Asked by: Julian Lewis (Conservative - New Forest East)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what (a) mechanisms exist and (b) steps he is taking to ensure that integrated care boards are accountable for their commissioning of children’s palliative care.
Answered by Stephen Kinnock - Minister of State (Department of Health and Social Care)
Integrated care boards (ICBs) are responsible for the commissioning of palliative and end of life care services, including for children and young people, to meet the needs of their local populations. To support ICBs in this duty, NHS England has published statutory guidance and service specifications.
NHS England has a legal duty to annually assess the performance of each ICB in respect of each financial year, and to publish a summary of its findings. This assessment must include how well the ICB has discharged its functions.
Asked by: Julian Lewis (Conservative - New Forest East)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, how many legal cases brought against the NHS by mesh-damaged women have been settled (a) in and (b) out of court in each of the past ten years.
Answered by Ashley Dalton - Parliamentary Under-Secretary (Department of Health and Social Care)
NHS Resolution (NHSR) manages clinical negligence and other claims against the National Health Service in England, and while the information is not available in the format requested, they have provided the data below. This information only covers England and not the rest of the United Kingdom, and NHSR has interpreted ‘in court’ as being where the court proceedings have been served, rather than where a case has gone to trial.
Claims notified and open are not guaranteed to be settled in the same year and can take many years to be concluded. Claims notified in any given year will often relate to incidents that have occurred many years prior. Claims closed and settled in one year will often relate to claims notified in different years. Many of the claims notified will have been repudiated and settled without damages paid.
It is also possible that the same claim may appear more than once in a dataset, across different year groups, for example, where the case has been closed as unsuccessful, challenged, reopened, and closed again at conclusion.
The following table shows the number of clinical claims and incidents received between the financial years 2014/15 and 2023/24, where the claim has been identified as a vaginal mesh claim:
Year of notification | Number of claims |
2014/15 | 5 |
2015/16 | 12 |
2016/17 | 15 |
2017/18 | 54 |
2018/19 | 70 |
2019/20 | 209 |
2020/21 | 396 |
2021/22 | 226 |
2022/23 | 166 |
2023/24 | 99 |
Total | 1,252 |
Source: NHSR
In addition, the following table shows the number of clinical claims settled between the financial years 2015/16 and 2023/24 with a damages payment, where the claim has been identified as a vaginal mesh claim, broken down by litigation status:
Year of settlement and litigation status | Number of claims |
2015/16 | # |
Litigation | # |
No Litigation | # |
2016/17 | # |
Litigation | # |
No Litigation | # |
2017/18 | 16 |
Litigation | 8 |
No Litigation | 8 |
2018/19 | # |
Litigation | 8 |
No Litigation | # |
2019/20 | # |
Litigation | 11 |
No Litigation | # |
2020/21 | 32 |
Litigation | 22 |
No Litigation | 10 |
2021/22 | 61 |
Litigation | 19 |
No Litigation | 42 |
2022/23 | 116 |
Litigation | 27 |
No Litigation | 89 |
2023/24 | 101 |
Litigation | 22 |
No Litigation | 79 |
Total | 356 |
Source: NHSR
Finally, the following table shows the number of clinical claims settled between the financial years 2015/16 and 2023/24 with no damages paid, where the claim has been identified as a vaginal mesh claim, broken down by litigation status:
Year of settlement and litigation status | Number of claims |
2015/16 | # |
Litigation | # |
No Litigation | 8 |
2016/17 | # |
Litigation | # |
No Litigation | 6 |
2017/18 | # |
Litigation | # |
No Litigation | 7 |
2018/19 | 43 |
Litigation | 5 |
No Litigation | 38 |
2019/20 | # |
Litigation | # |
No Litigation | 43 |
2020/21 | 90 |
Litigation | 6 |
No Litigation | 84 |
2021/22 | 167 |
Litigation | 64 |
No Litigation | 103 |
2022/23 | 179 |
Litigation | 28 |
No Litigation | 151 |
2023/24 | 120 |
Litigation | 10 |
No Litigation | 110 |
Total | 678 |
Source: NHSR
Notes: NHSR has supressed low figures as NHSR believe that disclosure of information to a member of the public would contravene one or more of the data protection principles. In some instances, for low numbers of claims, namely fewer than 5, in each category, the likelihood exists that individuals who are the subject of this information may be identified. As this information is sensitive personal data, NHSR believes it has a greater responsibility to protect those individuals’ identities, as disclosure could potentially cause damage and/or distress to those involved. Due to small numbers in the tables, NHSR has used a ‘#’ symbol in the relevant field.
Asked by: Julian Lewis (Conservative - New Forest East)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, if he will publish current waiting lists totals at each of the mesh removal centres set up following the publication of the Cumberlege report; and whether mesh-damaged women are given an option to attend mesh removal centres other than ones led by surgeons who implanted their mesh originally.
Answered by Karin Smyth - Minister of State (Department of Health and Social Care)
Tackling waiting lists is a key part of our Health Mission and we are taking steps to return to the 18-week standard. The Elective Reform Plan sets out how the National Health Service will reform elective care services to meet the 18-week referral to treatment standard by March 2029.
There are nine specialist mesh centres across England, ensuring that women in every region with complications of mesh inserted for urinary incontinence and vaginal prolapse get the right support. Each mesh centre is led by a multi-disciplinary team to ensure patients get access to the specialist care and treatment that they need, including pain management and psychological support. NHS England publishes data on referral to treatment waiting times, which is available at the following link:
https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/
Data is published at the level of specialties, for example gynaecology, and is not routinely published at sub-speciality level. The most recent waiting time data held by NHS England from 2024 indicated that the average waiting time across the nine centres was 28 weeks.
The surgery to remove mesh implanted for stress urinary incontinence and vaginal prolapse is a relatively new surgical discipline. Expertise is, therefore, concentrated in a limited number of specialist centres led by a core multi-disciplinary team, including consultant specialists in urogynaecology, urology, and pain management. Patients, when requesting treatment for mesh complications, can exercise patient choice and be referred to another centre, ensuring that they can be seen by another surgeon where appropriate.
Asked by: Julian Lewis (Conservative - New Forest East)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, if he will take steps to commission (a) research into, and (b) training programmes for, improved techniques for removal of failed pelvic mesh implants from injured women including those removal methods developed in Missouri by Dr Dionysios Veronikis currently unavailable in the United Kingdom.
Answered by Karin Smyth - Minister of State (Department of Health and Social Care)
The Department, through the National Institute for Health and Care Research (NIHR), is currently funding research to develop a patient-reported outcome measure (PROM) for prolapse, incontinence, and mesh complication surgery. This will enable women to self-report the ways in which any surgical treatment for these conditions, mesh and non-mesh related, has affected their quality of life. Once testing of the PROM is completed, women will be able to complete it as part of their care. It will also be suitable for use by national registries and with women taking part in clinical trials. The NIHR continues to welcome funding applications for research into any aspect of women’s health, including pelvic mesh.
NHS England has established nine specialist mesh centres across England, ensuring that women in every region with complications of mesh inserted for urinary incontinence and vaginal prolapse get the right support. Each mesh centre is led by a multi-disciplinary team to ensure patients get access to the specialist care and treatment that they need, including pain management and psychological support.
The National Health Service’s service specification sets out the standards of care expected from organisations funded by NHS England to provide specialised care. The specification for complications of mesh inserted for urinary incontinence, vaginal or internal, and external rectal prolapse states that specialised mesh centres must use trust appraisal systems to ensure that surgeons are appropriately trained, current in their practice, that they adhere to clinical and NICE guidance, comply with Pelvic Floor Registry data requirements, and report complications. The service specification is available at the following link:
Asked by: Julian Lewis (Conservative - New Forest East)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what his policy is on patient confidentiality in relation to sharing information on (a) inquiry reports and (b) other relevant information on killings by mentally ill people with the (i) families of their victims and (ii) general public; and what his policy is on (A) publishing independent homicide reports and (B) intervening to consider publication in such cases, in the context of patient confidentiality.
Answered by Stephen Kinnock - Minister of State (Department of Health and Social Care)
It is important that in such cases, National Health Service organisations are as transparent as possible within the bounds of the law, and that independent homicide reports are published and shared in line with legal guidance and with engagement from families. These decisions are for the organisations which commissioned the reports on a case-by-case basis.
In the case of the independent investigation into the care and treatment provided to Valdo Calocane, the NHS took the decision to publish the investigation’s report in full in line with the wishes of the families and given the level of detail already in the public domain.
The Department will work with NHS England and partners to set out next steps for how future independent mental health homicide reports should be published to ensure that NHS organisations act as transparently as possible, in line with their legal obligations.
Asked by: Julian Lewis (Conservative - New Forest East)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what discussions he has had with the National Institute for Health and Care Excellence on the use of Fenfluramine to treat Lennox Gastaut Syndrome; and what representations his Department has had from hospitals in Southampton on this matter.
Answered by Karin Smyth - Minister of State (Department of Health and Social Care)
The National Institute for Health and Care Excellence (NICE) develops its guidance on new medicines independently and the Department has had no discussions with the NICE about its appraisal of fenfluramine for the treatment of Lennox Gastaut syndrome. Furthermore, I am not aware of any correspondence or representations from hospitals in Southampton on this matter.
The NICE recently published draft guidance that recommends fenfluramine for the treatment of patients meeting specific clinical criteria, and registered stakeholders now have an opportunity to appeal. The NICE currently expects to publish final guidance on 26 March 2025.
Asked by: Julian Lewis (Conservative - New Forest East)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what guidance his Department gives to medical practitioners on the (a) risks of harmful long-term effects resulting from the prescription of Lariam (Mefloquine) as an anti-malarial prophylaxis and (b) treatment recommended for alleviation of such effects when experienced by people after being prescribed Lariam.
Answered by Karin Smyth - Minister of State (Department of Health and Social Care)
Mefloquine, commercially known as Lariam, is effective in the prevention and treatment of malaria and is licensed for use by the Medicines and Healthcare products Regulatory Agency (MHRA) in the United Kingdom. The current product information for mefloquine states that neuropsychiatric adverse reactions may occur during treatment and includes warnings and precautions to minimise these risks. It also states that such adverse reactions may persist for months, or longer, even after discontinuation of the drug. It has not been established, however, that such adverse reactions may be permanent.
The UK was involved in the European Union’s safety review in 2013 which concluded there was a need for additional measures to strengthen the existing safety warnings for neuropsychiatric effects. A range of regulatory actions were implemented in Europe and the UK, including a letter to healthcare professionals highlighting the strengthened warnings about psychiatric effects in the product information for mefloquine, prescribing guides and checklists for healthcare professionals, and an alert card for patients. These documents are available at the following link:
https://www.medicines.org.uk/emc/product/9670/smpc
An article highlighting the new advice was also published in the MHRA’s Drug Safety Update newsletter, which is available at the following link:
Subsequently, in 2014, the mefloquine product information was revised to warn that some psychiatric reactions may occur after discontinuation of mefloquine and may persist for some time after discontinuation. These updates were implemented across Europe including in the UK. Annual reminder letters highlighting the main risks associated with mefloquine and the patient checklist and alert card were issued until 2021 after which time it was agreed that due to low use of the product and a lack of enquiries for the risk minimisation materials annual letters were no longer required. The patient checklist and alert card remain available in the UK.
As with any medicine, clinicians are responsible for making prescribing decisions for their patients, considering best prescribing practice and the local commissioning decisions of their respective integrated care boards (ICBs). They are also expected to take account of appropriate national guidance on clinical effectiveness and safety, and are accountable for their prescribing decisions, both professionally and to their service commissioners. Prescribers are responsible for ensuring that any side effects experienced by their patients are addressed promptly; they should work with their patient to decide on the most suitable management plan, with the provision of the most clinically appropriate care for the individual always being the primary consideration.
Asked by: Julian Lewis (Conservative - New Forest East)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what recent assessment he has made of trends in the totals of students on (a) all BSc nursing degree courses, and (b) specific courses for the degree of BSc Nursing (Learning Disabilities) since 2016; what percentage of students on BSc Nursing (Learning Disabilities) degree courses were in receipt of NHS bursaries in the year prior to the discontinuation of such bursaries; and what percentage of students currently on BSc Nursing (Learning Disabilities) degree courses are in receipt of apprenticeships.
Answered by Karin Smyth - Minister of State (Department of Health and Social Care)
The National Health Service continues to offer rewarding careers, with many thousands of people choosing to study nursing and midwifery every year. The Department monitors the information published by the Universities and Colleges Admissions Service (UCAS) which shows that healthcare courses were in high demand during the pandemic and now we are seeing a decrease in number of applicants across these programmes. The following table shows the number of acceptances to undergraduate nursing courses in England, from 2019 to 2024:
Year | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 |
Acceptances | 19,770 | 25,510 | 25,815 | 23,240 | 20,790 | 20,920 |
Source: data is from UCAS, and is available at the following link:
https://www.ucas.com/data-and-analysis/undergraduate-statistics-and-reports/ucas-undergraduate-end-cycle-data-resources-2024
While the data from UCAS is not detailed enough to report acceptances to individual branches of nursing, the Office for Students tracks the number of starters on learning disabilities nursing routes, through their Higher Education Students Early Statistics Survey. The following table therefore shows the number of undergraduate starters on learning disabilities nursing courses from 2016 to 2023:
Year | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 |
Starters | 495 | 315 | 375 | 425 | 580 | 570 | 535 | 345 |
Source: data is from the Office for Students, and is available at the following link:
https://www.officeforstudents.org.uk/data-and-analysis/data-collection/get-the-heses-data/
Prior to the student funding reforms in 2017, nursing, midwifery, and allied health professions training places were centrally commissioned by Health Education England (HEE). All students on HEE commissioned places would have been in receipt of a non-means tested NHS Bursary and had their tuition fees paid. However, the Department does not hold the information that is able to confirm the proportion of Bachelor of Science in Nursing (Learning Disabilities) students who were in receipt of means tested elements of the National Health Service’s bursaries scheme or other allowances available to students in the year prior to their discontinuation.
The Department does not hold information on the percentage of students currently on Bachelor of Science in Nursing (Learning Disabilities) degree courses who are in receipt of apprenticeships.
Asked by: Julian Lewis (Conservative - New Forest East)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what assessment he has made of the potential implications of the differential effects of the changes in last year's budget to National Insurance Contributions on employers of Learning Disabilities nurses who work (a) directly for the NHS and (b) for independent health and social care suppliers who are contracted by the NHS to give support to its patients.
Answered by Karin Smyth - Minister of State (Department of Health and Social Care)
We have taken tough decisions to fix the foundations in the public finances at Autumn Budget, and this enabled the Spending Review settlement of a £22.6 billion increase in resource spending for the Department from 2023/24 outturn to 2025/26. The employer National Insurance rise will be implemented from April 2025, and NHS England has set out the approach to funding providers in planning guidance for the next financial year.
Asked by: Julian Lewis (Conservative - New Forest East)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, for what reason NHS hospitals have not commissioned beds available in care homes to restore capacity on hospital wards by enabling patients to be discharged.
Answered by Stephen Kinnock - Minister of State (Department of Health and Social Care)
Local authorities should determine the volume and type of services, including care home beds, that are required to meet their responsibilities under the Care Act 2014. National Health Service integrated care boards, local authorities, and providers should work together to ensure that efforts to discharge individuals from hospital into social care are joined up and make best use of the available resources, in line with the duty to cooperate as set out in Section 82 of the NHS Act 2006.
In December 2024 there were, on average, 12,000 adult patients in acute hospital beds per day with delayed discharges, 5% fewer than in December 2023.