Found: Follow up Written Evidence Submitted by Lord Kamall, Minister for Technology, Innovation and Life Sciences

Question to the Department of Health and Social Care:

To ask Her Majesty's Government, further to the Written Answers by Lord Kamall on 24 May (HL476 and HL475), what is the legal underpinning for the policy set out in the Gender Identity Toolkit for General Practice that only gender, not sex and gender, are included on medical records.

Answered by Lord Kamall - Parliamentary Under-Secretary (Department of Health and Social Care)

The Gender Recognition Act 2004 provides additional rights and safeguards for those with a Gender Recognition Certificate (GRC), such as making it an offence to disclose protected information. This includes information pertaining to the previously recorded sex of a person who holds a GRC where that information has been obtained in an official capacity and the person has not consented to its disclosure, subject to limited exceptions.

The Gender Identity Toolkit for General Practice is made available by the Institute of General Practice Management, Indigo Gender Service, Practice Index and Pride in Practice. However, it is not Government guidance. The Toolkit provides voluntary information to general practices on the administration of changes to medical records and makes reference to the Gender Recognition Act.

Question to the Department of Health and Social Care:

To ask Her Majesty's Government, further to the Written Answers by Lord Kamall on 24 May (HL476 and HL475), what is the policy for recording the gender of people who self-identify as non-binary in medical records; and what is the legal underpinning for this policy.

Answered by Lord Kamall - Parliamentary Under-Secretary (Department of Health and Social Care)

The Government continues to consider emerging data and research on the experiences of non-binary people to understand how future policy can be developed. In general, the National Health Service identifies individuals as male or female via NHS numbers and medical records. This aligns with the Gender Recognition Act 2004 which refers to two sexes: male and female. NHS bodies must always consider any legal obligations under the Equality Act 2010 and compliance with the European Convention on Human Rights in respect of those who identify as non-binary.

Question to the Department of Health and Social Care:

To ask Her Majesty's Government, further to the Written Answer by Lord Kamall on 11 July (HL1271), how many children attending day special schools access eye tests through the domiciliary scheme.

Answered by Lord Kamall - Parliamentary Under-Secretary (Department of Health and Social Care)

The information requested is not collected centrally.

Question to the Department of Health and Social Care:

To ask Her Majesty's Government, further to the Written Answers by Lord Kamall on 24 May (HL476 and HL475), what assessment they have made of the risks to (1) patients, and (2) medical professionals, that might arise as a result of the policy on recording gender set out in the Gender Identity Toolkit for General Practice.

Answered by Lord Kamall - Parliamentary Under-Secretary (Department of Health and Social Care)

No formal risk assessment has been made.

Question to the Department of Health and Social Care:

To ask Her Majesty's Government further to the Written Answers by Lord Kamall on 24 May (HL476 and HL475), what assessment they have made of the (1) clarity, and (2) inclusivity, of using the language “people with cervixes” in the Gender Identity Toolkit for General Practice.

Answered by Lord Kamall - Parliamentary Under-Secretary (Department of Health and Social Care)

No specific assessment has been made. The Toolkit is made available by the Institute of General Practice Management, Indigo Gender Service, Practice Index and Pride in Practice. It is designed to improve the knowledge of general practice teams when providing inclusive and equitable care to transgender and non-binary patients.

Question to the Department of Health and Social Care:

To ask Her Majesty's Government, further to the Written Answers by Lord Kamall on 24 May (HL476 and HL475), how medical professionals are held to account for any negative consequences that arise from how they have recorded a patient’s gender.

Answered by Lord Kamall - Parliamentary Under-Secretary (Department of Health and Social Care)

All regulated healthcare professionals are required to register with the relevant professional regulator, such as the General Medical Council, in order to practice in the United Kingdom. These regulators determine the standards which registered professionals must meet and the professional values, knowledge, skills and behaviours required. Regulators are independent bodies and can take action to restrict the practise of healthcare professionals who fail to meet the expected standards.

Question to the Department of Health and Social Care:

To ask Her Majesty's Government, further to the answer by Lord Kamall on 6 July (HL Deb cols 1001–2) regarding the scientific evidence available regarding folic fortification, whether they will publish the science brief referred to by Lord Kamall referencing heliocentrism versus geocentrism.

Answered by Lord Kamall - Parliamentary Under-Secretary (Department of Health and Social Care)

The scientific contestation referred to is summarised in the paper Folic acid and neural tube defects: Discovery, debate and the need for policy change by Professor Nicholas Wald. Professor Wald asserts that the United Kingdom should pursue a higher level of fortification than would be permitted by the UK’s Tolerable Upper Level (TUL). A copy of the paper is attached.

The Government and its independent scientific advisory bodies have agreed that fortification of non-wholemeal wheat flour with folic acid, at a level informed by the guidance for supplemental intake of folic acid intake advised by the UK Expert Group on Vitamins and Minerals, is a safe and effective measure to reduce the number of neural tube defects (NTDs).

This view is supported by the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) and by the Scientific Advisory Committee on Nutrition (SACN). In 2018 COT published Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment: COT position paper on the current upper level for folic acid intake in response to a previous paper by Professor Wald, addressing the technical points raised in objection to the TUL and continuing to recommend its use. A copy of this paper is attached.

Deaths associated with high levels of folic acid refers to potential unintended harms which may arise following the fortification of flour with folic acid, such as an increase in the potential masking of vitamin B12 deficiency or pernicious anaemia where the deficiency can cause permanent neurological damage which can lead to death if untreated.

No recent discussions have taken place with countries which have implemented folic acid fortification on unintended consequences of the policy. However, evidence from a number of countries, including those which have implemented folic acid fortification policies, was considered by the SACN and COT to establish the safety and efficacy of fortifying food with folic acid. Analysis by COT and the SACN found that there was insufficient evidence to discount a number of potential risks at very levels of fortification.

While there is no specific scientific briefing relating to the debate between heliocentrism versus geocentrism, as I stated in the debate, we will routinely review the policy post-implementation to ensure it meets the objective of reducing NTDs while avoiding any unintended consequences. The forthcoming consultation will outline the proposed fortification levels with the supporting scientific rationale.

Question to the Department of Health and Social Care:

To ask Her Majesty's Government, further to the answer by Lord Kamall on 6 July (HL Deb col 1000), whether they will give details of the cases where people “have died because of high levels of folic acid”.

Answered by Lord Kamall - Parliamentary Under-Secretary (Department of Health and Social Care)

The scientific contestation referred to is summarised in the paper Folic acid and neural tube defects: Discovery, debate and the need for policy change by Professor Nicholas Wald. Professor Wald asserts that the United Kingdom should pursue a higher level of fortification than would be permitted by the UK’s Tolerable Upper Level (TUL). A copy of the paper is attached.

The Government and its independent scientific advisory bodies have agreed that fortification of non-wholemeal wheat flour with folic acid, at a level informed by the guidance for supplemental intake of folic acid intake advised by the UK Expert Group on Vitamins and Minerals, is a safe and effective measure to reduce the number of neural tube defects (NTDs).

This view is supported by the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) and by the Scientific Advisory Committee on Nutrition (SACN). In 2018 COT published Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment: COT position paper on the current upper level for folic acid intake in response to a previous paper by Professor Wald, addressing the technical points raised in objection to the TUL and continuing to recommend its use. A copy of this paper is attached.

Deaths associated with high levels of folic acid refers to potential unintended harms which may arise following the fortification of flour with folic acid, such as an increase in the potential masking of vitamin B12 deficiency or pernicious anaemia where the deficiency can cause permanent neurological damage which can lead to death if untreated.

No recent discussions have taken place with countries which have implemented folic acid fortification on unintended consequences of the policy. However, evidence from a number of countries, including those which have implemented folic acid fortification policies, was considered by the SACN and COT to establish the safety and efficacy of fortifying food with folic acid. Analysis by COT and the SACN found that there was insufficient evidence to discount a number of potential risks at very levels of fortification.

While there is no specific scientific briefing relating to the debate between heliocentrism versus geocentrism, as I stated in the debate, we will routinely review the policy post-implementation to ensure it meets the objective of reducing NTDs while avoiding any unintended consequences. The forthcoming consultation will outline the proposed fortification levels with the supporting scientific rationale.

Question to the Department of Health and Social Care:

To ask Her Majesty's Government, further to the answer by Lord Kamall on 6 July (HL Deb col 999), whether they will cite the “scientific contestation” referred to concerning folic acid fortification as part of the Bread and Flour Regulations review.

Answered by Lord Kamall - Parliamentary Under-Secretary (Department of Health and Social Care)

The scientific contestation referred to is summarised in the paper Folic acid and neural tube defects: Discovery, debate and the need for policy change by Professor Nicholas Wald. Professor Wald asserts that the United Kingdom should pursue a higher level of fortification than would be permitted by the UK’s Tolerable Upper Level (TUL). A copy of the paper is attached.

The Government and its independent scientific advisory bodies have agreed that fortification of non-wholemeal wheat flour with folic acid, at a level informed by the guidance for supplemental intake of folic acid intake advised by the UK Expert Group on Vitamins and Minerals, is a safe and effective measure to reduce the number of neural tube defects (NTDs).

This view is supported by the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) and by the Scientific Advisory Committee on Nutrition (SACN). In 2018 COT published Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment: COT position paper on the current upper level for folic acid intake in response to a previous paper by Professor Wald, addressing the technical points raised in objection to the TUL and continuing to recommend its use. A copy of this paper is attached.

Deaths associated with high levels of folic acid refers to potential unintended harms which may arise following the fortification of flour with folic acid, such as an increase in the potential masking of vitamin B12 deficiency or pernicious anaemia where the deficiency can cause permanent neurological damage which can lead to death if untreated.

No recent discussions have taken place with countries which have implemented folic acid fortification on unintended consequences of the policy. However, evidence from a number of countries, including those which have implemented folic acid fortification policies, was considered by the SACN and COT to establish the safety and efficacy of fortifying food with folic acid. Analysis by COT and the SACN found that there was insufficient evidence to discount a number of potential risks at very levels of fortification.

While there is no specific scientific briefing relating to the debate between heliocentrism versus geocentrism, as I stated in the debate, we will routinely review the policy post-implementation to ensure it meets the objective of reducing NTDs while avoiding any unintended consequences. The forthcoming consultation will outline the proposed fortification levels with the supporting scientific rationale.

Question to the Department of Health and Social Care:

To ask Her Majesty's Government, further to the Written Answer by Lord Kamall on 17 June (HL645), whether an agenda for NHS England's Clinical Priorities Advisory Group's next meeting has been finalised; and if so, when it will be shared with relevant stakeholders.

Answered by Lord Kamall - Parliamentary Under-Secretary (Department of Health and Social Care)

The agenda has been finalised and made available to relevant stakeholders.

Question to the Department of Health and Social Care:

To ask Her Majesty's Government, further to the Written Answer by Lord Kamall on 17 June (HL645), whether an agenda for NHS England's Clinical Priorities Advisory Group's next meeting has been finalised; and if so, when the agenda will be shared with stakeholders.

Answered by Lord Kamall - Parliamentary Under-Secretary (Department of Health and Social Care)

The agenda has been finalised and made available to relevant stakeholders.

Question to the Department of Health and Social Care:

To ask Her Majesty's Government, further to the Written Answer by Lord Kamall on 28 June (HL985), whether Hartismere hospital in Suffolk is under consideration as a community diagnostic centre.

Answered by Lord Kamall - Parliamentary Under-Secretary (Department of Health and Social Care)

There are currently no existing community diagnostic centres (CDCs) in Suffolk and potential locations remain under review. NHS England’s discussions with local integrated care systems, diagnostic networks and primary care services have considered Hartismere Hospital as a potential site for a CDC. However, these locations will be determined alongside wider system plans for providing more accessible diagnostics to the local population, including potential sites in Ipswich and Newmarket.

Question to the Department of Health and Social Care:

To ask Her Majesty's Government, further to the Written Answer by Lord Kamall on 28 June  (HL985), which community diagnostic centres have already been identified in Suffolk and which are under consideration.

Answered by Lord Kamall - Parliamentary Under-Secretary (Department of Health and Social Care)

There are currently no existing community diagnostic centres (CDCs) in Suffolk and potential locations remain under review. NHS England’s discussions with local integrated care systems, diagnostic networks and primary care services have considered Hartismere Hospital as a potential site for a CDC. However, these locations will be determined alongside wider system plans for providing more accessible diagnostics to the local population, including potential sites in Ipswich and Newmarket.

Question to the Department of Health and Social Care:

To ask Her Majesty's Government, further to the Written Answer by Lord Kamall on 27 June (HL1046), what plans they have to record data on the number of health care professionals who were hired from countries graded as red by the World Health Organisation.

Answered by Lord Kamall - Parliamentary Under-Secretary (Department of Health and Social Care)

We have no plans to do so.

We collate data from published sources to monitor the patterns of staff joining the National Health Service who have trained outside the United Kingdom. This includes data from the the Nursing and Midwifery Council’s register and the Electronic Staff Record’s information on the nationality of staff.

Question to the Department of Health and Social Care:

To ask Her Majesty's Government, further to the Written Answer by Lord Kamall on 22 June (HL620), why the decision was made to remove central funding of the local clinical excellence awards scheme from 31 March; what assessment they have made of the impact this change will have on clinical academies; and why the planned amendment of Schedule 30 to include clinical academies within the group with a contractual entitlement to apply for such awards was abandoned.

Answered by Lord Kamall - Parliamentary Under-Secretary (Department of Health and Social Care)

From 2018 to March 2022, the Department was involved in tripartite negotiations between employers, the British Medical Association (BMA) and the Hospital Consultants and Specialists Association to reform local clinical excellence awards. However, the proposal was rejected by the executive committees of the trades unions and the negotiations concluded without agreement.

National Health Service trusts are therefore reverting to the arrangements in Schedule 30 of the consultant contract, agreed with the BMA in 2018. This does not alter the funding and eligibility position for clinical academics and represents a continuation of existing provisions.

Question to the Department of Health and Social Care:

To ask Her Majesty's Government, further to the Written Answer by Lord Kamall on 17 May (HL71), what is the average rate of staff turnover within the Coronavirus Test Device Approval team since its implementation; and what steps they are taking to ensure that this does not affect the ability of the review team, including new scientific advisors, to address the ongoing COVID diagnostics application backlog.

Answered by Lord Kamall - Parliamentary Under-Secretary (Department of Health and Social Care)

We are unable to provide the information requested on average staff turnover as it is not held in the format requested and could only be obtained at disproportionate cost.

The number of scientific advisors has remained stable. There are six new posts currently advertised to recruit permanent civil servants as scientific advisors, to replace contractors in these roles. In addition, organisational learning is being recorded to ensure continuity, including a new management information system and appropriate handover periods as staff are replaced.

Found: James Morris MP, on behalf of Lord Kamall 7 COMMISSION O N HUMAN MEDICINES ANNUAL REPORT

Found: James Morris MP, on behalf of Lord Kamall 8 COMMISSION ON HUMAN MEDICINES ANNUAL REPORT

Found: Letter dated 21/07/2022 from Lord Kamall to Peers regarding questions raised during a briefing on the

Found: Letter dated 18/07/2022 from Lord Kamall to Peers regarding issues raised in the Draft Pharmacy (Responsible

Found: Letter dated 08/07/2022 from Lord Kamall to Peers regarding questions raised following the Oral Statement