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931632

	registered interest
	date	26/06/2018
	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	Liothyronine
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty's Government what action they propose to ensure that the Brighton and Sussex University Hospitals NHS Trust withdraws its policy of no longer making Liothyronine (T3) available to NHS patients, contrary to advice issued by NHS England which sets out the circumstances under which Liothyronine (T3) can be prescribed to new patients and continued for existing patients.
	tabling member printed	Lord Hunt of Kings Heath
	uin	HL8980
	answer	answer is ministerial correction date of answer 10/07/2018 answer text <p>The national guidelines advise clinical commissioning groups (CCGs) that local decisions should be made regarding arrangements for the on-going prescribing of liothyronine, taking into account the local needs of the population. While CCGs are expected to have regard to national guidance, they are entitled to develop their own local approaches to its implementation. During a debate on 20 June on the Branded Health Service Medicines (Costs) Regulations, I committed to pursuing further with NHS England ways in which they can clarify the guidelines on the prescribing of liothyronine to CCGs, including looking at whether greater clarity on the criteria for appropriate patient usage is merited.</p><p>The prescribing of Liothyronine (T3) was considered by the Sussex and East Surrey Sustainability and Transformation Partnership (STP) clinical board, which covers Brighton and Sussex University Hospitals, and High Weald, Lewes and Havens CCG, following engagement with primary care clinicians and endocrinologists. Based on the evidence presented, the decision not to routinely prescribe Liothyronine (T3) was supported across the STP region. It was, however, recognised that there would be some exceptions to this and that the use of the individual funding request triage process would be an appropriate mechanism to consider these.</p><p><strong> </strong></p> answering member printed Lord O'Shaughnessy grouped question UIN HL8981 HL8982 HL8983 question first answered 10/07/2018 15:41:18 answering member 4545 label Biography information for Lord O'Shaughnessy
	tabling member	2024 label Biography information for Lord Hunt of Kings Heath

931634

	registered interest
	date	26/06/2018
	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	Liothyronine
	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 Brighton and Sussex University Hospitals NHS Trust mistakenly stating that the only option for patients wishing to continue Liothyronine (T3) therapy is through the private sector, contrary to advice issued by NHS England which sets out the circumstances under which Liothyronine (T3) can be prescribed to new patients and continued for existing patients.
	tabling member printed	Lord Hunt of Kings Heath
	uin	HL8982
	answer	answer is ministerial correction date of answer 10/07/2018 answer text <p>The national guidelines advise clinical commissioning groups (CCGs) that local decisions should be made regarding arrangements for the on-going prescribing of liothyronine, taking into account the local needs of the population. While CCGs are expected to have regard to national guidance, they are entitled to develop their own local approaches to its implementation. During a debate on 20 June on the Branded Health Service Medicines (Costs) Regulations, I committed to pursuing further with NHS England ways in which they can clarify the guidelines on the prescribing of liothyronine to CCGs, including looking at whether greater clarity on the criteria for appropriate patient usage is merited.</p><p>The prescribing of Liothyronine (T3) was considered by the Sussex and East Surrey Sustainability and Transformation Partnership (STP) clinical board, which covers Brighton and Sussex University Hospitals, and High Weald, Lewes and Havens CCG, following engagement with primary care clinicians and endocrinologists. Based on the evidence presented, the decision not to routinely prescribe Liothyronine (T3) was supported across the STP region. It was, however, recognised that there would be some exceptions to this and that the use of the individual funding request triage process would be an appropriate mechanism to consider these.</p><p><strong> </strong></p> answering member printed Lord O'Shaughnessy grouped question UIN HL8980 HL8981 HL8983 question first answered 10/07/2018 15:41:18 answering member 4545 label Biography information for Lord O'Shaughnessy
	tabling member	2024 label Biography information for Lord Hunt of Kings Heath

834485

	registered interest
	date	31/01/2018
	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	Liothyronine
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty's Government whether they intend to commission research to evaluate the impact on patients of reduced access to liothyronine (T3) for the treatment of thyroid disease.
	tabling member printed	Lord Hunt of Kings Heath
	uin	HL5291
	answer	answer is ministerial correction date of answer 08/02/2018 answer text <p>We understand that whilst it is recognised that some patients on levothyroxine remain symptomatic despite treatment leading to thyroid stimulating hormone levels in the therapeutic range, it is not possible to predict the number as the reasons for this are not fully understood; such patients should be under the care of an endocrinologist. Where clinical commissioning groups decide to implement recommendations in NHS England’s guidance, they are responsible for deciding whether further action is required, such as commissioning research, to monitor uptake and outcomes.</p> answering member printed Lord O'Shaughnessy grouped question UIN HL5226 question first answered 08/02/2018 15:11:48 answering member 4545 label Biography information for Lord O'Shaughnessy
	tabling member	2024 label Biography information for Lord Hunt of Kings Heath

833608

	registered interest
	date	30/01/2018
	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	Liothyronine
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty's Government whether any Clinical Commissioning Groups refused to allow patients to be prescribed liothyronine (T3) before the consultation on Items which should not be routinely prescribed in primary care: Guidance for CCGs commenced; and if so, why.
	tabling member printed	Lord Hunt of Kings Heath
	uin	HL5228
	answer	answer is ministerial correction date of answer 08/02/2018 answer text <p>We understand that the British Thyroid Association (BTA) advises that a small proportion of patients treated with the most commonly used drug, levothyroxine, continue to suffer with symptoms despite adequate biochemical correction. In these circumstances, where levothyroxine has failed and in line with BTA guidance, endocrinologists providing NHS services may recommend liothyronine for individual patients after a carefully audited trial of at least three months’ duration of liothyronine.</p><p>NHS England’s recommendations to clinical commissioning groups (CCGs) take account of those of the BTA and are to:</p><p>- Advise CCGs that prescribers in primary care should not initiate liothyronine for any new patient;</p><p> </p><p>- Advise CCGs that individuals currently prescribed liothyronine should be reviewed by a consultant NHS endocrinologist with consideration given to switching to levothyroxine where clinically appropriate; and</p><p> </p><p>- Advise CCGs that a local decision, involving the Area Prescribing Committee (or equivalent) informed by national guidance (e.g. from the National Institute for Health and Care Excellence or the Regional Medicines Optimisation Committee), should be made regarding arrangements for on-going prescribing of liothyronine. This should be for individuals who, in exceptional circumstances, have an on-going need for liothyronine as confirmed by a consultant National Health Service endocrinologist.</p><p>A number of CCGs had already created local policies on the prescribing of liothryronine before the national consultation started in July 2017.</p> answering member printed Lord O'Shaughnessy grouped question UIN HL5225 question first answered 08/02/2018 15:03:07 answering member 4545 label Biography information for Lord O'Shaughnessy
	tabling member	2024 label Biography information for Lord Hunt of Kings Heath

832881

	registered interest
	date	29/01/2018
	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	Liothyronine
	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 degree to which the analysis contained in the NHS England document Items which should not be routinely prescribed in primary care: Guidance for CCGs justifies the advice given that prescribers in primary care should not prescribe liothyronine (T3) for any new patients.
	tabling member printed	Lord Hunt of Kings Heath
	uin	HL5203
	answer	answer is ministerial correction date of answer 07/02/2018 answer text <p>In November 2017 NHS England published commissioning guidance for clinical commissioning groups, entitled <em>Items which should not be routinely prescribed in primary care: A Consultation on guidance for CCGs, </em>following a three month consultation. A joint clinical working group comprised of clinical representatives reviewed the consultation findings and made evidence-based recommendations for consideration by the NHS England Board. Liothyronine attracted a significant number of responses and following detailed review, significant amendments to the original proposals were made before being published in the finalised guidance. NHS England’s recommendations are that National Health Service consultant endocrinologists may still initiate and recommend liothyronine for new patients, following audited individual trial periods of use, as recommended by the British Thyroid Association.</p><p> </p> answering member printed Lord O'Shaughnessy question first answered 07/02/2018 12:11:38 answering member 4545 label Biography information for Lord O'Shaughnessy
	tabling member	2024 label Biography information for Lord Hunt of Kings Heath

833606

	registered interest
	date	30/01/2018
	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	Liothyronine
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty's Government whether they have evidence showing that there are more cost-effective products available than liothyronine for the treatment of thyroid disease; and if so, whether they will publish that evidence.
	tabling member printed	Lord Hunt of Kings Heath
	uin	HL5227
	answer	answer is ministerial correction date of answer 09/02/2018 answer text <p>NHS England have sought advice from the leading clinical experts in this field. These are the Royal College of Physicians, the British Thyroid Association and the European Thyroid Association. These experts recommend that, for the vast majority of patients, levothyroxine alone is used in the treatment of hypothyroidism. They also advise that liothyronine should be considered in exceptional circumstances.</p> answering member printed Lord O'Shaughnessy question first answered 09/02/2018 12:00:40 answering member 4545 label Biography information for Lord O'Shaughnessy
	tabling member	2024 label Biography information for Lord Hunt of Kings Heath

833609

	registered interest
	date	30/01/2018
	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	Liothyronine
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty's Government what estimate they have made of (1) the additional workload, and (2) the added cost for secondary care providers resulting from the decisions that (a) individuals currently prescribed liothyronine should be reviewed by a consultant NHS endocrinologist with consideration given to switching to levothyroxine where clinically appropriate, and (b) individual patients with an ongoing need for liothyronine should have that confirmed by a consultant NHS endocrinologist.
	tabling member printed	Lord Hunt of Kings Heath
	uin	HL5229
	answer	answer is ministerial correction date of answer 08/02/2018 answer text <p>We have made no such estimate. However NHS England expects local clinical commissioning groups (CCGs) – who have responsibility for commissioning these services - to have regard to the guidance when determining their local prescribing decisions. As such, it will be for local CCGs, in conjunction with local providers to determine what is best for patients and as part of their decision making, the resources available to implement any change.</p><p>The Regional Medicines Optimisation Committee (South) has considered this issue in further detail and a statement will be issued by them in due course to support CCGs and secondary care providers in reviewing patients, in line with the recommendations made. Regional Medicines Optimisation Committees make recommendations, provide resources and co-ordinate activities to ensure the optimal use of medicines for the benefit of patients and the National Health Service.</p><p><strong> </strong></p> answering member printed Lord O'Shaughnessy question first answered 08/02/2018 15:12:56 answering member 4545 label Biography information for Lord O'Shaughnessy
	tabling member	2024 label Biography information for Lord Hunt of Kings Heath

928857

	registered interest
	date	21/06/2018
	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	Liothyronine
	house id	2
	legislature	25277 pref label House of Lords
	question text	To ask Her Majesty's Government whether they have held discussions with NHS England about why NHS bodies in Wessex are developing guidelines on the use of liothyronine which are at variance with national guidelines issued by NHS England.
	tabling member printed	Lord Hunt of Kings Heath
	uin	HL8858
	answer	answer is ministerial correction date of answer 04/07/2018 answer text <p>The Department has not had specific discussions with NHS England on this issue with Wessex. However, the national guidelines advise clinical commissioning groups (CCGs) that local decisions should be made regarding arrangements for the on-going prescribing of liothyronine, taking into account both the local needs of the population and the best practice set out in the guidance. While CCGs are expected to have regard to national guidance, they are entitled to develop their own local approaches to its implementation.</p><p>Advice developed by the Regional Medicines Optimisation Committee (South) will, however, be made available to CCGs to support a consistent national approach to the on-going prescribing of liothyronine.</p><p>As I mentioned in the debate on Branded Health Service Medicines (Costs) Regulations on the 20 of June, <em>Official Report</em>, columns 2076-80, I will pursue this further with NHS England to promote appropriate adoption of the guidance.</p> answering member printed Lord O'Shaughnessy question first answered 04/07/2018 16:32:39 answering member 4545 label Biography information for Lord O'Shaughnessy
	tabling member	2024 label Biography information for Lord Hunt of Kings Heath