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Written Question
Earwax: Medical Treatments
Monday 26th February 2024

Asked by: Margaret Greenwood (Labour - Wirral West)

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, if she will have discussions with NHS England on the potential (a) impact of not including ear wax removal services in the standard general medical services contract on health inequalities and (b) merits of appointing a (i) national clinical director and (ii) specialty advisor on audiology to advise on this matter.

Answered by Andrea Leadsom - Parliamentary Under-Secretary (Department of Health and Social Care)

In June 2018, there was an update to the National Institute for Health and Care Excellence’s (NICE) guidance, which states that ear wax syringing is no longer recommended due to safety concerns. Instead, self-care methods including olive-oil drops and, if required, ear irrigation or micro-suctioning, are recommended.

The Government has no plans to include ear wax removal services in the national Standard General Medical Services Contract. Irrigation and micro-suctioning require a higher level of expertise and specialist equipment than syringing, which most general practices (GPs) do not have. This means that patients who were previously treated with syringing by their GPs may now require a referral to other National Health Service providers, to access irrigation or micro-suctioning services.

Local commissioners, including integrated care boards, are responsible for arranging services which will meet the recommendations on ear wax removal, as set out in the NICE guidance. This may involve commissioning GPs who agree to develop the required expertise to deliver these treatments or other providers, to whom GPs may refer patients, to provide ear wax removal services.

NHS England issued a communication to all commissioners in June 2022 which asked them to ensure that GPs, with whom they have agreed will not deliver ear irrigation or have not been commissioned to provide micro-suction services, are able to refer patients to appropriate local NHS services for ear wax removal, where symptoms persist following self-care methods. This includes arranging services in line with guidance on ear wax removal services, published by NICE. This guidance is available at the following link:

https://www.nice.org.uk/guidance/ng98/chapter/Recommendations#removing-earwax

The Department is not aware of any plans by NHS England to appoint a national clinical director or speciality advisor for ear wax removal services. Finally, the Department has noted the publication of the Royal National Institute for Deaf People’s (RNID) report Blocked Ears, Blocked Access with interest, and will meet with members of the RNID to discuss this report in due course.


Written Question
Earwax: Medical Treatments
Monday 26th February 2024

Asked by: Margaret Greenwood (Labour - Wirral West)

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, if she will make an assessment of the potential implications for her policies of the RNID's findings in its report entitled Blocked Ears, Blocked Access: The crisis of NHS ear wax removal in England, published in January 2024.

Answered by Andrea Leadsom - Parliamentary Under-Secretary (Department of Health and Social Care)

In June 2018, there was an update to the National Institute for Health and Care Excellence’s (NICE) guidance, which states that ear wax syringing is no longer recommended due to safety concerns. Instead, self-care methods including olive-oil drops and, if required, ear irrigation or micro-suctioning, are recommended.

The Government has no plans to include ear wax removal services in the national Standard General Medical Services Contract. Irrigation and micro-suctioning require a higher level of expertise and specialist equipment than syringing, which most general practices (GPs) do not have. This means that patients who were previously treated with syringing by their GPs may now require a referral to other National Health Service providers, to access irrigation or micro-suctioning services.

Local commissioners, including integrated care boards, are responsible for arranging services which will meet the recommendations on ear wax removal, as set out in the NICE guidance. This may involve commissioning GPs who agree to develop the required expertise to deliver these treatments or other providers, to whom GPs may refer patients, to provide ear wax removal services.

NHS England issued a communication to all commissioners in June 2022 which asked them to ensure that GPs, with whom they have agreed will not deliver ear irrigation or have not been commissioned to provide micro-suction services, are able to refer patients to appropriate local NHS services for ear wax removal, where symptoms persist following self-care methods. This includes arranging services in line with guidance on ear wax removal services, published by NICE. This guidance is available at the following link:

https://www.nice.org.uk/guidance/ng98/chapter/Recommendations#removing-earwax

The Department is not aware of any plans by NHS England to appoint a national clinical director or speciality advisor for ear wax removal services. Finally, the Department has noted the publication of the Royal National Institute for Deaf People’s (RNID) report Blocked Ears, Blocked Access with interest, and will meet with members of the RNID to discuss this report in due course.


Written Question
Earwax: Medical Treatments
Monday 26th February 2024

Asked by: Margaret Greenwood (Labour - Wirral West)

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether her Department has had recent discussions with NHS England about the potential inclusion of ear wax removal services in the standard general medical services contract for 2024-25.

Answered by Andrea Leadsom - Parliamentary Under-Secretary (Department of Health and Social Care)

In June 2018, there was an update to the National Institute for Health and Care Excellence’s (NICE) guidance, which states that ear wax syringing is no longer recommended due to safety concerns. Instead, self-care methods including olive-oil drops and, if required, ear irrigation or micro-suctioning, are recommended.

The Government has no plans to include ear wax removal services in the national Standard General Medical Services Contract. Irrigation and micro-suctioning require a higher level of expertise and specialist equipment than syringing, which most general practices (GPs) do not have. This means that patients who were previously treated with syringing by their GPs may now require a referral to other National Health Service providers, to access irrigation or micro-suctioning services.

Local commissioners, including integrated care boards, are responsible for arranging services which will meet the recommendations on ear wax removal, as set out in the NICE guidance. This may involve commissioning GPs who agree to develop the required expertise to deliver these treatments or other providers, to whom GPs may refer patients, to provide ear wax removal services.

NHS England issued a communication to all commissioners in June 2022 which asked them to ensure that GPs, with whom they have agreed will not deliver ear irrigation or have not been commissioned to provide micro-suction services, are able to refer patients to appropriate local NHS services for ear wax removal, where symptoms persist following self-care methods. This includes arranging services in line with guidance on ear wax removal services, published by NICE. This guidance is available at the following link:

https://www.nice.org.uk/guidance/ng98/chapter/Recommendations#removing-earwax

The Department is not aware of any plans by NHS England to appoint a national clinical director or speciality advisor for ear wax removal services. Finally, the Department has noted the publication of the Royal National Institute for Deaf People’s (RNID) report Blocked Ears, Blocked Access with interest, and will meet with members of the RNID to discuss this report in due course.


Written Question
Earwax: Medical Treatments
Monday 26th February 2024

Asked by: Margaret Greenwood (Labour - Wirral West)

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, if she will require NHS England to publish commissioning guidance to integrated care boards on universal provision of ear wax removal services.

Answered by Andrea Leadsom - Parliamentary Under-Secretary (Department of Health and Social Care)

In June 2018, there was an update to the National Institute for Health and Care Excellence’s (NICE) guidance, which states that ear wax syringing is no longer recommended due to safety concerns. Instead, self-care methods including olive-oil drops and, if required, ear irrigation or micro-suctioning, are recommended.

The Government has no plans to include ear wax removal services in the national Standard General Medical Services Contract. Irrigation and micro-suctioning require a higher level of expertise and specialist equipment than syringing, which most general practices (GPs) do not have. This means that patients who were previously treated with syringing by their GPs may now require a referral to other National Health Service providers, to access irrigation or micro-suctioning services.

Local commissioners, including integrated care boards, are responsible for arranging services which will meet the recommendations on ear wax removal, as set out in the NICE guidance. This may involve commissioning GPs who agree to develop the required expertise to deliver these treatments or other providers, to whom GPs may refer patients, to provide ear wax removal services.

NHS England issued a communication to all commissioners in June 2022 which asked them to ensure that GPs, with whom they have agreed will not deliver ear irrigation or have not been commissioned to provide micro-suction services, are able to refer patients to appropriate local NHS services for ear wax removal, where symptoms persist following self-care methods. This includes arranging services in line with guidance on ear wax removal services, published by NICE. This guidance is available at the following link:

https://www.nice.org.uk/guidance/ng98/chapter/Recommendations#removing-earwax

The Department is not aware of any plans by NHS England to appoint a national clinical director or speciality advisor for ear wax removal services. Finally, the Department has noted the publication of the Royal National Institute for Deaf People’s (RNID) report Blocked Ears, Blocked Access with interest, and will meet with members of the RNID to discuss this report in due course.


Written Question
Earwax: Medical Treatments
Wednesday 20th December 2023

Asked by: Margaret Greenwood (Labour - Wirral West)

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what data her Department holds on the (a) maximum and (b) minimum cost of an ear wax removal treatment by a private sector provider.

Answered by Andrea Leadsom - Parliamentary Under-Secretary (Department of Health and Social Care)

Details of the National Health Service provider costs are included in the National Cost Collection which can be found at the following link:

https://www.england.nhs.uk/costing-in-the-nhs/national-cost-collection/

There are also unit prices for the “Clearance of External Auditory Canal (19 years and over)” and the “Clearance of External Auditory Canal (18 years and under)” published in Annex A of the NHS Payment Scheme which can be found at the following link:

https://www.england.nhs.uk/publication/2023-25-nhs-payment-scheme/

Where NHS England or Integrated Care Boards commission these services from private sector providers, the unit prices must be used.

However, the Department does not hold any information on the cost of these services delivered by private providers outside of the NHS, or what they may charge individuals for the service.


Written Question
Earwax: Medical Treatments
Monday 18th December 2023

Asked by: Margaret Greenwood (Labour - Wirral West)

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what data her Department holds on the number and proportion of ear wax removal treatments commissioned by integrated care boards that were carried out by private sector providers in (a) Cheshire and Merseyside and (b) England (i) between July 2022 and March 2023 and (ii) since April 2023.

Answered by Andrea Leadsom - Parliamentary Under-Secretary (Department of Health and Social Care)

There are very few private providers of (Ear, Nose Throat) ENT that deliver ear wax removal (ear irrigation) as a specifically commissioned service in Cheshire and Merseyside.

NHS Cheshire and Merseyside Integrated Care Board has confirmed that there is one private ENT provider in Wirral and two private ENT providers in Knowsley – both of which deliver a much wider outpatient ENT service that may involve ear irrigation.

However, there is no activity data specifically for ear irrigation (or the removal of earwax generally) as it is carried out as part of an ENT treatment pathway, not a standalone procedure.

This information is not collected at the national level. However, the overall proportion of NHS England’s spend on independent sector providers (ISPs) across services has remained relatively consistent in recent years. In 2013-14, 6.1% of total health spending was spent on purchase of healthcare from independent sector providers (£6.9bn). In 2021-22, this was 5.9% (£10.9bn).


Written Question
Cystic Fibrosis: Drugs
Thursday 30th November 2023

Asked by: Margaret Greenwood (Labour - Wirral West)

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, with reference to the draft guidance published by NICE entitled Ivacaftor–tezacaftor–elexacaftor, tezacaftor–ivacaftor and lumacaftor–ivacaftor for treating cystic fibrosis, published on 3 November 2023, whether she has made an assessment of the potential impact of the recommendation that modular therapies should not be provided on the NHS on the health of people with cystic fibrosis.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

The National Institute for Health and Care Excellence (NICE) has recently consulted on its draft recommendations on the use of lumacaftor–ivacaftor (Orkambi), tezacaftor–ivacaftor (Symkevi) and ivacaftor–tezacaftor–elexacaftor (Kaftrio) and has not yet published its final recommendations. NICE continues to work with stakeholders to address the issues highlighted by the committee in the draft guidance. Under the terms of the interim access agreement for the cystic fibrosis medicines, Orkambi, Symkevi and Kaftrio, eligible children and adults with cystic fibrosis can continue to receive ongoing treatment and be initiated onto treatment with these medicines, as clinically appropriate, while NICE concludes its evaluation.


Written Question
Cystic Fibrosis: Drugs
Thursday 30th November 2023

Asked by: Margaret Greenwood (Labour - Wirral West)

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what recent discussions she has had with people with (a) cystic fibrosis and (b) representative organisations on the draft guidance on the future availability of (i) Orkambi, (ii) Symkevi and (iii) Kaftrio on the NHS.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

The National Institute for Health and Care Excellence (NICE) is an independent body and is responsible for leading engagement with interested parties in the development of its recommendations on medicines. NICE has recently consulted on its draft guidance on the use of Orkambi, Symkevi and Kaftrio for the treatment of cystic fibrosis and continues to work with stakeholders to address the issues highlighted by the committee in the draft guidance. The Department encourages stakeholders such as patients and representative organisations to continue to engage in the NICE appraisal process.


Written Question
Cystic Fibrosis: Drugs
Thursday 30th November 2023

Asked by: Margaret Greenwood (Labour - Wirral West)

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether a child suffering from cystic fibrosis who is currently taking Orkambi will be able to move on to taking Kaftrio if their clinician considers it more effective once current NICE recommendations are ratified.

Answered by Andrew Stephenson - Minister of State (Department of Health and Social Care)

The commercial deal NHS England reached with Vertex covers their entire portfolio of licensed cystic fibrosis treatments. NHS England’s continued expectation in implementing the agreement is that Vertex will enable any patients already initiated on any of the treatments covered by the portfolio deal to have access to the full range of licensed treatments going forward, as recommended by their clinical teams.


Written Question
Electronic Cigarettes
Friday 8th September 2023

Asked by: Margaret Greenwood (Labour - Wirral West)

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what recent estimate he has made of the number of people (a) under and (b) over the age of 18 who vape in (i) Wirral and (ii) England.

Answered by Neil O'Brien

Data is not available at local authority level, including in Wirral. However, data on vaping is available at England level for adults and children.

The NHS Smoking, Drinking and Drug use among Young People in England publication shows current vaping prevalence among those aged 11 to 15 was 9% in 2021.

Data from the Office for National Statistics Adult smoking habits in the UK publication shows that in 2022 there were an estimated 3.8 million vapers over the age of 16.