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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

431742

registered interest
date	23/11/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Mental Health Services: Per Capita Costs
house id	1
legislature	25259 pref label House of Commons
question text	To ask the Secretary of State for Health, how much NHS England spent per head on mental health in each year since 2008.
tabling member constituency	Central Suffolk and North Ipswich
tabling member printed	Dr Poulter
uin	17404
answer	answer is ministerial correction date of answer 26/11/2015 answer text <p>NHS England was formed in April 2013.</p><br /><p>The table below shows actual expenditure by clinical commissioning groups (CCGs) on mental health in 2013/14 and 2014/15 and forecast spend in 2015/16. This does not include spending on mental health services directly commissioned by NHS England.</p><p>Total actual expenditure by on mental health by CCGs across all providers for 2013/14 and 2014/15 and the total forecast expenditure for 2015/16</p><br /><table><tbody><tr><td><p>2013/14 actual spend (£ <ins class="ministerial">billion </ins><del class="ministerial">million</del>)</p></td><td><p>2014/15 actual spend (£ <ins class="ministerial">billion</ins><del class="ministerial">million</del>)</p></td><td><p>2015/16 forecast spend (£ <ins class="ministerial">billion </ins><del class="ministerial">million</del>)</p></td></tr><tr><td><p>9.6</p></td><td><p>10.1</p></td><td><p>10.6</p></td></tr></tbody></table><br /><p><em>Source:</em> NHS England</p> answering member constituency Mid Norfolk answering member printed George Freeman question first answered 26/11/2015 16:25:03 question first ministerially corrected 02/12/2015 14:16:07 answering member 4020 label Biography information for George Freeman previous answer version 32352 answering member constituency Mid Norfolk answering member printed George Freeman answering member 4020 label Biography information for George Freeman
tabling member	3932 label Biography information for Dr Dan Poulter

428810

registered interest
date	17/11/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Mental Health Services
house id	1
legislature	25259 pref label House of Commons
question text	To ask the Secretary of State for Health, what the cost to the NHS of NHS mental health patients being treated in non-NHS institutions has been in each of the last three years.
tabling member constituency	Liverpool, Wavertree
tabling member printed	Luciana Berger
uin	16648
answer	answer is ministerial correction date of answer 20/11/2015 answer text <p>NHS England’s specialised commissioning total spend on contracts with independent sector mental health providers is as follows:</p><br /><table><tbody><tr><td><p>Year</p></td><td><p>Spend (£ million)</p></td></tr><tr><td><p>2013/14</p></td><td><p>478</p></td></tr><tr><td><p>2014/15</p></td><td><p>581</p></td></tr><tr><td><p>2015/16</p></td><td><p>576</p></td></tr></tbody></table><br /><p>Note: figures are based on contract values.</p><p>This expenditure relates to a number of different service types including: adult secure services; eating disorder services, gender identity services, child and adolescent mental health in patient services.</p><p><del class="ministerial">Details of local clinical commissioning group spend with independent sector providers is not collected centrally.</del></p><p><ins class="ministerial"> <p><ins class="ministerial">The total NHS expenditure on non-NHS providers is collected centrally, and is published on page 47 of the Department’s annual report, available from:</ins></p><p><ins class="ministerial"><a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/447002/DH_accounts_14-15_web.pdf" target="_blank">https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/447002/DH_accounts_14-15_web.pdf</a></ins></p><p><ins class="ministerial">This report divides providers by type (i.e. independent sector providers, voluntary organisations) – it does not specify the different types of services provided.</ins></p></ins></p> <br /><p><br /></p> answering member constituency North East Bedfordshire answering member printed Alistair Burt question first answered 20/11/2015 14:43:09 question first ministerially corrected 06/01/2016 10:24:57 answering member 1201 label Biography information for Alistair Burt previous answer version 31280 answering member constituency North East Bedfordshire answering member printed Alistair Burt answering member 1201 label Biography information for Alistair Burt
tabling member	4036 label Biography information for Luciana Berger

424296

registered interest
date	27/10/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Perinatal Mortality
house id	1
legislature	25259 pref label House of Commons
question text	To ask the Secretary of State for Health, if he will make it her policy to include stillbirths in the remit of Child Death Overview Panels.
tabling member constituency	Eddisbury
tabling member printed	Antoinette Sandbach
uin	13567
answer	answer is ministerial correction date of answer 04/11/2015 answer text <p><br /></p><p>Child Death Overview Panels are the responsibility of Local Safeguarding Children’s Boards (LSCBs). LSCBs in England have a responsibility under the Children Act 2004 to conduct child death reviews for all under 18s who die and who were normally resident in their area. They are required to collect and analyse information relating to the deaths in order to identify:</p><br /><p>- any cases which may also require a serious case review;</p><p>- any matters affecting the safety and welfare of children in that area; and</p><p>- any wider public health or safety concerns arising from a particular death or patterns of death.</p><br /><p>Stillbirths are not within their legal statutory remit set out in the Act and there are no plans to extend this remit.</p><br /><p>We are however committed to reducing the number of stillbirths and want England to achieve the lowest rate of stillbirth and neonatal death in the world. The Department is currently working in partnership with the stillbirth charity Sands, and a range of key organisations including NHS England to take forward a programme of work on stillbirth prevention. Reducing stillbirth and infant mortality and improving the safety of maternity services improvement areas for the NHS in the NHS Outcomes Framework. In addition, the Department provided start-up funding for the Royal College of Obstetricians and Gynaecologists’ ‘Each Baby Counts’ programme, which aims to reduce stillbirths, early neonatal deaths and brain injuries due to incidents in labour in the United Kingdom by 50% by 2020.</p><br /><p><ins class="ministerial">NHS England has asked Baroness Julia Cumberlege to lead a major review of maternity services to modernise care for women and babies across the country, as first set out in NHS England’s Five Year Forward View.</ins></p> answering member constituency Ipswich answering member printed Ben Gummer question first answered 04/11/2015 16:38:04 question first ministerially corrected 05/11/2015 14:11:41 answering member 3988 label Biography information for Ben Gummer previous answer version 27789 answering member constituency Ipswich answering member printed Ben Gummer answering member 3988 label Biography information for Ben Gummer
tabling member	4506 label Biography information for Antoinette Sandbach

422660

registered interest
date	20/10/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Pregnancy: Mental Health Services
house id	1
legislature	25259 pref label House of Commons
question text	To ask the Secretary of State for Health, what the net change has been in the number of inpatient perinatal mental health beds since 2010.
tabling member constituency	Liverpool, Wavertree
tabling member printed	Luciana Berger
uin	12670
answer	answer is ministerial correction date of answer 23/10/2015 answer text <p><ins class="ministerial">Since 2010 there has been a net reduction in the number of inpatient perinatal mental health beds from 118 beds in 2010 to 115 beds in 2015.</ins></p><p><del class="ministerial">Since 2010 there has been a net reduction of mother and baby units from 17 units to 15 units.</del></p><br /> answering member constituency North East Bedfordshire answering member printed Alistair Burt question first answered 23/10/2015 13:48:26 question first ministerially corrected 29/10/2015 10:29:54 answering member 1201 label Biography information for Alistair Burt previous answer version 25494 answering member constituency North East Bedfordshire answering member printed Alistair Burt answering member 1201 label Biography information for Alistair Burt
tabling member	4036 label Biography information for Luciana Berger

421090

registered interest
date	13/10/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Mental Health Services
house id	1
legislature	25259 pref label House of Commons
question text	To ask the Secretary of State for Health, what proportion of people referred for talking therapies received cognitive behaviour therapy in each of the last five years.
tabling member constituency	Liverpool, Wavertree
tabling member printed	Luciana Berger
uin	11784
answer	answer is ministerial correction date of answer 16/10/2015 answer text <p>Information on the proportion of people referred for talking therapies who received cognitive behavioural therapy during 2013/14 is given on the attached table <em>Proportion of Improving Access to Psychological Therapies (IAPT) referrals that finished a course of treatment between 1<sup>st</sup> April 2013 and 31<sup>st</sup> March 2014, for selected therapy types, England</em>. Information for previous years is not available centrally. Information on 2014/15 will be published in November 2015.</p> answering member constituency North East Bedfordshire answering member printed Alistair Burt question first answered 16/10/2015 12:56:33 question first ministerially corrected 16/10/2015 13:29:49 answering member 1201 label Biography information for Alistair Burt attachment 1 file name PQ 11784 IAPT referrals 2013-14.xlsx title IAPT Referrals for Selected Therapy Types 2013-14 previous answer version 23809 answering member constituency North East Bedfordshire answering member printed Alistair Burt answering member 1201 label Biography information for Alistair Burt
tabling member	4036 label Biography information for Luciana Berger

420822

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

416385

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

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