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63777

registered interest
date	24/06/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Spinal Injuries
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what action they are taking to ensure that there are enough designated beds in spinal injury centres for patients with spinal injuries resulting in paralysis.
tabling member printed	Baroness Masham of Ilton
uin	HL561
answer	answer is ministerial correction date of answer 01/07/2014 answer text <p>NHS England has advised that all three centres have periodically experienced problems admitting patients promptly, especially for those patients requiring ventilation, and consequently waiting lists for admission have developed. To ensure patients awaiting admission receive appropriate assessment and support, the centres have been providing outreach care to patients at the hospitals to which they are admitted, which will usually be a major trauma centre.</p><p> </p><p>The fluctuations of waiting times and the ability to discharge a patient to the next phase of their care are key factors in enabling the admission of new patients to a centre. NHS England, the eight specialist centres in England and the Spinal Injuries Association are working together to recommend changes to the continuing care process that would enable spinal cord injured patients to move to the next stage of their care as soon as clinically appropriate.</p><p> </p><p>The overall bed complement for England is being reviewed through a demand and capacity project, led by the Spinal Cord Injury Clinical Reference Group (CRG). The CRG aims to produce a report in 2015-16.</p> answering member printed Earl Howe grouped question UIN HL562 question first answered 01/07/2014 11:44:59 answering member 2000 label Biography information for Earl Howe
tabling member	1850 label Biography information for Baroness Masham of Ilton

63778

registered interest
date	24/06/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Spinal Injuries
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government how long the waiting lists for beds for patients with spinal injuries are at the spinal units at (1) the National Spinal Injuries Centre, Stoke Mandeville Hospital, (2) the Duke of Cornwall Spinal Treatment Centre, Salisbury, and (3) the Royal National OrthopaedicHospital, Stanmore.
tabling member printed	Baroness Masham of Ilton
uin	HL562
answer	answer is ministerial correction date of answer 01/07/2014 answer text <p>NHS England has advised that all three centres have periodically experienced problems admitting patients promptly, especially for those patients requiring ventilation, and consequently waiting lists for admission have developed. To ensure patients awaiting admission receive appropriate assessment and support, the centres have been providing outreach care to patients at the hospitals to which they are admitted, which will usually be a major trauma centre.</p><p> </p><p>The fluctuations of waiting times and the ability to discharge a patient to the next phase of their care are key factors in enabling the admission of new patients to a centre. NHS England, the eight specialist centres in England and the Spinal Injuries Association are working together to recommend changes to the continuing care process that would enable spinal cord injured patients to move to the next stage of their care as soon as clinically appropriate.</p><p> </p><p>The overall bed complement for England is being reviewed through a demand and capacity project, led by the Spinal Cord Injury Clinical Reference Group (CRG). The CRG aims to produce a report in 2015-16.</p> answering member printed Earl Howe grouped question UIN HL561 question first answered 01/07/2014 11:44:59 answering member 2000 label Biography information for Earl Howe
tabling member	1850 label Biography information for Baroness Masham of Ilton

62470

registered interest
date	18/06/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Diabetes
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what steps they are taking to ensure that people with diabetes are able to access innovative medicines.
tabling member printed	Baroness Masham of Ilton
uin	HL399
answer	answer is ministerial correction date of answer 25/06/2014 answer text <p>We want to ensure that patients, including those with diabetes, have access to new and effective treatments on terms that represent value to the National Health Service and the taxpayer.</p><p> </p><p>The National Institute for Health and Care Excellence (NICE) has recommended a number of medicines for diabetes. National Health Service commissioners are legally required by regulations to fund those medicines recommended by NICE in its technology appraisal guidance.</p> answering member printed Earl Howe question first answered 25/06/2014 12:55:05 answering member 2000 label Biography information for Earl Howe
tabling member	1850 label Biography information for Baroness Masham of Ilton

62471

registered interest
date	18/06/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Diabetes
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government how they plan to review NHS England's progress in implementing the Action for Diabetes plan.
tabling member printed	Baroness Masham of Ilton
uin	HL400
answer	answer is ministerial correction date of answer 30/06/2014 answer text <p>Action for Diabetes sets out the broad vision and direction for how NHS England will support improvements in outcomes for people with and at risk of diabetes in the coming years, as a direct commissioner of services and supporting clinical commissioning groups (CCGs) in their commissioning role.</p><p> </p><p>Outcomes for people with diabetes will continue to be measured through the NHS Outcomes Framework and the CCG Outcomes Indicator Set, which are both updated and published annually. Outcomes for people with diabetes will also be assessed through the National Diabetes Audit, which includes the core audit, the national inpatient diabetes audit, the national diabetes pregnancy audit, the national patient experience of diabetes services survey and the national diabetes foot audit. The latter of these is due to be launched this summer.</p> answering member printed Earl Howe question first answered 30/06/2014 10:55:27 answering member 2000 label Biography information for Earl Howe
tabling member	1850 label Biography information for Baroness Masham of Ilton

62472

registered interest
date	18/06/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Diabetes
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what steps are being taken to ensure that people with diabetes receive the care processes recommended by the National Institute for Health and Care Excellence.
tabling member printed	Baroness Masham of Ilton
uin	HL401
answer	answer is ministerial correction date of answer 01/07/2014 answer text <p>The management of people with diabetes is measured and reported on through the Quality and Outcomes Framework (QOF), the CCG Outcomes Indicator Set (OIS) and National Diabetes Audit. These publications and data are used by local commissioners, providers and healthcare professionals to assess the quality of the services provided and to drive improvements.</p><p> </p><p>General practitioners (GPs) are incentivised to ensure completion of the care processes recommended by The National Institute for Health and Care Excellence (NICE) through the QOF. The latest available data (2011-12) shows a 60.5% completion rate of all the eight measurable NICE-recommended care processes for diabetes. However, it is for individual GP practices, working with the CCGs in their area, to assess their own performance on completion of the care processes, and take action where improvement is necessary.</p><p> </p><p>CCGs can use the information reported from the OIS indicator on completion of the care processes for people with diabetes to assess progress in improvement in their area and against their peers. Where completion rates are low, CCGs can then take action jointly with other practices in their area to make improvements.</p><p> </p><p>To support local commissioning, NHS England has also developed a non-mandatory service specification for diabetes, based on the diabetes NICE Quality Standard, which is currently being piloted with some CCGs. The pilot will be evaluated to assess how useful the specification has been to commissioners, and this will inform decisions about its future development.</p><p> </p><p>The Patient Experience of Diabetes Services survey, part of the National Diabetes Audit, is measuring the healthcare experiences of people with diabetes in England and Wales. The survey pilot tested an online-only approach to measure patient experience in GP and specialist diabetes services. Any diabetes service in England and Wales should be able to use the survey to get feedback from their patients. The survey can help to raise standards and drive out variation, and also empower services to understand at a local level how satisfied their patients are with the service being provided.</p> answering member printed Earl Howe grouped question UIN HL402 question first answered 01/07/2014 11:37:32 answering member 2000 label Biography information for Earl Howe
tabling member	1850 label Biography information for Baroness Masham of Ilton

62473

registered interest
date	18/06/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Diabetes
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what steps are being taken to ensure that the treatment targets for people with diabetes recommended by the National Institute for Health and Care Excellence are being met.
tabling member printed	Baroness Masham of Ilton
uin	HL402
answer	answer is ministerial correction date of answer 01/07/2014 answer text <p>The management of people with diabetes is measured and reported on through the Quality and Outcomes Framework (QOF), the CCG Outcomes Indicator Set (OIS) and National Diabetes Audit. These publications and data are used by local commissioners, providers and healthcare professionals to assess the quality of the services provided and to drive improvements.</p><p> </p><p>General practitioners (GPs) are incentivised to ensure completion of the care processes recommended by The National Institute for Health and Care Excellence (NICE) through the QOF. The latest available data (2011-12) shows a 60.5% completion rate of all the eight measurable NICE-recommended care processes for diabetes. However, it is for individual GP practices, working with the CCGs in their area, to assess their own performance on completion of the care processes, and take action where improvement is necessary.</p><p> </p><p>CCGs can use the information reported from the OIS indicator on completion of the care processes for people with diabetes to assess progress in improvement in their area and against their peers. Where completion rates are low, CCGs can then take action jointly with other practices in their area to make improvements.</p><p> </p><p>To support local commissioning, NHS England has also developed a non-mandatory service specification for diabetes, based on the diabetes NICE Quality Standard, which is currently being piloted with some CCGs. The pilot will be evaluated to assess how useful the specification has been to commissioners, and this will inform decisions about its future development.</p><p> </p><p>The Patient Experience of Diabetes Services survey, part of the National Diabetes Audit, is measuring the healthcare experiences of people with diabetes in England and Wales. The survey pilot tested an online-only approach to measure patient experience in GP and specialist diabetes services. Any diabetes service in England and Wales should be able to use the survey to get feedback from their patients. The survey can help to raise standards and drive out variation, and also empower services to understand at a local level how satisfied their patients are with the service being provided.</p> answering member printed Earl Howe grouped question UIN HL401 question first answered 01/07/2014 11:37:33 answering member 2000 label Biography information for Earl Howe
tabling member	1850 label Biography information for Baroness Masham of Ilton

61489

registered interest
date	11/06/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Pregnancy: Drugs
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government how the Department of Health plans to cover the cost of the number of children requiring specialised healthcare due to the effects of fetal valproate syndrome.
tabling member printed	Baroness Masham of Ilton
uin	HL267
answer	answer is ministerial correction date of answer 18/06/2014 answer text <p>The health and care needs of children with fetal valproate syndrome will be met by a range of services and in the majority of cases the local clinical commissioning group (CCG) will decide on the level of provision of services, taking into account the needs of the population it serves. The CCG's decisions are underpinned by clinical insight and knowledge of local healthcare needs.</p> answering member printed Earl Howe question first answered 18/06/2014 11:52:59 answering member 2000 label Biography information for Earl Howe
tabling member	1850 label Biography information for Baroness Masham of Ilton

61490

registered interest
date	11/06/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Pregnancy: Drugs
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government whether there are any plans to implement a system to ensure that female patients prescribed valproate or any other anti-convulsant medication are given information relating to potential problems in pregnancy.
tabling member printed	Baroness Masham of Ilton
uin	HL268
answer	answer is ministerial correction date of answer 19/06/2014 answer text <p>All doctors, during undergraduate and postgraduate training, are made aware of all of the current evidence when prescribing in pregnancy. This is especially so when prescribing drugs that are potentially teratogenic such as anticonvulsants.</p><p> </p><p>The core curriculum for trainee obstetricians which is overseen by the Royal College of Gynaecologists contains a detailed module on epilepsy in pregnancy including sodium valproate which all trainees are required to complete.</p><p> </p><p>The Royal College of Physicians has a similar core learning module on drugs in pregnancy for physicians in training. It is recommended that women with epilepsy attend for pre pregnancy counselling so that management of their epilepsy in any future pregnancy can be discussed as well as any risks and benefits of medication they are taking.</p><p> </p><p>NHS England expects all clinicians prescribing these drugs to follow the National Institute for Health and Care Excellence (NICE) guidance. This is a very powerful tool to improve commissioning. The NICE guidance issued in January 2012 recommends that epilepsy nurse specialists should be an integral part of the network of care of children, young people and adults with epilepsy (para 1.8.3). One of their roles is to educate, inform and support the patient and their family with specific training about the management of epilepsy.</p> answering member printed Earl Howe question first answered 19/06/2014 11:55:04 answering member 2000 label Biography information for Earl Howe
tabling member	1850 label Biography information for Baroness Masham of Ilton

61491

registered interest
date	11/06/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Pregnancy: Drugs
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what information is currently given to female patients concerning the potential problems of taking valproate in pregnancy; and how that information reflects the guidelines established by the National Institute for Health and Care Excellence on those issues.
tabling member printed	Baroness Masham of Ilton
uin	HL269
answer	answer is ministerial correction date of answer 18/06/2014 answer text <p>The Patient Information Leaflet (PIL) that accompanies the medicine is intended to supplement the information provided by the prescriber. The PIL for Epilim (a brand of valproate for the treatment of epilepsy) states that women who are pregnant or of childbearing age should not take valproate unless explicitly advised by their doctor and provides information on birth defects, impaired development and other problems which may occur in babies born to mothers who take valproate during pregnancy. The PILs for other brands of valproate used in the treatment of epilepsy and to control mania in bipolar disorder contain similar warnings. The warnings in the information for healthcare professionals, the Summary of Product Characteristics (SPC) and the PIL are currently the subject of a Europe–wide review which was prompted by new data on the risk of developmental disorders in children born to mothers who took valproate during pregnancy.</p><p> </p><p>The National Institute for Health and Care Excellence (NICE) clinical guideline on epilepsy made the following recommendation as a key priority for implementation: &quot;Women and girls with epilepsy and their partners, as appropriate, must be given accurate information and counselling about contraception, conception, pregnancy, caring for children, breastfeeding and menopause.&quot; NICE's clinical guideline on bipolar disorder recommends that valproate should not routinely be prescribed to pregnant women with bipolar disorder.</p> answering member printed Earl Howe question first answered 18/06/2014 11:52:30 answering member 2000 label Biography information for Earl Howe
tabling member	1850 label Biography information for Baroness Masham of Ilton

61492

registered interest
date	11/06/2014
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Pregnancy: Drugs
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what practical steps are being taken to ensure that the experiences and interests of children with fetal valproate syndrome and their families are represented as an integral part of patient involvement at every level of the reformed National Health Service.
tabling member printed	Baroness Masham of Ilton
uin	HL270
answer	answer is ministerial correction date of answer 19/06/2014 answer text <p>NHS England has developed a delivery model which sets out a systematic approach to the way that it works. Each aspect of its work is underpinned by a commitment to increase patient experience, engagement and participation. This is reflected in their business plan 2014-15 to 2016-17.</p><p> </p><p>In September 2013, it launched a package of measures designed to ensure that the voices of patients, their carers and the public are at the centre of healthcare services.</p><p> </p><p>‘Transforming Participation in Health and Care – The NHS belongs to us all' has been developed by NHS England with a wide range of stakeholders and partners. Its purpose is to support commissioners to improve individual and public participation and to better understand and respond to the needs of the communities they serve.</p><p> </p><p>It supports two legal duties requiring clinical commissioning groups (CCGs) and commissioners in NHS England to enable:</p><p> </p><p>- patients and carers to participate in planning, managing and making decisions about their care and treatment, through the services they commission; and</p><p> </p><p>- the effective participation of the public in the commissioning process itself, so that services provided reflect the needs of local people.</p><p> </p><p>The guidance highlights a range of ways in which National Health Service commissioners can fulfil their statutory responsibilities and seize the opportunity to deliver personalised and responsive care to all. It includes a wide range of tools, resources and case studies that commissioners will find useful when developing their own responses.</p><p> </p><p>The guidance is a starting point and NHS England will be working with partners to develop further resources to support commissioners to develop their approaches to both individual and public participation.</p><p> </p><p>The reforms to the health and social care system set out in the Health and Social Care Act have also emphasised the need for integration. Central to these reforms is the establishment of statutory health and wellbeing boards to encourage local authorities to take a more strategic approach to providing integrated health and local government services. The boards are intended to bring together bodies from the NHS, public and local government, including Healthwatch as the patient's voice, jointly to plan how best to meet local health and care needs, and to commission services accordingly.</p> answering member printed Earl Howe question first answered 19/06/2014 11:54:29 answering member 2000 label Biography information for Earl Howe
tabling member	1850 label Biography information for Baroness Masham of Ilton