Asked by: Baroness Gardner of Parkes (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what plans they have to ensure that the amount of time between the administration of the first and the second dose of the Pfizer/BioNTech COVID-19 vaccine does not exceed six weeks.
Answered by Lord Bethell
Since December 2020, the Government’s policy has been to offer people their second vaccine dose up to 12 weeks after their first dose. The decision to update the dosing interval will give as many people at the highest risk their first dose as soon as possible and it is in line with the conditions of authorisation from Medicines and Healthcare and Regulatory Authority for the vaccine.
This approach is based on advice from the Joint Committee on Vaccination and Immunisation and four UK Chief Medical Officers and is designed to save lives. Analysis carried out by Public Health England suggests that the COVID-19 vaccination programme prevented 6,100 deaths in England up to the end of February 2021.
The Government is in constant contact with the vaccine manufacturers and remains confident that the supply of vaccine to the UK will not be disrupted, and will enable everyone to receive their second dose within 12 weeks of their first.
Asked by: Baroness Gardner of Parkes (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what level of protection one dose of the Pfizer/BioNTech COVID-19 vaccine provides against COVID-19; and what plans they have to publish the evidence base that informs their data on the effectiveness of one such dose.
Answered by Lord Bethell
Since the beginning of the vaccination programme, Public Health England (PHE) has been monitoring the effectiveness of the vaccines in the real world. PHE’s first analysis of the early effects of COVID-19 vaccination in England, using routine testing and vaccination data, was published on 1 March. The data shows effectiveness of a single dose of the Pfizer/BioNTech vaccine against symptomatic COVID-19 reaches approximately 60% in those aged 70 and over in the general population, reaching 85% to 90% after two doses in those aged 80 years and over. The data also shows a single dose of the Pfizer vaccine is 80% and 95% effective at reducing hospitalisation and mortality from COVID-19, respectively, in those aged 70 and over. PHE’s latest vaccine effectiveness report can be found attached entitled, ‘Public Health England vaccine effectiveness report March 2021’
Asked by: Baroness Gardner of Parkes (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what plans they have to pre-book COVID-19 tests for all university students to take before they return to university after the Christmas break.
Answered by Lord Bethell
The Government has established a large number of asymptomatic test sites across higher education institutions. We are working to make the return to higher education as safe as possible. All students will have the opportunity to be tested on their return to university at the start of the spring term. The Government has provided guidance for universities to implement a staggered return of students over five weeks to minimise the transmission risk from the mass movement of students. Further guidance will be provided in due course, considering future developments and the relevant scientific advice.
Asked by: Baroness Gardner of Parkes (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what steps they are taking to increase the availability of National Health Service dental treatment for patients of all ages.
Answered by Lord Bethell
National Health Service dental practices were able to restart face-to-face care from 8 June, with the aim of increasing levels of service for all patients, as fast as is safely possible, taking into account Public Health England guidance and continued infection risks.
Urgent dental care centres remain open to support the provision of urgent and emergency face-to-face care for dental patients and patients will be referred to urgent dental care centres, where needed locally.
Asked by: Baroness Gardner of Parkes (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government, further to the Written Answer by Baroness Blackwood of North Oxford on 6 August 2019 (HL17643), how much new funding they provided in 2019 for new measures to prevent the transmission of carbapenem-resistant Enterobacteriaceae.
Answered by Baroness Blackwood of North Oxford
Public Health England has not received any new funding for the prevention of transmission of the carbapenem-resistant Enterobacteriaceae.
Asked by: Baroness Gardner of Parkes (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what steps they intend to take in respone to the shortage of National Health Service dentists.
Answered by Baroness Blackwood of North Oxford
The latest headcount data published by NHS Digital show that the total number of dentists actively delivering National Health Service services increased from 24,308 to 24,545 during the period 2017/18 to 2018/19.
Both NHS England and Health Education England (HEE) have initiatives in place to tackle recruitment and retention issues. HEE’s current programme Advancing Dental Care is exploring the opportunities for flexible dental training pathways that can better serve patients as well as improving dental workforce retention. NHS England is introducing ‘flexible commissioning’, which allows local NHS commissioners to commission a wider range of services from dental practices which is expected to make NHS dentistry more attractive to newly qualified dentists.
These initiatives sit alongside the Department’s and NHS England’s work to reform the current NHS dental contract to support dentists to deliver preventatively focussed care. The patient pathway in the new model makes greater use of the whole dental team including nurses and therapists which moves away from needing dentists to complete every course of treatment.
The interim NHS People Plan, published in June 2019, sets out plans for the future dental workforce. This commits to creating a capable and motivated multidisciplinary dental workforce, of a sufficient size, to meet population health needs.
Asked by: Baroness Gardner of Parkes (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government, further to the Written Answer by Baroness Blackwood of North Oxford on 9 July (HL16592), what is their view of the proportion of each of the resulting illness, deaths and costs that could be prevented by new efforts to prevent transmission; and what are the costs of new measures introduced in 2019 to prevent transmission of carbapenem-resistant Enterobacteriaceae.
Answered by Baroness Blackwood of North Oxford
Public Health England (PHE) has prioritised collecting the necessary data across the National Health Service to enable estimation and monitoring of the proportion of cases, deaths and costs attributable to carbapenemase-resistant Enterobacteriaceae.
In May 2015 PHE implemented an enhanced surveillance system of all carbapenemase-producing Gram negative bacteria, which was modified in 2019 to maximise efficiency. The health burden of cases, estimated from these data, will be published in the English Surveillance Programme for Antimicrobial Utilisation Report in November 2019.
The few published reports of outbreaks have estimated costs of at least £1 million, and up to £5 million, all indicating multi-model control measures are required, as outlined in the PHE toolkit for prevention and control of carbapenemase-producing Enterobacteriaceae which is currently being updated.
Using national surveillance and patient administration data to develop mathematical models, work is ongoing to estimate the reduction in levels of illness and death when specified detection and control measures are applied by 2020. Developed models will enable associated costs incurred to be estimated and the cost-effectiveness of control measures to be established by 2021.
Asked by: Baroness Gardner of Parkes (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government, further to the Written Answer by Baroness Blackwood of North Oxford on 4 June (HL15832), what assessment they have made of (1) the future costs to the NHS as a result of the spread of carbapenem-resistant Enterobacteriaceae, (2) the costs of new measures introduced in 2019 specifically to prevent the transmission of such Enterobacteriaceae, and (3) the views of infection control nurses on investment to prevent the transmission of such Enterobacteriaceae.
Answered by Baroness Blackwood of North Oxford
Public Health England (PHE) has predicted future spread and the health and cost impact to the National Health Service of the Enterobacteriaceae Escherichia coli and a national outbreak of a highly-resistant organism, reflecting carbapenem-resistant Enterobacteriaceae. The models used in this assessment are published in the paper A Risk Assessment of Antibiotic Pan-Drug-Resistance in the UK: Bayesian Analysis of an Expert Elicitation Study. A copy of the paper is attached.
Such predictions are highly uncertain. There remain unknowns regarding transmission, efficacy of interventions and the additional hospital stay for infected patients (constituting a large part of the cost to the NHS).
PHE has worked with NHS colleagues, estimating the cost of controlling a carbapenemase-producing Enterobacteriaceae (CPE) outbreak in five London hospitals to be over £1 million. Monitoring costs alongside implementation of PHE’s upcoming update of the CPE toolkit for health and social care is an important component of enabling cost-effectiveness evaluation.
Staff interviewed about the challenges of implementing the existing CPE toolkit highlighted maintaining awareness and training as key challenges, alongside infection prevention resourcing. An analysis of the responses was published in the paper An evaluation of a toolkit for the early detection, management, and control of carbapenemase-producing Enterobacteriaceae: a survey of acute hospital trusts in England. A copy is attached.
Asked by: Baroness Gardner of Parkes (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government, further to the Written Answer by Baroness Blackwood of North Oxford on 14 May (HL15384), what assessment they have made of the number of people, with or without resistant blood stream infections, who have Carbapenem resistant E. coli-like bacteria present in their bodies; and what (1) proposed, and (2) current, initiatives there are to control the transmission of such bacteria.
Answered by Baroness Blackwood of North Oxford
The 2018 English surveillance programme for antimicrobial utilisation and resistance report contains information on carbapenem-resistant Escherichia coli (E. coli) causing bloodstream infections in England. In 2017 there were 18 cases. The number of people with other infections and carriage of E. coli resistant to carbapenems is harder to ascertain as surveillance is not as uniform.
Public Health England (PHE) publishes guidance on the prevention and control of carbapenemase-producing Enterobacteriaceae (including E. coli); guidance is available for both acute and non-acute settings, copies of the Toolkit for managing carbapenemase-producing Enterobacteriaceae in non-acute and community settings and Acute trust toolkit for the early detection, management and control of carbapenemase-producing Enterobacteriaceae are attached. PHE is supporting actions outlined in the United Kingdom’s Tackling Antimicrobial Resistance National Action Plan that aim to prevent and control the transmission of carbapenem-resistant bacteria, which includes reducing the number of specific drug-resistant infections in people by 10% by 2025; reducing UK antimicrobial use in humans by 15% by 2024; and adding carbapenem-resistant Gram-negative infections to the list of notifiable diseases in existing laboratory reporting systems.
Asked by: Baroness Gardner of Parkes (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what assessment they have made of the effectiveness of their 2013–18 antimicrobial resistance strategy at addressing the problem of multi-resistant E. coli-like bacteria; what assessment they have made of recent trends in the number of multi-resistant E. coli-like bacteria in the UK; and what factors inform their view of the balance between efforts to reduce transmission and efforts to reduce the use of antibiotics.
Answered by Baroness Blackwood of North Oxford
While we can count many successes from our 2013-18 Antimicrobial Resistance (AMR) Strategy, resistance has continued to increase. In the United Kingdom we have seen a 35% increase in resistant blood stream infections in humans from 2013-17.
The number of bloodstream infections (BSIs) is increasing each year. Although the proportion of antibiotic resistant BSIs remain stable year to year, the burden on resistance increases. This is mostly due to increasing prevalence of E.coli bloodstream infections.
Estimates of the multi-resistant cases can be made, however not all the bacteria are tested against the same antibiotics, so a definitive number of cases cannot be given. The Public Health England Fingertips tool also has an indicator showing the rolling quarterly average proportion of E. coli blood specimens non-susceptible to at least three of the key antimicrobials (gentamicin, ciprofloxacin, piperacillin/tazobactam, 3rd-generation cephalosporins or carbapenems). For England this is 5.5% with little fluctuation over time.
This is exactly why the UK’s five-year national action plan for AMR, published alongside the UK 20-year vision for AMR on 24 January 2019, includes a strengthened focus on infection prevention and control, renewing our commitment to halve levels of healthcare associated Gram-negative blood stream infections (mostly E.coli) by 2023-24. The plan also sets a world-first target to reduce the actual numbers of resistant infections, with the aim to reduce them by 10% by 2025.
We are working with the devolved health administrations to develop consistent methodologies for reporting the incidence and mortality of key antibiotic resistant infections and antimicrobial use to allow us to report progress on the ambitions of the AMR national action plan.
As reductions in inappropriate prescribing also reduces the risk of promoting the growth of antibiotic-resistant bacteria, interventions to reduce antibiotic prescribing or transmission of the bacteria are complementary.