Asked by: Cheryl Gillan (Conservative - Chesham and Amersham)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, if his Department will establish a multi-disciplinary centre of excellence with leadership from a senior clinician to focus on Mast Cell Activation Syndrome.
Answered by Steve Brine
Care for patients with Mast Cell Activation Syndrome (MCAS) in an outpatient setting will typically be within local allergy clinics, available in most hospitals. These services are commissioned locally by clinical commissioning groups. There are no current plans to designate or commission the care of patients with MCAS as a prescribed national specialised clinic or service.
A list of local allergy clinics can be obtained from the British Society for Allergy and Clinical Immunology at:
http://www.bsaci.org/professionals/allergy-specialists
The Royal College of Physician’s Improving Quality in Allergy Services scheme at:
www.rcplondon.ac.uk/projects/outputs/improving-quality-allergy-services
Asked by: Cheryl Gillan (Conservative - Chesham and Amersham)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, if his Department will include Mast Cell Activation Syndrome (MCAS) in the 100K genome project and establish links to the MCAS Research Centre at the University of Bonn Institute of Genetics.
Answered by Jackie Doyle-Price
Mast Cell Activation Syndrome (MCAS) does not currently have a specific disease category within the 100,000 Genomes Project but patients with MCAS in the context of other medical disorders or congenital malformations suggestive of a genetic cause are eligible. In addition, a proposal for inclusion of familial MCAS in the project is currently under peer review and will be considered by the Genomics England Science Advisory Committee at their next meeting.
Genomics England will seek to establish links between the relevant Genomics England Clinical Interpretation Partnership (GeCIP) domains and the MCAS Research Centre at the University Of Bonn Institute Of Genetics.
More about GeCIP can be found here:
https://www.genomicsengland.co.uk/about-gecip/
Asked by: Cheryl Gillan (Conservative - Chesham and Amersham)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what assessment he has made of the potential merits of allowing the use of off-label medications in the treatment of Mast Cell Activation Syndrome.
Answered by Steve Brine
We have made no such assessment. Prescribers are able to use medicinal products outside their licensed indications where they are satisfied that they best meet the individual clinical needs of their patient. This is part and parcel of normal clinical practice.
Asked by: Cheryl Gillan (Conservative - Chesham and Amersham)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, whether tests for mast cell activation markers, completed by the Protein Reference Unit Lab in Sheffield, are available on the NHS.
Answered by Steve Brine
A number of standard tests relevant to patients being cared for in allergy clinics are available at most hospitals. Mast cell activation marker tests are not standard tests within the National Health Service and are ordered by individual NHS clinicians using local procedures based on the assessment of individual cases.
The expertise required to investigate and manage the allergic symptoms experienced exists within allergy clinics provided by the NHS. A list of allergy clinics can be obtained from the British Society for Allergy and Clinical Immunology at:
http://www.bsaci.org/professionals/allergy-specialists
The Royal College of Physician’s Improving Quality in Allergy Services scheme at:
www.rcplondon.ac.uk/projects/outputs/improving-quality-allergy-services
Asked by: Cheryl Gillan (Conservative - Chesham and Amersham)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, which (a) adult and (b) paediatric NHS hospitals receive Mast Cell Activation Syndrome patients with a GP referral.
Answered by Steve Brine
Care for patients with Mast Cell Activation Syndrome in an outpatient setting is provided by local allergy clinics, available in most hospitals. These services are commissioned locally by clinical commissioning groups.
A list of allergy clinics can be obtained from the British Society for Allergy and Clinical Immunology at:
http://www.bsaci.org/professionals/allergy-specialists
The Royal College of Physician’s Improving Quality in Allergy Services scheme:
www.rcplondon.ac.uk/projects/outputs/improving-quality-allergy-services
Asked by: Cheryl Gillan (Conservative - Chesham and Amersham)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, if he will make it his Department’s policy to prioritise the production of NHS guidelines on the diagnosis of Mast Cell Activation Syndrome.
Answered by Steve Brine
Mast Cell Activation Syndrome is managed within local allergy clinics commissioned by clinical commissioning groups. A list of allergy clinics can be obtained from the British Society for Allergy and Clinical Immunology at:
http://www.bsaci.org/professionals/allergy-specialists
The Royal College of Physician’s Improving Quality in Allergy Services scheme at:
www.rcplondon.ac.uk/projects/outputs/improving-quality-allergy-services
Clinical guidelines are developed by the National Institute for Health and Care Excellence (NICE) or speciality based colleges and NHS England will ensure this topic is raised with NICE in relation to their consideration of future topics.
Asked by: Cheryl Gillan (Conservative - Chesham and Amersham)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps his Department is taking to help raise awareness among doctors so that Mast Cell Activation Syndrome is considered as an alternative differential diagnosis.
Answered by Steve Brine
The outpatient management of Mast Cell Activation Syndrome (MCAS) is within local allergy clinics, which fall within the responsibility of clinical commissioning groups. Doctors are expected to ensure their clinical knowledge remains up-to-date and to identify their ongoing learning needs as part of their continuing professional development. This activity should include taking account of new research and developments in guidance in relevant specialty areas, such as that produced by the National Institute for Health and Care Excellence or the Royal Colleges, to ensure that they can continue to provide high quality care to all patients.
With the aim of improving the lives of all those affected by a rare disease, of which MCAS is one, the Government is committed to implementing the UK Strategy for Rare Diseases which covers five themes: empowering those affected by rare diseases; identifying and preventing rare diseases; diagnosis and early intervention; coordination of care and the role of research. Today the UK Rare Diseases Policy Board, which oversees the implementation of the UK Strategy for Rare Diseases, published its second Progress Report describing the progress achieved over the past two years.
Asked by: Cheryl Gillan (Conservative - Chesham and Amersham)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps his Department is taking to ensure access to compounded medications including antihistamines are free of (a) colourings and (b) preservatives.
Answered by Jackie Doyle-Price
Anti-histamines are generally available over-the-counter. Often there are several brands available and it is usually possible to select a colour-free brand or avoid an additive of concern. If an additive can cause allergic reactions or has other known effects it must be named on the outer label of the product as well as included in the list of ingredients stated in the Patient Information Leaflet (PIL).
Information about the ingredients used in medicines is available on the website of the Medicines and Healthcare products Regulatory Agency (MHRA) at the following link:
Access to the PIL for medicines licensed in the United Kingdom and the list of ingredients in full is available using the link. Alternatively, patients or healthcare professionals may wish to contact the MHRA to ask whether products free from a particular ingredient have a marketing authorisation and identify the authorisation holder.
Although colours may be considered unnecessary they can help to prevent medication errors by assisting the differentiation between products, especially when they are placed in multi-compartment compliance aids.
All colourings permitted for use in medicines are also permitted for use in foods and allergic reactions to them are extremely rare and usually mild. It is a requirement that the warning “may cause allergic reaction” is in the PIL of medicines when azo colouring agents are used although it is accepted that patients cannot always choose whether or not to use a particular medicine.
The European Medicines Agency (EMA) issued guidance in 2008 and 2013 which discourages the use of colourings with allergenic or toxicological potential in new medicines for children and as more new medicines are licensed the number of colour–free medicines available for children should increase.
Concerns in relation to the more general inclusion colours in medicines have been raised by the MHRA at European level, most recently in November 2017. The MHRA is continuing to work with the EMA to develop further guidance in this area and is leading in the preparation of new guidance on warnings in relation to azo colours and is also involved in initiatives aimed at increasing the availability of colour-free products.
Liquid medicines, such as anti-histamines intended for children, need to last for many months to enable their distribution through the supply chain and be kept in the home ready for the occasion when they are needed. This would be impossible without the use of preservatives preventing microbiological spoilage and the risks this would pose to patients. As a consequence of this, the use of preservatives is necessary in such medicines. Alternatives to preservatives such as syrup based medicines or use of alcohols are also unsuitable for, or are not favoured by, a number of patients.
Asked by: Cheryl Gillan (Conservative - Chesham and Amersham)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, with reference to the announcement by NHS England of 11 April 2017 on mechanical thrombectomy, when NHS England will start to commission mechanical thrombectomy; when it is planned that the first 1,000 patients will be refitted from mechanical thrombectomy; and when it is planned that 8,000 patients a year will be benefitting from mechanical thrombectomy.
Answered by Steve Brine
NHS England agreed to fund thrombectomy for stroke in April 2017.
Progression to full implementation will need to take place on a phased basis to ensure the service providers can put in place the necessary staffing and working arrangements. In the short term there will be an interim set of arrangements.
Initially the procedure will be undertaken in neuroscience centres which are currently being assessed to ensure that they meet the standards set out in the service specification that is currently out for public consultation. This information will be used by a national oversight group and regional commissioning teams to assess who is able to provide the service in this interim period and will not be published. Further work with the providers of this service will be completed with regional commissioners and the services directly to establish clear action plans which will lead to full implementation.
It is anticipated that there will be some 1,000 cases completed by the end of March 2018; and that, by 2023, about 10% of stroke admissions in England (8,000 cases) will be treated with thrombectomy annually. NHS England have not undertaken an independent cost benefit analysis of thrombectomy but there have been research studies published such as Jean Ganesalingam et al – “Cost-Utility Analysis of Mechanical Thrombectomy Using Stent Retrievers”, in Acute Ischemic Stroke 2015;46:2591-2598. This showed that it is a highly cost effective treatment, particularly when the longer term health and social care costs are taken into account.
Asked by: Cheryl Gillan (Conservative - Chesham and Amersham)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, with reference to the announcement by NHS England of 11 April 2017 on mechanical thrombectomy, when the assessment of the readiness of each of the 24 neuroscience centres to carry out mechanical thrombectomy will be completed; and whether the results of this assessment will be published.
Answered by Steve Brine
NHS England agreed to fund thrombectomy for stroke in April 2017.
Progression to full implementation will need to take place on a phased basis to ensure the service providers can put in place the necessary staffing and working arrangements. In the short term there will be an interim set of arrangements.
Initially the procedure will be undertaken in neuroscience centres which are currently being assessed to ensure that they meet the standards set out in the service specification that is currently out for public consultation. This information will be used by a national oversight group and regional commissioning teams to assess who is able to provide the service in this interim period and will not be published. Further work with the providers of this service will be completed with regional commissioners and the services directly to establish clear action plans which will lead to full implementation.
It is anticipated that there will be some 1,000 cases completed by the end of March 2018; and that, by 2023, about 10% of stroke admissions in England (8,000 cases) will be treated with thrombectomy annually. NHS England have not undertaken an independent cost benefit analysis of thrombectomy but there have been research studies published such as Jean Ganesalingam et al – “Cost-Utility Analysis of Mechanical Thrombectomy Using Stent Retrievers”, in Acute Ischemic Stroke 2015;46:2591-2598. This showed that it is a highly cost effective treatment, particularly when the longer term health and social care costs are taken into account.