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422660

registered interest
date	20/10/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Pregnancy: Mental Health Services
house id	1
legislature	25259 pref label House of Commons
question text	To ask the Secretary of State for Health, what the net change has been in the number of inpatient perinatal mental health beds since 2010.
tabling member constituency	Liverpool, Wavertree
tabling member printed	Luciana Berger
uin	12670
answer	answer is ministerial correction date of answer 23/10/2015 answer text <p><ins class="ministerial">Since 2010 there has been a net reduction in the number of inpatient perinatal mental health beds from 118 beds in 2010 to 115 beds in 2015.</ins></p><p><del class="ministerial">Since 2010 there has been a net reduction of mother and baby units from 17 units to 15 units.</del></p><br /> answering member constituency North East Bedfordshire answering member printed Alistair Burt question first answered 23/10/2015 13:48:26 question first ministerially corrected 29/10/2015 10:29:54 answering member 1201 label Biography information for Alistair Burt previous answer version 25494 answering member constituency North East Bedfordshire answering member printed Alistair Burt answering member 1201 label Biography information for Alistair Burt
tabling member	4036 label Biography information for Luciana Berger

421090

registered interest
date	13/10/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Mental Health Services
house id	1
legislature	25259 pref label House of Commons
question text	To ask the Secretary of State for Health, what proportion of people referred for talking therapies received cognitive behaviour therapy in each of the last five years.
tabling member constituency	Liverpool, Wavertree
tabling member printed	Luciana Berger
uin	11784
answer	answer is ministerial correction date of answer 16/10/2015 answer text <p>Information on the proportion of people referred for talking therapies who received cognitive behavioural therapy during 2013/14 is given on the attached table <em>Proportion of Improving Access to Psychological Therapies (IAPT) referrals that finished a course of treatment between 1<sup>st</sup> April 2013 and 31<sup>st</sup> March 2014, for selected therapy types, England</em>. Information for previous years is not available centrally. Information on 2014/15 will be published in November 2015.</p> answering member constituency North East Bedfordshire answering member printed Alistair Burt question first answered 16/10/2015 12:56:33 question first ministerially corrected 16/10/2015 13:29:49 answering member 1201 label Biography information for Alistair Burt attachment 1 file name PQ 11784 IAPT referrals 2013-14.xlsx title IAPT Referrals for Selected Therapy Types 2013-14 previous answer version 23809 answering member constituency North East Bedfordshire answering member printed Alistair Burt answering member 1201 label Biography information for Alistair Burt
tabling member	4036 label Biography information for Luciana Berger

420822

registered interest
date	17/09/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Department of Health: Legal Costs
house id	1
legislature	25259 pref label House of Commons
question text	To ask the Secretary of State for Health, what proportion of his Department's budget is spent on legal fees and damages.
tabling member constituency	Warrington South
tabling member printed	David Mowat
uin	901477
answer	answer is ministerial correction date of answer 13/10/2015 answer text <p>The Departmental Group spend on legal fees is captured in the Annual Report and Accounts for 2014-15. The Departmental Group spend on legal fees is separately identified under Legal Fees in Other Administration Costs,<del class="ministerial"> £61,159k</del> <ins class="ministerial">£61.159 million </ins>and Programme Costs <del class="ministerial">£128,642k,</del> <ins class="ministerial">£128,642 million </ins>totalling <del class="ministerial">£189,801k.</del><ins class="ministerial">£189,801 million.</ins></p><p>The majority of the Core Department’s spend on legal fees is captured as part of ‘Other’ spend under ‘Other Administration Costs’, ‘Programme Costs’ and in “Consultancy services”. The Annual Report and Accounts is available at:</p><p><a href="https://www.gov.uk/government/publications/department-of-health-annual-report-and-accounts-2014-to-2015" target="_blank">https://www.gov.uk/government/publications/department-of-health-annual-report-and-accounts-2014-to-2015</a></p><p>It is intended that from the 2015-16 financial year, spend on legal fees for the core Department will be discussed separately in the accounts.</p> answering member constituency Battersea answering member printed Jane Ellison question first answered 13/10/2015 16:48:38 question first ministerially corrected 14/10/2015 14:55:18 answering member 3918 label Biography information for Jane Ellison previous answer version 23237 answering member constituency Battersea answering member printed Jane Ellison answering member 3918 label Biography information for Jane Ellison
tabling member	4080 label Biography information for David Mowat

416385

registered interest
date	04/09/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Accident and Emergency Departments
house id	1
legislature	25259 pref label House of Commons
question text	To ask the Secretary of State for Health, by what indicators he plans to use to assess the improvement of Trusts receiving support from the Emergency Care Improvement Programme.
tabling member constituency	Copeland
tabling member printed	Mr Jamie Reed
uin	8995
answer	answer is ministerial correction date of answer 14/09/2015 answer text <p><del class="ministerial">Public Health England has developed a campaign to raise awareness of the symptom of breathlessness which ran as a local pilot in Oldham and Rochdale from 24 February – 23 March 2014 and as a regional pilot in the East of England 2 February – 1 March 2015.</del></p><p> </p><p> </p><p> </p><p><del class="ministerial">The Breathlessness campaign aims to encourage those with inappropriate breathlessness (breathlessness that is disproportionate to the level of activity undertaken i.e. at rest or on minimal exertion) to go and see their general practitioner (GP). It is primarily aimed at earlier diagnosis of heart and lung disease, including chronic obstructive pulmonary disease, with scope to reduce premature mortality and to improve the quality of life of those living with these conditions. The key message of the campaign is “If you get out of breath doing things that you used to be able to do, see your GP. Getting out of breath could be a sign of heart or lung disease. Finding it early makes it more treatable, so don’t ignore it, tell your doctor”.</del></p><p> </p><p> </p><p> </p><p><del class="ministerial">Evaluation of the regional pilot is still underway, although early findings from follow-up in-depth interviews with a sample of local GPs and pharmacists and pre and post awareness tracking research among the public, are positive.</del></p><p> </p><p> </p><p><ins class="ministerial"> <p> </p><p><ins class="ministerial">The Emergency Care Improvement Programme (ECIP) is a clinically led programme that will offer practical help and support to the 27 urgent and emergency care systems across England that are under the most pressure. </ins></p><p> </p><p><ins class="ministerial"> </ins></p><p> </p><p><ins class="ministerial">The progress of trusts taking part in ECIP will be measured by monitoring improvements in their accident and emergency (A&amp;E) four hour waiting time standard, along with patient outcome and experience indicators. The urgent and emergency care systems taking part in this programme were selected based on performance against the A&amp;E four hour standard in 2014/15 and Q1 of 2015/16 alongside discussions with regional teams from NHS England, Monitor and the Trust Development Authority.</ins></p><p><ins class="ministerial"> </ins></p></ins></p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p> answering member constituency Battersea answering member printed Jane Ellison question first answered 14/09/2015 15:55:26 question first ministerially corrected 14/09/2015 17:19:34 answering member 3918 label Biography information for Jane Ellison previous answer version 21204 answering member constituency Battersea answering member printed Jane Ellison answering member 3918 label Biography information for Jane Ellison
tabling member	1503 label Biography information for Mr Jamie Reed

390599

registered interest
date	16/07/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Anaemia
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government what action they are taking to address the problems associated with the late diagnosis of pernicious anaemia, in the light of the results of the survey published in the <i>British Nursing Journal</i> in April 2014.
tabling member printed	The Countess of Mar
uin	HL1539
answer	answer is ministerial correction date of answer 24/07/2015 answer text <p>It is important that patients suffering from pernicious anaemia, the result of a vitamin B12 (cobalamin) deficiency, receive a prompt and appropriate diagnosis. Pernicious anaemia develops gradually, and can cause a range of symptoms, including fatigue, lethargy, feeling faint and headaches, which vary from patient to patient. Because of the gradual progression of the condition, the variety of symptoms, which are shared with a range of other conditions, diagnosis at early onset can be challenging.</p><p>To support the diagnosis of pernicious anaemia, the British Committee for Standards in Haematology (BCSH) has published <em>Guidelines for the diagnosis and treatment of Cobalamin and Folate disorders,</em> which sets out that cobalamin status is the recommended first line diagnostic test. However, the guidance states that there is no gold standard test for the condition and makes it clear that the clinical picture of a patient is the most important factor in assessing the significance of the test results. This means clinicians should take into account all of the symptoms the patent is experiencing, their medical history, age and other relevant factors when considering the implications of a patient’s cobalamin status. The BCSH guidance highlights the risk of neurological impairment if treatment is delayed.</p><p><br /> The BCSH operates independently of Department and NHS England and produces evidence based guidelines for both clinical and laboratory haematologists on the diagnosis and treatment of haematological disease, drawing on the advice of expert consultants and clinical scientists practicing in the United Kingdom. It would be for the BCSH, not the Department, to consider whether any adjustments to current best practice in the diagnosis and treatment of patients with pernicious anaemia were needed, including whether any new or additional tests were appropriate. A copy of the BCSH guidance document <del class="ministerial">has already been placed in the Library and</del> is attached.</p><p><br /> More general clinical guidance on the diagnosis and management of pernicious anaemia can also be found on the National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summaries website. This is a freely accessible online resource that covers the causes, symptoms, diagnosis and treatment of pernicious anaemia, as well as potential complications of the condition. In addition to this, NHS Choices provides similar, though less technical, information on pernicious anaemia for the public.</p> answering member printed Lord Prior of Brampton question first answered 24/07/2015 13:21:19 question first ministerially corrected 14/10/2015 11:21:08 answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name colbalamin and folate disorders.pdf title BCSH Guidelines pernicious anaemia previous answer version 17459 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name colbalamin and folate disorders.pdf title BCSH Guidelines pernicious anaemia
tabling member	1861 label Biography information for The Countess of Mar

390600

registered interest
date	16/07/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Anaemia
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government how they propose to alert medical practitioners to the severe and irreversible nerve damage that can occur when pernicious anaemia is misdiagnosed.
tabling member printed	The Countess of Mar
uin	HL1540
answer	answer is ministerial correction date of answer 24/07/2015 answer text <p>It is important that patients suffering from pernicious anaemia, the result of a vitamin B12 (cobalamin) deficiency, receive a prompt and appropriate diagnosis. Pernicious anaemia develops gradually, and can cause a range of symptoms, including fatigue, lethargy, feeling faint and headaches, which vary from patient to patient. Because of the gradual progression of the condition, the variety of symptoms, which are shared with a range of other conditions, diagnosis at early onset can be challenging.</p><p>To support the diagnosis of pernicious anaemia, the British Committee for Standards in Haematology (BCSH) has published <em>Guidelines for the diagnosis and treatment of Cobalamin and Folate disorders,</em> which sets out that cobalamin status is the recommended first line diagnostic test. However, the guidance states that there is no gold standard test for the condition and makes it clear that the clinical picture of a patient is the most important factor in assessing the significance of the test results. This means clinicians should take into account all of the symptoms the patent is experiencing, their medical history, age and other relevant factors when considering the implications of a patient’s cobalamin status. The BCSH guidance highlights the risk of neurological impairment if treatment is delayed.</p><p><br /> The BCSH operates independently of Department and NHS England and produces evidence based guidelines for both clinical and laboratory haematologists on the diagnosis and treatment of haematological disease, drawing on the advice of expert consultants and clinical scientists practicing in the United Kingdom. It would be for the BCSH, not the Department, to consider whether any adjustments to current best practice in the diagnosis and treatment of patients with pernicious anaemia were needed, including whether any new or additional tests were appropriate. A copy of the BCSH guidance document <del class="ministerial">has already been placed in the Library and</del> is attached.</p><p><br /> More general clinical guidance on the diagnosis and management of pernicious anaemia can also be found on the National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summaries website. This is a freely accessible online resource that covers the causes, symptoms, diagnosis and treatment of pernicious anaemia, as well as potential complications of the condition. In addition to this, NHS Choices provides similar, though less technical, information on pernicious anaemia for the public.</p> answering member printed Lord Prior of Brampton question first answered 24/07/2015 13:21:19 question first ministerially corrected 14/10/2015 11:21:19 answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name colbalamin and folate disorders.pdf title BCSH Guidelines pernicious anaemia previous answer version 17460 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton attachment 1 file name colbalamin and folate disorders.pdf title BCSH Guidelines pernicious anaemia
tabling member	1861 label Biography information for The Countess of Mar

386702

registered interest
date	30/06/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Medicine: Education
house id	1
legislature	25259 pref label House of Commons
question text	To ask the Secretary of State for Health, what the average cost to the taxpayer is of training someone to become a doctor in the UK.
tabling member constituency	East Yorkshire
tabling member printed	Sir Greg Knight
uin	4761
answer	answer is ministerial correction date of answer 08/07/2015 answer text <p>The Department does not hold information on the average cost to the taxpayer of training someone to become a doctor in the United Kingdom.</p><br /> <br /> <br /><p>The Personal Social Services Research Unit at the University of Kent estimates within their report ‘Unit Costs of Health and Social Care 2014’, published March 2014, that the average cost in <ins class="ministerial">2013/14 </ins><del class="ministerial">2014/15</del> of training to become a general practitioner is £485,390 with the consultant training cost being £726,551. These figures reflect the pre-registration costs of tuition, living expenses/lost production and clinical placements and the post-graduate costs of tuition and replacement costs not the average cost to the taxpayer.</p><br /> answering member constituency Ipswich answering member printed Ben Gummer question first answered 08/07/2015 13:27:38 question first ministerially corrected 02/11/2015 11:19:49 answering member 3988 label Biography information for Ben Gummer previous answer version 12875 answering member constituency Ipswich answering member printed Ben Gummer answering member 3988 label Biography information for Ben Gummer
tabling member	1200 label Biography information for Sir Greg Knight

385301

registered interest
date	24/06/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Hepatitis
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government why the national waiting time criterion for referral to hepatitis C treatment is 18 weeks whereas the national waiting time criterion for referral to specialist services for HIV treatment is two weeks.
tabling member printed	Baroness Masham of Ilton
uin	HL784
answer	answer is ministerial correction date of answer 08/07/2015 answer text <p><del class="ministerial">NHS England and Public Health England (PHE) are working alongside a coalition of other organisations and patient groups to draft a framework for hepatitis C improvement. This hepatitis C improvement framework will set high level aims for the public health system towards elimination of hepatitis C related liver disease as a significant public health concern.</del></p><p> </p><p> </p><p> </p><p><del class="ministerial">The hepatitis C improvement framework will be referred to in PHE’s liver disease framework.</del></p><p> </p><p><ins class="ministerial">Timing for access to care or treatments for all NHS England service specifications or policies is based on an assessment of the evidence for clinical effectiveness, cost effectiveness and affordability.</ins></p><p> </p><p> </p> answering member printed Lord Prior of Brampton question first answered 08/07/2015 13:53:15 question first ministerially corrected 08/07/2015 14:59:37 answering member 127 label Biography information for Lord Prior of Brampton previous answer version 12907 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton
tabling member	1850 label Biography information for Baroness Masham of Ilton

348423

registered interest
date	03/06/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	General Practitioners
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 results of a survey on behalf of Monitor, which found that one in ten people are dissatisfied with their general practitioner surgery.
tabling member printed	Lord Taylor of Warwick
uin	HL235
answer	answer is ministerial correction date of answer 17/06/2015 answer text <p>On 1 June 2015, Monitor published <em>Improving GP Services: Commissioners and Patient Choice</em>, which included the findings of a nationally representative survey conducted by Ipsos Mori.</p><p> </p><p> </p><p> </p><p>The report noted a high level of satisfaction with general practice overall. It found that 81% of patients were satisfied with their general practitioner (GP) practice, while only 10% were dissatisfied.</p><p> </p><p> </p><p> </p><p>Monitor’s report found that, after location, patients most value the ease of getting an appointment when choosing a GP practice. In order to improve access for patients, the Government has invested £175 million over two years through the Prime Minister’s GP Access Fund. This is testing improved and innovative access to GP services through longer opening hours, such as at evenings and weekends, but also different ways of accessing services, for example the use of Skype consultations. Altogether, there are now 57 schemes covering over 2,500 practices, meaning that over 18 million patients are expected to benefit from improved access and transformational change at local level by March 2016.</p><p>Additionally, the Primary Care Infrastructure Fund is investing £1 billion<ins class="ministerial">, including</ins> <del class="ministerial">and</del> £25 million as part of the Prime Minister’s GP Access Fund, over four years to improve premises and information technology, which will also improve access.</p><p> </p> answering member printed Lord Prior of Brampton question first answered 17/06/2015 13:19:17 question first ministerially corrected 19/06/2015 11:00:07 answering member 127 label Biography information for Lord Prior of Brampton previous answer version 5697 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton
tabling member	1796 label Biography information for Lord Taylor of Warwick

347943

registered interest
date	02/06/2015
answering body	Department of Health
answering dept id	17
answering dept short name	Health
answering dept sort name	Health
hansard heading	Human Papillomavirus: Vaccination
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty’s Government, to date, how many adverse reactions to (1) Cervarix, (2) Gardasil and (3) generic human papilloma virus vaccines have been reported to the Medicines and Healthcare products Regulatory Agency; for each category, how many of those reports are of serious adverse reactions; and what age-specific rate those figures represent.
tabling member printed	The Countess of Mar
uin	HL229
answer	answer is ministerial correction date of answer 16/06/2015 answer text <p>A total of 8,243 suspected adverse drug reaction (ADR) reports with human papilloma virus (HPV) vaccines have been reported to the Medicines and Healthcare products Regulatory Agency (MHRA), via the Yellow Card Scheme, up to 3 June 2015.</p><p> </p><p> </p><p> </p><p>To date, more than 8 million doses of HPV vaccine have been given across the United Kingdom as part of the routine immunisation programme. The MHRA does not hold data on age-specific vaccine usage, and therefore age-specific reporting rates cannot be calculated.</p><p> </p><p> </p><p> </p><p>It is important to note that a Yellow Card report is not proof of a side effect occurring, but a suspicion by the reporter that the vaccine may have been the cause. Yellow Card data cannot be used as a reliable indicator of the frequency of suspected ADRs to vaccines or medicines. The level of ADR reporting may fluctuate between given years due to a variety of reasons such as a medicine being new (reporting rates are generally higher when a product is first introduced), stimulated interest/publicity and variations in exposure to the medicine.</p><p> </p><p> </p><p> </p><p>The possible known side effects, and the frequency, are listed in the product information which is provided with the vaccines. The vast majority of the 8,243 ADRs relate to the known risks of vaccination that are well-described in the available product information. The proportion of suspected ADRs for HPV vaccines that were reported as serious (32%) is less than the proportion reported as serious for other routinely used vaccines (68% overall) during the same time period. The expected benefits in protecting against HPV-related mortality and disease outweigh the known side effects of HPV vaccine.</p><p> </p><p> </p><p> </p><p>The following table provides a breakdown of UK suspected spontaneous ADRs received via the Yellow Card Scheme in association with the HPV vaccine. The MHRA does not hold data on age-specific vaccine usage, and therefore age-specific reporting rates cannot be calculated.</p><p> </p><p> </p><p> </p><table><tbody><tr><td><p>Vaccine Brand</p></td><td><p>Total number of reports</p></td><td><p>Number of serious reports (% of total)</p></td><td><p>Reporting rate per 1000 doses (serious reporting rates per 1000)</p></td></tr><tr><td><p>Cervarix</p></td><td><p>6,266</p></td><td><p>1,768 (28%)</p></td><td><p><ins class="ministerial">n/a **</ins><del class="ministerial">0.78 (0.22)</del></p></td></tr><tr><td><p>Gardasil</p></td><td><p>1,471</p></td><td><p>504 (34%)</p></td><td><p><ins class="ministerial">n/a **</ins><del class="ministerial">0.18 (0.06)</del></p></td></tr><tr><td><p>HPV Brand unspecified</p></td><td><p>507</p></td><td><p>326 (64%)</p></td><td><p><ins class="ministerial">n/a ** </ins><del class="ministerial">0.06 (0.04)</del></p></td></tr><tr><td><p>Total for Human Papilloma virus vaccines</p></td><td><p>*8,244</p></td><td><p>2,598 (32%)</p></td><td><p>1.03 (0.32)</p></td></tr></tbody></table><p> </p><p><em>Source:</em> MHRA sentinel database for adverse reactions.</p><p> </p><p>* It should be noted that the total number of reports received will not be equal to the totals in the table above as some reports of suspected adverse reactions may have included more than one vaccine.</p><p><ins class="ministerial">**Updated UK-wide brand-specific usage data are not available to MHRA at the time of writing based on a minimum of 8 million combined doses of Cervarix and Gardasil administered across the UK to date.</ins></p><p> </p><p><ins class="ministerial"> <p> </p><p> </p><p> </p></ins></p><p> </p><p> </p><p> </p><p> </p><p> </p><p>The seriousness criteria for ADR reporting were determined by a working group of the Council for International Organizations of Medical Sciences (CIOMS) and are defined as 6 possible categories which are explained on the Yellow Card. The MHRA asks reporters to select one of the following criteria by ticking the appropriate box on the Yellow Card: (1) patient died due to reaction; (2) life threatening; (3) resulted in hospitalisation or prolonged inpatient hospitalisation; (4) congenital abnormality; and (5) involved persistent or significant disability or incapacity; or (6) if the reaction was deemed medically significant. In addition to this, seriousness of reaction terms has also been defined by the MHRA in its medical dictionary. Therefore an ADR report can be serious because the reporter considers the reaction to be serious or because the reaction term itself is considered serious in the MHRA medical dictionary.</p><p> </p> answering member printed Lord Prior of Brampton question first answered 16/06/2015 14:35:02 question first ministerially corrected 03/07/2015 14:01:13 answering member 127 label Biography information for Lord Prior of Brampton previous answer version 5462 answering member printed Lord Prior of Brampton answering member 127 label Biography information for Lord Prior of Brampton
tabling member	1861 label Biography information for The Countess of Mar