Asked by: Baroness Bennett of Manor Castle (Green Party - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what assessment they have made of the number of general practices which have stopped offering prescriptions for hormones for transgender patients; and what steps, if any, they are taking to ensure that these prescriptions are available to all patients within a reasonable reach of their home.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The Department does not hold this data centrally. NHS England is currently carrying out a review of adult gender services, chaired by Dr David Levy, with the aim of producing an updated service specification. The review will examine the model of care and operating procedures of each service, and will carefully consider experiences, feedback, and outcomes from clinicians and patients. It will also look at how to overcome the challenges that some individuals face in accessing a timely prescription.
NHS England has also increased the number of adult gender dysphoria clinics in England from seven to 12, with the rollout of five new pilot adult clinics since July 2020. The rollout of these new clinics is helping to tackle long waiting times.
Asked by: Baroness Bennett of Manor Castle (Green Party - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what assessment they have made of the number of NHS Trusts in England allowing physician associates to prepare recommended summary plan for emergency care and treatment (ReSPECT) forms and apply do not resuscitate orders; and whether they consider this practice to be legal and appropriate.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The Department and NHS England do not hold data on individual Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions at National Health Service trusts in England.
ReSPECT is a process which records personalised recommendations for a person’s clinical care and treatment for a future emergency in which they are not able to make decisions or to express wishes. These recommendations, including a cardiopulmonary resuscitation (CPR) decision, are developed through conversations between a person and the health care professionals involved with their care. Recommendations are recorded on a non-legally binding form.
The Resuscitation Council UK has produced guidance for organisations and healthcare professionals using the ReSPECT process. CPR decision policies are determined locally by organisations providing NHS care.
The Resuscitation Council UK, the British Medical Association, and the Royal College of Nursing have jointly produced guidance on decisions about CPR. It states that the overall clinical responsibility for decisions about CPR, including DNACPR decisions, rests with the most senior clinician responsible for the person’s care as defined explicitly by local policy.
The Government has commissioned Professor Gillian Leng CBE to lead an independent review of the physician and anaesthesia associate professions. It will consider the safety of the roles and their contribution to multidisciplinary healthcare teams. The conclusions of the review will inform the workforce plan to deliver the 10-Year Health Plan.
The review will consider the approach that was adopted in England to support the safe introduction, employment, and deployment of these new roles.
Asked by: Baroness Bennett of Manor Castle (Green Party - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what action they have taken towards achieving no antibiotic prescription without diagnostic confirmation by 2027, as recommended by the World Innovation Summit for Health, and what future plans they have towards that aim.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
Reducing unnecessary antimicrobial prescriptions by supporting clinicians to prescribe the right antimicrobials only to those who need them is a core undertaking of the Government’s 2024 to 2029 antimicrobial resistance (AMR) national action plan (NAP). The NAP highlights the importance of accurate diagnostic testing to guide effective antibiotic use to help tackle AMR. Specifically, outcome four of the NAP commits to strengthening antimicrobial and diagnostic stewardship by improved targeting of antimicrobials and diagnostic tools. Furthermore, outcome six relates to supporting the development of diagnostics for infection.
The NAP includes targets to achieve a 5% reduction in total antibiotic use in human populations by 2029 from the 2019 baseline, and to ensure 70% of antibiotics used across the human healthcare system are from the ‘Access’ category, a new United Kingdom category, by 2029. The Department continues to work with cross Government bodies, including NHS England and the UK Health Security Agency, to deliver the outcomes and commitments outlined in the NAP.
Asked by: Baroness Bennett of Manor Castle (Green Party - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what plans they have to manage the NHS provision of biologic medications and other high-cost treatments, particularly to avoid inequality between patients under different integrated care boards.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The National Institute for Health and Care Excellence (NICE) makes evidence-based recommendations for the National Health Service in England on whether new medicines, including biologics, should be routinely funded by the NHS based on an assessment of their clinical and cost-effectiveness.
The NICE evaluates all new medicines and significant licence extensions for existing medicines, and NHS England and the integrated care boards are legally required to fund the medicines recommended in a NICE appraisal, usually within three months of final guidance. The NICE’s evaluations and the associated funding requirement ensures that patients are consistently able to benefit from clinically and cost-effective medicines wherever they live in England.
Asked by: Baroness Bennett of Manor Castle (Green Party - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what steps they will take to ensure the future of the Greener NHS programme following the abolition of NHS England.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
Ministers and senior Department officials will work with the new transformation team at the top of NHS England, led by Sir Jim Mackey, to lead this transformation. As we work to return many of NHS England’s current functions to the Department, we will ensure that we continue to evaluate impacts of all kinds.
Asked by: Baroness Bennett of Manor Castle (Green Party - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what steps they are taking to ensure that medical-grade probe covers are used in ultrasound procedures instead of non-medical materials, such as condoms.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The Medicines and Healthcare products Regulatory Agency (MHRA) is the regulator of medical devices in the United Kingdom. It works to make sure that medicines and healthcare products available in the UK are safe and effective. We would expect the use of probes that are medical devices to be within their intended purpose as defined by their manufacturer. Use of a medical device outside of its intended purpose can be done at the discretion of a healthcare professional.
The MHRA does not have a role in regulating healthcare practitioners in clinical settings. The MHRA has issued guidance on the off-label use of medical devices, which sets out that an individual should use medical devices as described by the manufacturer in the instructions. If you use the device in any other way, it’s considered ‘off-label’ use.
Asked by: Baroness Bennett of Manor Castle (Green Party - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what steps they are taking to ensure that known allergens and perfumes present in condoms are labelled on condom packaging.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The Medicines and Healthcare products Regulatory Agency (MHRA) is continuing its work to strengthen the regulation of medical devices in the United Kingdom and ensure medical devices are safe and effective. A condom is a medical device, and medical devices placed on the UK market are subject to rules requiring labels and instructions for use to contain precautions related to certain materials in the device that could result in sensitisation or an allergic reaction.
The MHRA undertakes a range of compliance and enforcement activities to ensure medical devices being placed on the UK market meet relevant regulation requirements. Once a medical device is on the market, the MHRA continuously monitors their safety, including via reports of suspected adverse events associated with medical devices received through the Yellow Card scheme. Should any new safety concerns be identified, we will take necessary regulatory action to minimise these and ensure the benefits of use continue to outweigh the risks.
Asked by: Baroness Bennett of Manor Castle (Green Party - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what plans they have to update the recommendations of the Eatwell Guide to address the health of the gut microbiome, and the environmental impacts of the food system.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
There are no plans at this time to update the Eatwell Guide, as the key messages conveyed by the guide are up to date with all current dietary recommendations. The Eatwell Guide depicts a healthy, balanced diet that is based on fruit, vegetables, and higher fibre starchy carbohydrates. The principles of the guide are promoted through the NHS.UK website and the Government’s social marketing campaign, Better Health, including Healthier Families and Start for Life.
The gut microbiome is highly complex and varies considerably among individuals. The impacts of dietary interventions targeting the gut microbiome, such as probiotics and prebiotics, are not well understood due to variability in the microbiome itself, differences in diet, and other characteristics among individuals. The evidence base is still developing, and there would need to be sufficient evidence for the Scientific Advisory Committee on Nutrition to conduct an independent full dietary risk assessment, which would be needed before recommendations on the microbiome could be made.
Greater adherence to the Eatwell Guide has been shown to significantly improve both health, with an up to 7% reduction in mortality, and environmental outcomes, with a reduction in emissions by 30%. Given that most people in the United Kingdom do not currently follow a diet in line with Government’s dietary recommendations, moving the population to dietary intakes in line with the Eatwell Guide remains the priority and would go a significant way to meeting sustainability targets.
Asked by: Baroness Bennett of Manor Castle (Green Party - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, following the meeting of the NHS England's physician associate and anaesthesia associate prescribing working group on 3 July 2024, what action has been taken regarding the concern about the use of patient specific directives, particularly where a range of dosages and frequencies is given, when the drugs are to be administered under the oversight of anaesthetist associates.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The exploratory work undertaken by NHS England’s Physician Associate (PA) and Anaesthesia Associate (AA) prescribing group has been paused in light of the Leng Review.
Following the July 2024 working group meeting, NHS England engaged with NHS Employers, who published updated guidance on the role of PAs and AAs in the National Health Service. The guidance sets out that under locally determined governance arrangements, an AA may administer medicines under a patient specific direction (PSD).
Whilst any suitably trained and competent person may follow a PSD for administration, some organisations may extend or limit those who are authorised to administer medicines under a PSD within their local medicines policies and governance arrangements.
The employer is responsible for ensuring that the healthcare professionals it employs are properly trained, and undertake only those responsibilities specified in the agreed job descriptions.
Asked by: Baroness Bennett of Manor Castle (Green Party - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what advice they are giving to GP surgeries on the recruitment of new physician associates in the light of the recommendations of the Royal College of Physicians' guidance Physician Associates in general practice: Scope of practice (9 October 2024); and what estimate have they made of the number of physician associates recruited by GP surgeries since that advice was issued.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
NHS England does not hold data on the number of Physician Associates (PAs) recruited by general practices (GPs) since 9 October 2024.
On 20 November 2024, the Government announced it had commissioned an independent review of PAs and Anaesthesia Associates (AAs), led by Professor Gillian Leng CBE. The review will consider the safety of the roles and their contribution to multidisciplinary healthcare teams. The review will report in spring 2025.
While the review is ongoing, it is up to trusts, Primary Care Networks, and GPs to make recruitment decisions about PAs.
NHS England has issued guidance on the deployment of PAs and AAs in the National Health Service which describes the expectations of how organisations providing NHS care should deploy them so that they can contribute to the delivery of safe and effective healthcare in a supportive environment. This guidance remains in place whilst the review is ongoing, and is available at the NHS.UK website, in an online only format.