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421239

registered interest
date	14/10/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	NHS: Working Hours
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what is their response to the comments of the President of the Royal College of Physicians, reported on 14 October, that their plan for a seven-day NHS will require more doctors, more funding, and increased provision of services currently provided by hospitals during the working week.
tabling member printed	Lord Hunt of Kings Heath
uin	HL2610
answer	answer is ministerial correction date of answer 23/10/2015 answer text <p>The Government is investing £10 billion in the NHS Five Year Forward View which includes developing a framework for how seven day services can be delivered sustainably and affordably, where this makes a clinical difference to outcomes.</p><br /><p>Implementing seven day services will involve different approaches in different areas, not least because current levels of service provision at weekends currently vary between hospitals. All areas will implement in the way that makes sense for them, minimising additional costs and maximising opportunities for using existing resources better.</p><p><strong></strong></p><p>It will be for local providers and their Local Education and Training Boards to develop workforce plans for delivering seven day services in hospitals which will make the best use of staff skills and expertise. There may be additional staff needed, including doctors, and the Department is working with NHS England and Health Education England to make sure we have the workforce we need, including looking at new working patterns and roles such as physician associates.</p><p><strong></strong></p><p>In order to provide safe, high-quality urgent and emergency care services seven days a week, NHS England recommended that hospitals prioritise implementation of four of the 10 clinical standards agreed by their ‘NHS Services, Seven Days a Week’ Forum. These ensure that patients who have urgent and emergency hospital care needs will have access to the same level of consultant assessment and review, diagnostic tests and consultant-led interventions seven days a week. The Government will ensure that by March 2017 a quarter of the population will have access to care that meets these standards and, by March 2020, there will be complete coverage for the whole of England. This means that hospitals will have to increase their provision of services in key specialties at the weekend if they are not currently meeting these standards.</p><br /><p>Although we are prioritising the standards which will have the biggest impact on improving patient care at weekends, we expect all hospitals to work towards embedding all ten clinical standards by 2020.</p> answering member printed Lord Prior of Brampton grouped question UIN HL2611 question first answered 23/10/2015 10:55:48 answering member 127 label Biography information for Lord Prior of Brampton
tabling member	2024 label Biography information for Lord Hunt of Kings Heath

421240

registered interest
date	14/10/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	NHS: Working Hours
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 number and cost of extra doctors, nurses, therapists and diagnostic staff required for seven-day working in the NHS.
tabling member printed	Lord Hunt of Kings Heath
uin	HL2611
answer	answer is ministerial correction date of answer 23/10/2015 answer text <p>The Government is investing £10 billion in the NHS Five Year Forward View which includes developing a framework for how seven day services can be delivered sustainably and affordably, where this makes a clinical difference to outcomes.</p><br /><p>Implementing seven day services will involve different approaches in different areas, not least because current levels of service provision at weekends currently vary between hospitals. All areas will implement in the way that makes sense for them, minimising additional costs and maximising opportunities for using existing resources better.</p><p><strong></strong></p><p>It will be for local providers and their Local Education and Training Boards to develop workforce plans for delivering seven day services in hospitals which will make the best use of staff skills and expertise. There may be additional staff needed, including doctors, and the Department is working with NHS England and Health Education England to make sure we have the workforce we need, including looking at new working patterns and roles such as physician associates.</p><p><strong></strong></p><p>In order to provide safe, high-quality urgent and emergency care services seven days a week, NHS England recommended that hospitals prioritise implementation of four of the 10 clinical standards agreed by their ‘NHS Services, Seven Days a Week’ Forum. These ensure that patients who have urgent and emergency hospital care needs will have access to the same level of consultant assessment and review, diagnostic tests and consultant-led interventions seven days a week. The Government will ensure that by March 2017 a quarter of the population will have access to care that meets these standards and, by March 2020, there will be complete coverage for the whole of England. This means that hospitals will have to increase their provision of services in key specialties at the weekend if they are not currently meeting these standards.</p><br /><p>Although we are prioritising the standards which will have the biggest impact on improving patient care at weekends, we expect all hospitals to work towards embedding all ten clinical standards by 2020.</p> answering member printed Lord Prior of Brampton grouped question UIN HL2610 question first answered 23/10/2015 10:55:49 answering member 127 label Biography information for Lord Prior of Brampton
tabling member	2024 label Biography information for Lord Hunt of Kings Heath

421241

registered interest
date	14/10/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Hospitals: Food
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what is their policy for ensuring that elderly patients who have missed their daytime meals due to medical tests receive a hot evening meal.
tabling member printed	Lord Mawson
uin	HL2612
answer	answer is ministerial correction date of answer 22/10/2015 answer text <p>Decisions about hospital food are made locally by National Health Service providers, but we expect them to provide properly for all their patients’ nutritional needs. In the 2015 Patient-led Assessments of the Care Environment (PLACE), 96% of NHS hospitals reported that they provide one or more hot options for the evening meal.</p><br /><p>In August 2014, the Department of Health recommended five food standards to be applied to all hospitals. These include NHS England’s, ‘10 Key Characteristics of Good Nutritional Care in Hospitals’, attached, which are relevant for all patient types (including elderly patients). Two of the characteristics relate to reducing the number of missed meals and providing alternatives when meals are missed. These are:</p><br /><p>- The ward implements Protected Mealtimes to provide an environment conducive to patients enjoying and being able to eat their food; and.</p><br /><p>- Hospital facilities are designed to be flexible and patient centred with the aim of providing and delivering an excellent experience of food service and nutritional care 24 hours a day, every day.</p><br /><p>Implementation of the food standards is included in the NHS Standard Contract 2015/16 and is therefore mandatory. According to PLACE results 2015, 90.8% of NHS hospitals report that they meet the ’10 Key Characteristics of Good Nutritional Care’.</p> answering member printed Lord Prior of Brampton question first answered 22/10/2015 11:58:34 answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name NHS 10 key characteristics.pdf title NHS 10 Key Characteristics
tabling member	3830 label Biography information for Lord Mawson

421242

registered interest
date	14/10/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Patients: Safety
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what research is being undertaken to establish the impact of the safeguarding policy for patients on the behaviour of nurses in attending to the needs of patients.
tabling member printed	Lord Mawson
uin	HL2613
answer	answer is ministerial correction date of answer 28/10/2015 answer text <p>No central research has been commissioned to assess the impact of safeguarding policies for patients on the behaviour of nurses in attending to the needs of patients. Research may have been commissioned at a local level; however, this data is not collected centrally.</p><br /><p>The Care Act 2014, which placed adult safeguarding on a statutory footing for the first time, made clear the responsibilities of agencies in relation to adult safeguarding with a greater focus on the prevention of abuse and neglect.</p><br /><p>The Department is clear in statutory guidance supporting the Care Act that workers across a wide range of organisations, and not just those in frontline health and social care roles, need to be vigilant on behalf of those unable to protect themselves.</p><br /><p>Commissioners and providers will have clear policies and procedures that set out the roles of nurses and all other staff in relation to safeguarding and the training and support that is required in order for them to fulfil those roles.</p><br /><p>The Department and NHS England’s Compassion in Practice nursing strategy was published in December 2012 and is based around six core values: Care, Compassion, Competence, Communication, Courage, and Commitment. The vision aims to embed these values, known as the 6C’s, in all nursing, midwifery and care-giving settings throughout the NHS and social care to improve care for patients. A copy of the strategy is attached and can be found at:</p><br /><p><a href="http://www.england.nhs.uk/nursingvision/" target="_blank">http://www.england.nhs.uk/nursingvision/</a></p> answering member printed Lord Prior of Brampton question first answered 28/10/2015 12:21:43 answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name compassion-in-practice.pdf title Compassion in Practice
tabling member	3830 label Biography information for Lord Mawson

421245

registered interest
date	14/10/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Nurses: Pay
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what is the average wage for a nurse in the NHS after working for (1) one, (2) five, and (3) 10 years.
tabling member printed	Lord Roberts of Llandudno
uin	HL2616
answer	answer is ministerial correction date of answer 21/10/2015 answer text <p>This information is not held centrally.</p> answering member printed Lord Prior of Brampton question first answered 21/10/2015 11:02:08 answering member 127 label Biography information for Lord Prior of Brampton
tabling member	3691 label Biography information for Lord Roberts of Llandudno

421251

registered interest
date	14/10/2015
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 action they are taking to raise awareness of the challenge of Lyme disease in the light of suggestions that the problem has spread to urban environments.
tabling member printed	Lord Condon
uin	HL2622
answer	answer is ministerial correction date of answer 28/10/2015 answer text <p>Public Health England (PHE), alongside various stakeholders including local authorities, undertakes a number of local and national initiatives to raise public awareness of the risks posed by ticks and the illnesses they may carry. The National Institute of Health and Care Excellence and Lyme Disease Action have produced guidance, which is attached, and training modules for general practitioners (GPs), and PHE has a helpline for doctors, as well as running GP training days.</p> answering member printed Lord Prior of Brampton question first answered 28/10/2015 12:23:18 answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name HL2622.pdf title Lyme Disease Guidance
tabling member	2171 label Biography information for Lord Condon

421268

registered interest
date	14/10/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Hypothyroidism
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what steps they have taken to help patients with undiagnosed hypothyroidism who present clinical signs and symptoms of that condition, but are refused any treatment as their blood test results remain normal.
tabling member printed	Lord Pendry
uin	HL2639
answer	answer is ministerial correction date of answer 27/10/2015 answer text <p>A blood test measuring hormone levels is the only accurate way to find out if there is a thyroid problem.</p><br /><p>Best practice on the identification and management of hypothyroidism has been set out by the Royal College of Physicians (RCP) in its guidance, <em>The Diagnosis and Management of Primary Hypothyroidism</em>, first published in 2008. The guidance, which is attached, was developed on behalf of key organisations, including the British Thyroid Association (BTA), the British Thyroid Foundation (BTF) and the Society for Endocrinology (SOE), and is endorsed by the Royal College of General Practitioners. A copy of the UK Guidelines is attached.</p><br /><p>The RCP guidance sets out that the only validated method of testing thyroid function is through a blood sample, which must include measurement of the levels of thyroid‐stimulating hormone (TSH) and free thyroxine (FT4) in serum, as recommended in the <em>UK Guidelines for the Use of Thyroid Function Tests</em> published by the BTA.</p><br /><p>The RCP guidelines set out that overwhelming evidence supports the use of thyroxine hormone replacement (T4 or tetra-iodothyronine) alone in the treatment of hypothyroidism, with this usually being prescribed as levothyroxine. However, this does not prevent clinicians considering other forms of thyroid hormone replacement if appropriate.</p><p>The guidance remains up-to-date and a statement from the BTA Executive Committee supporting the existing guidelines was published in May 2015 in <em>Clinical Endocrinology</em> and endorsed by the Association for Clinical Biochemistry and Laboratory Medicine, the BTF, the RCP and the SOE. The full statement is attached and available online at:</p><br /><p><a href="http://onlinelibrary.wiley.com/doi/10.1111/cen.12824/full" target="_blank">http://onlinelibrary.wiley.com/doi/10.1111/cen.12824/full</a></p><br /><p>Regarding international guidance and harmonisation on approaches to testing, the existing United Kingdom guidelines have now been supported by new guidance published in the United States of America which draws on the latest research and available evidence on the management of the condition. The USA guidance also includes a section on the ethics of prescribing thyroid hormone combination therapies when the potential long-term harmful effects are not known.</p> answering member printed Lord Prior of Brampton attachment 1 file name Okosieme_et_al-2015-Clinical_Endocrinology.pdf title Clinical Endocrinology paper 2 file name the-diagnosis-and-management-of-primary-hypothyroidism-revised-statement-14-june-2011_2.pdf title Royal College of Physicians guidance 3 file name TFT_guideline_final_version_July_2006.pdf title UK Guidelines Thyroid Function Tests grouped question UIN HL2640 HL2641 HL2642 question first answered 27/10/2015 17:53:42 answering member 127 label Biography information for Lord Prior of Brampton
tabling member	457 label Biography information for Lord Pendry

421269

registered interest
date	14/10/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Hypothyroidism
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government whether there are any plans to amend the diagnosis of hypothyroidism, which under current guidance is based solely on a blood test.
tabling member printed	Lord Pendry
uin	HL2640
answer	answer is ministerial correction date of answer 27/10/2015 answer text <p>A blood test measuring hormone levels is the only accurate way to find out if there is a thyroid problem.</p><br /><p>Best practice on the identification and management of hypothyroidism has been set out by the Royal College of Physicians (RCP) in its guidance, <em>The Diagnosis and Management of Primary Hypothyroidism</em>, first published in 2008. The guidance, which is attached, was developed on behalf of key organisations, including the British Thyroid Association (BTA), the British Thyroid Foundation (BTF) and the Society for Endocrinology (SOE), and is endorsed by the Royal College of General Practitioners. A copy of the UK Guidelines is attached.</p><br /><p>The RCP guidance sets out that the only validated method of testing thyroid function is through a blood sample, which must include measurement of the levels of thyroid‐stimulating hormone (TSH) and free thyroxine (FT4) in serum, as recommended in the <em>UK Guidelines for the Use of Thyroid Function Tests</em> published by the BTA.</p><br /><p>The RCP guidelines set out that overwhelming evidence supports the use of thyroxine hormone replacement (T4 or tetra-iodothyronine) alone in the treatment of hypothyroidism, with this usually being prescribed as levothyroxine. However, this does not prevent clinicians considering other forms of thyroid hormone replacement if appropriate.</p><p>The guidance remains up-to-date and a statement from the BTA Executive Committee supporting the existing guidelines was published in May 2015 in <em>Clinical Endocrinology</em> and endorsed by the Association for Clinical Biochemistry and Laboratory Medicine, the BTF, the RCP and the SOE. The full statement is attached and available online at:</p><br /><p><a href="http://onlinelibrary.wiley.com/doi/10.1111/cen.12824/full" target="_blank">http://onlinelibrary.wiley.com/doi/10.1111/cen.12824/full</a></p><br /><p>Regarding international guidance and harmonisation on approaches to testing, the existing United Kingdom guidelines have now been supported by new guidance published in the United States of America which draws on the latest research and available evidence on the management of the condition. The USA guidance also includes a section on the ethics of prescribing thyroid hormone combination therapies when the potential long-term harmful effects are not known.</p> answering member printed Lord Prior of Brampton attachment 1 file name Okosieme_et_al-2015-Clinical_Endocrinology.pdf title Clinical Endocrinology paper 2 file name the-diagnosis-and-management-of-primary-hypothyroidism-revised-statement-14-june-2011_2.pdf title Royal College of Physicians guidance 3 file name TFT_guideline_final_version_July_2006.pdf title UK Guidelines Thyroid Function Tests grouped question UIN HL2639 HL2641 HL2642 question first answered 27/10/2015 17:53:42 answering member 127 label Biography information for Lord Prior of Brampton
tabling member	457 label Biography information for Lord Pendry

421270

registered interest
date	14/10/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Hypothyroidism
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what progress is being made on the initiative to achieve greater harmonisation on approaches to diagnosing hypothyroidism internationally.
tabling member printed	Lord Pendry
uin	HL2641
answer	answer is ministerial correction date of answer 27/10/2015 answer text <p>A blood test measuring hormone levels is the only accurate way to find out if there is a thyroid problem.</p><br /><p>Best practice on the identification and management of hypothyroidism has been set out by the Royal College of Physicians (RCP) in its guidance, <em>The Diagnosis and Management of Primary Hypothyroidism</em>, first published in 2008. The guidance, which is attached, was developed on behalf of key organisations, including the British Thyroid Association (BTA), the British Thyroid Foundation (BTF) and the Society for Endocrinology (SOE), and is endorsed by the Royal College of General Practitioners. A copy of the UK Guidelines is attached.</p><br /><p>The RCP guidance sets out that the only validated method of testing thyroid function is through a blood sample, which must include measurement of the levels of thyroid‐stimulating hormone (TSH) and free thyroxine (FT4) in serum, as recommended in the <em>UK Guidelines for the Use of Thyroid Function Tests</em> published by the BTA.</p><br /><p>The RCP guidelines set out that overwhelming evidence supports the use of thyroxine hormone replacement (T4 or tetra-iodothyronine) alone in the treatment of hypothyroidism, with this usually being prescribed as levothyroxine. However, this does not prevent clinicians considering other forms of thyroid hormone replacement if appropriate.</p><p>The guidance remains up-to-date and a statement from the BTA Executive Committee supporting the existing guidelines was published in May 2015 in <em>Clinical Endocrinology</em> and endorsed by the Association for Clinical Biochemistry and Laboratory Medicine, the BTF, the RCP and the SOE. The full statement is attached and available online at:</p><br /><p><a href="http://onlinelibrary.wiley.com/doi/10.1111/cen.12824/full" target="_blank">http://onlinelibrary.wiley.com/doi/10.1111/cen.12824/full</a></p><br /><p>Regarding international guidance and harmonisation on approaches to testing, the existing United Kingdom guidelines have now been supported by new guidance published in the United States of America which draws on the latest research and available evidence on the management of the condition. The USA guidance also includes a section on the ethics of prescribing thyroid hormone combination therapies when the potential long-term harmful effects are not known.</p> answering member printed Lord Prior of Brampton attachment 1 file name Okosieme_et_al-2015-Clinical_Endocrinology.pdf title Clinical Endocrinology paper 2 file name the-diagnosis-and-management-of-primary-hypothyroidism-revised-statement-14-june-2011_2.pdf title Royal College of Physicians guidance 3 file name TFT_guideline_final_version_July_2006.pdf title UK Guidelines Thyroid Function Tests grouped question UIN HL2639 HL2640 HL2642 question first answered 27/10/2015 17:53:43 answering member 127 label Biography information for Lord Prior of Brampton
tabling member	457 label Biography information for Lord Pendry

421271

registered interest
date	14/10/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Hypothyroidism
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government whether there are any plans to amend the treatment of hypothyroidism by including thyroid hormone combination therapies other than treatment by levothyroxine in the standard of care.
tabling member printed	Lord Pendry
uin	HL2642
answer	answer is ministerial correction date of answer 27/10/2015 answer text <p>A blood test measuring hormone levels is the only accurate way to find out if there is a thyroid problem.</p><br /><p>Best practice on the identification and management of hypothyroidism has been set out by the Royal College of Physicians (RCP) in its guidance, <em>The Diagnosis and Management of Primary Hypothyroidism</em>, first published in 2008. The guidance, which is attached, was developed on behalf of key organisations, including the British Thyroid Association (BTA), the British Thyroid Foundation (BTF) and the Society for Endocrinology (SOE), and is endorsed by the Royal College of General Practitioners. A copy of the UK Guidelines is attached.</p><br /><p>The RCP guidance sets out that the only validated method of testing thyroid function is through a blood sample, which must include measurement of the levels of thyroid‐stimulating hormone (TSH) and free thyroxine (FT4) in serum, as recommended in the <em>UK Guidelines for the Use of Thyroid Function Tests</em> published by the BTA.</p><br /><p>The RCP guidelines set out that overwhelming evidence supports the use of thyroxine hormone replacement (T4 or tetra-iodothyronine) alone in the treatment of hypothyroidism, with this usually being prescribed as levothyroxine. However, this does not prevent clinicians considering other forms of thyroid hormone replacement if appropriate.</p><p>The guidance remains up-to-date and a statement from the BTA Executive Committee supporting the existing guidelines was published in May 2015 in <em>Clinical Endocrinology</em> and endorsed by the Association for Clinical Biochemistry and Laboratory Medicine, the BTF, the RCP and the SOE. The full statement is attached and available online at:</p><br /><p><a href="http://onlinelibrary.wiley.com/doi/10.1111/cen.12824/full" target="_blank">http://onlinelibrary.wiley.com/doi/10.1111/cen.12824/full</a></p><br /><p>Regarding international guidance and harmonisation on approaches to testing, the existing United Kingdom guidelines have now been supported by new guidance published in the United States of America which draws on the latest research and available evidence on the management of the condition. The USA guidance also includes a section on the ethics of prescribing thyroid hormone combination therapies when the potential long-term harmful effects are not known.</p> answering member printed Lord Prior of Brampton attachment 1 file name Okosieme_et_al-2015-Clinical_Endocrinology.pdf title Clinical Endocrinology paper 2 file name the-diagnosis-and-management-of-primary-hypothyroidism-revised-statement-14-june-2011_2.pdf title Royal College of Physicians guidance 3 file name TFT_guideline_final_version_July_2006.pdf title UK Guidelines Thyroid Function Tests grouped question UIN HL2639 HL2640 HL2641 question first answered 27/10/2015 17:53:43 answering member 127 label Biography information for Lord Prior of Brampton
tabling member	457 label Biography information for Lord Pendry