Asked by: Lord Turnberg (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 Health Foundation report <i>A Perfect Storm: an impossible climate for NHS Providers' Finances?</i> which reports a shortfall in NHS funding of £2.8 billion in 2015–16 and predicts a widening gap between demand and funding levels despite proposed efficiency savings.
Answered by Lord Prior of Brampton
The Government has listened and responded to what the NHS has said about the profile of investment it needs to deliver the Five Year Forward View, and that is why we are investing an additional £10 billion that the NHS has said it needs to implement its own plan for the future - with £6 billion frontloaded over 2015-16 and 2016-17.
For next year (2016-17) we have created the Sustainability and Transformation Fund that will give the NHS the resources it needs to transform and create sustainable services for years to come.
Delivering the Five Year Forward View, including proposed efficiencies, will put the NHS on a financially sustainable footing by enabling the NHS to live within its means, eliminating organisational deficits and ensuring a balanced NHS budget in each year. We are putting the right measures in place to help spend taxpayer’s money more efficiently, and reduce variation and waste.
Asked by: Lord Turnberg (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what proportion of the UK's GDP was spent on social care in each year between 1999 and 2015.
Answered by Lord Prior of Brampton
Expenditure on adult social care in England as a proportion of gross domestic product (GDP) is detailed in the table below. Expenditure data for the rest of the United Kingdom is not available.
Financial Year | UK GDP (£ billions) | England adult social care (£ billions) | Proportion of UK GDP on England's adult social care |
1999-2000 | 980 | 8.50 | 0.87% |
2000-01 | 1,040 | 9.05 | 0.87% |
2001-02 | 1,080 | 9.48 | 0.88% |
2002-03 | 1,140 | 10.30 | 0.90% |
2003-04 | 1,210 | 11.51 | 0.95% |
2004-05 | 1,270 | 12.62 | 0.99% |
2005-06 | 1,350 | 13.46 | 1.00% |
2006-07 | 1,430 | 13.98 | 0.98% |
2007-08 | 1,500 | 14.33 | 0.96% |
2008-09 | 1,500 | 15.08 | 1.01% |
2009-10 | 1,500 | 15.72 | 1.05% |
2010-11 | 1,570 | 16.06 | 1.02% |
2011-12 | 1,630 | 15.55 | 0.95% |
2012-13 | 1,680 | 15.35 | 0.91% |
2013-14 | 1,760 | 15.51 | 0.88% |
2014-15 | 1,830 | 15.51 | 0.85% |
2014-15 is the last year we have outturn data for spend on adult social care.
The cash terms figures and comparisons to GDP for gross spend on children and young people’s services in England, calculated from the Department for Education section 251 data returns are set out in the table below. Expenditure data for the rest of the UK is not available.
Financial Year | UK GDP (£ billions) | England children’s social care (£ billions) | Proportion of UK GDP on England's children’s social care |
2010-11 | 1,570 | 9.26 | 0.59% |
2011-12 | 1,630 | 8.65 | 0.53% |
2012-13 | 1,680 | 8.88 | 0.53% |
2013-14 | 1,760 | 8.99 | 0.51% |
2010-11 was the first time that national level income and expenditure data were presented in the form of a statistical release. To derive comparable figures for previous years would incur disproportionate cost.
Asked by: Lord Turnberg (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government when they expect NICE to publish its opinion about the availability of Translarna for the treatment of patients with Duchene Muscular Dystrophy, following its approval by the European Medicines Agency in July 2014.
Answered by Lord Prior of Brampton
The National Institute for Health and Care Excellence (NICE) is the independent body that provides guidance on the clinical and cost effectiveness of drugs and treatments. NICE is currently evaluating Translarna (ataluren) for the treatment of Duchenne muscular dystrophy through its highly specialised technology programme. NICE currently expects to publish its final guidance in February 2016.
The NHS in England is legally required to fund drugs and treatments recommended in NICE highly specialised technology guidance within three months of its final guidance being issued. In the absence of guidance from NICE, it is for commissioners to make decisions on whether to fund medicines based on an assessment of the available evidence.
Asked by: Lord Turnberg (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 impact of the proposed new contract for junior doctors on (1) their average salary and the number of doctors who will be financially disadvantaged, (2) the number of hours they will be expected to work to receive overtime benefits, (3) the number of hours per week they will be expected to work, and (4) the overall levels of patient care.
Answered by Lord Prior of Brampton
On 4 November, the Government published a firm offer for a new contract published by NHS Employers alongside a new calculator that offers specific information on how the new contract will impact doctors’ salary. On the same day, I issued a Written Ministerial Statement (HLWS282) in Parliament and the Secretary of State wrote directly to all junior doctors. The Government guaranteed that under the new contract:
‒ average pay will be maintained, and that the pay of all junior doctors working safe hours in the transition to the new contract would be protected and those junior doctors who could complete their training within four years will continue to be paid based on the existing contract. We want the British Medical Association to work with us on the detail and the Secretary of State for Health will be setting out the details of the Government’s offer to junior doctors in the coming days;
‒ basic pay will reflect a 40 hour week, and planned hours worked on top of this (up to a maximum of eight hours) will be paid proportionately i.e at the standard rate for the time of day worked;
‒ there will be a mutual contractual obligation on employers and trainees to respect the following limits on working hours:
o A maximum of 48 weekly hours on average (extended, but still limited, to 56 hours a week on average for those trainees who choose to opt- out of the Working Time Regulations);
o New maximum of 72 hours in any consecutive seven day period (lower than the 91 hours possible within average weekly hours of 48);
o No rostered shift to exceed 13 hours (excluding overnight on-call periods); and
o A new limit of no more than five consecutive long shifts (i.e. more than 10 hours); no more than four consecutive night shifts (where at least three hours fall between 11pm and 6am); and no more than seven consecutive days and nights on-call.
‒ introduce a safer, fairer contract for junior doctors that will help improve their training experience to better support patient care every day of the week.
The published contract offer to junior doctors and calculator is attached and can be found at:
http://www.nhsemployers.org/your-workforce/need-to-know/junior-doctors-contract
Asked by: Lord Turnberg (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what plans they have to provide alternative means of funding immuno-oncology treatments, while awaiting a decision by the National Institute for Health and Care Excellence in the light of the suspension of new applications to the Cancer Drugs Fund.
Answered by Lord Prior of Brampton
In the absence of guidance from the National Institute for Health and Care Excellence, it is for commissioners to make funding decisions on new drugs and treatments based on the available evidence.
Asked by: Lord Turnberg (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether NHS patients will be able to access Nivolumab on the Cancer Drugs Fund while the National Institute for Health and Care Excellence concludes single technology appraisals of the drug for the treatment of melanoma, non-squamous lung cancer and squamous lung cancer.
Answered by Lord Prior of Brampton
In the absence of guidance from the National Institute for Health and Care Excellence, it is for commissioners to make funding decisions on new drugs and treatments based on the available evidence.
Asked by: Lord Turnberg (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what factors were taken into account when deciding that the National Institute for Health and Care Excellence may only consider a medicine under its end of life criteria if it is indicated for fewer than 7,000 patients across all licensed indications.
Answered by Lord Prior of Brampton
The National Institute for Health and Care Excellence (NICE) is responsible for the methods it uses in the development of its technology appraisal guidance, including the criteria it considers in deciding whether to apply the flexibilities for the appraisal of life-extending drugs and treatments for patients at the end of their lives.
The supplementary advice to its Appraisal Committees on appraising life-extending, end of life treatments, published in 2009, explains the factors that NICE took into account in developing the criteria. It states that “In developing this supplementary advice, the Institute has taken account the Appraisal Committees’ previous decisions, together with the relevant principles in the guide to the use of Social Value Judgements. It has also had regard to the consideration given by the Citizens Council, at its meeting in November 2008, to the circumstances in which it might be appropriate to support the use of treatments outside the Institute’s cost per quality adjusted life years (QALY) threshold range”. A copy is attached and is available at:
NICE has advised that the definition of a small patient population as “normally not exceeding a cumulative total of 7,000 for all licensed indications in England” was originally based on an estimate of the annual number of deaths in England from rarer terminal cancers, obtained by NICE in 2008.
Asked by: Lord Turnberg (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether they will make Translama available for the treatment of NHS patients with Duchenne muscular dystrophy as a matter of urgency.
Answered by Lord Prior of Brampton
NHS England published its investment decisions for certain specialised services on 2 July 2015.
NHS England has agreed with the recommendations from NHS England’s Clinical Priorities Advisory Group that a final funding decision on Ataluren (Translarna) for Duchenne muscular dystrophy should be made after the National Institute for Health and Care Excellence (NICE) has concluded its Highly Specialised Technology Appraisal process.
NICE is expected to produce draft guidance on Ataluren (Translarna) in October, with final guidance to follow shortly after. The European medicines regulator has also asked the manufacturer to undertake further studies of the treatment for completion in October.
There is also a process which allows for the consideration of critically clinically urgent cases falling outside of routine commissioned provision.
Asked by: Lord Turnberg (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what discussions they have had with the pharmaceutical industry about the costs of new treatments for cancer and rare diseases.
Answered by Lord Prior of Brampton
Ensuring that the National Health Service is able to support the availability and use of effective medicines for cancer and rare conditions is a key priority for this Government. We continue to work with the pharmaceutical industry on a range of issues, including the pricing of new medicines, through mechanisms such as the Pharmaceutical Price Regulation Scheme.
The Cancer Drugs Fund has already helped over 72,000 people and this year £340 million will be provided so people get the drugs they need. A working party made up of NHS England, cancer charities, the National Institute for Health and Care Excellence, the Ethical Medicines Industry Group and the Association of the British Pharmaceutical Industry is looking at options for the sustainable long-term commissioning of cancer drugs.
We take the issue of ensuring rapid access to innovative therapies very seriously, which is why we have launched an Accelerated Access Review to make recommendations to Government later in the year on speeding up access for NHS patients to innovative and cost effective new medicines, diagnostics and medical technologies.
Asked by: Lord Turnberg (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether they have asked NHS England whether it will rationalise the number of committees concerned with assessing the funding of treatments for patients with rare diseases.
Answered by Earl Howe - Deputy Leader of the House of Lords
NHS England substantially revised their decision making process regarding specialised services at the end of 2014 in preparation for work planning in 2015.
NHS England has responsibility for the commissioning of specialised services and is currently consulting on changes to the principles and processes by which it makes decisions on prioritising investment in specialised services.
NHS England has provided assurance that any prioritisation which is urgent on clinical grounds will continue to be dealt with quickly through their existing procedures. The route for individual funding requests remains in place.
The consultation can be found at:
www.engage.england.nhs.uk/consultation/investing-in-specialised-commissioning