Asked by: Baroness Suttie (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether latent tuberculosis infection screening is incorporated into routine medical checks at immigration centres.
Answered by Lord Prior of Brampton
People admitted to immigration removal centres (IRCs) are not currently screened for latent tuberculosis infection (LTBI). However, a national partnership agreement between Home Office Immigration Enforcement (HOIE), NHS England and Public Health England (PHE) published in April 2015 committed all three organisations to work together to improve the pro-active detection, surveillance and management of infectious diseases in IRCs and improve capability to detect and respond to outbreaks and incidents. A copy of the ‘Partnership Agreement between Home Office Immigration Enforcement, NHS England & Public Health England’ is available at the following link and is attached.
A working group on LTBI among detainees in IRCs is being established this summer by PHE (health and justice, travel and migrant health and tuberculosis (TB) sections) to explore these issues. This work will contribute to the overarching joint PHE and NHS five year TB strategy for England which was published in January 2015. A copy of ‘Collaborative Tuberculosis Strategy for England, 2015-2020’ is available at the following link and is attached.
https://www.gov.uk/government/publications/collaborative-tuberculosis-strategy-for-england.
Included among several identified areas for priority action are: tackling TB in under-served populations (including migrants and those in secure and detained settings) and systematic implementation of new entrant LTBI screening.
PHE will work to provide expert advice to NHS England and HOIE on how to implement LTBI screening in IRCs once this work has been completed.
Asked by: Baroness Suttie (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what estimate they have made of the annual cost of diabetes-related depression to the National Health Service.
Answered by Lord Prior of Brampton
The Department has not made any estimate of the annual cost of diabetes-related depression to the National Health Service.
The National Institute for Health and Care Excellence (NICE) has estimated that approximately 15–25% of people with chronic physical health problems, such as diabetes, also meet diagnostic criteria for depression. This is reflected in NICE’s Diabetes in adults quality standard, which sets out that people with diabetes should be assessed for psychological problems which should then be managed appropriately. A copy is attached.
Asked by: Baroness Suttie (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether records are kept on the proportion of new arrivals at immigration centres who have communicable diseases.
Answered by Lord Prior of Brampton
Healthcare in Immigration Removal Centres (IRCs) in England is commissioned by NHS England.
Each of the IRCs has a primary healthcare service provided on site. The range of healthcare provision typically available includes initial health screening and risk assessment, including routine treatment of evident infection and active case finding for diseases commonly found among detainees including pulmonary tuberculosis, blood-borne viruses and sexually transmitted infections (if indicated by the initial assessment).
IRCs currently operate under the Detention Centre Rules and Operating Standards for the purposes of health screening and access to a general practitioner (GP) targets for initial healthcare screening and assessment which means all detainees to be seen by a nurse for an initial health assessment within 2 hours of admission and to be seen by a GP within 24 hours of admission (which may vary on assessment by competent nurse). Any health problems identified, tests or treatments prescribed and their outcomes are recorded on computerised health informatics systems in IRCs (e.g. SystmOne) and information can be shared between prisons and IRCs.
IRCs, like prisons, are required to notify Public Heath England Centres’ Health Protection Teams of cases or outbreaks of reportable diseases. This information is collated at national level by the Health & Justice Team.
Asked by: Baroness Suttie (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what emotional and psychological support is available for people with both diabetes and depression.
Answered by Lord Prior of Brampton
The National Institute for Health and Care Excellence guidance, Diabetes in adults quality standard, sets out that people with diabetes should be assessed for psychological problems which should then be managed appropriately.
Talking therapies, provided through the Improving Access to Psychological Therapies programme, are increasing access to appropriate, evidence based services for people suffering from depression and other mental health problems.
Asked by: Baroness Suttie (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government, in the light of the recommendations of the most recent collaborative tuberculosis strategy for England, what criteria they plan to use to determine who should be screened and treated for latent tuberculosis.
Answered by Lord Prior of Brampton
When implemented, the systematic latent tuberculosis infection (LTBI) testing and treatment programme for recent migrants will have the following eligibility criteria:
a) Born or spent more than six months in high TB incidence country (150 cases per 100,000 or more/Sub-Saharan Africa);
b) Entered the United Kingdom within the last five years (including where entry was via other countries (e.g within European Union/European Economic Area);
c) Aged 16-35 years;
d) No history of TB either treated or untreated; and
e) Never screened for TB in UK.
In addition to this, The National Institute for Health and Care Excellence recommends LTBI testing for other groups at higher risk of infection, such as close contacts of active TB cases or individuals who are immunocompromised. The decision to screen and treat these persons is usually made on an individual patient basis and funding is available through local arrangements.
Asked by: Baroness Suttie (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government, in the light of the recommendations of the most recent collaborative tuberculosis strategy for England, whether they have put in place provisions for screening and treating latent tuberculosis in vulnerable and marginalised groups.
Answered by Lord Prior of Brampton
The Collaborative Tuberculosis (TB) Strategy for England, which is attached, recommends ten key areas of action, including tackling TB in underserved groups and to systematically implement new entrant latent TB screening. The systematic screening and treatment of individuals with latent tuberculosis infection (LTBI) is therefore expected to significantly decrease the incidence of TB in England. LTBI screening for new entrants from TB high incidence areas is an effective and cost effective public health intervention1 and is recommended by the National Institute for Health and Care Excellence (NICE). The NICE Tuberculosis guideline is attached.
LTBI testing and treatment for other vulnerable groups, such as prisoners and substance abusers is more complex and requires an individualised patient-centred approach to ensure arrangements to assist with subsequent treatment completion are robust. Whilst the Collaborative Strategy supports current NICE recommendations, including the expansion of active case finding and available support for these underserved populations, arrangements for LTBI testing among these groups will be a carefully balanced decision for local health services.
Notes:
Asked by: Baroness Suttie (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what assessment they have made of the recommendations contained in the McKinsey Global Institute's report <i>Overcoming obesity: an initial economic analysis</i>; and in particular whether they intend to take a stronger approach towards reformulation, labelling, and marketing practices, in the light of the report's findings.
Answered by Earl Howe - Shadow Deputy Leader of the House of Lords
McKinsey Global Institute's report Overcoming obesity: an initial economic analysis reminds us how costly obesity is, not just to the individual, but also to the global economy. As the report makes clear there is no single solution that will fix the problem, but in the United Kingdom, we are moving in the right direction with obesity rates levelling off.
Through our voluntary partnership with industry we are working with the food and drink industry to help people make healthier choices. Some of our biggest supermarkets and food manufacturers have made commitments to help people cut their calorie consumption through reformulation, portion size reductions and promoting healthier options. We are the first country in Europe to introduce a voluntary front of pack nutrition labelling scheme. Businesses that have committed to use this scheme account for nearly two-thirds of all food sold in the UK.
Asked by: Baroness Suttie (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government when the review of the National Peer Review Programme's priorities will be reported; and what plans there are to continue that programme's review of children and young people's paediatric diabetes services in 2015 and 2016.
Answered by Earl Howe - Shadow Deputy Leader of the House of Lords
We are advised that NHS England is currently reviewing the national peer review programme with a view to considering how its success might be extended into other new areas of specialised commissioning.
Regardless of the outcome of this review, cancer peer review will continue to play a critical part of any broader peer review programme NHS England may look to introduce. NHS England is currently building co-commissioning arrangements with Clinical Commissioning Groups and future programmes of work could be agreed - these may include Paediatric Diabetes.
Asked by: Baroness Suttie (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what plans they have to implement a national outreach service for diseases such as tuberculosis, HIV and diabetes for areas with high health inequalities.
Answered by Earl Howe - Shadow Deputy Leader of the House of Lords
The Department through NHS England has a legal duty to have regard to reducing health inequalities and this will be reflected in any assessment for the potential development of national services.
Diagnosing, treating and preventing transmission of TB among under-served groups will prevent transmission of infection to the wider population and reduce health and social inequalities. Public Health England and NHS England will launch the Collaborative TB Strategy for England 2015-2020 this year. The strategy sets out the improvements that need to be achieved across 10 key evidence based areas of action to reduce TB in England, and the mechanisms by which these should be delivered. One of the key evidence based areas of action is to reduce incidence of TB in under-served populations by providing specific and targeted outreach interventions (informed by proven models such as “Find & Treat” in London). These include specific services for active case finding for TB of the lungs among homeless people and those attending substance misuse services, use of mobile X-ray units (MXUs) with incentives for people to have chest X-rays, enhanced case management and return to service interventions to prevent loss to follow up.
There are a number of actions being taken to improve access to HIV testing and reduce late diagnosis, especially in areas with high inequalities. These include the Terrence Higgins Trust to manage a national HIV Prevention Contract which the Department funds; information PHE publishes on rates of late HIV diagnoses by LA, socio-demography, and risk group; and joint PHE and DH approaches to increase HIV testing through funding a national home-sampling service that resulted in a large number of the most at-risk getting tested for HIV.
Clinical commissioning groups are responsible for commissioning diabetes services, so they would decide, depending on local needs and circumstances, whether an outreach service was appropriate. The NHS Health Check plays an important role in reducing the risk of diabetes and identifying people earlier who have the disease and plays a key role in tackling health inequalities.
Asked by: Baroness Suttie (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what is their assessment of the impact of the provision of housing on treatment completion for vulnerable populations in the United Kingdom suffering from (1) hepatitis B, and (2) hepatitis C.
Answered by Earl Howe - Shadow Deputy Leader of the House of Lords
Public Health England has not made any formal assessment of the impact of the provision of housing on treatment completion for vulnerable populations in the United Kingdom suffering from hepatitis B, and hepatitis C.
Our estimates of the prevalence of chronic hepatitis B and C infection in the UK population are 180,0001 and 214,000[2] respectively.
Studies of hepatitis B and C in the UK homeless population are limited but a recent survey of people who inject drugs found that those who had ever been homeless were more likely to have antibodies against hepatitis C (42%) than those that were in stable accommodation (34%)3.
Notes:
[1]Department of Health. (2002a) Getting ahead of the curve: a strategy for combating infectious diseases (including other aspects of health protection). A report by the Chief Medical Officer.London
2Hepatitis C in the UK, Annual Report 2014 Public Health England.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/337115/HCV_in_the_UK_2014_24_July.pdf
3Health Protection Agency, Health Protection Scotland, National Public Health Service for Wales, CDSC Northern Ireland, CRDHB. Shooting Up: Infections among injecting drug users in the United Kingdom 2008. London: Health Protection Agency, October 2009.