Asked by: Lord Willis of Knaresborough (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what assessment they have made of the impact of using paper-based systems for prescribing medicines on the efficacy of homecare medicines services.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
An assessment, through a commissioned piece of user-research of homecare paper-based prescribing, was done during the COVID-19 pandemic. NHS England will use the information in this assessment to understand the issues in homecare, as well as to inform future improvement actions, particularly developing and adoption of the Electronic Prescription Service (EPS).
No assessment has been made of the impact of requirements under the Human Medicines Regulations 2012. The only advanced electronic signature (AES) is through EPS. Not many e-prescribing systems used in secondary care have the capability to meet this AES requirement.
Asked by: Lord Willis of Knaresborough (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what assessment they have made of the impact of requirements under the Human Medicines Regulations 2012 (SI 2012/1916) for prescriptions to have either a wet signature or an advanced electronic signature on the efficiency of homecare medicines services.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
An assessment, through a commissioned piece of user-research of homecare paper-based prescribing, was done during the COVID-19 pandemic. NHS England will use the information in this assessment to understand the issues in homecare, as well as to inform future improvement actions, particularly developing and adoption of the Electronic Prescription Service (EPS).
No assessment has been made of the impact of requirements under the Human Medicines Regulations 2012. The only advanced electronic signature (AES) is through EPS. Not many e-prescribing systems used in secondary care have the capability to meet this AES requirement.
Asked by: Lord Willis of Knaresborough (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what steps they are taking to improve interoperability of (1) NHS information management systems, and (2) homecare medicines services information management systems.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
An Information Standard Notice (ISN) which puts in place definitions that are to be used when a health professional sends or receives patient medication and allergy/intolerance information, by computer system, between care locations, has been published under section 250 of the Health and Social Care Act 2012.
The purpose is to ensure that medication and allergy information is transferred between systems and locations in a machine-readable format. This will be achieved by: transferring medication information using the newest version for the United Kingdom of Fast Healthcare Interoperability Resource, by use of either ‘Medication Codable Concept’ or ‘Medication Resource’ as is most appropriate to the use case; usage of dose syntax to transfer the amount of medication per dose as a simple coded quantity; and transferring allergy/intolerance information using Systematized Nomenclature of Medicine Clinical Terms and dictionary of medicines and devices codes.
All clinical IT systems that will be used for prescribing homecare medicines will be required to be compliant with this ISN.
Asked by: Lord Willis of Knaresborough (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what steps they are taking to enable prescriptions to be shared electronically between (1) NHS services, and (2) homecare medicines service providers.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
The National Homecare Medicines Committee’s (NHMC) vision for digital transformation, including e-prescribing in homecare, is available in a short video in an online-only format on the YouTube website. The digital subgroup of the NHMC is working with the National Health Service, Electronic Prescribing and Medicines Administration (ePMA) systems vendors and homecare providers to produce an output-based specification for an Electronic Prescribing System (EPS), particularly focusing on the technical aspects of homecare requirements for EPS. This will include interoperable prescribing systems. Any ePMA systems used in secondary care need to be Dictionary of medicines and devices compliant and this applies for homecare medicines too; this is needed to support interoperability.
The output-based specification aims to standardise requirements in homecare medicines e-prescribing, accelerating adoption of e-prescribing system development in homecare. This specification is undergoing final review by NHS England before publication by the NHMC.
Asked by: Lord Willis of Knaresborough (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government when they anticipate all NHS Trusts to have implemented Electronic Prescribing and Medicines Administration systems.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
The COVID-19 pandemic and the subsequent focus on recovery has seen some National Health Service trusts delay implementing Electronic Prescribing and Medication Administration, meaning the timeline for implementation has been pushed to 2025. However, the implementation of e-prescribing in NHS trusts remains a key and appropriate deliverable as part of the vision to digitally transform the NHS. Additionally, the Electronic Prescription Service, which has been widely used in primary care over the past 18 years, is being made available to all NHS trusts by March 2025, should they want to utilise it.
Asked by: Lord Willis of Knaresborough (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what is the estimated cost of VAT to the NHS applied to the purchase of patient drugs in each of the past five financial years.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
The information requested is not held centrally.
Asked by: Lord Willis of Knaresborough (Liberal Democrat - Life peer)
Question to the HM Treasury:
To ask His Majesty's Government why VAT is applied if an NHS hospital pharmacy supplies out-patient medicine but if a private sector pharmacy supplies the same medicine it is zero-rated.
Answered by Baroness Penn
A prescription made by a medical practitioner for medicine dispensed from an NHS hospital pharmacy to an out-patient for self-administration off the hospital site is not subject to VAT. A supply by a private sector pharmacy can be zero-rated in similar circumstances.
If medicine forms part of the hospital supply of medical care to a patient, the medicine will be exempt from VAT.
Asked by: Lord Willis of Knaresborough (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what steps are being taken to (1) significantly reduce, and (2) reform, the amount of regulators and regulatory systems in the health and care sector.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
The Government is committed to reforming the system of regulation for healthcare professionals in the United Kingdom, making it faster, fairer, more flexible and less adversarial. A modernised regulatory framework will be introduced first for anaesthesia associates and physician associates, who will be brought into regulation under the General Medical Council by the end of 2024, before the reformed legislation is rolled out to doctors, and to the professions regulated by the Nursing and Midwifery Council and the Health and Care Professions Council over the following couple of years.
The Care Quality Commission has set out plans to introduce a new single assessment framework for care providers, local authorities, and integrated care systems, which will prevent duplication and provide a consistent and accessible means of ensuring safe and high-quality provision of care at all levels.
Asked by: Lord Willis of Knaresborough (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government which minister is directly responsible for the ‘Homecare Medicines Service’; and what arrangements are in place to (1) coordinate, and (2) evaluate the service.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
The Minister of State for Health, Will Quince MP, is the minister responsible for the Homecare Medicines Service.
Providers of Homecare Medicine services to National Health Service patients do so under framework agreements which may be held at different authority levels as follows:
- National level, via NHS England;
- Regional level, via NHS procurement hubs; or
- Local level via hospital trusts.
This therefore requires a high degree of centralised co-ordination for which the National Homecare Medicines Committee (NHMC) supports and advises the NHS on matters relating to homecare medicines services.
Homecare medicines services are regulated by three different regulators, namely the Medicines and Healthcare products Regulatory Agency, the General Pharmaceutical Council, and the Care Quality Commission, depending on the service being provided. The NHMC acts as the national focus for developing and improving administration and governance processes for homecare medicines services and has published a large volume of guidance and templates to support consistent best practice across the country.
Each Chief Pharmacist within each NHS trust is the responsible officer for the homecare medicines services that the hospital provides and is responsible for the monitoring and performance management of its contracts for these services.
Asked by: Lord Willis of Knaresborough (Liberal Democrat - Life peer)
Question to the Department for Education:
To ask His Majesty's Government what assessment they have made of the briefing The Cost of Delaying Reform to Children’s Social Care, published in May, which summarised analysis commissioned by the children charities Action for Children, Barnardo’s, the Children’s Society, the NSPCC, and the National Children’s Bureau.
Answered by Baroness Barran - Shadow Minister (Education)
There needs to be a fundamental shift away from crisis intervention and towards earlier intervention, and the ‘Stable Homes, Built on Love’ Implementation Strategy and Consultation sets out how the department intend to achieve that. The consultation can be found attached. These are complex reforms, with complicated systemic interactions, and it is critical that we take a test and learn approach and make sure we have models that can be rolled out effectively.
Alongside the Implementation Strategy, the department has announced we are investing £200 million by 2024/25 to address urgent issues facing children and families, to lay the foundations for whole system reform and set national direction for change. This is on top of the £142 million invested by 2024/25 to take forward reforms to unregulated provision in children’s social care, the £160 million as announced in March 2022 to deliver our Adoption Strategy over the next three years, the £259 million to maintain capacity and expand provision in secure and open residential children’s homes over the Spending Review 21 period, and the £230 million over the same period to support young people leaving care.
This is all in addition to the £3.85 billion social care grant that the government is providing to local authorities for adults and children’s social care this year.
After two years, the department will refresh the ‘Stable Homes, Built on Love’ strategy, and seek to scale up the new approaches we have tested and developed, including bringing forward new legislation where necessary (subject to parliamentary time).