Asked by: Baroness Randerson (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what is the estimated prevalence of hepatitis C in England broken down by (1) local authority, and (2) Operational Delivery Network.
Answered by Lord O'Shaughnessy
The data is not available in the format requested.
Asked by: Baroness Randerson (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government, further to the Written Answer by Lord Prior of Brampton on 21 November (HL3153), what plans they have to produce a national improvement framework for hepatitis C.
Answered by Lord O'Shaughnessy
The United Kingdom has a comprehensive surveillance system in place combining laboratory diagnoses data, risk behaviour data, outcome data, statistical modelling and service evaluation. This enables the health and social care system to monitor the cascade of care (the pathway for testing and diagnosis to contact with health services through to treatment and outcomes), detect outbreaks, and generate burden estimates. Prevention efforts in minimising harm to people who inject drugs are focused on increasing access to opiate substitution therapies and needle syringe exchange programmes, and the use of disinfection tablets in prisons. NHS England leads on treatment and continues to support National Health Service-led Operational Delivery Networks to provide National Institute for Health and Care Excellence approved treatments for hepatitis C.
Public Health England supports the Government’s efforts by publishing hepatitis C metrics which are available in the report Hepatitis C in the UK 2016 report: Working towards its elimination as a major public health threat. A copy of the report is attached.
Asked by: Baroness Randerson (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether the NHS Commercial Medicines Unit has procured a new Hepatitis C treatment in the last 12 months; and if so, what was the cost.
Answered by Lord O'Shaughnessy
The Department’s Commercial Medicines Unit has continued to procure medicines for hepatitis C as part of a nationally agreed programme, established in 2015, which establishes framework agreements.
The Unit undertakes a six-monthly rolling regional tender programme on behalf of National Health Service trusts in England, which includes all the new hepatitis C medicines on the market at the time of tendering. Regional annual framework agreements are then established for use by NHS trusts.
The costs associated with the regional tender programme are not separately identifiable.
Asked by: Baroness Randerson (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether NHS England intends to reassess the cap on new Hepatitis C treatments for patients; and if not, why not.
Answered by Lord O'Shaughnessy
The guidance issued by the National Institute for Health and Care Excellence (NICE) in relation to new direct acting antivirals specifically requires Operational Delivery Networks (ODNs) to prioritise hepatitis C patients on the basis of highest unmet clinical need. NHS England’s commitment to treat 10,000 patients in 2016-17, increasing to 12,500 in 2017-18 and rising to 15,000 in 2021 is in line with NICE’s estimate of activity included in the costing tools published to support implementation of the guidance. Each ODN has a number of treatment slots available each month to treat eligible patients. This is known as the monthly treatment run rate, and it ensures the expansion of treatment takes place equitably across the country.
The High Court has considered NHS England’s approach. Its judgement in September 2016 stated “a monthly run rate is not an arbitrary cap but a legitimate way of giving effect to the guidance”.
The planning approach for hepatitis C is set out in the NICE Technological Appraisals 363, 364 and 365.
Asked by: Baroness Randerson (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government how many people they estimate will need to receive hepatitis C treatment in England over the next 13 years in order to achieve the World Health Organisation's goal of eliminating hepatitis C by 2030.
Answered by Lord O'Shaughnessy
The World Health Organization (WHO) Global Health Sector Strategy on Viral Hepatitis 2016-21 proposes milestones and targets to achieve the aim of eliminating hepatitis C as a major public health threat. The WHO’s strategy highlights the role of prevention activities, including blood safety, safe injections, and harm reduction interventions among people who inject drugs. The strategy also sets a 2030 target that 80% of eligible persons with chronic hepatitis C are treated. A copy of the strategy is attached. An estimated 160,000 persons are currently infected with hepatitis C in England, many of whom are not yet diagnosed.
Asked by: Baroness Randerson (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government how many people in England have purchased hepatitis C treatments online and are currently being monitored by the NHS.
Answered by Lord O'Shaughnessy
Information on treatments prescribed and purchased privately online is not collected.
Asked by: Baroness Randerson (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government, in the light of the UK's commitment to the elimination of viral hepatitis C by 2030 made at the World Health Organisation in May, what measures they are putting in place to achieve this aim in England, and whether they will reconsider the case for a national improvement framework for hepatitis C.
Answered by Lord Prior of Brampton
Several key measures contribute to the United Kingdom’s efforts to achieve the aims of the global strategy, including the national programme of screening of blood donors and blood transfusions for blood-borne viruses to ensure safe supplies. 100% of blood donors are screened with quality assured methods, and national guidance and legislation around infection control in healthcare settings includes a policy for healthcare workers to prevent nosocomial transmission of blood-borne viruses. Prevention efforts focus on minimising harm in people who inject drugs through access to opiate substitution therapies and needle syringe exchange programmes, with National Institute for Health and Care Excellence (NICE) guidance Needle and syringe programmes, 2014 to support these interventions. NICE guidance Hepatitis B and C testing: people at risk of infection, 2012 has also been published to improve uptake of testing for hepatitis C in various settings. Copies of both publications are attached.
While treatment coverage has been historically low, in 2015, approximately 8000 people infected with hepatitis C were estimated to be treated, an increase of around 40% on the previous year which may reflect improved access to and acceptability of treatments, including the new Direct Acting Antivirals.
Public Health England has published hepatitis C metrics for the report Hepatitis C in the UK 2016 report - Working towards its elimination as a major public health threat. A copy of this report is attached.
Asked by: Baroness Randerson (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether NHS England has undertaken procurement exercises in relation to hepatitis C medicines which have enabled those medicines to be obtained at a lower cost than the cost used for the purposes of appraisal by the National Institute for Health and Care Excellence.
Answered by Lord Prior of Brampton
The Department’s Commercial Medicines Unit (DHCMU), rather than NHS England, is responsible for medicines procurement in secondary care.
DHCMU manages, on behalf of the National Health Service in secondary care, a tender process which establishes price framework agreements for hepatitis C medicines. This programme commenced in August 2015 and has resulted in ongoing price reductions. The six-monthly rolling regional tender programme undertaken on behalf of NHS trusts in England has continued to exert a downward pressure on the prices paid (costs) for the new oral hepatitis C medicines.
The evaluation of hepatitis C products by the National Institute for Health and Care Excellence (NICE) is completely separate to the DHCMU tender process. In developing its guidance on several hepatitis C drugs, NICE took into account prices that had been agreed by the DHCMU at the time its guidance was being developed, as the companies provided this information as part their evidence submissions to NICE.
In common with other medicines, where new competing products become available, procurements managed by the DHCMU may secure reduced prices in the years following NICE’s decisions. As with other medicines, NHS England has taken account of the prices DHCMU procurements achieve for hepatitis C medicines to inform the additional investment required in meeting its commitments to roll out the new treatments.
Asked by: Baroness Randerson (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether they provide a lower level of support for the surviving partners of those infected by hepatitis C through contaminated blood, compared to the surviving partners of those infected by HIV or co-infected, and if so, why.
Answered by Lord Prior of Brampton
Under the reformed ex-gratia payment scheme for infected blood announced on 13 July 2016, the partner/spouse at the time of death of a primary beneficiary will be entitled to a £10,000 one-off lump sum where HIV or hepatitis C infection contributed to the death of their partner/spouse. This will apply to those already bereaved, provided they register before the end of this financial year. Anyone newly bereaved from this year will automatically receive the lump sum. Discretionary support, in an enhanced form from financial year 2018/19, will continue to be available to all bereaved partners/spouses.
Asked by: Baroness Randerson (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what guidance they have issued to ensure that HIV clinics also test patients annually for hepatitis C.
Answered by Lord Prior of Brampton
In February 2014 the British Association for Sexual Health and HIV (BASSH) convened an expert working group, including representation from Public Health England, to formally review evidence and produce Recommendations for testing for sexually transmitted infections (STIs) men who have sex with men (MSM). The recommendations are attached.
The National Institute for Health and Care Excellence has also published Hepatitis B and C testing - people at risk of infection, recommending testing to all services users at increased risk of infection. A copy of the guidance is attached.