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1049581

registered interest
date	28/01/2019
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	Liothyronine
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 Liothyronine (T3) is purchased at a cost in line with other EU countries.
tabling member printed	Lord Hunt of Kings Heath
uin	HL13168
answer	answer is ministerial correction date of answer 11/02/2019 answer text <p>All United Kingdom marketing authorisation holders of liothyronine are obliged to ensure that the product complies with the minimum standard as specified in the updated British Pharmacopoeia monograph for liothyronine tablets. Liothyronine on the market in other European Union Member States may not comply with the updated British Pharmacopoeia monograph and therefore would not be considered therapeutically equivalent.</p><p>Liothyronine is an unbranded generic medicine. The Department encourages competition between suppliers of unbranded generic medicines to keep prices down. This generally works well and has led to some of the lowest prices in Europe. Concerns about anti-competitive behaviour are a matter for the Competition and Markets Authority (CMA) to investigate.</p><p>Liothyronine, marketed by Advanz Pharma (formerly Concordia), is currently the subject of an investigation by the CMA. The CMA has provisionally found that the company abused its dominant position to overcharge the National Health Service by millions of pounds for liothyronine tablets. A provisional decision does not necessarily lead to an infringement decision. Where companies have breached competition law, the Department will seek damages and invest that money back into the NHS.</p> answering member printed Baroness Blackwood of North Oxford question first answered 11/02/2019 13:48:58 answering member 4019 label Biography information for Baroness Blackwood of North Oxford
tabling member	2024 label Biography information for Lord Hunt of Kings Heath

1041209

registered interest
date	14/01/2019
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	University Hospitals Bristol NHS Foundation Trust: Liothyronine
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what action they plan to take to lift the ban on the prescription of liothyronine (T3) by University Hospital Bristol in contradiction of the advice given by NHS England.
tabling member printed	Lord Hunt of Kings Heath
uin	HL12791
answer	answer is ministerial correction date of answer 22/01/2019 answer text <p>NHS England is working closely with clinical commissioning groups (CCGs) on the prescribing of liothyronine to support them with the implementation of guidance for CCGs on items which should not be routinely prescribed in primary care. The Department has not had specific discussions with NHS England or made an assessment on these issues.</p><p>CCGs are expected to have regard to national guidance, and are responsible for developing their own local approaches to its implementation taking into account local priorities and needs. CCGs set the policy which governs what hospitals and trusts implement, therefore the prescription of liothyronine at University Hospital Bristol and Musgrove Park Hospital in Taunton is a matter for those CCGs.</p><p>This guidance for CCGs on items which should not be routinely prescribed in primary care includes recommendations on the use of liothyronine in line with the British Thyroid Association, who advise that a small proportion of patients treated with levothyroxine continue to suffer with symptoms despite adequate biochemical correction. In these circumstances,</p><p>where levothyroxine has failed and in line with this guidance, endocrinologists providing NHS services may recommend liothyronine for individual patients after a carefully audited trial of at least three months duration of the drug.</p><p>Further guidance on the prescribing of liothyronine has been published by the Regional Medicines Optimisation Committee. The aim of the guidance is to make best practice on the prescribing of liothyronine clearer. A copy of <em>Guidance – Prescribing of Liothyronine</em> is attached.</p> answering member printed Baroness Manzoor grouped question UIN HL12792 HL12793 HL12794 question first answered 22/01/2019 16:17:24 answering member 4289 label Biography information for Baroness Manzoor attachment 1 file name RMOC-Liothyronine-Guidance-v2.0-final-1.pdf title RMOC liothyronine guidance
tabling member	2024 label Biography information for Lord Hunt of Kings Heath

1041210

registered interest
date	14/01/2019
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	Musgrove Park Hospital: Liothyronine
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what action they plan to take to change the approach to the prescription of liothyronine (T3) being taken by Musgrove Hospital, Taunton which is in contradiction of the advice given by NHS England.
tabling member printed	Lord Hunt of Kings Heath
uin	HL12792
answer	answer is ministerial correction date of answer 22/01/2019 answer text <p>NHS England is working closely with clinical commissioning groups (CCGs) on the prescribing of liothyronine to support them with the implementation of guidance for CCGs on items which should not be routinely prescribed in primary care. The Department has not had specific discussions with NHS England or made an assessment on these issues.</p><p>CCGs are expected to have regard to national guidance, and are responsible for developing their own local approaches to its implementation taking into account local priorities and needs. CCGs set the policy which governs what hospitals and trusts implement, therefore the prescription of liothyronine at University Hospital Bristol and Musgrove Park Hospital in Taunton is a matter for those CCGs.</p><p>This guidance for CCGs on items which should not be routinely prescribed in primary care includes recommendations on the use of liothyronine in line with the British Thyroid Association, who advise that a small proportion of patients treated with levothyroxine continue to suffer with symptoms despite adequate biochemical correction. In these circumstances,</p><p>where levothyroxine has failed and in line with this guidance, endocrinologists providing NHS services may recommend liothyronine for individual patients after a carefully audited trial of at least three months duration of the drug.</p><p>Further guidance on the prescribing of liothyronine has been published by the Regional Medicines Optimisation Committee. The aim of the guidance is to make best practice on the prescribing of liothyronine clearer. A copy of <em>Guidance – Prescribing of Liothyronine</em> is attached.</p> answering member printed Baroness Manzoor grouped question UIN HL12791 HL12793 HL12794 question first answered 22/01/2019 16:17:24 answering member 4289 label Biography information for Baroness Manzoor attachment 1 file name RMOC-Liothyronine-Guidance-v2.0-final-1.pdf title RMOC liothyronine guidance
tabling member	2024 label Biography information for Lord Hunt of Kings Heath

1041211

registered interest
date	14/01/2019
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	Liothyronine
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what discussions they have had with NHS England about the ability for doctors to follow the advice given on the prescription of liothyronine (T3) when bans on its prescription have been put in place at a local level.
tabling member printed	Lord Hunt of Kings Heath
uin	HL12793
answer	answer is ministerial correction date of answer 22/01/2019 answer text <p>NHS England is working closely with clinical commissioning groups (CCGs) on the prescribing of liothyronine to support them with the implementation of guidance for CCGs on items which should not be routinely prescribed in primary care. The Department has not had specific discussions with NHS England or made an assessment on these issues.</p><p>CCGs are expected to have regard to national guidance, and are responsible for developing their own local approaches to its implementation taking into account local priorities and needs. CCGs set the policy which governs what hospitals and trusts implement, therefore the prescription of liothyronine at University Hospital Bristol and Musgrove Park Hospital in Taunton is a matter for those CCGs.</p><p>This guidance for CCGs on items which should not be routinely prescribed in primary care includes recommendations on the use of liothyronine in line with the British Thyroid Association, who advise that a small proportion of patients treated with levothyroxine continue to suffer with symptoms despite adequate biochemical correction. In these circumstances,</p><p>where levothyroxine has failed and in line with this guidance, endocrinologists providing NHS services may recommend liothyronine for individual patients after a carefully audited trial of at least three months duration of the drug.</p><p>Further guidance on the prescribing of liothyronine has been published by the Regional Medicines Optimisation Committee. The aim of the guidance is to make best practice on the prescribing of liothyronine clearer. A copy of <em>Guidance – Prescribing of Liothyronine</em> is attached.</p> answering member printed Baroness Manzoor grouped question UIN HL12791 HL12792 HL12794 question first answered 22/01/2019 16:17:24 answering member 4289 label Biography information for Baroness Manzoor attachment 1 file name RMOC-Liothyronine-Guidance-v2.0-final-1.pdf title RMOC liothyronine guidance
tabling member	2024 label Biography information for Lord Hunt of Kings Heath

1041212

registered interest
date	14/01/2019
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	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 barriers in place to the prescription of liothyronine (T3) in England, if any; and what steps they plan to take to overcome any such barriers.
tabling member printed	Lord Hunt of Kings Heath
uin	HL12794
answer	answer is ministerial correction date of answer 22/01/2019 answer text <p>NHS England is working closely with clinical commissioning groups (CCGs) on the prescribing of liothyronine to support them with the implementation of guidance for CCGs on items which should not be routinely prescribed in primary care. The Department has not had specific discussions with NHS England or made an assessment on these issues.</p><p>CCGs are expected to have regard to national guidance, and are responsible for developing their own local approaches to its implementation taking into account local priorities and needs. CCGs set the policy which governs what hospitals and trusts implement, therefore the prescription of liothyronine at University Hospital Bristol and Musgrove Park Hospital in Taunton is a matter for those CCGs.</p><p>This guidance for CCGs on items which should not be routinely prescribed in primary care includes recommendations on the use of liothyronine in line with the British Thyroid Association, who advise that a small proportion of patients treated with levothyroxine continue to suffer with symptoms despite adequate biochemical correction. In these circumstances,</p><p>where levothyroxine has failed and in line with this guidance, endocrinologists providing NHS services may recommend liothyronine for individual patients after a carefully audited trial of at least three months duration of the drug.</p><p>Further guidance on the prescribing of liothyronine has been published by the Regional Medicines Optimisation Committee. The aim of the guidance is to make best practice on the prescribing of liothyronine clearer. A copy of <em>Guidance – Prescribing of Liothyronine</em> is attached.</p> answering member printed Baroness Manzoor grouped question UIN HL12791 HL12792 HL12793 question first answered 22/01/2019 16:17:24 answering member 4289 label Biography information for Baroness Manzoor attachment 1 file name RMOC-Liothyronine-Guidance-v2.0-final-1.pdf title RMOC liothyronine guidance
tabling member	2024 label Biography information for Lord Hunt of Kings Heath

1037606

registered interest
date	08/01/2019
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	Health Services: Foreign Nationals
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government how many written submissions they have received as part of the review of the National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2017; how many case studies were submitted to the review where urgent care was withheld; and what assessment they have made of the number of case studies submitted where urgent care was, or may have, been incorrectly withheld.
tabling member printed	Lord Hunt of Kings Heath
uin	HL12662
answer	answer is ministerial correction date of answer 22/01/2019 answer text <p>The Department engaged with 79 organisations as part of the process of reviewing of the National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2017 and received 57 formal responses. Of these, 22 case studies included instances where individuals were required to make advance payment for treatment that the Department has concluded was arguably, on proper analysis, immediately necessary and/or urgent.</p><p>The common issue in these cases is that clinicians have not fully taken into account the date at which those seeking treatment have been expected to leave the United Kingdom, something that national guidance is clear must be taken into consideration when making a decision as to whether or not treatment is considered urgent. To mitigate this risk and help ensure the regulations are applied as intended the Department has updated its guidance, published on 24 December 2018, and is planning further updates to relevant training material and case studies in early 2019 to ensure all relevant circumstances are considered when deciding if a treatment is to be considered immediately necessary, urgent or non-urgent.</p> answering member printed Baroness Manzoor question first answered 22/01/2019 16:03:35 answering member 4289 label Biography information for Baroness Manzoor
tabling member	2024 label Biography information for Lord Hunt of Kings Heath

1036954

registered interest
date	07/01/2019
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	Clinical Commissioning Groups
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government whether they intend to publish the letter sent by the Deputy Chief Executive Officer of NHS England in November 2018, requiring Clinical Commissioning Groups to explore mergers and joint ways of working.
tabling member printed	Lord Hunt of Kings Heath
uin	HL12596
answer	answer is ministerial correction date of answer 21/01/2019 answer text <p>The letter dated 23 November 2018 was sent to all Clinical Commissioning Group (CCG) Accountable Officers and CCG Chief Financial Officers in England from the Deputy Chief Executive of NHS England. A copy of the letter is attached.</p> answering member printed Baroness Manzoor question first answered 21/01/2019 16:31:41 answering member 4289 label Biography information for Baroness Manzoor attachment 1 file name CCG admin letter final 231118.pdf title 23 November 2018 letter to CCGs
tabling member	2024 label Biography information for Lord Hunt of Kings Heath

1029625

registered interest
date	20/12/2018
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	Health Services: Foreign Nationals
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government whether they will publish the results of the review of the NHS (Charges to Overseas Visitors) (Amendment) Regulations 2017.
tabling member printed	Lord Hunt of Kings Heath
uin	HL12511
answer	answer is ministerial correction date of answer 07/01/2019 answer text <p>The Department has no plans to produce and publish a formal review document or the evidence collected as part of it.</p> answering member printed Baroness Manzoor question first answered 07/01/2019 16:50:39 answering member 4289 label Biography information for Baroness Manzoor
tabling member	2024 label Biography information for Lord Hunt of Kings Heath

1025353

registered interest
date	14/12/2018
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 are taking to negotiate a reduction of the cost of liothyronine (T3) for use in primary care.
tabling member printed	Lord Hunt of Kings Heath
uin	HL12319
answer	answer is ministerial correction date of answer 20/12/2018 answer text <p>Liothyronine is an unbranded generic medicine. The Department encourages competition between suppliers of unbranded generic medicines to keep prices down. This generally works well and has led to some of the lowest prices in Europe.</p><p>Concerns about anti-competitive behaviour are a matter for the Competition and Markets Authority (CMA) to investigate. Liothyronine, marketed by Concordia, is currently the subject of an investigation by the CMA, which has provisionally found that Concordia abused its dominant position to overcharge the National Health Service by millions for liothyronine tablets. A provisional decision does not necessarily lead to an infringement decision. Where companies have breached competition law, the Department will seek damages and invest that money back into the NHS.</p><p>The Department also has its own powers to limit prices of unbranded generic medicines and will consult early in 2019 with the relevant industry bodies on implementation of those powers.</p> answering member printed Lord O'Shaughnessy question first answered 20/12/2018 15:44:26 answering member 4545 label Biography information for Lord O'Shaughnessy
tabling member	2024 label Biography information for Lord Hunt of Kings Heath

1020276

registered interest
date	05/12/2018
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	Hospitals: Wheelchairs
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 availability of sufficient wheelchairs in NHS hospitals for disabled people visiting patients.
tabling member printed	Lord Hunt of Kings Heath
uin	HL12068
answer	answer is ministerial correction date of answer 19/12/2018 answer text <p>No central guidance is provided by the Department and no such assessments have been made.</p><p> </p><p>All National Health Service trusts as public organisations are subject to the general duty in the Equality Act 2010 to have due regard to the need to take steps to meet the needs of persons who share a relevant protected characteristic that are different from the needs of persons who do not share it. Disability is a protected characteristic.</p> answering member printed Lord O'Shaughnessy grouped question UIN HL12069 HL12070 HL12071 question first answered 19/12/2018 12:46:53 answering member 4545 label Biography information for Lord O'Shaughnessy
tabling member	2024 label Biography information for Lord Hunt of Kings Heath