the cerebrospinal fluid of patients suspected of having Lyme disease using the Trinity Biotech kit at the Health Protection Agency’s Lyme Borreliosis Unit began; how many patients' samples were tested in that way; and how many patients were recorded as being positive over that period of time.
tabling member printed	The Countess of Mar
uin	HL998
answer	answer is ministerial correction date of answer 24/07/2014 answer text <p>The Trinity Biotech blot has been in use since 2007 by the former Health Protection Agency's Lyme Borreliosis Unit for testing cerebrospinal fluid (CSF) and proved very reliable. It has also been used in this way by other laboratories in Europe. However, CSF antibodies will not be present if there is no evidence of any other antibodies in the serum. Data is not collected centrally on specific samples from patients as the final diagnosis is made by the clinician on the basis of the test results and the clinical presentation.</p> answering member printed Earl Howe question first answered 24/07/2014 12:31:17 answering member 2000 label Biography information for Earl Howe
tabling member	1861 label Biography information for The Countess of Mar

77265

registered interest
date	10/07/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Lyme Disease
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government whether, in December 2011, the Clinical Pathology Accreditation Service was made aware of modifications by the Health Protection Agency’s Lyme Borreliosis Unit to the Trinity Biotech immunoblot kit to be used for testing human cerebrospinal fluid.
tabling member printed	The Countess of Mar
uin	HL999
answer	answer is ministerial correction date of answer 24/07/2014 answer text <p>The former Health Protection Agency's Lyme Borreliosis Unit (HPA LBU) was accredited by Clinical Pathology Accreditation who had access to, and was able to review, all the standard operating procedures of the unit.</p><p> </p><p>The Trinity Biotech Lyme Western Blot is a qualitative in vitro assay for the detection of Immunoglobulin (IgG or IgM) antibodies in human samples against specific antigens/proteins of <em>Borrelia afzelii, Borrelia garinii and Borrelia burgdorferi</em>. The Trinity Biotech Lyme Western Blot is intended as a confirmatory assay for use in testing human samples which have been previously found to be positive or equivocal using an Enzyme Immunoassay and Immunofluroescent Assay or other appropriate screening method. Positive second-tier results are supportive evidence of infection with <em>B. burgdorferi</em>. The diagnosis of Lyme disease should be made based on history and symptoms (such as erythema migrans), and other laboratory data, in addition to the presence of antibodies to <em>B. burgdorferi</em>. The Trinity Biotech blot has been in use since 2007 by the former HPA’s LBU for testing cerebrospinal fluid (CSF) and proved very reliable. This technique has also been in use widely across Europe during this period as a diagnostic test using CSF as a sample to support the diagnosis of neuroborreliosis.</p> answering member printed Earl Howe question first answered 24/07/2014 12:32:59 answering member 2000 label Biography information for Earl Howe
tabling member	1861 label Biography information for The Countess of Mar

77266

registered interest
date	10/07/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Lyme Disease
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what evidence existed to show that the Health Protection Agency’s Lyme Borreliosis Unit (LBU) conformed with European Union and United Kingdom legislation for the use of the Trinity Biotech kit for <i>in vitro</i> testing when used with cerebrospinal fluid; and what testing was carried out by the LBU to verify that the use of that test kit was suitable, and sufficiently sensitive, for the detection of European and United Kingdom species of Borrelia infections in cerebrospinal fluid.
tabling member printed	The Countess of Mar
uin	HL1000
answer	answer is ministerial correction date of answer 24/07/2014 answer text <p>The former Health Protection Agency's Lyme Borreliosis Unit adhered to legislation related to diagnostic testing. The Trinity Biotech Lyme Western Blot technique was widely used in Europe at that time for serum and samples. Controls were run with each batch of the test to verify the tests accuracy and sensitivity. Quality assurance samples were run to ensure independent validation of the results.</p> answering member printed Earl Howe question first answered 24/07/2014 14:21:30 answering member 2000 label Biography information for Earl Howe
tabling member	1861 label Biography information for The Countess of Mar

77267

registered interest
date	10/07/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Lyme Disease
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government whether the Health Protection Agency’s Lyme Borreliosis Unit adhered to the Health Protection Agency's published guidelines on <i>Commercial and In-House Diagnostic Tests: Evaluations and Validations</i> in carrying out testing of cerebrospinal fluid of patients suspected of having Lyme disease using the Trinity Biotech kit.
tabling member printed	The Countess of Mar
uin	HL1001
answer	answer is ministerial correction date of answer 24/07/2014 answer text <p>The former Health Protection Agency's (HPA) Lyme Borreliosis Unit adhered to the HPA’s published guidelines on Commercial and In-House Diagnostic Tests.</p> answering member printed Earl Howe question first answered 24/07/2014 13:24:08 answering member 2000 label Biography information for Earl Howe
tabling member	1861 label Biography information for The Countess of Mar

77268

registered interest
date	10/07/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Lyme Disease
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government whether the Health Protection Agency's Lyme Borreliosis Unit informed clinicians and patients of test results on cerebrospinal fluid in accordance with Medicines and Healthcare Products Regulatory Agency guidance in carrying out testing of cerebrospinal fluid of patients suspected of having Lyme disease using the Trinity Biotech kit.
tabling member printed	The Countess of Mar
uin	HL1002
answer	answer is ministerial correction date of answer 24/07/2014 answer text <p>The former Health Protection Agency's Lyme Borreliosis Unit (HPA LBU) informed requesting clinicians but not patients of the results on cerebrospinal fluid (CSF) and also provided a clinical interpretive service to the requesting clinician. Referring laboratories and clinicians managing patients with Lyme disease were aware of the limitations of diagnostic tests for serum and CSF through publications and educational meetings. It is the role of the requesting clinician to be guided by the interpretation of the laboratory result and to use these results in the light of the clinical presentation to make a diagnosis and a management plan for individual patients. It is also important to note that the former HPA’s LBU performed diagnostic tests on samples referred by other laboratories</p> answering member printed Earl Howe question first answered 24/07/2014 13:33:24 answering member 2000 label Biography information for Earl Howe
tabling member	1861 label Biography information for The Countess of Mar

77269

registered interest
date	10/07/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Lyme Disease
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government whether the Health Protection Agency's Lyme Borreliosis Unit informed clinicians and patients of test results on cerebrospinal fluid in accordance with Medicines and Healthcare Products Regulatory Agency guidance on devices used off-label.
tabling member printed	The Countess of Mar
uin	HL1003
answer	answer is ministerial correction date of answer 24/07/2014 answer text <p>The former Health Protection Agency's Lyme Borreliosis Unit informed requesting clinicians but not patients of the results on cerebrospinal fluid (CSF) and also provided a clinical interpretive service to the requesting clinician. There was no approved ‘on-label’ test for CSF at that time, which is why the use of this test was carefully controlled and its quality assured in each test run. It is the role of the requesting clinician to be guided by the interpretation of the laboratory result and to use these results in the light of the clinical presentation to make a diagnosis and a management plan for individual patients. In addition to the controls for the test, the CSF sample was run with the patient’s serum. If the patient had Lyme disease, serology would have demonstrated this and the patient treated appropriately for their clinical presentation whether the CSF was positive or negative.</p> answering member printed Earl Howe question first answered 24/07/2014 14:20:46 answering member 2000 label Biography information for Earl Howe
tabling member	1861 label Biography information for The Countess of Mar