Asked by: Lord Harrison (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what options they are considering to ensure that the student numbers for podiatry are maintained after August 2017.
Answered by Lord Prior of Brampton
The Department will run a consultation on how the funding reforms for nursing, midwifery and allied health education can be most successfully implemented. We currently expect to consult during March 2016. As part of this, an economic impact assessment and equality impact assessment will be published.
Health Education England (HEE) will continue to have a key leading role in the commissioning of nursing, midwifery and allied health courses. It will continue to provide sufficient clinical placement funding for those places needed to meet the workforce planning needs of the National Health Service.
Asked by: Lord Harrison (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether an impact assessment was carried out regarding removing bursaries for students of podiatry; and if so, with what result.
Answered by Lord Prior of Brampton
The Department will run a consultation on how the funding reforms for nursing, midwifery and allied health education can be most successfully implemented. We currently expect to consult during March 2016. As part of this, an economic impact assessment and equality impact assessment will be published.
Health Education England (HEE) will continue to have a key leading role in the commissioning of nursing, midwifery and allied health courses. It will continue to provide sufficient clinical placement funding for those places needed to meet the workforce planning needs of the National Health Service.
Asked by: Lord Harrison (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government, further to the Written Answer by Lord Prior of Brampton on 26 November (HL3958), what plans they have to ensure that podiatric services are available to diabetics who need them; and what criteria they are recommending that Clinical Commissioning Groups use to differentiate between those diabetics who will continue to require podiatric services and those who will not.
Answered by Lord Prior of Brampton
Podiatry services are commissioned locally by clinical commissioning groups working with local partners and based on the need of the local population, resources available and evidence based practice. Treatment decisions should always be made by doctors based on a patient’s individual clinical needs.
Preventing diabetes and promoting the best possible care for people with diabetes is a key priority for this Government and is part of the 2016/17 Mandate to NHS England. Building on the NHS Diabetes Prevention Programme, the Department of Health and NHS England are exploring options for ensuring a sustained focus on improving the management and care of people with diabetes.
The new National Diabetes Foot Care Audit, a module of the National Diabetes Audit, aims to establish the extent to which national guidelines on the management of diabetic foot disease are being met. The audit will provide local teams with the evidence needed to tackle any identified differences in practice which will lead to an overall improvement in management and outcomes for patients. Local and national level results will be available in March 2016. However, we do know that there has been an increase in the proportion of Trusts with multidisciplinary diabetic foot care teams, from around 60% in 2011 to over 70% in 2013.
Asked by: Lord Harrison (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether they are changing the availability of podiatric services to diabetics, and if so, based on what criteria.
Answered by Lord Prior of Brampton
Podiatry services are commissioned locally by clinical commissioning groups working with local partners and based on the need of the local population, resources available and evidence based practice. These commissioning decisions are informed by the Joint Strategic Needs Assessment and the local Health and Wellbeing Strategy. Clinical networks provide opportunity to adopt and disseminate best practice.
Asked by: Lord Harrison (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what estimate they have made of the cost over a five-year period of providing group-based education courses for all people living with diabetes.
Answered by Lord Prior of Brampton
The National Institute for Health and Care Excellence Quality Standard for diabetes, attached, sets out that people with diabetes should receive a structured educational programme. NHS England is statutorily required to have regard to this.
There are a number of national and locally developed patient education programmes available including Dose Adjustment For Normal Eating (DAFNE) for Type 1 diabetes, and Diabetes Education and Self-management for Ongoing and Newly Diagnosed (DESMOND) for Type 2 diabetes.
While there is still much room for improvement, the proportion of people with diabetes being offered structured education is improving. 16% of people newly diagnosed with diabetes were offered structured education in 2012/13 compared to 8.4% of those diagnosed in 2009. In the same period the number of people newly diagnosed with diabetes offered or attending structured education rose from 11% to 18.4%.
No estimate has been made of the cost over a five-year period of providing group based education courses for all people living with diabetes.
The Department is developing plans to improve outcomes for those with diabetes. This will be announced in due course.
Asked by: Lord Harrison (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what plans they have to increase the number of people living with diabetes who receive structured education courses to help them self-manage their diabetes, in the light of recommendations by NICE.
Answered by Lord Prior of Brampton
The National Institute for Health and Care Excellence Quality Standard for diabetes, attached, sets out that people with diabetes should receive a structured educational programme. NHS England is statutorily required to have regard to this.
There are a number of national and locally developed patient education programmes available including Dose Adjustment For Normal Eating (DAFNE) for Type 1 diabetes, and Diabetes Education and Self-management for Ongoing and Newly Diagnosed (DESMOND) for Type 2 diabetes.
While there is still much room for improvement, the proportion of people with diabetes being offered structured education is improving. 16% of people newly diagnosed with diabetes were offered structured education in 2012/13 compared to 8.4% of those diagnosed in 2009. In the same period the number of people newly diagnosed with diabetes offered or attending structured education rose from 11% to 18.4%.
No estimate has been made of the cost over a five-year period of providing group based education courses for all people living with diabetes.
The Department is developing plans to improve outcomes for those with diabetes. This will be announced in due course.
Asked by: Lord Harrison (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what progress has been made in reducing the national diabetes-related amputation rate since their commitment to halve the rate two years ago.
Answered by Earl Howe - Deputy Leader of the House of Lords
NHS England and clinical commissioning groups have responsibility for determining the overall approach to improving clinical outcomes from healthcare services for people with diabetes. Nevertheless, there are various actions at a national level which will help to ensure that all patients with diabetes receive good quality care, including foot care, to help improve outcomes and minimise amputation rates.
The new National Diabetes Foot Care Audit, a module of the National Diabetes Audit, aims to establish the extent to which national guidelines on the management of diabetic foot disease are being met. The audit will provide local teams with the evidence needed to tackle any identified differences in practice which will lead to an overall improvement in management and outcomes for patients. Local and national level results will be available in March 2016. However, we do know that there has been an increase in the proportion of trusts with multidisciplinary diabetic footcare teams, from around 60% in 2011 to over 70% in 2013.
As part of its focus on the Cardiovascular Disease Outcomes Strategy, NHS Improving Quality is working with the National Clinical Director for Diabetes to identify potential areas of service improvement such as diabetic foot disease. A number of Cardiovascular Strategic Clinical Networks are focussing on this to ensure that appropriate clinical pathways are in place which will deliver improved clinical outcomes for people with diabetes, including minimising amputation rates.
Within NHS England, the National Clinical Director for Rehabilitation and Recovering in the Community and the Chief Allied Health Professions Officer are leading work to improve rehabilitation services, including collection and dissemination of good practice. This will help to improve outcomes, such as improving/maintaining foot health, by putting the patient at the centre of their care, and a focus on their goals.
Asked by: Lord Harrison (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what action they have (1) considered, and (2) taken, to reduce the number of preventable amputations occurring within the National Health Service.
Answered by Earl Howe - Deputy Leader of the House of Lords
Diabetes is one of the most common causes of amputations in the United Kingdom and there are a variety of mechanisms in place to support the care of people with diabetes to minimise the risk of amputations. NHS England published Action for Diabetes, which sets out that in many cases amputation as a result of diabetes is avoidable.
NHS England has also piloted a diabetes service specification in a small number of clinical commissioning groups (CCGs). Feedback has been very positive and they have now published the service specification on the NHS Commissioning Assembly website so that it is available nationally for CCGs to use.
In addition, the National Diabetes Foot Care Audit was launched this year. The audit aims to establish the extent to which national guidelines on the management of diabetic foot disease are being met, and will provide local teams with the evidence needed to tackle any identified differences in practice which will lead in turn to an overall improvement in management and outcomes for patients.
Finally, NHS Improving Quality is supporting a project to reduce the high mortality associated with diabetic foot disease. People with diabetic foot disease are at particularly high risk of premature death, much of which is due to cardiovascular disease, with 5 year mortality for those with Type 1 or Type 2 diabetes and diabetic foot disease around 50%. The project will pilot an approach in several multidisciplinary foot clinics across the country over the next 18 months to introduce an additional clinical pathway which includes a cardiological test and subsequent actions to address risk.
Asked by: Lord Harrison (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government in how many Clinical Commissioning Groups rates of (1) major, and (2) minor, amputations are more than 33 per cent above the national average; and how the national average compares with other European Union member states.
Answered by Earl Howe - Deputy Leader of the House of Lords
It is not possible to distinguish in Hospital Episode Statistics between 'major' and 'minor' amputations.
The Health and Social Care Information Centre (HSCIC) has calculated the England average rate of amputation per 100,000 population and highlighted the clinical commissioning groups (CCGs) of residence having rates more than 33% higher than the national average. There are 25 such CCGs.
This is not a count of people as the same person may have had more than one episode of care within the same time period.
We do not have information on a comparison of rates of amputation with other European Union member states.
Clinical Commissioning Group of residence | Count of finished consultant episodes | Population | Rate per 100,000 population |
NHS SCARBOROUGH AND RYEDALE CCG | 68 | 110,488 | 61.5 |
NHS EAST RIDING OF YORKSHIRE CCG | 169 | 314,504 | 53.7 |
NHS DONCASTER CCG | 159 | 302,739 | 52.5 |
NHS MANSFIELD AND ASHFIELD CCG | 101 | 192,539 | 52.5 |
NHS BLACKPOOL CCG | 72 | 141,976 | 50.7 |
NHS KNOWSLEY CCG | 74 | 145,936 | 50.7 |
NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG | 138 | 273,043 | 50.5 |
NHS KERNOW CCG | 272 | 540,178 | 50.4 |
NHS FAREHAM AND GOSPORT CCG | 98 | 196,078 | 50.0 |
NHS LANCASHIRE NORTH CCG | 78 | 158,528 | 49.2 |
NHS NORTHERN, EASTERN AND WESTERN DEVON CCG | 421 | 869,408 | 48.4 |
NHS STOKE ON TRENT CCG | 124 | 258,114 | 48.0 |
NHS TELFORD AND WREKIN CCG | 80 | 167,682 | 47.7 |
NHS HEREFORDSHIRE CCG | 88 | 184,932 | 47.6 |
NHS HULL CCG | 122 | 257,204 | 47.4 |
NHS NORTH KIRKLEES CCG | 88 | 186,706 | 47.1 |
NHS BOLTON CCG | 131 | 278,984 | 47.0 |
NHS EAST STAFFORDSHIRE CCG | 58 | 123,945 | 46.8 |
NHS COASTAL WEST SUSSEX CCG | 222 | 476,677 | 46.6 |
NHS LINCOLNSHIRE EAST CCG | 106 | 228,111 | 46.5 |
NHS HALTON CCG | 58 | 125,692 | 46.1 |
NHS NEWARK & SHERWOOD CCG | 53 | 115,897 | 45.7 |
NHS THANET CCG | 62 | 135,661 | 45.7 |
NHS SOMERSET CCG | 243 | 534,950 | 45.4 |
NHS BRADFORD CITY CCG | 37 | 82,319 | 44.9 |
Asked by: Lord Harrison (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government how many of the 4,200 extra health visitors they are seeking to recruit by 2015 they expect (1) to work in the National Health Service, and (2) to complete training on identifying the signs of postnatal depression.
Answered by Earl Howe - Deputy Leader of the House of Lords
The additional 4,200 health visitors will all be providing front line services to families. Health visitor services are currently commissioned by NHS England as part of Section 7A of the NHS Act 2006*. NHS England’s Local Area Teams determine the most suitable local service provider. Currently, most provision is through a variety of National Health Service organisations, with a small proportion delivered by other organisations, including social enterprises. The trajectory for delivering growth of the health visitor workforce is not related to the type of provider. All services are based on a national model of health visiting and the NHS England service specification.
NHS England Area Teams and local authorities are working together in co-commissioning these services, prior to the lead commissioning role moving to local authorities in October 2015.
All health visitors, including the additional 4,200 being delivered by 2015, receive education and training on maternal mental health, so they can detect the early signs of postnatal depression and ensure all women get support during and after birth.
The NHS England 2014-15 service specification emphasises throughout, the role of the health visitor in promoting maternal mental health within clearly defined pathways. It makes clear that health visitors are expected to be trained and developed to be competent in delivering the evidence-based assessments and interventions set out in the Healthy Child Programme. In addition, NHS England is resourcing Area Teams to support delivery of the new model of health visiting which explicitly includes maternal mental health as a high impact area.
To supplement core training, health visitors are able to enhance their skills and knowledge in the context of their specific roles. The Department has earlier this year, commissioned the training of 375 perinatal mental health champions across England. The champions are cascading their training in local areas so as to facilitate the spread of knowledge and practice among colleagues. In addition to the champions’ training, all health visitors are able to access perinatal mental health e-learning modules.
Note:
*As amended by the Health and Social Care Act 2012.