Asked by: Lord Mendelsohn (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what plans they have to work with patient groups, including on blood cancer, to allow continued access to treatments at the end of a Cancer Drugs Fund access agreement that meet the original end of life criteria but not the new severity modifier criteria following updates to the NICE health technology evaluations manual.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The Department has had no discussions and has made no current plans. The National Institute for Health and Care Excellence (NICE) is responsible for developing the methods and processes it uses and engaged with a wide range of stakeholders during the development of its updated manual for health technology evaluations, including on the severity modifier. Patient groups were directly involved in the methods review in the working group, task and finish groups and in two public consultations. Additionally, NICE engaged separately with industry and patient groups on the impact of the changes to it methods and processes for medicines currently in the Cancer Drugs Fund.
NICE also works closely with patient groups and other stakeholders in the development of its guidance on individual technologies. In 2022/23, 89% of NICE’s final recommendations on cancer drugs were positive, including all of the cancer medicines appraised using NICE’s updated methods and processes. No cancer medicines have completed their exit from the CDF using NICE’s updated methods and processes. However, NICE has released positive final draft guidance for the first, which treats a blood cancer.
If NICE determines at the end of a managed access period that a technology is not a good use of National Health Service resources, then people already having treatment may continue until they and their NHS clinician consider it appropriate to stop.
Asked by: Lord Mendelsohn (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government why they have withdrawn the opportunity for COVID-19 vaccine boosters to people living with the immunocompromised people at risk of severe infection or death from COVID-19.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
Following advice from the independent Joint Committee on Vaccination and Immunisation (JCVI), in autumn 2022 an extra booster dose was offered to individuals aged 50 years old and over, residents in care homes for older people, frontline health and social care workers, those aged five to 49 years old in a clinical risk group and individuals aged five to 49 years old who were household contacts of people with immunosuppression or carers, as defined in the UK Health Security Agency green book. The autumn programme closed on 12 February 2023 in England.
On 7 March 2023, the Government accepted the advice of the JCVI to offer an additional booster vaccine dose in spring 2023. The primary aim of the COVID-19 vaccination programme continues to be the prevention of severe disease, hospitalisation and mortality, arising from COVID-19. Therefore, the spring booster has been offered to those at highest risk of severe COVID-19, adults aged 75 years old and over, residents in a care home for older adults and individuals aged five years old and over who are immunosuppressed.
The spring booster programme in 2022 also focused on those at highest risk of severe COVID-19 and offered an additional dose to these same targeted groups from 12 years old and up.
Asked by: Lord Mendelsohn (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what provision is being made for immunocompromised people who are struggling financially from the financial impact of the COVID-19 pandemic and its ongoing challenges for those still vulnerable to the virus; and how they will support those affected in the light of their prescription waiver on anti-viral drugs being withdrawn
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
Treatments for COVID-19 are available free of charge on the National Health Service in England for eligible high-risk patients with a positive COVID-19 test result. In addition, the charge waiver will continue to apply to therapeutic treatments made available through the HEAL-COVID and STIMULATE-ICP trials.
There are also a wide range of exemptions from prescription charges already in place, covering children, pregnant women, those over 60 years old, people on certain income related benefits or whose partner is in receipt of those benefits as well as those with specific medical conditions. Around 89% of prescription items are free on the NHS in England. On top of that, people on a low income can apply for support through the NHS Low Income Scheme, and all patients can also buy a pre-payment certificate which covers all the items they need for just over £2 per week.
Asked by: Lord Mendelsohn (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the statement by the Joint Committee on Vaccination and Immunisation COVID-19 vaccination programme for 2023: JCVI interim advice, 8 November 2022, what estimate they have made of the number of vaccinations required to prevent a COVID-19 hospital admission for individuals in clinical risk groups, as outlined in the Green Book; and whether they will provide a link to Appendix A of this statement.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The numbers needed to vaccinate (NNV) for the prevention of hospitalisation was calculated to consider the benefits of continued offers of primary vaccination, booster vaccination, the autumn booster and potential boosting in the spring of 2023, for example, for those newly entering a risk group. This calculation estimates the number of people in a particular group who would need to be vaccinated in order to prevent one hospitalisation. The lower the number, the more beneficial vaccination of that group would be.
Strong age effects were seen, as well as large differences within adult ages, by clinical risk group. The oldest age groups and the older individuals in clinical risk groups had the lowest NNV for prevention of hospitalisation. There is also a trend for higher NNV for prevention of hospitalisation when moving from the primary to each booster dose.
The spring 2023 booster is for immunosuppressed people at risk rather than all individuals in a clinical risk group.
The results of NNV by age and clinical risk group are shown in Tables 3b and 4a of Appendix 1, which is attached.
These cover all individuals in a risk group based on analysis of data including the national immunisation register. The NNV has not been broken down into separate clinical risk groups, as outlined in the Green Book.
Asked by: Lord Mendelsohn (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the Written Answer by Lord Markham on 6 March (HL5937), why the National Institute for Clinical Excellence (NICE) request for referral of 8 June is described as for “referral of Evusheld for treatment of COVID-19” but, as confirmed in a NICE freedom of information response, the request was for “referral of tixagevimab-cilgavimab for preventing COVID-19 [ID6136] on 8 June 2022”, causing delay to the possibility of a decision at a time when the preventative prophylaxis Evusheld was highly efficacious.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The request made by the National Institute for Health and Care Excellence (NICE) to the Department on 8 June 2022 was for the referral of Evusheld for the treatment of COVID-19 for inclusion into its multiple technology appraisal on therapeutics for COVID-19, not Evusheld for prevention. I understand from NICE that an error was made in its response to the freedom of information request, and that a correction will be issued accordingly. I apologise that this happened.
Asked by: Lord Mendelsohn (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what (1) evidential basis, and (2) rationale, the Joint Committee on Vaccination and Immunisation used to determine that family members of, and carers for, people in the clinical risk groups identified in the Green Book are not recommended to receive COVID-19 booster vaccinations.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
In November 2022, the Joint Committee on Vaccination and Immunisation (JCVI) provided interim advice which indicated that in autumn 2023, persons at higher risk of severe COVID-19 could be offered a booster vaccine dose in preparation for winter 2023 to 2024. As it was interim advice, the JCVI report does not contain any evidential basis for proposed cohorts. Final advice on who will be advised to receive COVID-19 boosters in autumn 2023 will be provided in due course. The considerations for any future decisions will be referenced in JCVI reports and meeting minutes.
In February 2023, JCVI provided advice for the spring 2023 COVID-19 vaccination programme. As a precautionary measure, JCVI advised a spring booster dose for the most vulnerable in the population, as a proportionate response: those over the age of 75 years, residents in a care home for older adults, and those over five years of age who are immunosuppressed. These groups were chosen as they continue to be at highest risk of severe COVID-19.
Asked by: Lord Mendelsohn (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what are their reasons for implementing restrictions on the spring 2023 COVID-19 booster programme; and what factors were considered in determining the eligibility criteria for the booster programme.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
As with all vaccination programmes in the United Kingdom, the decision on which groups are eligible for a particular vaccination programme is only made following careful consideration of the groups most at risk of illness, severe illness, or death because of infection. For COVID-19, the primary aim of the vaccination programme continues to be the prevention of severe disease, both in hospitalisation and mortality, arising from COVID-19.
Therefore, in February 2023, the Joint Committee on Vaccination and Immunisation (JCVI) provided advice for the spring 2023 COVID-19 vaccination programme. As a precautionary measure, JCVI advised a spring booster dose for the most vulnerable in the population, as a proportionate response: those over the age of 75 years, residents in a care home for older adults, and those over five years of age who are immunosuppressed.
Asked by: Lord Mendelsohn (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, following the decision by the Joint Committee on Vaccination and Immunisation that family members of, and carers for, people in the clinical risk groups are not recommended to receive COVID-19 booster vaccinations, what steps they are taking to protect people in clinical risk groups from contracting COVID-19.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
As set out in the Written Ministerial Statement titled ‘Approach to Managing Covid-19’ on 30 March 2023, in 2023/24 the Government will maintain a range of capabilities to protect those at higher risk of severe illness from COVID-19. Given the continued effectiveness of vaccines and improved treatments, for most people there is a much lower risk of severe illness compared to earlier in the pandemic.
We will therefore continue to encourage people to take up the vaccines to which they are entitled, and we will continue to fund and provide COVID-19 testing, to manage outbreaks in some high-risk settings and to enable access to treatments for those who are eligible. We will also maintain essential COVID-19 surveillance activities in the community, primary and secondary care, and in high-risk settings. Additionally, we will retain proportionate capability for testing in the event of a COVID-19 wave or variant that results in a significant increase in pressure on the National Health Service.
Vaccination does not significantly limit transmission, so there is no strong reason to prioritise vaccination for carers of those who are at high risk of severe illness.
Asked by: Lord Mendelsohn (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government whether the minutes of the Joint Committee on Vaccination and Immunisation meeting that set out the clinical risk groups for the COVID-19 vaccination programme in Spring 2023 will be made available to the public.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The minutes of the meeting of the Joint Committee on Vaccination and Immunisation, which discussed which groups would be eligible for the precautionary COVID-19 booster programme of spring 2023, will be made publicly available through the GOV.UK website in due course.
Asked by: Lord Mendelsohn (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the Written Answer by Lord Markham on 1 March (HL5824), which body will assume responsibility for ensuring that the immunocompromised will continue to be treated as a priority after the disbanding of the Antivirus and Therapeutics Taskforce, and its related programme and strategy boards.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
In line with the Government’s strategy of living with COVID-19, as of 31 March 2023 the Antiviral and Therapeutics Taskforce has been stood down. The treatment of COVID-19 patients will continue to be overseen by National Health Service and will operate in line with evidence-based recommendations from the National Institute for Health and Care Excellence, following the established processes in this area.
The welfare of immunocompromised patients remains a priority, hence the enhanced protections we continue to offer, including the recently announced spring booster vaccinations, free lateral flow tests and guidance in addition to COVID-19 treatments.