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1141919

registered interest
date	24/07/2019
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Bacterial Diseases
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government, further to the Written Answer by Baroness Blackwood of North Oxford on 9 July (HL16592), what is their view of the proportion of each of the resulting illness, deaths and costs that could be prevented by new efforts to prevent transmission; and what are the costs of new measures introduced in 2019 to prevent transmission of carbapenem-resistant Enterobacteriaceae.
tabling member printed	Baroness Gardner of Parkes
uin	HL17463
answer	answer is ministerial correction date of answer 06/08/2019 answer text <p>Public Health England (PHE) has prioritised collecting the necessary data across the National Health Service to enable estimation and monitoring of the proportion of cases, deaths and costs attributable to carbapenemase-resistant Enterobacteriaceae.</p><p>In May 2015 PHE implemented an enhanced surveillance system of all carbapenemase-producing Gram negative bacteria, which was modified in 2019 to maximise efficiency. The health burden of cases, estimated from these data, will be published in the <em>English Surveillance Programme for Antimicrobial Utilisation Report</em> in November 2019.</p><p>The few published reports of outbreaks have estimated costs of at least £1 million, and up to £5 million, all indicating multi-model control measures are required, as outlined in the PHE toolkit for prevention and control of carbapenemase-producing Enterobacteriaceae which is currently being updated.</p><p>Using national surveillance and patient administration data to develop mathematical models, work is ongoing to estimate the reduction in levels of illness and death when specified detection and control measures are applied by 2020. Developed models will enable associated costs incurred to be estimated and the cost-effectiveness of control measures to be established by 2021.</p><p> </p> answering member printed Baroness Blackwood of North Oxford question first answered 06/08/2019 15:07:02 answering member 4019 label Biography information for Baroness Blackwood of North Oxford
tabling member	3596 label Biography information for Baroness Gardner of Parkes

1135065

registered interest
date	26/06/2019
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Bacterial Diseases
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government, further to the Written Answer by Baroness Blackwood of North Oxford on 4 June (HL15832), what assessment they have made of (1) the future costs to the NHS as a result of the spread of carbapenem-resistant Enterobacteriaceae, (2) the costs of new measures introduced in 2019 specifically to prevent the transmission of such Enterobacteriaceae, and (3) the views of infection control nurses on investment to prevent the transmission of such Enterobacteriaceae.
tabling member printed	Baroness Gardner of Parkes
uin	HL16692
answer	answer is ministerial correction date of answer 09/07/2019 answer text <p>Public Health England (PHE) has predicted future spread and the health and cost impact to the National Health Service of the Enterobacteriaceae Escherichia coli and a national outbreak of a highly-resistant organism, reflecting carbapenem-resistant Enterobacteriaceae. The models used in this assessment are published in the paper <em>A Risk Assessment of Antibiotic Pan-Drug-Resistance in the UK: Bayesian Analysis of an Expert Elicitation Study</em>. A copy of the paper is attached.</p><p>Such predictions are highly uncertain. There remain unknowns regarding transmission, efficacy of interventions and the additional hospital stay for infected patients (constituting a large part of the cost to the NHS).</p><p>PHE has worked with NHS colleagues, estimating the cost of controlling a carbapenemase-producing Enterobacteriaceae (CPE) outbreak in five London hospitals to be over £1 million. Monitoring costs alongside implementation of PHE’s upcoming update of the CPE toolkit for health and social care is an important component of enabling cost-effectiveness evaluation.</p><p>Staff interviewed about the challenges of implementing the existing CPE toolkit highlighted maintaining awareness and training as key challenges, alongside infection prevention resourcing. An analysis of the responses was published in the paper <em>An evaluation of a toolkit for the early detection, management, and control of carbapenemase-producing Enterobacteriaceae: a survey of acute hospital trusts in England</em>. A copy is attached.</p> answering member printed Baroness Blackwood of North Oxford attachment 1 file name A Risk Assessment of Antibiotic Pan-Drug-Resistance in the UK.pdf title Risk Assessment of Antibiotic Pan Drug Resistance 2 file name An evaluation of a toolkit for the early detection management and control of carbapenemase-producing Enterobacteriaceae. A survey of acute hospital .pdf title An evaluation of a toolkit question first answered 09/07/2019 13:34:21 answering member 4019 label Biography information for Baroness Blackwood of North Oxford
tabling member	3596 label Biography information for Baroness Gardner of Parkes

1127421

registered interest
date	20/05/2019
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Bacterial Diseases
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government, further to the Written Answer by Baroness Blackwood of North Oxford on 14 May (HL15384), what assessment they have made of the number of people, with or without resistant blood stream infections, who have Carbapenem resistant E. coli-like bacteria present in their bodies; and what (1) proposed, and (2) current, initiatives there are to control the transmission of such bacteria.
tabling member printed	Baroness Gardner of Parkes
uin	HL15832
answer	answer is ministerial correction date of answer 04/06/2019 answer text <p>The 2018 English surveillance programme for antimicrobial utilisation and resistance report contains information on carbapenem-resistant Escherichia coli (E. coli) causing bloodstream infections in England. In 2017 there were 18 cases. The number of people with other infections and carriage of E. coli resistant to carbapenems is harder to ascertain as surveillance is not as uniform.</p><p>Public Health England (PHE) publishes guidance on the prevention and control of carbapenemase-producing Enterobacteriaceae (including E. coli); guidance is available for both acute and non-acute settings, copies of the <em>Toolkit for managing carbapenemase-producing Enterobacteriaceae in non-acute and community settings</em> and <em>Acute trust toolkit for the early detection, management and control of carbapenemase-producing Enterobacteriaceae</em> are attached. PHE is supporting actions outlined in the United Kingdom’s Tackling Antimicrobial Resistance National Action Plan that aim to prevent and control the transmission of carbapenem-resistant bacteria, which includes reducing the number of specific drug-resistant infections in people by 10% by 2025; reducing UK antimicrobial use in humans by 15% by 2024; and adding carbapenem-resistant Gram-negative infections to the list of notifiable diseases in existing laboratory reporting systems.</p> answering member printed Baroness Blackwood of North Oxford attachment 1 file name Acute_trust_toolkit_for_the_early_detection.pdf title Acute trust toolkit 2 file name CPE-Non-AcuteToolkit_CORE.pdf title CPE Non Acute toolkit question first answered 04/06/2019 13:45:10 answering member 4019 label Biography information for Baroness Blackwood of North Oxford
tabling member	3596 label Biography information for Baroness Gardner of Parkes

1123746

registered interest
date	29/04/2019
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Antibiotics: Drug Resistance
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 effectiveness of their 2013–18 antimicrobial resistance strategy at addressing the problem of multi-resistant E. coli-like bacteria; what assessment they have made of recent trends in the number of multi-resistant E. coli-like bacteria in the UK; and what factors inform their view of the balance between efforts to reduce transmission and efforts to reduce the use of antibiotics.
tabling member printed	Baroness Gardner of Parkes
uin	HL15384
answer	answer is ministerial correction date of answer 14/05/2019 answer text <p>While we can count many successes from our 2013-18 Antimicrobial Resistance (AMR) Strategy, resistance has continued to increase. In the United Kingdom we have seen a 35% increase in resistant blood stream infections in humans from 2013-17.</p><p>The number of bloodstream infections (BSIs) is increasing each year. Although the proportion of antibiotic resistant BSIs remain stable year to year, the burden on resistance increases. This is mostly due to increasing prevalence of E.coli bloodstream infections.</p><p>Estimates of the multi-resistant cases can be made, however not all the bacteria are tested against the same antibiotics, so a definitive number of cases cannot be given. The Public Health England Fingertips tool also has an indicator showing the rolling quarterly average proportion of E. coli blood specimens non-susceptible to at least three of the key antimicrobials (gentamicin, ciprofloxacin, piperacillin/tazobactam, 3rd-generation cephalosporins or carbapenems). For England this is 5.5% with little fluctuation over time.</p><p>This is exactly why the UK’s five-year national action plan for AMR, published alongside the UK 20-year vision for AMR on 24 January 2019, includes a strengthened focus on infection prevention and control, renewing our commitment to halve levels of healthcare associated Gram-negative blood stream infections (mostly E.coli) by 2023-24. The plan also sets a world-first target to reduce the actual numbers of resistant infections, with the aim to reduce them by 10% by 2025.</p><p>We are working with the devolved health administrations to develop consistent methodologies for reporting the incidence and mortality of key antibiotic resistant infections and antimicrobial use to allow us to report progress on the ambitions of the AMR national action plan.</p><p>As reductions in inappropriate prescribing also reduces the risk of promoting the growth of antibiotic-resistant bacteria, interventions to reduce antibiotic prescribing or transmission of the bacteria are complementary.</p><p> </p> answering member printed Baroness Blackwood of North Oxford question first answered 14/05/2019 16:29:42 answering member 4019 label Biography information for Baroness Blackwood of North Oxford
tabling member	3596 label Biography information for Baroness Gardner of Parkes

947561

registered interest
date	24/07/2018
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Home Care Services: Pay
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what guidance they provide to local authorities regarding the payment for travel time to carers travelling between clients; and whether local authorities are required to check if any external contractors they use to provide caring services are paying those costs.
tabling member printed	Baroness Gardner of Parkes
uin	HL9845
answer	answer is ministerial correction date of answer 26/07/2018 answer text <p>The Government provides online guidance on the steps employers and others must take to comply with the National Minimum Wage, which states that the hours of work that count for minimum wage purposes include any time when a worker is travelling from one work assignment to another.</p><p>The Government is clear that local authorities should have regard to the cost of care when setting prices. This is set out in the statutory guidance to the Care Act 2014.</p><p> </p><p>In 2016 the Department worked with local government, the care sector and the Chartered Institute of Public Finance and Accountancy to produce a guide to understanding providers’ costs and fair fees – this was published in January 2017. A copy of <em>Working with care providers to understand costs</em><em>: </em><em>A guide for adult social care commissioners</em> is attached.</p> answering member printed Lord O'Shaughnessy question first answered 26/07/2018 12:44:46 answering member 4545 label Biography information for Lord O'Shaughnessy attachment 1 file name HL9845 - Cost_of_Care_Report.pdf title Working with care providers to understand costs
tabling member	3596 label Biography information for Baroness Gardner of Parkes

932348

registered interest
date	28/06/2018
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Foetal Alcohol Spectrum Disorder
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government how many patients with foetal alcohol spectrum disorders are receiving treatment on the NHS.
tabling member printed	Baroness Gardner of Parkes
uin	HL9060
answer	answer is ministerial correction date of answer 11/07/2018 answer text <p>Information on numbers of patients with foetal alcohol spectrum disorders (FASD) receiving treatment on the National Health Service is not collected centrally.</p><p>The United Kingdom Chief Medical Officers’ low risk drinking guidelines advise women who are pregnant or think they could become pregnant that the safest approach is not to drink alcohol at all, to reduce risks to the baby to a minimum.</p><p>As part of the Maternity Transformation Programme, Public Health England (PHE) is leading work to provide prevention-focused leadership to support a reduction in the proportion of women drinking alcohol during pregnancy. Midwives and health visitors also have a role in providing clear, consistent advice and early identification and support. Additionally PHE’s Start4Life programme also provides online information on the impact of drinking alcohol during pregnancy, including the risk of FASD.</p><p>The Department for Education through the Adoption Support Fund has made funding available to local authorities to support adopted children with a range of specialist assessments and therapy to treat a variety of conditions. This includes FASD.</p><p> </p> answering member printed Lord O'Shaughnessy grouped question UIN HL9061 HL9062 question first answered 11/07/2018 11:10:35 answering member 4545 label Biography information for Lord O'Shaughnessy
tabling member	3596 label Biography information for Baroness Gardner of Parkes

932349

registered interest
date	28/06/2018
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Foetal Alcohol Spectrum Disorder
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what information is provided to women to try to prevent foetal alcohol spectrum disorders.
tabling member printed	Baroness Gardner of Parkes
uin	HL9061
answer	answer is ministerial correction date of answer 11/07/2018 answer text <p>Information on numbers of patients with foetal alcohol spectrum disorders (FASD) receiving treatment on the National Health Service is not collected centrally.</p><p>The United Kingdom Chief Medical Officers’ low risk drinking guidelines advise women who are pregnant or think they could become pregnant that the safest approach is not to drink alcohol at all, to reduce risks to the baby to a minimum.</p><p>As part of the Maternity Transformation Programme, Public Health England (PHE) is leading work to provide prevention-focused leadership to support a reduction in the proportion of women drinking alcohol during pregnancy. Midwives and health visitors also have a role in providing clear, consistent advice and early identification and support. Additionally PHE’s Start4Life programme also provides online information on the impact of drinking alcohol during pregnancy, including the risk of FASD.</p><p>The Department for Education through the Adoption Support Fund has made funding available to local authorities to support adopted children with a range of specialist assessments and therapy to treat a variety of conditions. This includes FASD.</p><p> </p> answering member printed Lord O'Shaughnessy grouped question UIN HL9060 HL9062 question first answered 11/07/2018 11:10:35 answering member 4545 label Biography information for Lord O'Shaughnessy
tabling member	3596 label Biography information for Baroness Gardner of Parkes

932350

registered interest
date	28/06/2018
answering body	Department of Health and Social Care
answering dept id	17
answering dept short name	Health and Social Care
answering dept sort name	Health and Social Care
hansard heading	Foetal Alcohol Spectrum Disorder
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what support is available to parents or adopters of children with foetal alcohol spectrum disorders.
tabling member printed	Baroness Gardner of Parkes
uin	HL9062
answer	answer is ministerial correction date of answer 11/07/2018 answer text <p>Information on numbers of patients with foetal alcohol spectrum disorders (FASD) receiving treatment on the National Health Service is not collected centrally.</p><p>The United Kingdom Chief Medical Officers’ low risk drinking guidelines advise women who are pregnant or think they could become pregnant that the safest approach is not to drink alcohol at all, to reduce risks to the baby to a minimum.</p><p>As part of the Maternity Transformation Programme, Public Health England (PHE) is leading work to provide prevention-focused leadership to support a reduction in the proportion of women drinking alcohol during pregnancy. Midwives and health visitors also have a role in providing clear, consistent advice and early identification and support. Additionally PHE’s Start4Life programme also provides online information on the impact of drinking alcohol during pregnancy, including the risk of FASD.</p><p>The Department for Education through the Adoption Support Fund has made funding available to local authorities to support adopted children with a range of specialist assessments and therapy to treat a variety of conditions. This includes FASD.</p><p> </p> answering member printed Lord O'Shaughnessy grouped question UIN HL9060 HL9061 question first answered 11/07/2018 11:10:35 answering member 4545 label Biography information for Lord O'Shaughnessy
tabling member	3596 label Biography information for Baroness Gardner of Parkes