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1091313

	registered interest
	date	19/03/2019
	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	Prescriptions: Universal Credit
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, how many penalty notices have been issued by the NHSBSA in Dudley since the rollout of universal credit.
	tabling member constituency	Dudley North
	tabling member printed	Ian Austin
	uin	234108
	answer	answer is ministerial correction date of answer 22/03/2019 answer text <p>The number of prescription and dental penalty charge notices issued prior to universal credit (UC) rollout in Dudley by calendar year is provided in the following table:</p><p> </p><table><tbody><tr><td><p>Prior to the rollout of UC in Dudley by calendar year</p></td><td><p>Prescription penalty charge notice issued</p></td><td><p>Dental penalty charge notice issued</p></td></tr><tr><td><p>2012</p></td><td><p>Not held</p></td><td><p>51</p></td></tr><tr><td><p>2013</p></td><td><p>Not held</p></td><td><p>720</p></td></tr><tr><td><p>2014</p></td><td><p>1,018</p></td><td><p>2,570</p></td></tr><tr><td><p>2015</p></td><td><p>4,340</p></td><td><p>2,937</p></td></tr><tr><td><p>2016</p></td><td><p>7,914</p></td><td><p>4,190</p></td></tr><tr><td><p>2017 - until June</p></td><td><p>1,939 until June</p></td><td><p>2,234 until June</p></td></tr></tbody></table><p> </p><p> </p><p>The number of prescription and dental penalty charge notices issued since the rollout of UC in Dudley by calendar year is provided in the following table:</p><p> </p><table><tbody><tr><td><p>After the rollout of UC in Dudley by calendar year</p></td><td><p>Prescription penalty charge notice issued</p></td><td><p>Dental penalty charge notice issued</p></td></tr><tr><td><p>2017 – from July</p></td><td><p>6,653 * from July</p></td><td><p>2,517 * from July</p></td></tr><tr><td><p>2018</p></td><td><p>4,467</p></td><td><p>4,667</p></td></tr></tbody></table><p> </p><p>Notes:</p><p> </p><p>- The following postcodes were used to collate data for the Dudley area: B62, B63, B64, B65, DY1, DY2, DY3, DY4, DY5, DY6, DY7, DY8, DY9, WV1, WV4</p><p> </p><p>- UC commenced roll out in the Dudley area from July 2017 so this date has been used in the data collation. The data represents Penalty Charge Notices sent out against all exemption types ticked by the patient where an exemption could not be verified.</p> answering member constituency Winchester answering member printed Steve Brine grouped question UIN 234107 question first answered 22/03/2019 14:14:36 answering member 4067 label Biography information for Steve Brine
	tabling member	1511 label Biography information for Lord Austin of Dudley

1091311

	registered interest
	date	19/03/2019
	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	Prescriptions: Universal Credit
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, how many penalty notices were issued by the NHSBSA in Dudley prior to the rollout of universal credit in each year for which information is available.
	tabling member constituency	Dudley North
	tabling member printed	Ian Austin
	uin	234107
	answer	answer is ministerial correction date of answer 22/03/2019 answer text <p>The number of prescription and dental penalty charge notices issued prior to universal credit (UC) rollout in Dudley by calendar year is provided in the following table:</p><p> </p><table><tbody><tr><td><p>Prior to the rollout of UC in Dudley by calendar year</p></td><td><p>Prescription penalty charge notice issued</p></td><td><p>Dental penalty charge notice issued</p></td></tr><tr><td><p>2012</p></td><td><p>Not held</p></td><td><p>51</p></td></tr><tr><td><p>2013</p></td><td><p>Not held</p></td><td><p>720</p></td></tr><tr><td><p>2014</p></td><td><p>1,018</p></td><td><p>2,570</p></td></tr><tr><td><p>2015</p></td><td><p>4,340</p></td><td><p>2,937</p></td></tr><tr><td><p>2016</p></td><td><p>7,914</p></td><td><p>4,190</p></td></tr><tr><td><p>2017 - until June</p></td><td><p>1,939 until June</p></td><td><p>2,234 until June</p></td></tr></tbody></table><p> </p><p> </p><p>The number of prescription and dental penalty charge notices issued since the rollout of UC in Dudley by calendar year is provided in the following table:</p><p> </p><table><tbody><tr><td><p>After the rollout of UC in Dudley by calendar year</p></td><td><p>Prescription penalty charge notice issued</p></td><td><p>Dental penalty charge notice issued</p></td></tr><tr><td><p>2017 – from July</p></td><td><p>6,653 * from July</p></td><td><p>2,517 * from July</p></td></tr><tr><td><p>2018</p></td><td><p>4,467</p></td><td><p>4,667</p></td></tr></tbody></table><p> </p><p>Notes:</p><p> </p><p>- The following postcodes were used to collate data for the Dudley area: B62, B63, B64, B65, DY1, DY2, DY3, DY4, DY5, DY6, DY7, DY8, DY9, WV1, WV4</p><p> </p><p>- UC commenced roll out in the Dudley area from July 2017 so this date has been used in the data collation. The data represents Penalty Charge Notices sent out against all exemption types ticked by the patient where an exemption could not be verified.</p> answering member constituency Winchester answering member printed Steve Brine grouped question UIN 234108 question first answered 22/03/2019 14:14:36 answering member 4067 label Biography information for Steve Brine
	tabling member	1511 label Biography information for Lord Austin of Dudley

1091070

	registered interest
	date	18/03/2019
	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	Babylon Health
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, whether he holds information on the amount of revenue allocated from the NHS GP funding formula which Babylon Healthcare has spent on primary healthcare in each of the last five years; and if he will make a statement.
	tabling member constituency	Bristol North West
	tabling member printed	Darren Jones
	uin	233643
	answer	answer is ministerial correction date of answer 21/03/2019 answer text <p>This information is not held centrally.</p> answering member constituency Winchester answering member printed Steve Brine question first answered 21/03/2019 16:11:46 answering member 4067 label Biography information for Steve Brine
	tabling member	4621 label Biography information for Darren Jones

1091049

	registered interest
	date	18/03/2019
	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	Dialysis Machines
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, what assessment he has made of reductions in (a) travel times for patients, (b) recovery times, (c) reliance on additional medicines and (d) risk of death amongst patients with access to home dialysis provision.
	tabling member constituency	Newcastle-under-Lyme
	tabling member printed	Paul Farrelly
	uin	233481
	answer	answer is ministerial correction date of answer 21/03/2019 answer text <p>NHS England commissions dialysis services at a national level as a specialised service, setting out what providers should have in place to deliver dialysis care, including at home, as part of its remit to deliver specialised services. National Commissioning supports equity of access to high quality dialysis care. The service delivery contract sets out that the principle should be that home haemodialysis should always be an option for patients and that solutions should be sought to overcoming barriers that might prevent this. Decisions should be made on an individual basis but in general, patients suitable for home haemodialysis will be those who:</p><p>- have the ability and motivation to learn to carry out the process and the commitment to maintain treatment;</p><p>- are stable on dialysis;</p><p>- are free of complications and significant concomitant disease that would render home haemodialysis unsuitable or unsafe;</p><p>- have good functioning vascular access;</p><p>- have a carer who has (or carers who have) also made an informed decision to assist with the haemodialysis unless the individual is able to manage on his or her own; and</p><p>- have suitable space and facilities or an area that could be adapted within their home environment.</p><p><strong> </strong></p><p>NHS England’s renal services specifications can be found at the following link:</p><p> </p><p><a href="http://www.england.nhs.uk/commissioning/spec-services/npc-crg/group-a/a06/" target="_blank">www.england.nhs.uk/commissioning/spec-services/npc-crg/group-a/a06/</a></p><p> </p><p>NHS England Specialised Services use the Renal Registry Annual Report and data to support work with local dialysis services so they are aware where variation exists so this can be considered and addressed.</p><p> </p><p>The Atlas of variation, published by Public Health England in 2015, showed that for clinical commissioning groups (CCGs) in England, the percentage of dialysis patients who were receiving dialysis in the home (home haemodialysis and peritoneal dialysis combined) ranged from 4.1% to 44.0% (10.6-fold variation). When the seven CCGs with the highest percentages and the seven CCGs with the lowest percentages are excluded, the range is 7.6–33.7%, and the variation is 4.4-fold. Variation by parliamentary constituency is not available.</p><p> </p><p>Reasons for the degree of variation observed include differences in:</p><p> </p><p>- access to, and timely assessment by, a specialist kidney unit – working with patients to help them decide between treatments takes time, but in some areas 30% of patients are not known to their kidney team for even 90 days before they start renal replacement therapy;</p><p>- access to a multi-professional team, including staff who regularly support patients undertaking home dialysis; and</p><p>- levels of support for people undertaking home dialysis to help them maintain their independence, including access to respite in-centre dialysis.</p><p> </p><p>The Atlas can be found at the following link:</p><p> </p><p><a href="https://fingertips.phe.org.uk/profile/atlas-of-variation" target="_blank">https://fingertips.phe.org.uk/profile/atlas-of-variation</a></p><p><strong> </strong></p><p>According to the latest data from the UK Renal Registry (UKRR), there were 1,195 patients receiving home dialysis in the United Kingdom in 2014, 1,175 patients in 2015; and 1,256 patients in 2016. The UKRR collects, analyses and reports on data from 71 adult and 13 paediatric renal centres. Participation is mandated in England, via the national services specification published by NHS England.</p><p> </p><p>The latest report from the UK Renal Registry can be found at the following link:</p><p> </p><p><a href="http://www.renalreg.org/publications-reports/" target="_blank">www.renalreg.org/publications-reports/</a></p><p><strong> </strong></p><p>No specific assessment of the cost to the National Health Service of the provision of dialysis services in a patient’s home compared to a clinical setting has been undertaken. In its assessment of the evidence regarding cost, the National Institute for Health and Care Excellence (NICE) set out in its guideline, ‘Renal Replacement Therapy and Conservative Management’, published in October 2018, that there is uncertainty in current UK dialysis costs, but they may be lower at home. The committee acknowledged that these treatments can have very different effects on lifestyle and recommended patient choice. The NICE guideline can be found at the following link:</p><p><strong> </strong></p><p><a href="http://www.nice.org.uk/guidance/ng107/resources/renal-replacement-therapy-and-conservative-management-pdf-66141542991301" target="_blank">www.nice.org.uk/guidance/ng107/resources/renal-replacement-therapy-and-conservative-management-pdf-66141542991301</a></p><p><strong> </strong></p><p>Regarding the benefits of home dialysis, there is good evidence that home dialysis therapies offer advantages for suitable patients. The limitations of thrice weekly standard in-centre haemodialysis have been recognised in recent years. However, it is very difficult to separate the effect of different case mix, the most up to date and comprehensive data does not show a survival difference between patients who received more frequent versus thrice weekly (standard regimen) haemodialysis.</p><p> </p><p>The advantage of self-care haemodialysis includes not only those related to control and convenience but also the opportunity to conduct more frequent or longer sessions to optimise health prospects. The introduction of smaller more portable haemodialysis machines also provides opportunity for travel for employment or holidays. Furthermore, these therapies are cost effective in the UK when compared with hospital treatments and have been demonstrated to be safe. Information regarding a reduction in travel times and reliance on other medicines is not available.</p><p> </p> answering member constituency Winchester answering member printed Steve Brine grouped question UIN 233465 233478 233479 233480 question first answered 21/03/2019 16:14:41 answering member 4067 label Biography information for Steve Brine
	tabling member	1436 label Biography information for Paul Farrelly

1091048

	registered interest
	date	18/03/2019
	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	Dialysis Machines
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, what assessment he has made of the cost benefit to the NHS of the provision of dialysis services in a patient’s home compared to a clinical setting.
	tabling member constituency	Newcastle-under-Lyme
	tabling member printed	Paul Farrelly
	uin	233480
	answer	answer is ministerial correction date of answer 21/03/2019 answer text <p>NHS England commissions dialysis services at a national level as a specialised service, setting out what providers should have in place to deliver dialysis care, including at home, as part of its remit to deliver specialised services. National Commissioning supports equity of access to high quality dialysis care. The service delivery contract sets out that the principle should be that home haemodialysis should always be an option for patients and that solutions should be sought to overcoming barriers that might prevent this. Decisions should be made on an individual basis but in general, patients suitable for home haemodialysis will be those who:</p><p>- have the ability and motivation to learn to carry out the process and the commitment to maintain treatment;</p><p>- are stable on dialysis;</p><p>- are free of complications and significant concomitant disease that would render home haemodialysis unsuitable or unsafe;</p><p>- have good functioning vascular access;</p><p>- have a carer who has (or carers who have) also made an informed decision to assist with the haemodialysis unless the individual is able to manage on his or her own; and</p><p>- have suitable space and facilities or an area that could be adapted within their home environment.</p><p><strong> </strong></p><p>NHS England’s renal services specifications can be found at the following link:</p><p> </p><p><a href="http://www.england.nhs.uk/commissioning/spec-services/npc-crg/group-a/a06/" target="_blank">www.england.nhs.uk/commissioning/spec-services/npc-crg/group-a/a06/</a></p><p> </p><p>NHS England Specialised Services use the Renal Registry Annual Report and data to support work with local dialysis services so they are aware where variation exists so this can be considered and addressed.</p><p> </p><p>The Atlas of variation, published by Public Health England in 2015, showed that for clinical commissioning groups (CCGs) in England, the percentage of dialysis patients who were receiving dialysis in the home (home haemodialysis and peritoneal dialysis combined) ranged from 4.1% to 44.0% (10.6-fold variation). When the seven CCGs with the highest percentages and the seven CCGs with the lowest percentages are excluded, the range is 7.6–33.7%, and the variation is 4.4-fold. Variation by parliamentary constituency is not available.</p><p> </p><p>Reasons for the degree of variation observed include differences in:</p><p> </p><p>- access to, and timely assessment by, a specialist kidney unit – working with patients to help them decide between treatments takes time, but in some areas 30% of patients are not known to their kidney team for even 90 days before they start renal replacement therapy;</p><p>- access to a multi-professional team, including staff who regularly support patients undertaking home dialysis; and</p><p>- levels of support for people undertaking home dialysis to help them maintain their independence, including access to respite in-centre dialysis.</p><p> </p><p>The Atlas can be found at the following link:</p><p> </p><p><a href="https://fingertips.phe.org.uk/profile/atlas-of-variation" target="_blank">https://fingertips.phe.org.uk/profile/atlas-of-variation</a></p><p><strong> </strong></p><p>According to the latest data from the UK Renal Registry (UKRR), there were 1,195 patients receiving home dialysis in the United Kingdom in 2014, 1,175 patients in 2015; and 1,256 patients in 2016. The UKRR collects, analyses and reports on data from 71 adult and 13 paediatric renal centres. Participation is mandated in England, via the national services specification published by NHS England.</p><p> </p><p>The latest report from the UK Renal Registry can be found at the following link:</p><p> </p><p><a href="http://www.renalreg.org/publications-reports/" target="_blank">www.renalreg.org/publications-reports/</a></p><p><strong> </strong></p><p>No specific assessment of the cost to the National Health Service of the provision of dialysis services in a patient’s home compared to a clinical setting has been undertaken. In its assessment of the evidence regarding cost, the National Institute for Health and Care Excellence (NICE) set out in its guideline, ‘Renal Replacement Therapy and Conservative Management’, published in October 2018, that there is uncertainty in current UK dialysis costs, but they may be lower at home. The committee acknowledged that these treatments can have very different effects on lifestyle and recommended patient choice. The NICE guideline can be found at the following link:</p><p><strong> </strong></p><p><a href="http://www.nice.org.uk/guidance/ng107/resources/renal-replacement-therapy-and-conservative-management-pdf-66141542991301" target="_blank">www.nice.org.uk/guidance/ng107/resources/renal-replacement-therapy-and-conservative-management-pdf-66141542991301</a></p><p><strong> </strong></p><p>Regarding the benefits of home dialysis, there is good evidence that home dialysis therapies offer advantages for suitable patients. The limitations of thrice weekly standard in-centre haemodialysis have been recognised in recent years. However, it is very difficult to separate the effect of different case mix, the most up to date and comprehensive data does not show a survival difference between patients who received more frequent versus thrice weekly (standard regimen) haemodialysis.</p><p> </p><p>The advantage of self-care haemodialysis includes not only those related to control and convenience but also the opportunity to conduct more frequent or longer sessions to optimise health prospects. The introduction of smaller more portable haemodialysis machines also provides opportunity for travel for employment or holidays. Furthermore, these therapies are cost effective in the UK when compared with hospital treatments and have been demonstrated to be safe. Information regarding a reduction in travel times and reliance on other medicines is not available.</p><p> </p> answering member constituency Winchester answering member printed Steve Brine grouped question UIN 233465 233478 233479 233481 question first answered 21/03/2019 16:14:41 answering member 4067 label Biography information for Steve Brine
	tabling member	1436 label Biography information for Paul Farrelly

1091047

	registered interest
	date	18/03/2019
	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	Dialysis Machines
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, what estimate he has made of the number of patients receiving home-based dialysis in place of hospital-based dialysis in each of the past three years.
	tabling member constituency	Newcastle-under-Lyme
	tabling member printed	Paul Farrelly
	uin	233479
	answer	answer is ministerial correction date of answer 21/03/2019 answer text <p>NHS England commissions dialysis services at a national level as a specialised service, setting out what providers should have in place to deliver dialysis care, including at home, as part of its remit to deliver specialised services. National Commissioning supports equity of access to high quality dialysis care. The service delivery contract sets out that the principle should be that home haemodialysis should always be an option for patients and that solutions should be sought to overcoming barriers that might prevent this. Decisions should be made on an individual basis but in general, patients suitable for home haemodialysis will be those who:</p><p>- have the ability and motivation to learn to carry out the process and the commitment to maintain treatment;</p><p>- are stable on dialysis;</p><p>- are free of complications and significant concomitant disease that would render home haemodialysis unsuitable or unsafe;</p><p>- have good functioning vascular access;</p><p>- have a carer who has (or carers who have) also made an informed decision to assist with the haemodialysis unless the individual is able to manage on his or her own; and</p><p>- have suitable space and facilities or an area that could be adapted within their home environment.</p><p><strong> </strong></p><p>NHS England’s renal services specifications can be found at the following link:</p><p> </p><p><a href="http://www.england.nhs.uk/commissioning/spec-services/npc-crg/group-a/a06/" target="_blank">www.england.nhs.uk/commissioning/spec-services/npc-crg/group-a/a06/</a></p><p> </p><p>NHS England Specialised Services use the Renal Registry Annual Report and data to support work with local dialysis services so they are aware where variation exists so this can be considered and addressed.</p><p> </p><p>The Atlas of variation, published by Public Health England in 2015, showed that for clinical commissioning groups (CCGs) in England, the percentage of dialysis patients who were receiving dialysis in the home (home haemodialysis and peritoneal dialysis combined) ranged from 4.1% to 44.0% (10.6-fold variation). When the seven CCGs with the highest percentages and the seven CCGs with the lowest percentages are excluded, the range is 7.6–33.7%, and the variation is 4.4-fold. Variation by parliamentary constituency is not available.</p><p> </p><p>Reasons for the degree of variation observed include differences in:</p><p> </p><p>- access to, and timely assessment by, a specialist kidney unit – working with patients to help them decide between treatments takes time, but in some areas 30% of patients are not known to their kidney team for even 90 days before they start renal replacement therapy;</p><p>- access to a multi-professional team, including staff who regularly support patients undertaking home dialysis; and</p><p>- levels of support for people undertaking home dialysis to help them maintain their independence, including access to respite in-centre dialysis.</p><p> </p><p>The Atlas can be found at the following link:</p><p> </p><p><a href="https://fingertips.phe.org.uk/profile/atlas-of-variation" target="_blank">https://fingertips.phe.org.uk/profile/atlas-of-variation</a></p><p><strong> </strong></p><p>According to the latest data from the UK Renal Registry (UKRR), there were 1,195 patients receiving home dialysis in the United Kingdom in 2014, 1,175 patients in 2015; and 1,256 patients in 2016. The UKRR collects, analyses and reports on data from 71 adult and 13 paediatric renal centres. Participation is mandated in England, via the national services specification published by NHS England.</p><p> </p><p>The latest report from the UK Renal Registry can be found at the following link:</p><p> </p><p><a href="http://www.renalreg.org/publications-reports/" target="_blank">www.renalreg.org/publications-reports/</a></p><p><strong> </strong></p><p>No specific assessment of the cost to the National Health Service of the provision of dialysis services in a patient’s home compared to a clinical setting has been undertaken. In its assessment of the evidence regarding cost, the National Institute for Health and Care Excellence (NICE) set out in its guideline, ‘Renal Replacement Therapy and Conservative Management’, published in October 2018, that there is uncertainty in current UK dialysis costs, but they may be lower at home. The committee acknowledged that these treatments can have very different effects on lifestyle and recommended patient choice. The NICE guideline can be found at the following link:</p><p><strong> </strong></p><p><a href="http://www.nice.org.uk/guidance/ng107/resources/renal-replacement-therapy-and-conservative-management-pdf-66141542991301" target="_blank">www.nice.org.uk/guidance/ng107/resources/renal-replacement-therapy-and-conservative-management-pdf-66141542991301</a></p><p><strong> </strong></p><p>Regarding the benefits of home dialysis, there is good evidence that home dialysis therapies offer advantages for suitable patients. The limitations of thrice weekly standard in-centre haemodialysis have been recognised in recent years. However, it is very difficult to separate the effect of different case mix, the most up to date and comprehensive data does not show a survival difference between patients who received more frequent versus thrice weekly (standard regimen) haemodialysis.</p><p> </p><p>The advantage of self-care haemodialysis includes not only those related to control and convenience but also the opportunity to conduct more frequent or longer sessions to optimise health prospects. The introduction of smaller more portable haemodialysis machines also provides opportunity for travel for employment or holidays. Furthermore, these therapies are cost effective in the UK when compared with hospital treatments and have been demonstrated to be safe. Information regarding a reduction in travel times and reliance on other medicines is not available.</p><p> </p> answering member constituency Winchester answering member printed Steve Brine grouped question UIN 233465 233478 233480 233481 question first answered 21/03/2019 16:14:41 answering member 4067 label Biography information for Steve Brine
	tabling member	1436 label Biography information for Paul Farrelly

1091042

	registered interest
	date	18/03/2019
	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	Dialysis Machines
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, what assessment he has made of the availability of home-based dialysis services across each (a) Clinical Commissioning Group area and (b) Parliamentary constituency.
	tabling member constituency	Newcastle-under-Lyme
	tabling member printed	Paul Farrelly
	uin	233478
	answer	answer is ministerial correction date of answer 21/03/2019 answer text <p>NHS England commissions dialysis services at a national level as a specialised service, setting out what providers should have in place to deliver dialysis care, including at home, as part of its remit to deliver specialised services. National Commissioning supports equity of access to high quality dialysis care. The service delivery contract sets out that the principle should be that home haemodialysis should always be an option for patients and that solutions should be sought to overcoming barriers that might prevent this. Decisions should be made on an individual basis but in general, patients suitable for home haemodialysis will be those who:</p><p>- have the ability and motivation to learn to carry out the process and the commitment to maintain treatment;</p><p>- are stable on dialysis;</p><p>- are free of complications and significant concomitant disease that would render home haemodialysis unsuitable or unsafe;</p><p>- have good functioning vascular access;</p><p>- have a carer who has (or carers who have) also made an informed decision to assist with the haemodialysis unless the individual is able to manage on his or her own; and</p><p>- have suitable space and facilities or an area that could be adapted within their home environment.</p><p><strong> </strong></p><p>NHS England’s renal services specifications can be found at the following link:</p><p> </p><p><a href="http://www.england.nhs.uk/commissioning/spec-services/npc-crg/group-a/a06/" target="_blank">www.england.nhs.uk/commissioning/spec-services/npc-crg/group-a/a06/</a></p><p> </p><p>NHS England Specialised Services use the Renal Registry Annual Report and data to support work with local dialysis services so they are aware where variation exists so this can be considered and addressed.</p><p> </p><p>The Atlas of variation, published by Public Health England in 2015, showed that for clinical commissioning groups (CCGs) in England, the percentage of dialysis patients who were receiving dialysis in the home (home haemodialysis and peritoneal dialysis combined) ranged from 4.1% to 44.0% (10.6-fold variation). When the seven CCGs with the highest percentages and the seven CCGs with the lowest percentages are excluded, the range is 7.6–33.7%, and the variation is 4.4-fold. Variation by parliamentary constituency is not available.</p><p> </p><p>Reasons for the degree of variation observed include differences in:</p><p> </p><p>- access to, and timely assessment by, a specialist kidney unit – working with patients to help them decide between treatments takes time, but in some areas 30% of patients are not known to their kidney team for even 90 days before they start renal replacement therapy;</p><p>- access to a multi-professional team, including staff who regularly support patients undertaking home dialysis; and</p><p>- levels of support for people undertaking home dialysis to help them maintain their independence, including access to respite in-centre dialysis.</p><p> </p><p>The Atlas can be found at the following link:</p><p> </p><p><a href="https://fingertips.phe.org.uk/profile/atlas-of-variation" target="_blank">https://fingertips.phe.org.uk/profile/atlas-of-variation</a></p><p><strong> </strong></p><p>According to the latest data from the UK Renal Registry (UKRR), there were 1,195 patients receiving home dialysis in the United Kingdom in 2014, 1,175 patients in 2015; and 1,256 patients in 2016. The UKRR collects, analyses and reports on data from 71 adult and 13 paediatric renal centres. Participation is mandated in England, via the national services specification published by NHS England.</p><p> </p><p>The latest report from the UK Renal Registry can be found at the following link:</p><p> </p><p><a href="http://www.renalreg.org/publications-reports/" target="_blank">www.renalreg.org/publications-reports/</a></p><p><strong> </strong></p><p>No specific assessment of the cost to the National Health Service of the provision of dialysis services in a patient’s home compared to a clinical setting has been undertaken. In its assessment of the evidence regarding cost, the National Institute for Health and Care Excellence (NICE) set out in its guideline, ‘Renal Replacement Therapy and Conservative Management’, published in October 2018, that there is uncertainty in current UK dialysis costs, but they may be lower at home. The committee acknowledged that these treatments can have very different effects on lifestyle and recommended patient choice. The NICE guideline can be found at the following link:</p><p><strong> </strong></p><p><a href="http://www.nice.org.uk/guidance/ng107/resources/renal-replacement-therapy-and-conservative-management-pdf-66141542991301" target="_blank">www.nice.org.uk/guidance/ng107/resources/renal-replacement-therapy-and-conservative-management-pdf-66141542991301</a></p><p><strong> </strong></p><p>Regarding the benefits of home dialysis, there is good evidence that home dialysis therapies offer advantages for suitable patients. The limitations of thrice weekly standard in-centre haemodialysis have been recognised in recent years. However, it is very difficult to separate the effect of different case mix, the most up to date and comprehensive data does not show a survival difference between patients who received more frequent versus thrice weekly (standard regimen) haemodialysis.</p><p> </p><p>The advantage of self-care haemodialysis includes not only those related to control and convenience but also the opportunity to conduct more frequent or longer sessions to optimise health prospects. The introduction of smaller more portable haemodialysis machines also provides opportunity for travel for employment or holidays. Furthermore, these therapies are cost effective in the UK when compared with hospital treatments and have been demonstrated to be safe. Information regarding a reduction in travel times and reliance on other medicines is not available.</p><p> </p> answering member constituency Winchester answering member printed Steve Brine grouped question UIN 233465 233479 233480 233481 question first answered 21/03/2019 16:14:41 answering member 4067 label Biography information for Steve Brine
	tabling member	1436 label Biography information for Paul Farrelly

1091018

	registered interest
	date	18/03/2019
	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	Kidney Diseases
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, which stakeholder groups representing patients in need of kidney care his Department has engaged with in relation to the prevention Green Paper.
	tabling member constituency	Newcastle-under-Lyme
	tabling member printed	Paul Farrelly
	uin	233466
	answer	answer is ministerial correction date of answer 21/03/2019 answer text <p>The Department has not, in the context of work on the prevention Green paper, engaged specifically with groups representing patients of kidney care. However, conversations on this may have taken place elsewhere in the Department, outside the Green Paper. The Green Paper will consider options for preventing a wide range of physical and mental health problems and seek views on what actions are most needed.</p> answering member constituency Winchester answering member printed Steve Brine question first answered 21/03/2019 16:06:44 answering member 4067 label Biography information for Steve Brine
	tabling member	1436 label Biography information for Paul Farrelly

1091017

	registered interest
	date	18/03/2019
	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	Dialysis Machines
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, what assessment he has made of the equity of access to home-based dialysis services in England; and if he will make a statement.
	tabling member constituency	Newcastle-under-Lyme
	tabling member printed	Paul Farrelly
	uin	233465
	answer	answer is ministerial correction date of answer 21/03/2019 answer text <p>NHS England commissions dialysis services at a national level as a specialised service, setting out what providers should have in place to deliver dialysis care, including at home, as part of its remit to deliver specialised services. National Commissioning supports equity of access to high quality dialysis care. The service delivery contract sets out that the principle should be that home haemodialysis should always be an option for patients and that solutions should be sought to overcoming barriers that might prevent this. Decisions should be made on an individual basis but in general, patients suitable for home haemodialysis will be those who:</p><p>- have the ability and motivation to learn to carry out the process and the commitment to maintain treatment;</p><p>- are stable on dialysis;</p><p>- are free of complications and significant concomitant disease that would render home haemodialysis unsuitable or unsafe;</p><p>- have good functioning vascular access;</p><p>- have a carer who has (or carers who have) also made an informed decision to assist with the haemodialysis unless the individual is able to manage on his or her own; and</p><p>- have suitable space and facilities or an area that could be adapted within their home environment.</p><p><strong> </strong></p><p>NHS England’s renal services specifications can be found at the following link:</p><p> </p><p><a href="http://www.england.nhs.uk/commissioning/spec-services/npc-crg/group-a/a06/" target="_blank">www.england.nhs.uk/commissioning/spec-services/npc-crg/group-a/a06/</a></p><p> </p><p>NHS England Specialised Services use the Renal Registry Annual Report and data to support work with local dialysis services so they are aware where variation exists so this can be considered and addressed.</p><p> </p><p>The Atlas of variation, published by Public Health England in 2015, showed that for clinical commissioning groups (CCGs) in England, the percentage of dialysis patients who were receiving dialysis in the home (home haemodialysis and peritoneal dialysis combined) ranged from 4.1% to 44.0% (10.6-fold variation). When the seven CCGs with the highest percentages and the seven CCGs with the lowest percentages are excluded, the range is 7.6–33.7%, and the variation is 4.4-fold. Variation by parliamentary constituency is not available.</p><p> </p><p>Reasons for the degree of variation observed include differences in:</p><p> </p><p>- access to, and timely assessment by, a specialist kidney unit – working with patients to help them decide between treatments takes time, but in some areas 30% of patients are not known to their kidney team for even 90 days before they start renal replacement therapy;</p><p>- access to a multi-professional team, including staff who regularly support patients undertaking home dialysis; and</p><p>- levels of support for people undertaking home dialysis to help them maintain their independence, including access to respite in-centre dialysis.</p><p> </p><p>The Atlas can be found at the following link:</p><p> </p><p><a href="https://fingertips.phe.org.uk/profile/atlas-of-variation" target="_blank">https://fingertips.phe.org.uk/profile/atlas-of-variation</a></p><p><strong> </strong></p><p>According to the latest data from the UK Renal Registry (UKRR), there were 1,195 patients receiving home dialysis in the United Kingdom in 2014, 1,175 patients in 2015; and 1,256 patients in 2016. The UKRR collects, analyses and reports on data from 71 adult and 13 paediatric renal centres. Participation is mandated in England, via the national services specification published by NHS England.</p><p> </p><p>The latest report from the UK Renal Registry can be found at the following link:</p><p> </p><p><a href="http://www.renalreg.org/publications-reports/" target="_blank">www.renalreg.org/publications-reports/</a></p><p><strong> </strong></p><p>No specific assessment of the cost to the National Health Service of the provision of dialysis services in a patient’s home compared to a clinical setting has been undertaken. In its assessment of the evidence regarding cost, the National Institute for Health and Care Excellence (NICE) set out in its guideline, ‘Renal Replacement Therapy and Conservative Management’, published in October 2018, that there is uncertainty in current UK dialysis costs, but they may be lower at home. The committee acknowledged that these treatments can have very different effects on lifestyle and recommended patient choice. The NICE guideline can be found at the following link:</p><p><strong> </strong></p><p><a href="http://www.nice.org.uk/guidance/ng107/resources/renal-replacement-therapy-and-conservative-management-pdf-66141542991301" target="_blank">www.nice.org.uk/guidance/ng107/resources/renal-replacement-therapy-and-conservative-management-pdf-66141542991301</a></p><p><strong> </strong></p><p>Regarding the benefits of home dialysis, there is good evidence that home dialysis therapies offer advantages for suitable patients. The limitations of thrice weekly standard in-centre haemodialysis have been recognised in recent years. However, it is very difficult to separate the effect of different case mix, the most up to date and comprehensive data does not show a survival difference between patients who received more frequent versus thrice weekly (standard regimen) haemodialysis.</p><p> </p><p>The advantage of self-care haemodialysis includes not only those related to control and convenience but also the opportunity to conduct more frequent or longer sessions to optimise health prospects. The introduction of smaller more portable haemodialysis machines also provides opportunity for travel for employment or holidays. Furthermore, these therapies are cost effective in the UK when compared with hospital treatments and have been demonstrated to be safe. Information regarding a reduction in travel times and reliance on other medicines is not available.</p><p> </p> answering member constituency Winchester answering member printed Steve Brine grouped question UIN 233478 233479 233480 233481 question first answered 21/03/2019 16:14:41 answering member 4067 label Biography information for Steve Brine
	tabling member	1436 label Biography information for Paul Farrelly

1090952

	registered interest
	date	18/03/2019
	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	Cervical Cancer: Screening
	house id	1
	legislature	25259 pref label House of Commons
	question text	To ask the Secretary of State for Health and Social Care, what recent steps his Department has taken to reduce waiting times for smear test results.
	tabling member constituency	Coventry South
	tabling member printed	Mr Jim Cunningham
	uin	233451
	answer	answer is ministerial correction date of answer 21/03/2019 answer text <p>NHS England is taking steps to make sure the delivery, performance and oversight of screening services meet the high standard National Health Service patients rightly expect. This includes moving samples around the country to reduce the burden on those laboratories most under pressure.</p><p> </p><p>Unpublished management data has also shown a significant improvement in turnaround times in the last quarter of 2018/19, therefore it is expected that as the proportion of women benefitting from HPV primary screening continues to increase, waiting times for smear test results will reduce.</p><p> </p><p>Nevertheless, the 14-day turnaround time for test results to be provided remains a vital target for the NHS Cervical Screening Programme.</p> answering member constituency Winchester answering member printed Steve Brine question first answered 21/03/2019 16:25:47 answering member 4067 label Biography information for Steve Brine
	tabling member	308 label Biography information for Mr Jim Cunningham