Asked by: Yvonne Fovargue (Labour - Makerfield)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps his Department plans to take to encourage primary care clinicians to monitor potential over-prescribing of oral corticosteroids.
Answered by Gillian Keegan - Secretary of State for Education
While the National Institute of Health and Care Excellence’s (NICE) guideline ‘Asthma: diagnosis, monitoring and chronic asthma management’ does not specifically make recommendations on oral corticosteroids, NICE is working with the British Thoracic Society and the Scottish Intercollegiate Guidelines Network to produce United Kingdom-wide guidance to update and replace this guideline. Evidence on pharmacological management, including the use of oral corticosteroids, will be reviewed during this process.
The 2022/23 Quality and Outcomes Framework incentivises general practitioners to assess asthma control through a questionnaire, which records of the number of exacerbations, an assessment of inhaler technique and a written personalised action plan, to monitor potential over-prescribing. The Impact and Investment Fund currently contains two indicators which aim to improve the care of people with asthma, including recognising Primary Care Networks which reduce in the percentage of patients receiving six or more Short-Acting Beta Agonists (SABAs) prescriptions per year.
NICE’s guidelines for asthma and its guideline ‘Chronic obstructive pulmonary disease in over 16s: diagnosis and management’ recommend oral corticosteroids and alternatives. For adults with asthma, these include SABAs, leukotriene receptor antagonists and long-acting beta2 agonists. For chronic obstructive pulmonary disease (COPD), NICE recommends smoking cessation, SABAs and short-acting muscarinic antagonists, Theophylline tablets, oral mucolytic therapy, oral anti-oxidant therapy, oral anti-tussive therapy, oral prophylactic antibiotic therapy, long-term oxygen therapy, ambulatory oxygen therapy, short-burst oxygen therapy, non-invasive ventilation and pulmonary rehabilitation. NICE has also published technology appraisal guidance on biologics for those with severe asthma, such as Omalizumab for treating severe persistent allergic asthma.
No specific assessment has been made of the cost of caring for and treating adverse events in patients prescribed frequent or maintenance prescriptions of oral corticosteroids. However, in developing its guidelines, NICE has recommended a number of medicines for patients with severe asthma, such as mepolizumab, which considered the costs and benefits relating to a potential reduction in the use of corticosteroids.
NHS England and NHS Improvement’s Severe Asthma Collaborative is developing capacity in severe asthma centres to streamline patient pathways to biologic therapies and reduce variation in prescribing and patient management. A toolkit has been produced to support clinical teams.
The Royal College of General Practitioners’ guidance on long term condition recovery asks clinicians to consider all high-risk patients with COPD and asthma who have not received a review for more than 12 months and have been prescribed either three or more SABAs in the last 12 months; those aged five years old and over not on the asthma or COPD register who have received two or more courses of oral steroids in 12 months; and those on the asthma or COPD register to be prioritised for review.
Asked by: Yvonne Fovargue (Labour - Makerfield)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, if his Department will make recurrent oral corticosteroids prescriptions from primary care a trigger for referral to secondary or tertiary care for asthma patients.
Answered by Gillian Keegan - Secretary of State for Education
While the National Institute of Health and Care Excellence’s (NICE) guideline ‘Asthma: diagnosis, monitoring and chronic asthma management’ does not specifically make recommendations on oral corticosteroids, NICE is working with the British Thoracic Society and the Scottish Intercollegiate Guidelines Network to produce United Kingdom-wide guidance to update and replace this guideline. Evidence on pharmacological management, including the use of oral corticosteroids, will be reviewed during this process.
The 2022/23 Quality and Outcomes Framework incentivises general practitioners to assess asthma control through a questionnaire, which records of the number of exacerbations, an assessment of inhaler technique and a written personalised action plan, to monitor potential over-prescribing. The Impact and Investment Fund currently contains two indicators which aim to improve the care of people with asthma, including recognising Primary Care Networks which reduce in the percentage of patients receiving six or more Short-Acting Beta Agonists (SABAs) prescriptions per year.
NICE’s guidelines for asthma and its guideline ‘Chronic obstructive pulmonary disease in over 16s: diagnosis and management’ recommend oral corticosteroids and alternatives. For adults with asthma, these include SABAs, leukotriene receptor antagonists and long-acting beta2 agonists. For chronic obstructive pulmonary disease (COPD), NICE recommends smoking cessation, SABAs and short-acting muscarinic antagonists, Theophylline tablets, oral mucolytic therapy, oral anti-oxidant therapy, oral anti-tussive therapy, oral prophylactic antibiotic therapy, long-term oxygen therapy, ambulatory oxygen therapy, short-burst oxygen therapy, non-invasive ventilation and pulmonary rehabilitation. NICE has also published technology appraisal guidance on biologics for those with severe asthma, such as Omalizumab for treating severe persistent allergic asthma.
No specific assessment has been made of the cost of caring for and treating adverse events in patients prescribed frequent or maintenance prescriptions of oral corticosteroids. However, in developing its guidelines, NICE has recommended a number of medicines for patients with severe asthma, such as mepolizumab, which considered the costs and benefits relating to a potential reduction in the use of corticosteroids.
NHS England and NHS Improvement’s Severe Asthma Collaborative is developing capacity in severe asthma centres to streamline patient pathways to biologic therapies and reduce variation in prescribing and patient management. A toolkit has been produced to support clinical teams.
The Royal College of General Practitioners’ guidance on long term condition recovery asks clinicians to consider all high-risk patients with COPD and asthma who have not received a review for more than 12 months and have been prescribed either three or more SABAs in the last 12 months; those aged five years old and over not on the asthma or COPD register who have received two or more courses of oral steroids in 12 months; and those on the asthma or COPD register to be prioritised for review.
Asked by: Yvonne Fovargue (Labour - Makerfield)
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 effectiveness of home administration of biologics for severe asthma; and whether he has plans to extend that treatment.
Answered by Gillian Keegan - Secretary of State for Education
The NHS England and NHS Improvement Accelerated Access Collaborative (AAC) on Improving Access to Biologic Therapy estimates that approximately 200,000 or 5% of patients with asthma have severe asthma. Of these patients, the AAC estimates that between 50,000 to 100,000 may be eligible for biologic therapy, with approximately 11,000 patients receiving this treatment. The AAC aims to improve the identification of these patients in primary and secondary care settings, to allow referrals to specialist severe asthma centres to determine their suitability for biologic treatment.
No specific estimate of the number of patients awaiting an appointment at a severe asthma centre has been made as this information is not collected in the format requested. No specific assessment has been made of the effectiveness of home administration of biologics for severe asthma. The National Institute for Health and Care Excellence’s COVID-19 rapid guideline on severe asthma promoted the use of home administration for biologic treatments to maintain access and reduce risks to patients of COVID-19 exposure. While we are ensuring that patients who are eligible for this treatment are able to access it, there are no plans to extend the eligibility criteria.
Asked by: Yvonne Fovargue (Labour - Makerfield)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what estimate he has made of the number of patients awaiting an appointment at a severe asthma centre.
Answered by Gillian Keegan - Secretary of State for Education
The NHS England and NHS Improvement Accelerated Access Collaborative (AAC) on Improving Access to Biologic Therapy estimates that approximately 200,000 or 5% of patients with asthma have severe asthma. Of these patients, the AAC estimates that between 50,000 to 100,000 may be eligible for biologic therapy, with approximately 11,000 patients receiving this treatment. The AAC aims to improve the identification of these patients in primary and secondary care settings, to allow referrals to specialist severe asthma centres to determine their suitability for biologic treatment.
No specific estimate of the number of patients awaiting an appointment at a severe asthma centre has been made as this information is not collected in the format requested. No specific assessment has been made of the effectiveness of home administration of biologics for severe asthma. The National Institute for Health and Care Excellence’s COVID-19 rapid guideline on severe asthma promoted the use of home administration for biologic treatments to maintain access and reduce risks to patients of COVID-19 exposure. While we are ensuring that patients who are eligible for this treatment are able to access it, there are no plans to extend the eligibility criteria.
Asked by: Yvonne Fovargue (Labour - Makerfield)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what estimate he has made of the number of patients who are eligible for biologic treatment for severe asthma who are not currently accessing it.
Answered by Gillian Keegan - Secretary of State for Education
The NHS England and NHS Improvement Accelerated Access Collaborative (AAC) on Improving Access to Biologic Therapy estimates that approximately 200,000 or 5% of patients with asthma have severe asthma. Of these patients, the AAC estimates that between 50,000 to 100,000 may be eligible for biologic therapy, with approximately 11,000 patients receiving this treatment. The AAC aims to improve the identification of these patients in primary and secondary care settings, to allow referrals to specialist severe asthma centres to determine their suitability for biologic treatment.
No specific estimate of the number of patients awaiting an appointment at a severe asthma centre has been made as this information is not collected in the format requested. No specific assessment has been made of the effectiveness of home administration of biologics for severe asthma. The National Institute for Health and Care Excellence’s COVID-19 rapid guideline on severe asthma promoted the use of home administration for biologic treatments to maintain access and reduce risks to patients of COVID-19 exposure. While we are ensuring that patients who are eligible for this treatment are able to access it, there are no plans to extend the eligibility criteria.
Asked by: Yvonne Fovargue (Labour - Makerfield)
Question to the Department for Digital, Culture, Media & Sport:
To ask the Secretary of State for Digital, Culture, Media and Sport, whether she plans to include provisions for when a smart product is recalled within the Product Security and Telecommunications Infrastructure Bill.
Answered by Julia Lopez - Minister of State (Department for Science, Innovation and Technology)
The Product Security and Telecommunications Infrastructure Bill includes provisions that allow the Secretary of State to issue recall notices relating to relevant insecure consumer connected products, if deemed appropriate.
Asked by: Yvonne Fovargue (Labour - Makerfield)
Question to the Department for Digital, Culture, Media & Sport:
To ask the Secretary of State for Digital, Culture, Media and Sport, whether smart products sold on online marketplaces will be subject to the provisions of the Product Security and Telecommunications Infrastructure Bill.
Answered by Julia Lopez - Minister of State (Department for Science, Innovation and Technology)
Security requirements to be set out using the powers in the Product Security and Telecommunications Infrastructure Bill will have to be complied with relation to all relevant consumer connectable products sold to customers in the UK, including those sold on online marketplaces.
Asked by: Yvonne Fovargue (Labour - Makerfield)
Question to the Ministry of Justice:
To ask the Secretary of State for Justice, what steps the Government has taken to support the establishment of the Enforcement Conduct Authority proposed by Centre for Social Justice; and when his Department plans to publish the results of its 2018 call for evidence on enforcement agent reforms.
Answered by James Cartlidge - Minister of State (Ministry of Defence)
The Ministry of Justice strongly supports the creation of the independent oversight body for enforcement agents and firms that has been proposed by the Centre for Social Justice (CSJ). Officials have met regularly with the CSJ and the working group that is establishing the body to support its development. We will undertake a review of the body within two years of its operation to see if any legislative changes are necessary to place it on a statutory footing.
The publication of the response to our call for evidence about the enforcement agent reforms, which closed in February 2019, has been delayed as a result of the department’s response to the pandemic. That allowed us to refocus our priorities, which resulted, for example, in MoJ and DLUHC introducing an extended ban on enforcing evictions to prevent people being made homeless during Covid, so protecting public health and easing the burden on the NHS and local authorities.
We remain committed to raising standards in this sector and will publish the response as soon as possible.
Asked by: Yvonne Fovargue (Labour - Makerfield)
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 effect of covid-19 on people with asthma and severe asthma.
Answered by Maria Caulfield - Parliamentary Under Secretary of State (Department for Business and Trade) (Minister for Women)
As COVID-19 is a new disease, it is not yet clear what the physical, neurological, psychological and rehabilitation impacts will be for those with conditions such as asthma and severe asthma.
Asked by: Yvonne Fovargue (Labour - Makerfield)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps he is taking to reduce the geographical variation in the prescribing of biologics for severe asthma.
Answered by Jo Churchill - Minister of State (Department for Work and Pensions)
No estimate has been made and information on the number of severe asthma patients are receiving biologic therapies is not available in the format requested.
Clinicians are responsible for making prescribing decisions for their patients, taking into account the National Institute for Health and Care Excellence’s technology appraisals and guidance on management of asthma and the local commissioning decisions. Prescribing of biologics for severe asthma is co-ordinated through severe asthma centre multi-disciplinary teams to ensure current treatments are optimised and all appropriate treatments are considered with use of biologics as part of the treatment review for each patient.