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100977

registered interest
date	27/10/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	NHS: Drugs
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what safeguards exist to ensure that the pricing of "specials" drugs prescribed within the National Health Service is consistent and non-discriminatory, including when prescribed by general practitioners.
tabling member printed	Lord Lester of Herne Hill
uin	HL2433
answer	answer is ministerial correction date of answer 10/11/2014 answer text <p>The Drug Tariff sets out what National Health Service dispensing contractors will be paid for the products supplied as part of providing pharmaceutical services and the fees for providing those services in primary care.</p><p> </p><p> </p><p> </p><p>The current arrangements in the Drug Tariff for paying for specials were introduced in 2011. The Drug Tariff sets the price that the NHS pays to dispensing contractors for dispensing some of the most popular specials. Setting a reimbursement price encourages dispensing contractors to obtain best value for the NHS while also ensuring patients received the medicines they need, when they need them. The products listed and their reimbursement prices are agreed with the Pharmaceutical Services Negotiating Committee and reviewed regularly. However, due to the number of specials that can potentially be prescribed, it is not possible to list a reimbursement price for all available specials.</p><p> </p><p> </p><p> </p><p>Where the reimbursement price of a product has not been set, dispensing contractors are paid according to how the product is sourced. Where a dispensing contractor buys the product from a specials manufacturer or an importer, they must claim the invoice price of the pack size used to dispense the product minus any discounts or rebates received.</p><p> </p><p> </p><p> </p><p>NHS England is responsible for commissioning pharmaceutical services in primary care and it is for NHS England to consider whether dispensing contractors have acted appropriately. In addition, the General Pharmaceutical Council is responsible for regulating the pharmacy professions should there be any concerns of professional misconduct.</p><p> </p><p> </p><p> </p><p>Many hospital pharmacies manufacture their own specials on the premises. Any procurement of unlicensed medicines via framework agreements for the use of NHS secondary care establishments in England is undertaken through tenders governed by the Public Contracts Regulations (2006), as amended, which require the procurement to be conducted in a transparent and equitable manner.</p><p> </p> answering member printed Earl Howe question first answered 10/11/2014 14:29:40 answering member 2000 label Biography information for Earl Howe
tabling member	2037 label Biography information for Lord Lester of Herne Hill

101009

registered interest
date	27/10/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	General Practitioners: Pay
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government, further to the announcement by NHS England that general practitioners are to be paid an additional £55 for diagnosing dementia in patients, what other complaints or illnesses diagnosed by general practitioners are already rewarded by payments additional to their salaries; and whether they will review the system of additional payments of this sort.
tabling member printed	Lord Stoddart of Swindon
uin	HL2465
answer	answer is ministerial correction date of answer 05/11/2014 answer text <p>General Practitioner (GP) income is made up of global sum payments for carrying out essential and additional services under the contract. Practices may also receive further payments for specific services including:</p><p> </p><p> </p><p> </p><p>- enhanced services – those that require an enhanced level of service provision above what is required under the core contract. The additional payment for diagnosing dementia falls within this category; and</p><p> </p><p> </p><p> </p><p>- the quality and outcomes framework (QOF) - a voluntary incentive scheme that provides payment to GP practices for how well they care for patients based on performance against a number of agreed indicators.</p><p> </p><p> </p><p> </p><p>Specifically on diagnosis, a number of QOF indicators are concerned with the establishment of disease registers. In order to receive payment GPs are required to ensure diagnosis levels consistent with those expected for their population for the following conditions:</p><p> </p><p> </p><p> </p><p>- atrial fibrillation;</p><p> </p><p>- coronary heart disease;</p><p> </p><p>- heart failure;</p><p> </p><p>- hypertension;</p><p> </p><p>- peripheral arterial disease;</p><p> </p><p>- stroke and trans-ischaemic attack;</p><p> </p><p>- diabetes mellitus;</p><p> </p><p>- hypothyroidism;</p><p> </p><p>- asthma;</p><p> </p><p>- chronic obstructive pulmonary disease;</p><p> </p><p>- dementia;</p><p> </p><p>- depression;</p><p> </p><p>- schizophrenia, bipolar affective disorder and other psychoses and other patients on lithium therapy;</p><p> </p><p>- cancer;</p><p> </p><p>- chronic kidney disease;</p><p> </p><p>- epilepsy;</p><p> </p><p>- osteoporosis;</p><p> </p><p>- rheumatoid arthritis; and</p><p> </p><p>- obesity.</p><p> </p><p><strong> </strong></p><p> </p><p> </p><p> </p><p>Each year NHS Employers, on behalf of NHS England, negotiates the new GP contract with the General Practitioners Council of the British Medical Association. This includes discussion of changes to the Enhanced Services and QOF.</p><p> </p> answering member printed Earl Howe question first answered 05/11/2014 12:10:48 answering member 2000 label Biography information for Earl Howe
tabling member	950 label Biography information for Lord Stoddart of Swindon

100854

registered interest
date	24/10/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Care Workers: Minimum Wage
house id	1
legislature	25259 pref label House of Commons
question text	To ask the Secretary of State for Health, whether his Department has made an assessment of or received evidence on the effect on care standards of non-payment of the national minimum wage in the social care sector.
tabling member constituency	Stockton North
tabling member printed	Alex Cunningham
uin	211866
answer	answer is ministerial correction date of answer 03/11/2014 answer text <p>The Department has not conducted any recent research on the effect of treatment of staff on standards of care and on the relationship between levels of pay and quality of social care services.</p><p> </p><p> </p><p> </p><p>As part of the development of Caring for our Future white paper in 2011, the Department undertook extensive engagement with both service users and carers who highlighted a range of issues they felt needed addressing to ensure high quality care and support is available. In addressing this, the Department, working with the Sector Skills Council – Skills for Care – and other partners, has implemented a range of policies that has included setting out clear minimum training standards, recruiting more apprentices and supporting the transformation of the social work profession.</p><p> </p><p> </p><p> </p><p>There are a number of factors that determine the quality of care provided in the social care sector, including the way staff are treated. Pay is not the single most significant factor in delivering high quality services.</p><p> </p><p> </p><p> </p><p>The Department is clear however that care providers must abide by the law with regards to payment of the national minimum wage and is taking steps to ensure this happens. The Department is liaising with the Department for Business, Innovation and Skills to name and shame any social care providers who do not comply with the national minimum wage legislation and Her Majesty’s Revenue and Customs is continuing to carry out enforcement action in the social care sector and will investigate all complaints made by care workers that their employer is not paying them the national minimum wage. In addition, it is looking to ensure that the statutory guidance that will accompany the Care Act on commissioning and market shaping explicitly states local authorities should have evidence that contract terms, conditions and fee levels are appropriate to provide the agreed care packages with agreed quality of care.</p><p> </p><p> </p><p> </p> answering member constituency North Norfolk answering member printed Norman Lamb question first answered 03/11/2014 16:37:18 answering member 1439 label Biography information for Norman Lamb
tabling member	4122 label Biography information for Alex Cunningham

100891

registered interest
date	24/10/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Skin Cancer
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 his policy to introduce a screening programme for people who have previously had treatment for skin cancer.
tabling member constituency	Bassetlaw
tabling member printed	John Mann
uin	211914
answer	answer is ministerial correction date of answer 03/11/2014 answer text <p>The National Institute for Health and Care Excellence (NICE) has published cancer service guidance which outlines how healthcare services for people with skin tumours, including melanoma, should be organised. In May 2010 NICE issued a partial update to the guidance, including new recommendations on the management of low-risk basal cell carcinomas in the community.</p><p> </p><p> </p><p> </p><p>NICE is currently developing a clinical guideline on the assessment and management of melanoma, which is currently planned for publication in July 2015.</p><p> </p><p>Further details of NICE’s guidance on skin cancer are available at:</p><p> </p><p> </p><p> </p><p><a href="http://www.nice.org.uk/guidance/conditions-and-diseases/cancer/skin-cancer" target="_blank">http://www.nice.org.uk/guidance/conditions-and-diseases/cancer/skin-cancer</a></p><p> </p><p> </p><p> </p><p>Information for the public on skin cancer is available on the NHS Choices website.</p><p> </p> answering member constituency Battersea answering member printed Jane Ellison question first answered 03/11/2014 17:57:18 answering member 3918 label Biography information for Jane Ellison
tabling member	1387 label Biography information for Lord Mann

100925

registered interest
date	24/10/2014
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	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government whether they have any plans to locate health visitors in accident and emergency departments.
tabling member printed	Baroness Manzoor
uin	HL2393
answer	answer is ministerial correction date of answer 05/11/2014 answer text <p>The Department knows that some parts of the National Health Service are under pressure at the moment. Health Visitors and other health professionals have the potential to play a strong role in reducing the burden on emergency departments. We welcome proposals on innovative ways to achieve this.</p><p> </p><p> </p><p> </p><p>NHS England has advised that while health visiting services are currently provided in many community locations including children’s centres, community clinics and local general practitioner surgeries, NHS England is carrying out work to look at how health visitors, in response to local need, can support other frontline services and provide more support and advice to parents on caring for their children.</p><p> </p><p> </p><p> </p><p>For example, London and Midland and East Regions are looking at opportunities which will simultaneously enhance the health visiting service provision and support a reduction in accident and emergency attendance and waiting times over the winter period.</p><p> </p><p> </p><p> </p><p>In both regions the services offered will fall within the professional scope of Health Visitors and are designed to support families receive the most appropriate care. In addition, health visitors in accident and emergency departments can support delivery of the high impact areas: particularly managing minor illness, preventing accidents and also support maternal mental health, early attachment, and transition to parenthood and breastfeeding.</p><p> </p><p> </p><p> </p><p>These ideas have been shared with the other regions.</p><p> </p> answering member printed Earl Howe question first answered 05/11/2014 12:09:46 answering member 2000 label Biography information for Earl Howe
tabling member	4289 label Biography information for Baroness Manzoor

100939

registered interest
date	24/10/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Health and Social Care Act 2012
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government, further to the answer by Earl Howe on 22 October (HL Deb, col 631), what has been the cost of the reforms introduced under the Health and Social Care Act 2012 in (1) 2012, and (2) 2013; and what are the anticipated costs in (3) 2014, and (4) 2015.
tabling member printed	Lord Brooke of Alverthorpe
uin	HL2407
answer	answer is ministerial correction date of answer 05/11/2014 answer text <p>The cost of the reforms have been recorded by financial year as follows:</p><p> </p><p> </p><p> </p><p>2010-11 £199 million</p><p> </p><p>2011-12 £264 million</p><p> </p><p>2012-13 £633 million</p><p> </p><p>2013-14 £220 million</p><p> </p><p> </p><p> </p><p> </p><p> </p><p>We anticipate the future costs will be below £180 million and within the £1.5 billion as announced in my Written Ministerial Statement of 23 July 2014, columns WS135-136. The majority of the remaining anticipated costs are expected to be incurred in 2014-15.</p><p> </p><p><strong> </strong></p><p> </p><p>These costs have been more than covered by the savings arising from the Health and Social Care Act, which up to 31 March 2014, were approximately £4.9 billion.</p><p> </p> answering member printed Earl Howe question first answered 05/11/2014 12:08:50 answering member 2000 label Biography information for Earl Howe
tabling member	3335 label Biography information for Lord Brooke of Alverthorpe

100549

registered interest
date	22/10/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Tobacco: Packaging
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government whether ministerial agreement has been reached on whether the United Kingdom is to proceed with standardised tobacco packaging; and whether it had been reached when they notified the European Commission on the draft regulations.
tabling member printed	Lord Palmer
uin	HL2286
answer	answer is ministerial correction date of answer 04/11/2014 answer text <p>The Government has not yet made a final decision on whether to introduce standardised packaging of tobacco products.</p><p> </p> answering member printed Earl Howe question first answered 04/11/2014 15:43:17 answering member 2000 label Biography information for Earl Howe
tabling member	3192 label Biography information for Lord Palmer

100551

registered interest
date	22/10/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Alcoholic Drinks: Misuse
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what steps they are taking in respect of Britain's drinking culture in order to reduce liver disease deaths.
tabling member printed	Lord Taylor of Warwick
uin	HL2288
answer	answer is ministerial correction date of answer 04/11/2014 answer text <p>The Government is taking a number of steps to tackle alcohol problems and reduce alcohol-related liver disease. These are being led by Public Health England (PHE), working with partners across government and local authorities. Through the Responsibility Deal the Government is also working with industry partners to tackle alcohol problems.</p><p> </p><p> </p><p> </p><p>On 23 October 2014, PHE published its priorities for protecting and improving the nation’s health and one of the seven issues they will be focusing on is preventing and reducing the harmful effects of alcohol. This priority includes two actions relating to liver disease:</p><p> </p><p> </p><p> </p><p>- producing a framework on liver disease outlining public health actions to tackle liver disease, including alcohol; and</p><p> </p><p> </p><p> </p><p>- launching liver disease profiles to support local authority health and wellbeing boards to understand liver disease and its risk factors in their area and, in turn, design effective local population level interventions.</p><p> </p><p> </p><p> </p><p>Other key actions from PHE on alcohol and liver disease include:</p><p> </p><p> </p><p> </p><p>- developing the evidence base for what works in preventing alcoholic liver disease and increasing awareness of the harmful effects of alcohol and the impact of interventions, to support policy development nationally and locally;</p><p> </p><p> </p><p> </p><p>- supporting and promoting effective use of licensing legislation and local powers to create a safer drinking environment that encourages people who drink to do so at a lower risk levels. Part of this is improving the effectiveness of the powers directors of public health have on alcohol licencing;</p><p> </p><p> </p><p> </p><p>- encouraging and supporting people who drink to do so within the lower risk levels;</p><p> </p><p> </p><p> </p><p>- reducing the harmful impact of alcohol on individuals who already experience harm. PHE will be supporting a widespread roll-out of interventions and brief advice; and</p><p> </p><p> </p><p> </p><p>- supporting improvements in treatment provision in line with National Institute for Health and Care Excellence guidance. Locally, PHE is supporting the development of effective alcohol specialist services in secondary care and accessible, evidence-based specialist treatment for dependent drinkers.</p><p> </p> answering member printed Earl Howe question first answered 04/11/2014 15:43:53 answering member 2000 label Biography information for Earl Howe
tabling member	1796 label Biography information for Lord Taylor of Warwick

100590

registered interest
date	22/10/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Orthopaedics
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what action they have (1) considered, and (2) taken, to reduce the number of preventable amputations occurring within the National Health Service.
tabling member printed	Lord Harrison
uin	HL2327
answer	answer is ministerial correction date of answer 04/11/2014 answer text <p>Diabetes is one of the most common causes of amputations in the United Kingdom and there are a variety of mechanisms in place to support the care of people with diabetes to minimise the risk of amputations. NHS England published Action for Diabetes, which sets out that in many cases amputation as a result of diabetes is avoidable.</p><p> </p><p> </p><p> </p><p>NHS England has also piloted a diabetes service specification in a small number of clinical commissioning groups (CCGs). Feedback has been very positive and they have now published the service specification on the NHS Commissioning Assembly website so that it is available nationally for CCGs to use.</p><p> </p><p> </p><p> </p><p>In addition, the National Diabetes Foot Care Audit was launched this year. The audit aims to establish the extent to which national guidelines on the management of diabetic foot disease are being met, and will provide local teams with the evidence needed to tackle any identified differences in practice which will lead in turn to an overall improvement in management and outcomes for patients.</p><p> </p><p> </p><p> </p><p>Finally, NHS Improving Quality is supporting a project to reduce the high mortality associated with diabetic foot disease. People with diabetic foot disease are at particularly high risk of premature death, much of which is due to cardiovascular disease, with 5 year mortality for those with Type 1 or Type 2 diabetes and diabetic foot disease around 50%. The project will pilot an approach in several multidisciplinary foot clinics across the country over the next 18 months to introduce an additional clinical pathway which includes a cardiological test and subsequent actions to address risk.</p><p> </p> answering member printed Earl Howe question first answered 04/11/2014 12:33:24 answering member 2000 label Biography information for Earl Howe
tabling member	2488 label Biography information for Lord Harrison

100595

registered interest
date	22/10/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Ebola
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 research report by the Keenan Research Centre at St Michael's Hospital in Toronto which estimates that three ebola carriers fly out of the most affected countries each month and that their preferred destination is London; and whether they have any plans to further increase ebola testing at airports.
tabling member printed	Lord Blencathra
uin	HL2332
answer	answer is ministerial correction date of answer 05/11/2014 answer text <p>The report makes a number of assumptions, including that exit screening procedures were not in place in the major affected countries. Since the report was published in August exit screening in the three most affected countries is now in place.</p><p> </p><p> </p><p> </p><p>Screening is now in operation in Heathrow, Gatwick, Birmingham and Manchester airports and at St Pancras (Eurostar). The purpose of screening is to identify, and give advice to, passengers coming from high risk areas who will be spending time in the United Kingdom. This is to provide them with relevant advice on the nature of the virus, what to be aware of, and what action to take should they begin to display any symptoms.</p><p> </p> answering member printed Earl Howe question first answered 05/11/2014 15:52:37 answering member 2000 label Biography information for Earl Howe
tabling member	497 label Biography information for Lord Blencathra