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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

1037607

registered interest
date	08/01/2019
answering body	Department for Digital, Culture, Media and Sport
answering dept id	10
answering dept short name	Digital, Culture, Media and Sport
answering dept sort name	Digital, Culture, Media and Sport
hansard heading	Gambling: Internet
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what discussions they have had with the Children’s Commissioner about mystery boxes in online games; and whether those boxes encourage online gambling by children.
tabling member printed	Lord Hunt of Kings Heath
uin	HL12663
answer	answer is ministerial correction date of answer 17/01/2019 answer text <p>Mystery boxes in video games, also known as loot boxes do not fall under gambling law where the in-game items acquired are confined for use within the game and cannot be cashed out. However, the Government is aware of concerns that loot boxes could encourage gambling-like behaviour and longer term lead to gambling related harm, especially amongst children, and will continue to look closely at any evidence around this issue.</p><p> </p><p>In September 2018, 16 regulators from Europe and the USA, including the Gambling Commission signed a declaration which outlined common concerns around gaming and gambling. The regulators agreed to work together to monitor the characteristics of video games and social gaming and where there is potential cross-over into gambling.</p><p> </p><p>We welcomed the introduction last year by the VSC Ratings Board and PEGI of a new label for video games to warn parents where they include the opportunity to make in-games purchases such as loot boxes. Microtransactions in games—including loot boxes—are further subject to the Consumer Protection from Unfair Trading Regulations 2008 which protect against misleading or aggressive marketing.</p><p> </p><p>DCMS is working closely with the games industry, agencies such as the Video Standards Council (VSC) and others to improve online safety in games, including promoting healthy and responsible gaming. To better understand the relationship between social media and the mental health of children and young people up to 25 years old, the Chief Medical Officer will be leading a systematic review to examine all relevant international research in the area.</p><p> </p> answering member printed Lord Ashton of Hyde grouped question UIN HL12664 question first answered 17/01/2019 11:51:01 answering member 4247 label Biography information for Lord Ashton of Hyde
tabling member	2024 label Biography information for Lord Hunt of Kings Heath

1037609

registered interest
date	08/01/2019
answering body	Department for Digital, Culture, Media and Sport
answering dept id	10
answering dept short name	Digital, Culture, Media and Sport
answering dept sort name	Digital, Culture, Media and Sport
hansard heading	Gambling: Internet
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government what action, if any, they intend to take to prohibit the use of mystery boxes in online games.
tabling member printed	Lord Hunt of Kings Heath
uin	HL12664
answer	answer is ministerial correction date of answer 17/01/2019 answer text <p>Mystery boxes in video games, also known as loot boxes do not fall under gambling law where the in-game items acquired are confined for use within the game and cannot be cashed out. However, the Government is aware of concerns that loot boxes could encourage gambling-like behaviour and longer term lead to gambling related harm, especially amongst children, and will continue to look closely at any evidence around this issue.</p><p> </p><p>In September 2018, 16 regulators from Europe and the USA, including the Gambling Commission signed a declaration which outlined common concerns around gaming and gambling. The regulators agreed to work together to monitor the characteristics of video games and social gaming and where there is potential cross-over into gambling.</p><p> </p><p>We welcomed the introduction last year by the VSC Ratings Board and PEGI of a new label for video games to warn parents where they include the opportunity to make in-games purchases such as loot boxes. Microtransactions in games—including loot boxes—are further subject to the Consumer Protection from Unfair Trading Regulations 2008 which protect against misleading or aggressive marketing.</p><p> </p><p>DCMS is working closely with the games industry, agencies such as the Video Standards Council (VSC) and others to improve online safety in games, including promoting healthy and responsible gaming. To better understand the relationship between social media and the mental health of children and young people up to 25 years old, the Chief Medical Officer will be leading a systematic review to examine all relevant international research in the area.</p><p> </p> answering member printed Lord Ashton of Hyde grouped question UIN HL12663 question first answered 17/01/2019 11:51:02 answering member 4247 label Biography information for Lord Ashton of Hyde
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

1036965

registered interest
date	07/01/2019
answering body	Ministry of Defence
answering dept id	11
answering dept short name	Defence
answering dept sort name	Defence
hansard heading	Army: Recruitment
house id	2
legislature	25277 pref label House of Lords
question text	To ask Her Majesty's Government, further to the report by the National Audit Office Investigation into the British Army Recruiting Partnering Project, published on 14 December 2018, why they did not test the proposed changes to their recruitment approach for army recruitment prior to the introduction of the partnering agreement with Capita Business Services.
tabling member printed	Lord Hunt of Kings Heath
uin	HL12607
answer	answer is ministerial correction date of answer 17/01/2019 answer text <p>At the outset of the contract the Army and Capita failed to understand the complexity of the Army recruitment requirement and the challenges faced. These were compounded by the delays in developing the new information technology to support the processes.</p><p>The Army and Capita are implementing a range of policy and process changes to increase enlistments to the Army. These have been informed by lessons learned and are, where appropriate, being piloted prior to full introduction. The improvements include changes to simplify and streamline the process.</p> answering member printed Earl Howe grouped question UIN HL12610 question first answered 17/01/2019 16:11:09 answering member 2000 label Biography information for Earl Howe
tabling member	2024 label Biography information for Lord Hunt of Kings Heath