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The below Parliamentary question was asked by Lord Ouseley on 2015-11-18.

To ask Her Majesty’s Government what consideration they are giving to relaxing visa restrictions for those seeking to come to Britain as carers in order tackle nursing and care home staffing shortages.

Lord Bates

Tier 2 of the Points Based System for immigration – the skilled work route – has been reserved for graduate occupations since 2011. Carers do not qualify for entry to the UK under this route and sponsors are therefore unable to bring in workers from outside the EEA to fill such roles.

While the Government acknowledges that care work requires certain skills, it should be possible to source those skills from the resident workforce. The care sector, like others, needs to reduce its dependency on migration and develop a sustainable strategy for tackling high vacancy and turnover rates by doing more to attract, train and retain resident workers.

The below Parliamentary question was asked by Lord Ouseley on 2015-11-18.

To ask Her Majesty’s Government what action they are taking to increase the proportion of people with atrial fibrillation who are treated with anticoagulation therapy in order to prevent stroke.

Lord Prior of Brampton

NHS England has identified improved management of atrial fibrillation as a priority for reducing premature mortality.

NHS Improving Quality (NHS IQ) is taking action on atrial fibrillation. It is promoting the use of GRASP-AF (Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation) within GP practices in England. GRASP-AF is an audit tool developed by and trialled in the NHS, which greatly simplifies the process of identifying patients with atrial fibrillation who are not receiving the right management to help reduce their risk of stroke. NHS IQ is currently collaborating with partner organisations, including charities, to support the nationwide roll-out of GRASP-AF.

To support this work, NHS IQ recently published an analysis of the costs and benefits of using the anticoagulant drug warfarin to help prevent stroke in people with AF. A copy of this analysis is attached.

The National Institute for Health and Care Excellence (NICE) also published a Quality Standard on atrial fibrillation in July 2015, which sets out what a high quality atrial fibrillation service should look like and will help drive improvement locally. A copy is attached. The Quality and Outcomes Framework contains indicators for the management of AF which cover the use of anticoagulation therapy. This provides a further incentive for doctors to ensure AF patients receive anticoagulation where appropriate to manage their risk of stroke.

Public Health England (PHE) has recently published their Atlas of Variation which includes data on atrial fibrillation. Full data for all 216 clinical commissioning groups (CCGs) cannot be included in this reply due to its large size, but a map giving an overview of the results is attached. PHE have also collaborated with the Stroke Association to produce individualised CCG level reports on current performance in the detection and management of patients with atrial fibrillation to try and encourage poorly performing areas to improve.

The majority of the Strategic Clinical Networks (SCNs) have made atrial fibrillation management a priority, and in London the three Academic Health Science Networks and the SCN have identified atrial fibrillation as being the first area where there is a collaborative effort to improve performance.

One of the options now available for clinicians managing patients with atrial fibrillation is the novel oral anticoagulants. These drugs are useful when patients are unable or unwilling to tolerate warfarin and should result in a greater proportion of the population with atrial fibrillation being effectively treated. Additionally, NICE have now approved the use of devices to self-monitor warfarin, reducing the need for patients to attend health centres for blood testing. Again this should make anticoagulation easier and more acceptable for some patients.

The below Parliamentary question was asked by Lord Ouseley on 2015-11-18.

To ask Her Majesty’s Government, further to the Written Answer by Lord Prior of Brampton on 12 November (HL3373), what they intend to do to prevent discriminatory treatment of BME mental health patients, and what assessment they have made of the implications of discriminatory treatment for patients in mental health wards.

Lord Prior of Brampton

We are aware that people from black and minority ethnic (BME) groups often report poorer experiences of mental health services and there is some evidence of people from BME groups experiencing ethnic discrimination in how services are delivered by not ensuring equitable access or meeting diverse cultural needs.

The Human Rights Act 1998 and the Equality Act 2010 make it clear that people should not be discriminated against on the grounds of race or mental impairment. People with mental impairments are included within the groups of people with Protected Characteristics within the Equality Act 2010.

The Mental Health Act 1983 Code of Practice makes it clear that decisions relating to people detained under the Act should be lawful and in accordance with the requirements of the Human Rights Act 1998 and the Equality Act 2010.

The Department established the Mental Health Equalities Working Group (EWG) in 2013 to advise on equality and human rights issues, including BME issues.

The Joint Commissioning Panel published guidance in 2014, Guidance for commissioners of mental health services for people from black and minority ethnic communities, which set out 10 key messages for commissioners to improve services. A copy of the guidance is attached.

The Coalition Government published Closing the Gap: priorities for essential change in mental health in 2014, which included a specific action to tackle inequalities around access to mental health services and we continue to work to achieving that action. A copy of this document is attached.

The Department commissioned the Mental Health Providers’ Forum and the Race Equality Foundation to gather and review evidence of effective mental health services for BME groups, which was published this year. The report, Better practice in mental health for black and minority ethnic communities, found that organisations that were successful in providing mental health services that meet the needs of BME groups had developed local community-based approaches to service delivery which addressed cultural and linguistic differences and sought to actively engage hard to reach groups. A copy of this report is attached.

NHS England is also working with a number of BME groups and community leaders to raise awareness, reduce barriers and improve the uptake of Improving Access to Psychological Therapies (IAPT) to all sections of the community. We are also working with the National Health Service and commissioners to disseminate guidance and good practice of what good mental health services for BME communities look like.