Tag: Lord Hunt of Kings Heath

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2015-10-29.

To ask Her Majesty’s Government who are the members of, and what are the terms of reference for, the Department of Health’s Appraisal Alignment Working Group.

Lord Prior of Brampton

The current membership of the Appraisal Alignment Working Group is as follows:

Department of Health

Keith Derbyshire (Chair) Chief Analyst and Chief Economist

Danny Palnoch Senior Economic Adviser

Peter Bennett Senior Operational Research Scientist

Dr Mark Bale Deputy Chief Medical Officer

National Institute for Health and Care Excellence

Leeza Osipenko Associate Director

Meindert Boysen Associate Director

Public Health England

Prof Brian Ferguson Director for Knowledge & Intelligence

Dr Anne Mackie Director of Screening

Monitor

John Curnow Economics Project Director

Zephan Trent Impact Assessment Lead

NHS England

Dr Donald Franklin Senior Economic Adviser NHS England

Amy Lee Economic Advisor

Brunel University

Prof Martin Buxton Emeritus Professor of Health Economics

London School of Hygiene & Tropical Medicine Representing Joint Committee for Vaccines and Immunisations and Safety of Blood Tissues and Organs

Prof John Cairns Professor of Health Economics

The current Terms of Reference (agreed with ministers in February 2014) is replicated below:

Appraisal Alignment Working Group [AAWG] Terms of Reference & Objectives

The Appraisal Alignment Working Group (AAWG) is comprised of policy and analytic staff who work in, or give advice to, DH and its ALBs on the cost-benefit and cost-effectiveness of programmes, technologies and policies.

The purpose of the group is to share knowledge on the various techniques employed across the Health and Care sector, to discuss and debate the pros and cons of different approaches employed, to consider ways of rendering results comparable, and to understand the reasons for differences in approaches.

The working group is not a decision making body. Rather it is advisory. Individual members representing different organisations will take back recommendations and questions to their parent bodies for consideration.

It is proposed to have meetings every six to eight weeks to achieve the ‘Must Do’ (e.g. primary) objective described below.

The ‘Must Do’

Before the next Spending Review, (pencilled in for June to October 2015), it is essential the Department of Health (DH) and its Arm’s Length Bodies (ALBs) can present a consistent approach o HM Treasury (HMT) on the cost benefit of different programmes (e.g. vaccinations, screening new technologies). The cost benefit case for spending presented to HMT should follow public sector best practice as set out by HMT, in its Green Book. Therefore results of appraisals need to be capable of being expressed in HMT Green Book methodology terms (ie using the Green Book methodology as a “reference case”).

Having successfully achieved that, the Working Group will take stock and decide if the group (or some other forum) should continue and progress on three desiderata:

1. economic justification for methods employed in each area and clear rationale for when methods differ and/or diverge from HMT’s Green Book.
2. achieve greater alignment of techniques between the different sectors and organisations
3. serve as an expert panel to advise on the development and application of new techniques on an on-going basis.

This work would be less time critical and could be pursued by meetings every eight to twelve weeks.

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2015-11-10.

To ask Her Majesty’s Government how they will ensure that NHS Improvement ring-fences its activities in relation to NHS Foundation Trusts in order to fulfil statutory provisions, in particular those in the Health and Social Care Act 2012.

Lord Prior of Brampton

NHS Improvement will bring together Monitor, the NHS Trust Development Authority, and patient safety and improvement functions from across the health system, under a single leadership and operating model. These arrangements will not change the current statutory duties of Monitor or any of the other bodies involved.

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2015-11-19.

To ask Her Majesty’s Government what assessment they have made of the potential savings to the budgets of Clinical Commissioning Groups from the use of the drug bevacizumab in the treatment of age-related macular degeneration instead of ranibizumab.

Lord Prior of Brampton

No assessment of the potential savings to clinical commissioning group budgets has been made as there are two other effective licensed treatments for wet age-related macular degeneration recommended by the National Institute for Health and Care Excellence.

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2015-12-02.

To ask Her Majesty’s Government what action can be taken by a local authority or a successful provider when a contractor appointed to enable a local healthwatch to be established and run does not respect the distinction between its role and the local healthwatch organisation being run by that provider.

Lord Prior of Brampton

Local authorities are responsible for making contractual arrangements for local Healthwatch statutory activities to be delivered in their area. As commissioners of the service, we expect local authorities to manage their contracts in order to ensure the local Healthwatch is able to operate effectively.

The Local Government Association has published guidance to support local Healthwatch and local commissioners to put in place good governance arrangements, which includes clarity about the roles of all parties involved. A copy has been attached.

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2015-12-22.

To ask Her Majesty’s Government whether educational and patient-orientated organisations were involved in the planning of the NHS Supply Chain generic project plans for a national formulary for wound care.

Lord Prior of Brampton

The Clinical Specification Working Group has academic representation on the group from England and Wales. Patient orientated organisations may be involved, as appropriate, at an evaluation stage though they have not engaged with them at this point.

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2016-01-11.

To ask Her Majesty’s Government what are the membership and terms of reference of the investigation commissioned by NHS England into the circumstances leading up to the termination of the contract between Cambridgeshire and Peterborough Clinical Commissioning Group and UnitingCare Partnership to deliver urgent care for the over-65s and adult community services.

Lord Prior of Brampton

NHS England advises that it has commissioned David Stout OBE to carry out an independent review of the contract between Cambridgeshire and Peterborough Clinical Commissioning Group and UnitingCare Partnership. The terms of reference are to establish, from a commissioner perspective, the key facts and root causes behind the termination of the contract in December 2015 and to draw out recommendations and lessons to be learned. This will include a review of documentation and discussion with staff members.

Relevant individuals will be contacted during the course of the review to inform the findings. NHS England is also setting up a web page which will include an email address where comments and responses can be submitted. This will enable the public to contribute.

The review is expected to start in January and to be completed in February 2016. NHS England plans to publish the review when complete.

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2016-01-19.

To ask Her Majesty’s Government, in the light of the planned replacement of student bursaries by loans, what estimate they have made of the number of additional students who will be accepted into universities for nursing degree courses in 2017–18.

Baroness Evans of Bowes Park

We expect this reform to enable universities to provide up to 10,000 additional nursing, midwifery and allied health training places over this parliament.

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2016-02-01.

To ask Her Majesty’s Government whether the NHS Low Income Scheme refers to personal income or family income with regard to university students.

Lord Prior of Brampton

The NHS Low Income Scheme provides income-related help with health costs to students, as for all other adults.

The extent of any help is based on a comparison between a person’s weekly income and requirements at the date they apply to the NHS Low Income Scheme. For a student, income will include any maintenance grant or loan available, the assessment of which may be based on parental income, and the amount of parental contribution assessed by an education authority as payable. Any other income a student may have, such as non-assessed contributions from parents or earnings, will also be taken into account in calculating entitlement. Bursaries will not be included so long as they are clearly not intended for day to day living expenses.

The below Parliamentary question was asked by Lord Hunt of Kings Heath on 2016-02-08.

To ask Her Majesty’s Government why beauty clinics undertaking nail care are not required to use autoclaves to sterilise their equipment to prevent fungal infections.

Baroness Altmann

The Control of Substances Hazardous to Health Regulations 2002 require businesses offering beauty treatments to ensure that any risks to their client’s health from exposure to hazardous substances including micro-organisms, are prevented or effectively controlled. The duty extends to preventing or controlling client’s exposure to the risk of contracting fungal infections. The regulations do not prescribe what specific control measures are necessary. These will be based on the type of treatment carried out and the risks of cross-infection.

Where sterilisation is required, autoclaves are the most effective and efficient means to do so, and should be used especially for packaged items and items which have hollow parts or cavities. However alternative methods such as steam sterilisers and disinfectants can be used for simple items such as tweezers.

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.