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767937

registered interest
date	10/10/2017
answering body	Department for Business, Energy and Industrial Strategy
answering dept id	201
answering dept short name	Business, Energy and Industrial Strategy
answering dept sort name	Business, Energy and Industrial Strategy
hansard heading	Small Business Commissioner
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government, in the light of the commitment set out in the document Small Business Commissioner: Policy for Secondary Legislation, published in February, that the Small Business Commissioner's complaints scheme will formally begin on 1 October, whether small businesses may now submit complaints; and through what process they can do so.
tabling member printed	Lord Mendelsohn
uin	HL1856
answer	answer is ministerial correction date of answer 19/10/2017 answer text <p>On 2 October my Rt Hon Friend the Secretary of State announced the appointment of Paul Uppal as the UK’s first Small Business Commissioner (SBC). Mr Uppal and his team will provide general advice and information to small businesses on matters such as resolving payment disputes, including signposting small businesses through the SBC’s website to existing support and dispute resolution services.</p><p> </p><p>The SBC complaints scheme is dependent on secondary legislation, which is currently being considered by Parliament. Small businesses will be able to submit complaints once the service fully launches, including complaints relating to issues from <del class="ministerial">1</del> <ins class="ministerial">6</ins> April 2017. The office of the SBC will be operational by the end of 2017, subject to the will of Parliament.</p> answering member printed Lord Prior of Brampton question first answered 19/10/2017 14:11:50 question first ministerially corrected 13/11/2017 15:03:27 answering member 127 label Biography information for Lord Prior of Brampton previous answer version 16191 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton
tabling member	4286 label Biography information for Lord Mendelsohn

628245

registered interest
date	03/11/2016
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	General Practitioners: Greater London
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what was the ratio of GPs to patients in each Clinical Commissioning Group in London in each of the last five years.
tabling member printed	Baroness Kramer
uin	HL2980
answer	answer is ministerial correction date of answer 16/11/2016 answer text <p>Due to the size of the data, the information requested is shown in the attached table.</p> answering member printed Lord Prior of Brampton question first answered 16/11/2016 16:34:05 question first ministerially corrected 21/12/2016 11:49:39 answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name Copy of 161129 HL2980 amended PQ data.xlsx title GP to Patient ratio table amended previous answer version 20761 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name 161107 GP to patient ratio HL2980_Final.xls title GP to Patient ratio table
tabling member	1557 label Biography information for Baroness Kramer

522843

registered interest
date	06/06/2016
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Business: Billing
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government, further to the Written Answers by Earl Howe on 28 October 2013 (WA 213) and 5 December 2013 (WA 60–1), whether they will now answer the question why Public Health England, in comparing the percentages with dental fluorosis in fluoridated populations published by McGrady et al in 2012 with those from the York systematic review, cited small categories of fluorosis which were not found in the York review, but omitted the statistically comparable total-fluorosis figures of 55 per cent in fluoridated Newcastle against 48 per cent worldwide in the York review in 2000.
tabling member printed	Earl Baldwin of Bewdley
uin	HL394
answer	answer is ministerial correction date of answer 17/06/2016 answer text <p>Most dental fluorosis in England is mild and unlikely to be of any concern from a cosmetic perspective. When discussing the public health impact of this condition, it is useful to distinguish between mild to moderate dental fluorosis and more severe fluorosis which is likely to be of concern from a cosmetic perspective, rather than overall levels.</p><p> </p><p>The study described in the paper by McGrady et al in 2012 photographed teeth in order to reducing potential examiner bias, a key recommendation of the York Review. The results might therefore not be directly comparable to the results of studies using older methodology.</p><p> </p><p>Public Health England’s 2014 water fluoridation health monitoring report was published subsequent to the responses given on 28 October 2013 and 5 December 2013 and included a section on dental fluorosis, drawing upon the 2012 report by McGrady et al. A copy of <em>Water Fluoridation Health Monitoring Report for England 2014</em> is attached.</p><p> </p><p>The report displayed the individual categories of dental fluorosis that were used in the 2012 report by McGrady et al, including the proportion who showed no signs of dental fluorosis in the two cities studied. This is shown in the following table.</p><p> </p><p> </p><p> </p><p> </p><p>Descriptive data for fluorosis total-fluorosis (TF) scores by city</p><p> </p><table><tbody><tr><td><p> </p></td><td colspan="4"><p>City</p></td><td rowspan="3"><p>p-value (probability value)</p></td></tr><tr><td><p> </p></td><td colspan="2"><p>Newcastle (fluoridated)</p></td><td colspan="2"><p>Manchester (non-fluoridated)</p></td></tr><tr><td><p> </p></td><td><p>Number</p></td><td><p>%</p></td><td><p>Number</p></td><td><p>%</p></td></tr><tr><td><p>Fluorosis TF Score</p></td><td><p> </p></td><td><p> </p></td><td><p> </p></td><td><p> </p></td><td><p> </p></td></tr><tr><td><p>0</p></td><td><p>410</p></td><td><p>45%</p></td><td><p>638</p></td><td><p>73%</p></td><td rowspan="7"><p>P <del class="ministerial">&gt;</del> <ins class="ministerial">less than</ins><ins class="ministerial"> </ins>0.0001</p></td></tr><tr><td><p>1</p></td><td><p>355</p></td><td><p>39%</p></td><td><p>209</p></td><td><p>24%</p></td></tr><tr><td><p>2</p></td><td><p>79</p></td><td><p>9%</p></td><td><p>16</p></td><td><p>2%</p></td></tr><tr><td><p>3</p></td><td><p>53</p></td><td><p>6%</p></td><td><p>4</p></td><td><p>1%</p></td></tr><tr><td><p>4</p></td><td><p>8</p></td><td><p>1%</p></td><td><p>0</p></td><td><p>0%</p></td></tr><tr><td><p>5</p></td><td><p>1</p></td><td><p>0.1%</p></td><td><p>2</p></td><td><p>0.2%</p></td></tr><tr><td><p>Total</p></td><td><p>906</p></td><td><p> </p></td><td><p>869</p></td><td><p> </p></td></tr></tbody></table><p> </p><p>The probability values show that levels of dental fluorosis overall in fluoridated Newcastle were higher than in non-fluoridated Manchester. The proportion of children with dental fluorosis (TF score &gt;0) was 55% in Newcastle compared to 27% in Manchester. Fluorosis recorded at a level of TF3, considered to be mild or mild to moderate, was 6% in Newcastle and 1% in Manchester. The prevalence of higher scores (TF4 or greater) was very low in both cities.</p><p> </p><p>The methodology described in the 2012 paper by McGrady et al may give higher estimates of dental fluorosis compared to the direct examination by a dentist used in other surveys. The results give further assurance that there are low levels of dental fluorosis which might be of concern from a cosmetic perspective in both fluoridated and non-fluoridated areas.</p><p> </p> answering member printed Lord Prior of Brampton question first answered 17/06/2016 10:42:12 question first ministerially corrected 17/06/2016 12:57:51 answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name Water_fluoridation_health_monitoring_for_england__full_report_1Apr2014.pdf title Water Fluoridation Monitoring Report previous answer version 4271 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name Water_fluoridation_health_monitoring_for_england__full_report_1Apr2014.pdf title Water Fluoridation Monitoring Report
tabling member	3446 label Biography information for Earl Baldwin of Bewdley

451765

registered interest
date	09/02/2016
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Incontinence
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government whether Clinical Commissioning Groups and NHS trusts are responsible for the funding or provision of incontinence pads to residents of (1) care homes for personal care, and (2) care homes with nursing care.
tabling member printed	Baroness Greengross
uin	HL6040
answer	answer is ministerial correction date of answer 23/02/2016 answer text <p><ins class="ministerial">The legislation under which NHS England and clinical commissioning groups (CCGs) commission services requires them to arrange for the provision of services for which they are responsible, to such extent as they consider necessary to meet all reasonable requirements.</ins></p><p><ins class="ministerial">For CCGs, this includes offering continence services as part of their obligation to provide community health. Although CCGs often focus on prevention and treatment, it is expected any standard continence service should include access to products. </ins><del class="ministerial">There is no legal requirement to supply these products.</del> The criteria for the provisioning of continence products are set by individual <del class="ministerial">clinical commissioning groups (</del>CCGs<del class="ministerial">)</del>. To support CCGs, NHS England has recently published new guidance to help improve the care and experience of children and adults with continence issues. This encourages much greater collaboration between health and social care.</p><p> </p><p>A copy of the guidance <em>Excellence in continence care</em> is attached.</p><p> </p> answering member printed Lord Prior of Brampton question first answered 23/02/2016 12:41:19 question first ministerially corrected 22/03/2016 11:59:02 answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name Excellence in continence care guidance.pdf title Excellence in continence care previous answer version 46599 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name Excellence in continence care guidance.pdf title Excellence in continence care
tabling member	2518 label Biography information for Baroness Greengross

432082

registered interest
date	24/11/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Atrial Fibrillation: Screening
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what action they are taking to promote opportunistic screening for atrial fibrillation.
tabling member printed	Baroness Masham of Ilton
uin	HL3855
answer	answer is ministerial correction date of answer 08/12/2015 answer text <br /><p>NHS England is encouraging clinical commissioning groups to work with local practices to target people at risk of atrial fibrillation (AF). Innovative approaches such as pulse testing at flu clinics and by some dentists are being used to identify AF in older people. The NHS Health Check programme’s best practice guidance also recommends a pulse check is carried out as part of the process of taking a blood pressure reading. People found to have an irregular pulse rhythm should be referred to the general practitioner for further investigation.</p><br /><p>The National Institute for Health and Care Excellence (NICE) published an updated guideline on AF in June 2014. This offers evidence-based advice on the care and treatment of people with AF and includes recommendations on diagnosis. In July 2015 NICE also published a quality standard on AF.</p><br /><p>In addition to its clinical guideline on AF, NICE has published technology appraisal guidance on a number of new oral anticoagulants (NOACs), approving them for certain patients.</p><br /><p>There is a legal requirement on commissioners to provide funding for treatments and drugs recommended in NICE technology appraisal guidance within three months of the guidance being published.This is enshrined in the NHS Constitution as a right to NICE-approved drugs.</p><br /><p>A <a href="https://www.nice.org.uk/resource/CG180/pdf/c/cg180-atrial-fibrillation-nic-consensus-statement-on-the-use-of-noacs?id=gvyb3hjdqrcjtn6ytpwx3ydb64" target="_blank">consensus statement</a> by the <a href="https://www.nice.org.uk/News/Article/new-collaborative-aims-to-increase-nice-guidance-uptake" target="_blank">NICE Implementation Collaborative</a> was published alongside NICE’s updated guideline in June 2014. This addresses some of the barriers to implementing NICE’s recommendations on prescribing NOACs.</p><br /><p>The need to reduce variation and strengthen compliance of the uptake of NICE technology appraisals was identified in <em>Innovation Health and Wealth</em>, published in December 2011. In response, NHS England and the Health and Social Care Information Centre now publishes on a quarterly basis an Innovation Scorecard to enable commissioners to benchmark their own position and increase transparency to patients and the public. This assists the NHS in the identification of variation and the adoption of treatments such as NOACs that are recommended in NICE technology appraisals. In addition, NHS England advises that it expects practitioners to consider anticoagulant treatments in line with NICE guidelines.</p><p>Some progress is being made. The uptake of NOACs across England has doubled in recent years from 45,708 per 100,000 of the resident population in 2013-14 to 126,845 in 2014-15.</p><br /><p><del class="ministerial">No assessment has been made of the number of strokes related to AF could be prevented each year through the roll-out of Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation in primary care. However, in 2014, an economic analysis estimated that if all eligible patients at high risk were managed according to the NICE AF guidelines, an additional 11,600 AF related strokes per year could be avoided.</del></p><br /><p><del class="ministerial">Copies of the guidance referred to have been placed in the Library.</del></p><p><ins class="ministerial"></ins></p><p><ins class="ministerial">No assessment has been made of the number of strokes related to AF could be prevented each year through the roll-out of Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation (GRASP-AF) in primary care. However, in 2014, an economic analysis estimated that if all eligible patients at high risk were managed according to the NICE AF guidelines, an additional 11,600 AF related strokes per year could be avoided.</ins></p><p><ins class="ministerial"></ins></p><p><ins class="ministerial">Copies of the guidance referred to, excluding GRASP-AF have been placed in the Library.</ins></p> answering member printed Lord Prior of Brampton question first answered 08/12/2015 12:43:31 question first ministerially corrected 09/12/2015 13:42:42 answering member 127 label Biography information for Lord Prior of Brampton previous answer version 34227 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton
tabling member	1850 label Biography information for Baroness Masham of Ilton

432083

registered interest
date	24/11/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Atrial Fibrillation: Diagnosis
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what action they are taking to improve the diagnosis of atrial fibrillation.
tabling member printed	Baroness Masham of Ilton
uin	HL3856
answer	answer is ministerial correction date of answer 08/12/2015 answer text <p>NHS England is encouraging clinical commissioning groups to work with local practices to target people at risk of atrial fibrillation (AF). Innovative approaches such as pulse testing at flu clinics and by some dentists are being used to identify AF in older people. The NHS Health Check programme’s best practice guidance also recommends a pulse check is carried out as part of the process of taking a blood pressure reading. People found to have an irregular pulse rhythm should be referred to the general practitioner for further investigation.</p><br /><p>The National Institute for Health and Care Excellence (NICE) published an updated guideline on AF in June 2014. This offers evidence-based advice on the care and treatment of people with AF and includes recommendations on diagnosis. In July 2015 NICE also published a quality standard on AF.</p><br /><p>In addition to its clinical guideline on AF, NICE has published technology appraisal guidance on a number of new oral anticoagulants (NOACs), approving them for certain patients.</p><br /><p>There is a legal requirement on commissioners to provide funding for treatments and drugs recommended in NICE technology appraisal guidance within three months of the guidance being published.This is enshrined in the NHS Constitution as a right to NICE-approved drugs.</p><br /><p>A <a href="https://www.nice.org.uk/resource/CG180/pdf/c/cg180-atrial-fibrillation-nic-consensus-statement-on-the-use-of-noacs?id=gvyb3hjdqrcjtn6ytpwx3ydb64" target="_blank">consensus statement</a> by the <a href="https://www.nice.org.uk/News/Article/new-collaborative-aims-to-increase-nice-guidance-uptake" target="_blank">NICE Implementation Collaborative</a> was published alongside NICE’s updated guideline in June 2014. This addresses some of the barriers to implementing NICE’s recommendations on prescribing NOACs.</p><br /><p>The need to reduce variation and strengthen compliance of the uptake of NICE technology appraisals was identified in <em>Innovation Health and Wealth</em>, published in December 2011. In response, NHS England and the Health and Social Care Information Centre now publishes on a quarterly basis an Innovation Scorecard to enable commissioners to benchmark their own position and increase transparency to patients and the public. This assists the NHS in the identification of variation and the adoption of treatments such as NOACs that are recommended in NICE technology appraisals. In addition, NHS England advises that it expects practitioners to consider anticoagulant treatments in line with NICE guidelines.</p><p>Some progress is being made. The uptake of NOACs across England has doubled in recent years from 45,708 per 100,000 of the resident population in 2013-14 to 126,845 in 2014-15.</p><br /><p><del class="ministerial">No assessment has been made of the number of strokes related to AF could be prevented each year through the roll-out of Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation in primary care. However, in 2014, an economic analysis estimated that if all eligible patients at high risk were managed according to the NICE AF guidelines, an additional 11,600 AF related strokes per year could be avoided.</del></p><br /><p><del class="ministerial">Copies of the guidance referred to have been placed in the Library.</del></p><p><ins class="ministerial">No assessment has been made of the number of strokes related to AF could be prevented each year through the roll-out of Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation (GRASP-AF) in primary care. However, in 2014, an economic analysis estimated that if all eligible patients at high risk were managed according to the NICE AF guidelines, an additional 11,600 AF related strokes per year could be avoided.</ins></p><p><ins class="ministerial"></ins></p><p><ins class="ministerial">Copies of the guidance referred to, excluding GRASP-AF have been placed in the Library.</ins></p> answering member printed Lord Prior of Brampton question first answered 08/12/2015 12:43:31 question first ministerially corrected 09/12/2015 13:43:14 answering member 127 label Biography information for Lord Prior of Brampton previous answer version 34228 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton
tabling member	1850 label Biography information for Baroness Masham of Ilton

432084

registered interest
date	24/11/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Atrial Fibrillation: Strokes
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what assessment they have made of how many strokes related to atrial fibrillation could be prevented each year through the roll-out of GRASP-AF in primary care.
tabling member printed	Baroness Masham of Ilton
uin	HL3857
answer	answer is ministerial correction date of answer 08/12/2015 answer text <p>NHS England is encouraging clinical commissioning groups to work with local practices to target people at risk of atrial fibrillation (AF). Innovative approaches such as pulse testing at flu clinics and by some dentists are being used to identify AF in older people. The NHS Health Check programme’s best practice guidance also recommends a pulse check is carried out as part of the process of taking a blood pressure reading. People found to have an irregular pulse rhythm should be referred to the general practitioner for further investigation.</p><br /><p>The National Institute for Health and Care Excellence (NICE) published an updated guideline on AF in June 2014. This offers evidence-based advice on the care and treatment of people with AF and includes recommendations on diagnosis. In July 2015 NICE also published a quality standard on AF.</p><br /><p>In addition to its clinical guideline on AF, NICE has published technology appraisal guidance on a number of new oral anticoagulants (NOACs), approving them for certain patients.</p><br /><p>There is a legal requirement on commissioners to provide funding for treatments and drugs recommended in NICE technology appraisal guidance within three months of the guidance being published.This is enshrined in the NHS Constitution as a right to NICE-approved drugs.</p><br /><p>A <a href="https://www.nice.org.uk/resource/CG180/pdf/c/cg180-atrial-fibrillation-nic-consensus-statement-on-the-use-of-noacs?id=gvyb3hjdqrcjtn6ytpwx3ydb64" target="_blank">consensus statement</a> by the <a href="https://www.nice.org.uk/News/Article/new-collaborative-aims-to-increase-nice-guidance-uptake" target="_blank">NICE Implementation Collaborative</a> was published alongside NICE’s updated guideline in June 2014. This addresses some of the barriers to implementing NICE’s recommendations on prescribing NOACs.</p><br /><p>The need to reduce variation and strengthen compliance of the uptake of NICE technology appraisals was identified in <em>Innovation Health and Wealth</em>, published in December 2011. In response, NHS England and the Health and Social Care Information Centre now publishes on a quarterly basis an Innovation Scorecard to enable commissioners to benchmark their own position and increase transparency to patients and the public. This assists the NHS in the identification of variation and the adoption of treatments such as NOACs that are recommended in NICE technology appraisals. In addition, NHS England advises that it expects practitioners to consider anticoagulant treatments in line with NICE guidelines.</p><p>Some progress is being made. The uptake of NOACs across England has doubled in recent years from 45,708 per 100,000 of the resident population in 2013-14 to 126,845 in 2014-15.</p><br /><p><del class="ministerial">No assessment has been made of the number of strokes related to AF could be prevented each year through the roll-out of Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation in primary care. However, in 2014, an economic analysis estimated that if all eligible patients at high risk were managed according to the NICE AF guidelines, an additional 11,600 AF related strokes per year could be avoided.</del></p><br /><p><del class="ministerial">Copies of the guidance referred to have been placed in the Library.</del></p><p><ins class="ministerial">No assessment has been made of the number of strokes related to AF could be prevented each year through the roll-out of Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation (GRASP-AF) in primary care. However, in 2014, an economic analysis estimated that if all eligible patients at high risk were managed according to the NICE AF guidelines, an additional 11,600 AF related strokes per year could be avoided.</ins></p><p><ins class="ministerial"></ins></p><p><ins class="ministerial">Copies of the guidance referred to, excluding GRASP-AF have been placed in the Library.</ins></p> answering member printed Lord Prior of Brampton question first answered 08/12/2015 12:43:31 question first ministerially corrected 09/12/2015 13:43:28 answering member 127 label Biography information for Lord Prior of Brampton previous answer version 34229 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton
tabling member	1850 label Biography information for Baroness Masham of Ilton

432085

registered interest
date	24/11/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Atrial Fibrillation: Strokes
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what action they are taking to promote the implementation of NICE guidance on prescribing anticoagulants for the prevention of strokes related to atrial fibrillation.
tabling member printed	Baroness Masham of Ilton
uin	HL3858
answer	answer is ministerial correction date of answer 08/12/2015 answer text <p>NHS England is encouraging clinical commissioning groups to work with local practices to target people at risk of atrial fibrillation (AF). Innovative approaches such as pulse testing at flu clinics and by some dentists are being used to identify AF in older people. The NHS Health Check programme’s best practice guidance also recommends a pulse check is carried out as part of the process of taking a blood pressure reading. People found to have an irregular pulse rhythm should be referred to the general practitioner for further investigation.</p><br /><p>The National Institute for Health and Care Excellence (NICE) published an updated guideline on AF in June 2014. This offers evidence-based advice on the care and treatment of people with AF and includes recommendations on diagnosis. In July 2015 NICE also published a quality standard on AF.</p><br /><p>In addition to its clinical guideline on AF, NICE has published technology appraisal guidance on a number of new oral anticoagulants (NOACs), approving them for certain patients.</p><br /><p>There is a legal requirement on commissioners to provide funding for treatments and drugs recommended in NICE technology appraisal guidance within three months of the guidance being published.This is enshrined in the NHS Constitution as a right to NICE-approved drugs.</p><br /><p>A <a href="https://www.nice.org.uk/resource/CG180/pdf/c/cg180-atrial-fibrillation-nic-consensus-statement-on-the-use-of-noacs?id=gvyb3hjdqrcjtn6ytpwx3ydb64" target="_blank">consensus statement</a> by the <a href="https://www.nice.org.uk/News/Article/new-collaborative-aims-to-increase-nice-guidance-uptake" target="_blank">NICE Implementation Collaborative</a> was published alongside NICE’s updated guideline in June 2014. This addresses some of the barriers to implementing NICE’s recommendations on prescribing NOACs.</p><br /><p>The need to reduce variation and strengthen compliance of the uptake of NICE technology appraisals was identified in <em>Innovation Health and Wealth</em>, published in December 2011. In response, NHS England and the Health and Social Care Information Centre now publishes on a quarterly basis an Innovation Scorecard to enable commissioners to benchmark their own position and increase transparency to patients and the public. This assists the NHS in the identification of variation and the adoption of treatments such as NOACs that are recommended in NICE technology appraisals. In addition, NHS England advises that it expects practitioners to consider anticoagulant treatments in line with NICE guidelines.</p><p>Some progress is being made. The uptake of NOACs across England has doubled in recent years from 45,708 per 100,000 of the resident population in 2013-14 to 126,845 in 2014-15.</p><br /><p><del class="ministerial">No assessment has been made of the number of strokes related to AF could be prevented each year through the roll-out of Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation in primary care. However, in 2014, an economic analysis estimated that if all eligible patients at high risk were managed according to the NICE AF guidelines, an additional 11,600 AF related strokes per year could be avoided.</del></p><br /><p><del class="ministerial">Copies of the guidance referred to have been placed in the Library.</del></p><p><ins class="ministerial">No assessment has been made of the number of strokes related to AF could be prevented each year through the roll-out of Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation (GRASP-AF) in primary care. However, in 2014, an economic analysis estimated that if all eligible patients at high risk were managed according to the NICE AF guidelines, an additional 11,600 AF related strokes per year could be avoided.</ins></p><p><ins class="ministerial"></ins></p><p><ins class="ministerial">Copies of the guidance referred to, excluding GRASP-AF have been placed in the Library.</ins></p> answering member printed Lord Prior of Brampton question first answered 08/12/2015 12:43:31 question first ministerially corrected 09/12/2015 13:43:51 answering member 127 label Biography information for Lord Prior of Brampton previous answer version 34230 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton
tabling member	1850 label Biography information for Baroness Masham of Ilton

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