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

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.

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

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.

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

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.

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.

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.

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.

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.

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.

This information is not held by the Department or NHS England, as general practitioner (GP) and pharmacy contracts do not mandate pulse checks as part of the existing GP and pharmacy enhanced services for people over 65.

However, in England all local authorities are required to offer the NHS Health Check programme, with the large majority commissioning general practice to provide them on their behalf. Between 2014 and 2018 more than 15 million people aged 40-74 will be eligible for an NHS Health Check. 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.

The Joint Committee on Vaccination and Immunisation, the expert committee that advises Ministers on immunisation related issues, is currently in the process of considering the impact and cost-effectiveness of extending the human papilloma virus (HPV) vaccination to adolescent boys. This includes assessing all the necessary evidence and information on the potential impact of a boys vaccination programme on non-cervical cancers caused by HPV.

On the abolition of primary care trusts in April 2013, former primary care trust land, buildings and related contracts transferred either to NHS Property Services or to National Health Service trusts, depending on the details of the individual transfer schemes. Clinical equipment was not generally transferred to NHS Property Services.

Equipment donated after April 2013 directly to individual NHS hospital trusts and x-ray equipment bought for a trust by local fundraising efforts would belong to the NHS trust unless it has been specifically transferred to NHS Property Services under the terms of a particular transfer scheme.

My Lords, unsafe discharge of frail elderly patients is unacceptable. Discharge can be very complex, and the integration of health and social care is vital for safe, joined-up care. We are using sustainability and transformation plans to promote integration, supported by the better care fund, creating a seven-day NHS and supporting local systems to develop integrated discharge systems and new models of care.

Accident and emergency (A&E) waiting times for patients who arrive by ambulance start either when the ambulance crew hand over the patient to the A&E department, or 15 minutes after the ambulance registers its arrival at A&E, whichever is earlier.

Providing the complete information on the number of people who have joined the NHS Organ Donor Register by local authority and Parliamentary constituency in the main body of this reply would exceed the word limit for responses to written parliamentary questions. The information is therefore in the attached table.

The Department first published Uniforms and Work wear: An evidence base for developing local policy in 2007, with an update to this guidance published in March 2010. A copy of this document is attached.

The guidance was informed by two extensive literature reviews conducted by Thames Valley University and by practical research on washing uniform fabrics carried out at University College Hospital. Whilst there is a theoretical risk, this work‎ supported the conclusion that there was no evidence that uniforms and workwear played a direct role in spreading infection.

Nonetheless, the clothes that staff wear should facilitate good practice and minimise any risk to patients. Public attitudes and perceptions indicate that it is good practice for staff either to change at work or to cover their uniforms as they travel to and from work. Changing into and out of uniforms at work is included as a good practice example in the guidance.

The Joint Committee on Vaccination and Immunisation (JCVI), the independent expert body that advises ministers on immunisation matters, recommended a meningococcal B (MenB) immunisation programme that will protect infants because they are at highest risk, with the peak incidence of MenB being in infants at about five months of age. The MenB vaccine is offered to babies at two months of age, with further doses offered when they reach four and 12 months of age.

The JCVI keeps the eligibility criteria of all vaccination programmes under review and considers new evidence as it becomes available. If the JCVI provides further advice about the programme, we will consider this.

My Lords, community pharmacies are a vital part of the NHS. The Government believe efficiencies can be made without compromising the quality of services or public access to them. Our aim is to ensure that community pharmacies upon which people depend continue to thrive. We are consulting on a pharmacy access scheme which will provide more NHS funds to certain pharmacies compared to others, considering factors such as location and the health needs of the local population.

Sir Bruce Keogh, NHS England’s Medical Director, has undertaken a review of the National Clinical Director (NCD) resource designed to focus clinical advisory resources on areas where major programmes of work are currently being taking forward, or areas identified as priorities for improvement. As a result of the review, NHS England has proposed to change the way in which clinical advice is received in speciality areas in the future.

Where there will no longer be a specific NCD role, NHS England will secure expert clinical advice from its Clinical Networks and through its relationships with professional bodies and by appointing clinical advisors. For neurology it is planned that access to advice will be through clinical leads and members of the NHS England-funded neurology clinical networks, the Neurology Clinical Reference Group and Royal Colleges. It is expected that these new arrangements will be in place from 1 April 2016.

The Neurology Intelligence Network (NIN) is a joint partnership programme between Public Health England (PHE) and NHS England to support the generation and dissemination of neurology related health intelligence. PHE currently funds the on-going design, development and management of the NIN.

Local authorities’ public health allocations for 2016-17 and indicative allocations for 2017-18 were published on 11 February 2016. Allocations are set out in the attached document.