Asked by: Lord Hunt of Chesterton (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what steps they are taking to ensure (1) UK residents, and (2) medical organisations are aware of the guidance that has been issued on access to medicine in the case of a no-deal Brexit.
Answered by Baroness Blackwood of North Oxford
The Department has been working closely with the National Health Service, pharmaceutical companies and others in supply chains to make sure medicines continue to be available for the NHS, if the United Kingdom leaves the European Union without a deal.
The Department and NHS England published guidance on their websites for patients, including the online only policy paper, Getting Medication, on 18 January 2019. We have also been engaging with patient groups, trade associations and health care providers about messaging regarding access to medicines in a ‘no deal’ scenario.
The Department has issued guidance to all NHS trusts, pharmacies and general practices informing them of the Government’s plans for ensuring continuity of supply of medicines and advising them that they can expect to be able to continue accessing medicines through their existing supply routes in the event of a ‘no deal’ EU exit on 29 March. This guidance explained how hospitals, general practitioners and community pharmacies throughout the UK do not need to take any steps to stockpile additional medicines, beyond their business as usual stock levels. There is also no need for clinicians to write NHS prescriptions for larger quantities of medicines than usual. A copy of the Department’s letter of 7 December 2018 to the NHS in England is attached.
Asked by: Lord Hunt of Chesterton (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government whether, and if so how, they will maintain the use of (1) handicrafts, and (2) gardening as occupational therapy interventions for patients recovering from treatment in NHS England hospitals.
Answered by Baroness Blackwood of North Oxford
Therapeutic interventions and group programmes for rehabilitation are expected features of rehabilitation for both mental health and physical conditions – handicrafts, as a therapeutic intervention to improve fine coordination, and gardening, and other patient appropriate activity, are recommended by both the National Institute for Health and Care Excellence and the Royal College of Occupational Therapists.
Although the two interventions are not specifically held above others in recovery, handicrafts and gardening are commonly used in therapeutic programmes funded by the National Health Service.
Asked by: Lord Hunt of Chesterton (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what advice they are providing to (1) UK residents, and (2) medical organisations about how to access medicines from the EU in the UK.
Answered by Baroness Blackwood of North Oxford
It is a priority of the Department to ensure patients continue to have access to medicines as we leave the European Union, in all exit scenarios.
While a Withdrawal Agreement has been agreed between Government and the European Commission, as a responsible Government, we continue to prepare proportionately for all scenarios, including the outcome that we leave the European Union without a deal in March 2019.
The Department has issued guidance on 7 December 2018 to all National Health Service trusts, pharmacies and general practices informing them of our plans for ensuring continuity of supply of medicines and advising them that they can expect to be able to continue accessing medicines through their existing supply routes in the event of a ‘no deal’ EU exit on 29 March 2019. This guidance explained how hospitals, general practitioners and community pharmacies throughout the UK do not need to take any steps to stockpile additional medicines, beyond their business as usual stock levels. There is also no need for clinicians to write longer NHS prescriptions. A copy of the Department’s letter of 7 December to the NHS in England is attached.
NHS England and the devolved administrations have also communicated similar messages to the front line and patients have also been advised not to stockpile medicines. Unnecessary local stockpiling would increase pressure on the medicines supply chain and could lead to avoidable shortages and subsequent risks to patients.
Asked by: Lord Hunt of Chesterton (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what assessment they have made of the number of hours worked by GPs in the NHS; whether working hours are increasing; whether they intend to limit the number of hours worked; and what discussions they have had with doctors' organisations about GPs' working hours.
Answered by Lord O'Shaughnessy
Based on responses to the GP Worklife Survey, the average weekly hours worked by general practitioners (GPs) in England has remained relatively stable since 2008, but increased slightly from 41.4 hours to 41.8 hours per week between 2015 and 2017.
The following table summarises statistics for average weekly hours worked by GPs from 2008 to 2017.
Year | Number of responses | Mean |
2008 | 634 | 42.1 |
2010 | 1,054 | 41.4 |
2012 | 1,112 | 41.7 |
2015 | 1,113 | 41.4 |
2017 | 869 | 41.8 |
The Department regularly meets with the Royal College of General Practitioners and representatives from the profession to discuss a range of issues, including the number of hours worked by GPs. GP contractors are required to provide essential and additional services within core hours in order to meet the reasonable needs of their patients. It is for the practice partners to agree the working hours of individual GPs within the practice.
Any changes to these arrangements will need to be negotiated between NHS England and the GPs’ representative body, the General Practitioners’ Committee of the British Medical Association.
The working hours for salaried GPs are set out in the salaried GP model terms and conditions of service. This defines full-time as 37.5 hours per week, and specifies that working hours should be carefully defined within a job plan.
Asked by: Lord Hunt of Chesterton (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government how cures and treatments in the NHS are being developed to reduce the danger in hospitals of anti-microbial resistance.
Answered by Lord O'Shaughnessy
The UK Antimicrobial Resistance (AMR) Strategy published in 2013 set out the key actions needed to tackle AMR: preventing infections, making appropriate use of the treatments available, and promoting the development of new treatments. In 2016 the government announced ambitions to halve healthcare-associated Gram-negative bloodstream infections and inappropriate prescribing of antimicrobials by 2020-2021. To promote the development of new drugs, diagnostics and alternative treatments we have established unprecedented levels of research collaboration, together with increased investment, including the £50 million Global AMR Innovation Fund. The Government is committed to working with the global finance and health community to develop a global system that rewards companies that develop new, successful antibiotics and make them available to all who need them.
Asked by: Lord Hunt of Chesterton (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what are the professional qualifications of the Care Quality Commissioners who inspect NHS general practitioners' practices; whether they are required to inspect the premises and the work in those practices and to meet patients, as well as inspecting written and IT procedures; and what assessment they have made of the costs of such inspections to general practices which are assessed to be operating satisfactorily.
Answered by Lord O'Shaughnessy
The Care Quality Commission’s (CQC) inspection teams for general practitioner (GP) practices will always include a GP who is on the General Medical Council GP register and may include other specialist inspectors, such as practice nurses and/or practice managers. All of the CQC’s inspectors must also have experience of the health and social care sector.
Detailed information regarding the scope of the CQC’s inspections of GP practices and the personnel involved can be found in the GP Provider handbook. A copy of the handbook, How CQC regulates: NHS GP practices and GP out-of-hours services Provider handbook, is attached. Inspections of GP practices usually involve one day on site. Lines of enquiry focus on whether services are safe, effective, caring, responsive and well-led. During the visit, the inspection team speak to both people who use the service and staff.
The calculations for the regulation of National Health Service GPs for 2016/17 indicated a cost of £37.6 million. £20.9 million of the 2016/17 costs was made up of registration fees with the remainder coming from Government funding. Fees are calculated and charged on the basis of the size of a GP practice based on locations or patient list size rather than any rating awarded after an inspection by the CQC. As a result, we are unable to extrapolate the cost of inspections based on any awarded ratings as this information is not centrally collated.
Asked by: Lord Hunt of Chesterton (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what actions they are taking to ensure that patients staying overnight in hospitals always have access to professional nursing support.
Answered by Lord O'Shaughnessy
Appropriate staffing levels are a core element of the Care Quality Commission’s (CQC) registration regime. All providers of regulated activities must be registered with the CQC and meet the registration requirements. The 16 safety and quality requirements include a requirement to take steps to ensure that there are sufficient numbers of suitably qualified, skilled and experienced staff employed at all times.
In July 2016, the National Quality Board published Supporting NHS providers to deliver the right staff, with the right skills, in the right place at the right time: Safe, sustainable and productive staffing. This safe staffing improvement resource provides an updated set of expectations for nursing and midwifery care staffing, to help National Health Service provider boards make local decisions that will support the delivery of high quality care for patients within the available staffing resource.
There are over 12,100 (7.5%) more nurses on our wards, acute, elderly and general, since May 2010.
A copy of Supporting NHS providers to deliver the right staff, with the right skills, in the right place at the right time: Safe, sustainable and productive staffing is attached.
Asked by: Lord Hunt of Chesterton (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what advice they have issued to pedestrians, cyclists and drivers in London and other major cities about the use of anti-pollution face masks.
Answered by Lord Prior of Brampton
No formal advice has been issued by Her Majesty’s Government to pedestrians, cyclists and drivers in London or other major cities about the use of face masks.
Asked by: Lord Hunt of Chesterton (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what is the current and planned trend for the reduction of (1) district nurses, (2) midwife services, and (3) meals on wheels to elderly and sick people in their homes; and how this is affecting the ability of National Health Service hospitals to return patients to their homes and community care.
Answered by Earl Howe - Shadow Deputy Leader of the House of Lords
The Government is committed to making real changes to the quality and availability of all NHS services and has no plans to reduce services in the areas specified.
The Department published Care in local communities: A new vision and model for district nursing, in January 2013, to provide best practice guidance to be used locally to support the provision of the district nursing services that make a real difference to the patient's experience of health and wellbeing. Community nursing teams are usually led by district nurses, and are made up of an appropriate skill mix to meet local needs and this includes specialist nurses and staff nurses, with support from healthcare assistants. Local areas are using a wider skill mix within their community nursing teams, including extending the role of health care support workers. To ensure an adequate supply of skilled district nurses in the future Health Education England has increased the number of training places for district nurses for 2015-16 by 16.5%.
The Government is committed to improving choice of place of birth, continuity of care and women’s experience of care. There are more than 1,900 full-time equivalent midwives than in May 2010 and a record number, in excess of 5,000 in training. Women can expect a range of choices over maternity services, as set out in the NHS Choice Framework for 2013-14, although these will depend on what is best for them and their baby, as well as what is available locally. Women can choose to receive antenatal care from a midwife or a team of maternity health professionals, including midwives and obstetricians. They can choose to give birth either at home, in a local midwifery facility or in hospital. Postnatal care can also be received at home or in a community setting, such as a Sure Start Children’s Centre.
Meals are provided by the 152 individual councils with adult social services responsibilities on the basis of assessed eligible need. Provision of social care services is a matter for local decision. The Department is unable to provide data on planned trends in provision. The Government has just issued a ring-fenced grant for £25 million to councils that have hard-pressed hospitals in their areas to facilitate faster discharge through additional reablement packages.
In addition, the Government has implemented a number of initiatives to minimise cases of hospital-delayed discharges. The Government has given a record £700 million this winter for 700 more doctors, nearly 4,500 more nurses and 5,000 more beds, including in social care and community settings. This money has been allocated through System Resilience Groups (SRGs), who bring together partners across the health and social care system, including acute and community providers and local authorities. Plans developed by SRGs before the funds were released, were required to include processes of good practice on reducing delayed discharges.
The vast majority of the £5.3 billion Better Care Fund, which begins on 1 April 2015, is being spent on social care and community health services. The aim is to encourage joint working between local authorities and the National Health Service to keep people out of hospital in the first place, as well as helping them to return home as soon as it is safe to do so. The national conditions in the Better Care Fund include the protection of social care and improvements in seven day working across health and social care to help quicker, more appropriate discharge from hospital. All plans must meet these conditions before being approved.