Asked by: Baroness Walmsley (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what action they are taking to reduce the waiting time for treatment by Child and Adolescent Mental Health Services.
Answered by Lord O'Shaughnessy
We have introduced a new waiting time standard for treatment of children and young people with eating disorders, setting an expectation that by 2020, 95% of those referred will start treatment within one week if the case is urgent and four weeks if the case is non-urgent.
National data on the number of young people receiving treatment within this timeframe in England shows that over 73% of patients started urgent treatment within one week in Quarter 1 2017-18 (206 out of 281 patients started treatment within one week) and nearly 78.9% of patients started routine treatment within four weeks in Quarter 1 2017-18 (1,067 out of 1,355 patients started treatment within four weeks).
This is positive initial progress some three years before the 95% level of the standard comes into force.
We are also currently exceeding the waiting time standard for Early Intervention in Psychosis, with nearly 75% of patients starting treatment within two weeks in July 2017.
The upcoming children and young people’s mental health Green Paper, which will be published by the end of the year, will include plans to improve timely access to specialist mental health services for those children and young people who need it most.
Asked by: Baroness Walmsley (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government how many schools have received mental health first aid training.
Answered by Lord O'Shaughnessy
To date, 280 schools have received training during June, July and September (262 secondaries and 18 primaries) with a total of 401 people trained. We anticipate that over 1,000 schools will receive training by the end of 2017.
Asked by: Baroness Walmsley (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
Her Majesty's Government when the next meeting of the Crisis Care Concordat Steering Group will take place.
Answered by Baroness Chisholm of Owlpen
Departmental officials are liaising with Home Office officials to make arrangements for the next Crisis care Concordat Steering Group meeting later this year.
Asked by: Baroness Walmsley (Liberal Democrat - 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 1 November (HL2501), what steps they are taking to encourage the 58 CCGs who have currently not uploaded data from GRASP-AF to CHART online to do so.
Answered by Lord Prior of Brampton
CHART Online allows NHS England’s Sustainable Improvement Team to easily track the use of the Guidance on Risk Assessment and Stroke Prevention in Atrial Fibrillation (GRASP-AF) amongst general practitioner (GP) practices. However, there are a number of other tools in addition to GRASP-AF that are available to GPs to help audit management of atrial fibrillation (AF) patients. The Sustainable Improvement Team cannot easily track the use of these alternative tools, and many of the 58 clinical commissioning groups (CCGs) not using GRASP-AF, may be using one of these alternative tools. However, the Sustainable Improvement Team’s partnership with NHS RightCare will enable it to revisit practices in these CCGs to confirm the use of an alternative tool and to encourage the use of GRASP-AF in those practices that are not using, currently using it or an alternative.
The Sustainable Improvement Team uses aggregate data at CCG level or higher to help raise awareness of its work and to promote local improvement in the management of AF and has published a paper on the use of GRASP-AF and what it shows about the management of AF. A copy of the paper The use of anticoagulants in the management of atrial fibrillation among general practices in England is attached. The team also shares high level CHART Online data with organisations such as the Atrial Fibrillation Association and Public Health England.
The following table sets out information on variation in the prevalence and management of patients with AF.1
CCG level variation in the recorded prevalence and management of patients with AF
| Mean | Range |
AF Prevalence | 1.88% | 0.75-2.91% |
% of AF patients at high risk of stroke (CHADSVASc of 2 or more2 ): | 58.6% | 51.8-65.9% |
% of AF patients at high risk and on oral anticoagulant (as recommended by the National Institute for Health and Care Excellence [NICE]): | 63.5% | 48.3-80.8% |
% of AF patients at high risk and on aspirin alone (not recommended by NICE)3: | 27.9% | 11.3-42.5% |
Source: NHS England
1. These figures include only those CCGs which have at least 50% of their practices uploading to CHART Online, to avoid the data being skewed by individual practices.
2. CHADSVASc calculates stroke risk for patients with atrial fibrillation.
3. The removal of aspirin from the Quality Outcomes Framework some time ago may filter into the system as will continued adoption of the NICE guidance from 2015.
Asked by: Baroness Walmsley (Liberal Democrat - 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 1 November (HL2501), whether they intend to publish the key findings from the data collected through the GRASP-AF tool, saved on CHART online, to allow variations in services, diagnosis and care for patients with atrial fibrillation to be identified and addressed.
Answered by Lord Prior of Brampton
CHART Online allows NHS England’s Sustainable Improvement Team to easily track the use of the Guidance on Risk Assessment and Stroke Prevention in Atrial Fibrillation (GRASP-AF) amongst general practitioner (GP) practices. However, there are a number of other tools in addition to GRASP-AF that are available to GPs to help audit management of atrial fibrillation (AF) patients. The Sustainable Improvement Team cannot easily track the use of these alternative tools, and many of the 58 clinical commissioning groups (CCGs) not using GRASP-AF, may be using one of these alternative tools. However, the Sustainable Improvement Team’s partnership with NHS RightCare will enable it to revisit practices in these CCGs to confirm the use of an alternative tool and to encourage the use of GRASP-AF in those practices that are not using, currently using it or an alternative.
The Sustainable Improvement Team uses aggregate data at CCG level or higher to help raise awareness of its work and to promote local improvement in the management of AF and has published a paper on the use of GRASP-AF and what it shows about the management of AF. A copy of the paper The use of anticoagulants in the management of atrial fibrillation among general practices in England is attached. The team also shares high level CHART Online data with organisations such as the Atrial Fibrillation Association and Public Health England.
The following table sets out information on variation in the prevalence and management of patients with AF.1
CCG level variation in the recorded prevalence and management of patients with AF
| Mean | Range |
AF Prevalence | 1.88% | 0.75-2.91% |
% of AF patients at high risk of stroke (CHADSVASc of 2 or more2 ): | 58.6% | 51.8-65.9% |
% of AF patients at high risk and on oral anticoagulant (as recommended by the National Institute for Health and Care Excellence [NICE]): | 63.5% | 48.3-80.8% |
% of AF patients at high risk and on aspirin alone (not recommended by NICE)3: | 27.9% | 11.3-42.5% |
Source: NHS England
1. These figures include only those CCGs which have at least 50% of their practices uploading to CHART Online, to avoid the data being skewed by individual practices.
2. CHADSVASc calculates stroke risk for patients with atrial fibrillation.
3. The removal of aspirin from the Quality Outcomes Framework some time ago may filter into the system as will continued adoption of the NICE guidance from 2015.
Asked by: Baroness Walmsley (Liberal Democrat - 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 1 November (HL2501), within the CCGs which have uploaded data to CHART online, what variation exists regarding the management of patients with atrial fibrillation.
Answered by Lord Prior of Brampton
CHART Online allows NHS England’s Sustainable Improvement Team to easily track the use of the Guidance on Risk Assessment and Stroke Prevention in Atrial Fibrillation (GRASP-AF) amongst general practitioner (GP) practices. However, there are a number of other tools in addition to GRASP-AF that are available to GPs to help audit management of atrial fibrillation (AF) patients. The Sustainable Improvement Team cannot easily track the use of these alternative tools, and many of the 58 clinical commissioning groups (CCGs) not using GRASP-AF, may be using one of these alternative tools. However, the Sustainable Improvement Team’s partnership with NHS RightCare will enable it to revisit practices in these CCGs to confirm the use of an alternative tool and to encourage the use of GRASP-AF in those practices that are not using, currently using it or an alternative.
The Sustainable Improvement Team uses aggregate data at CCG level or higher to help raise awareness of its work and to promote local improvement in the management of AF and has published a paper on the use of GRASP-AF and what it shows about the management of AF. A copy of the paper The use of anticoagulants in the management of atrial fibrillation among general practices in England is attached. The team also shares high level CHART Online data with organisations such as the Atrial Fibrillation Association and Public Health England.
The following table sets out information on variation in the prevalence and management of patients with AF.1
CCG level variation in the recorded prevalence and management of patients with AF
| Mean | Range |
AF Prevalence | 1.88% | 0.75-2.91% |
% of AF patients at high risk of stroke (CHADSVASc of 2 or more2 ): | 58.6% | 51.8-65.9% |
% of AF patients at high risk and on oral anticoagulant (as recommended by the National Institute for Health and Care Excellence [NICE]): | 63.5% | 48.3-80.8% |
% of AF patients at high risk and on aspirin alone (not recommended by NICE)3: | 27.9% | 11.3-42.5% |
Source: NHS England
1. These figures include only those CCGs which have at least 50% of their practices uploading to CHART Online, to avoid the data being skewed by individual practices.
2. CHADSVASc calculates stroke risk for patients with atrial fibrillation.
3. The removal of aspirin from the Quality Outcomes Framework some time ago may filter into the system as will continued adoption of the NICE guidance from 2015.
Asked by: Baroness Walmsley (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether there will be a consultation on changes to the methodology used by the Joint Committee on Vaccination and Immunisation that result either from the report commissioned by the Department of Health on the Cost-Effectiveness Methodology for Immunisation Programmes and Procurement or from the work of the Department of Health’s Appraisal Alignment Working Group.
Answered by Lord Prior of Brampton
The Department will be publishing the Cost Effectiveness Methodology for Immunisation Programmes and Procurements report in due course. The timetable has not yet been confirmed.
A decision on consultation has not yet been made.
Asked by: Baroness Walmsley (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether they intend to publish the report commissioned by the Department of Health on the Cost Effectiveness Methodology for Immunisation Programmes and Procurement, and if so, when.
Answered by Lord Prior of Brampton
The Department will be publishing the Cost Effectiveness Methodology for Immunisation Programmes and Procurements report in due course. The timetable has not yet been confirmed.
A decision on consultation has not yet been made.
Asked by: Baroness Walmsley (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what action is being taken to build local primary care leadership to challenge variation, and drive quality improvement, in the detection and management of atrial fibrillation.
Answered by Lord Prior of Brampton
NHS England’s Sustainable Improvement Team is taking action to promote the use of GRASP-AF (Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation) within general practitioner (GP) practices in England. GRASP-AF is an audit tool developed by and trialled in the National Health Service which greatly simplifies the process of identifying patients with Atrial Fibrillation (AF) who are not receiving the right management to help reduce their risk of stroke.
The Sustainable Improvement Team is also working with NHS RightCare, a programme committed to improving people’s health and outcomes, to help promote the use of GRASP-AF in the programme’s 65 first wave clinical commissioning groups (CCGs). NHS RightCare’s ‘Commissioning for Value’ packs help CCGs identify priority areas such as AF, and the GRASP AF tool provides a practical method of addressing any inequalities. NHS England’s intention is that the work with NHS RightCare will increase the number of CCGs using GRASP-AF in a systematic way.
Anonymised data from GRASP-AF can be uploaded to CHART Online, a secure web enabled tool that helps practices improve performance through comparative data analysis. This allows practices and CCGs to benchmark their management of AF with other practices across England and so help identify and reduce any variation in practice.
The use of GRASP-AF is voluntary and its use therefore varies across CCGs. Currently 2,248 GP practices have uploaded data from GRASP-AF to CHART online across 151 out of the 209 CCGs. Of these, 19 CCGs have all GP practices in their area uploading data.
In addition to the NHS action outlined above, all local authorities in England are required to offer the NHS Health Check programme, with the large majority commissioning general practice to provide them on their behalf. More than 15 million people aged 40-74 are, have been or will be eligible for an NHS Health Check between 2014 and 2018. The programme’s best practice guidance recommends that a pulse check is carried out as part of the process of taking a blood pressure reading and those individuals who are found to have an irregular pulse rhythm should be referred for further investigation.
Asked by: Baroness Walmsley (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what proportion of clinical commissioning groups have undertaken a systematic audit across GP practices to identify people with (1) possible undiagnosed atrial fibrillation, and (2) atrial fibrillation at high risk of stroke who are not anticoagulated or maintained in therapeutic range.
Answered by Lord Prior of Brampton
NHS England’s Sustainable Improvement Team is taking action to promote the use of GRASP-AF (Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation) within general practitioner (GP) practices in England. GRASP-AF is an audit tool developed by and trialled in the National Health Service which greatly simplifies the process of identifying patients with Atrial Fibrillation (AF) who are not receiving the right management to help reduce their risk of stroke.
The Sustainable Improvement Team is also working with NHS RightCare, a programme committed to improving people’s health and outcomes, to help promote the use of GRASP-AF in the programme’s 65 first wave clinical commissioning groups (CCGs). NHS RightCare’s ‘Commissioning for Value’ packs help CCGs identify priority areas such as AF, and the GRASP AF tool provides a practical method of addressing any inequalities. NHS England’s intention is that the work with NHS RightCare will increase the number of CCGs using GRASP-AF in a systematic way.
Anonymised data from GRASP-AF can be uploaded to CHART Online, a secure web enabled tool that helps practices improve performance through comparative data analysis. This allows practices and CCGs to benchmark their management of AF with other practices across England and so help identify and reduce any variation in practice.
The use of GRASP-AF is voluntary and its use therefore varies across CCGs. Currently 2,248 GP practices have uploaded data from GRASP-AF to CHART online across 151 out of the 209 CCGs. Of these, 19 CCGs have all GP practices in their area uploading data.
In addition to the NHS action outlined above, all local authorities in England are required to offer the NHS Health Check programme, with the large majority commissioning general practice to provide them on their behalf. More than 15 million people aged 40-74 are, have been or will be eligible for an NHS Health Check between 2014 and 2018. The programme’s best practice guidance recommends that a pulse check is carried out as part of the process of taking a blood pressure reading and those individuals who are found to have an irregular pulse rhythm should be referred for further investigation.