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The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2016-02-29.

To ask Her Majesty’s Government, of the schools that had their admission arrangements objected to in (1) 2014, and (2) 2015, what was the average number of School Admissions Code breaches found in each case.

Lord Nash

In 2013/14 the total number of objections upheld and partially upheld was 99, out of 161 determinations published. In 2014/15 the number was 159, out of 260 determinations published.

We do not record data on the number of breaches found in individual cases.

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2016-02-29.

To ask Her Majesty’s Government whether, in the light of research presented to the American Academy for the Advancement of Science concerning the impact of hearing loss on the development of dementia, they will instruct Clinical Commissioning Groups to stop restricting access to hearing aids.

Lord Prior of Brampton

The Department does not issue advice to clinical commissioning groups (CCGs) on hearing aid provision. CCGs are responsible for the provision of conventional hearing aids for mild to moderate hearing loss within their local population. As with other services CCGs commission, they should take into consideration assessments of local need and any relevant clinical guidance from appropriate national bodies such as the National Institute for Health and Care Excellence.

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2016-02-29.

To ask Her Majesty’s Government whether they will publish all evidence they have available on the mechanism whereby increasing the presence of consultants and diagnostic tests at weekends will result in lower mortality and reduced length of stay.

Lord Prior of Brampton

The Department published a summary of the research examining the association between weekend hospital admissions and poorer patient outcomes, including higher rates of mortality, on 15 October 2015 on the gov.uk website. A range of potential causal links for this association have been identified; one of these is the availability of staff and services at weekends.

The following studies were published on the gov.uk website at the following address:

https://www.gov.uk/government/publications/research-into-the-weekend-effect-on-hospital-mortality/research-into-the-weekend-effect-on-patient-outcomes-and-mortality

Of these, the following four articles are published in academic journals and are only available by subscription.

Freemantle et al (2015), BMJ 2015; 351:h4596, Increased mortality associated with weekend hospital admission: a case for expanded seven day services?

Independent research that analysed 2013 to 2014 hospital episodes statistics (HES) data found:

– although there are fewer hospital admissions at weekends, patients who are admitted on Saturday and Sunday are sicker and face an increased likelihood of death within 30 days, even when severity of illness is taken into account;

– patients admitted on a Sunday have a 15% greater risk of mortality compared to those admitted on Wednesday;

– patients admitted on a Saturday have a 10% greater risk of mortality compared to those admitted on a Wednesday;

– there are around 11,000 excess deaths in hospitals every year among patients admitted on a Friday, Saturday, Sunday or Monday compared with other days of the week. The authors included the effect of Fridays and Mondays as ‘appropriate support services in hospitals are usually reduced from late Friday through the weekend, leading to disruption on Monday morning’;

– oncology patients admitted on a Sunday have a 29% increased risk of death compared to those admitted on a Wednesday; and

– patients with cardiovascular disease admitted on a Sunday have a 20% increased risk of death compared to those admitted on a Wednesday.

The study concluded that it is not possible to determine how many of the excess deaths were avoidable, but that the statistic is ‘not otherwise ignorable’ and ‘raises challenging questions about reduced service provision at weekends’.

The Global Comparators project: international comparison of 30-day in-hospital mortality by day of the week, BMJ Qual Saf Published Online First 6 July 2015, doi:10.1136/bmjqs-2014-003467

The Global Comparators dataset collects inpatient records across 50 hospitals in 10 countries. Analysis of a sub-sample of this data (28 hospitals across England, Australia, United States of America and Netherlands) for emergency admissions showed:

– there is an overall 30-day crude mortality rate of 3.9%; the English hospitals had the highest crude morality rate (4.6%); crude mortality rates for the English, Dutch and USA hospitals were higher at weekends compared with weekdays; and

– emergency patients in the English, USA and Dutch hospitals showed a significantly higher adjusted risk of death within 30 days following admission on a Saturday or Sunday compared with admission on a Monday.

This study did not show a difference in mortality within 30 days for patients admitted at weekends in Australian hospitals. However, when analysing mortality within seven days, the Australian hospitals showed 12% higher risk of death when admitted on a Saturday compared to a Monday, and 11% higher risk of death following a Sunday admission.

Freemantle et al (2012), J R Soc Med. 2012 Feb;105(2):74-84, Weekend hospitalisation and additional risk of death: an analysis of inpatient data

Analysis of 2009 to 2010 HES data found:

– patients admitted to hospital on a Sunday had a 16% greater risk of death within 30 days compared to those admitted on a Wednesday;

– patients admitted on a Saturday had an 11% increased risk of death within 30 days compared to those admitted on a Wednesday;

– day of admission was associated with increased risk of death in seven of the 10 most common CCS groups (clinical conditions), for example:

– patients admitted on a Sunday with acute and unspecified renal failure had a 37% increased risk of death compared with those admitted on a Wednesday; and

– patients admitted on a Sunday with acute myocardial infarction had an 11% increased risk of death compared to those admitted on a Wednesday.

Aylin et al (2010), Qual Saf Health Care 2010; 19:213-217, Weekend mortality for emergency admissions: a large multicentre study

This was one of the first, large scale studies of English data to explore weekend mortality rates for emergency admissions.

Using the data for financial year 2005 to 2006, the study found:

– crude mortality rates are higher for patients admitted at weekends compared to weekdays (5.2% for all weekend admissions; 4.9% for all weekday admissions; overall crude mortality rate: 5.0%);

– there is a 10% higher risk of death for patients admitted as an emergency at the weekend compared with those admitted on a weekday; and

– there may be a possible 3,369 excess deaths occurring at the weekend compared to weekdays (equivalent to a 7% higher risk of death).

East Midlands Clinical Senate (2014), 7 Day Services Report: Acute Collaborative Report

Ten East Midlands acute trusts undertook a data gathering exercise to look at current provision against the 10 clinical standards for urgent and emergency care that underpin consistently high quality care 7 days a week. A copy of this report is attached.

NHS Services, Seven Days a Week Forum (2013), was a clinically-led process which included an extensive review of the published literature alongside analysis of HES data to explore patient outcomes at weekends compared to during the week. A copy of this report is attached.

Academy of Medical Royal Colleges (2012), seven day consultant present care.

In light of evidence demonstrating less favourable patient outcomes at weekends compared to weekdays, the Academy of Medical Royal Colleges presented proposals for achieving parity for inpatient care throughout the week. A copy of the report is attached.

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2016-02-29.

To ask Her Majesty’s Government what action they are taking to ensure that the adoption of new medical device technology by the NHS is not frustrated by the five-year length of NHS Supply Chain Framework Agreements, given the life cycle of some inventions.

Lord Prior of Brampton

The framework agreements awarded by NHS Supply Chain primarily cover existing products and services. National frameworks reduce the duplication of effort faced by suppliers trying to ‘sell their’ products into the National Health Service on a trust by trust basis by providing a single route, compliant with European Union public procurement regulations.

The scope and duration of each framework agreement takes into account the nature of the product category, including an assessment of whether the product market is emerging or fast moving.

In addition, NHS Supply Chain hosts an Innovation Scorecard enabling suppliers to introduce truly innovative products into the NHS following a submission through the online tool on the organisation’s website. If a product is deemed to be innovative, the product can be fast-tracked and made available to the NHS through NHS Supply Chain’s online and national catalogues usually within a six month period.

The Accelerated Access Review, announced by the Minister for Life Sciences in November 2014 will make recommendations to Government on speeding up access to transformative new medicines and technologies for NHS patients, using data from initiatives such as the CDF and EAMS, as well as greater use of procurement purchasing power to accelerate cost effective uptake of innovations.

Its key aims are to improve care and outcomes by giving patients quicker access to new treatment and improve the longer-term affordability of the product pipeline. The Review published an interim report in October 2015 and will make further recommendations to Government by April 2016.

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2016-02-29.

To ask Her Majesty’s Government whether the Rapid Review Panel process can be extended to medical device technology, and if not, why not.

Lord Prior of Brampton

The Rapid Review Panel’s (RRP) primary remit is the evaluation of products for potential use in the National Health Service, to support claims of improved efficiency or efficacy of infection prevention and control interventions i.e. products that could reduce healthcare associated infections. The RRP, however, does not have the remit to regulate the safety of therapeutic products such as medical devices.

Due to the requirements of safety assurance and regulation of therapeutic products, which are verified through Notified Bodies applying a Conformité Européenne (CE) marking, medical device technology falls within the remit of the Medicines and Healthcare products Regulatory Agency (MHRA). The MHRA’s Innovation Office is set up to assist companies in the regulation of novel medical devices.