No formal assessment has been made. Patients with non-tuberculous mycobacteria will continue to be managed in primary and secondary care settings and treated with the current available treatments known as ‘Guideline Based Therapy’ as recommended by the British Thoracic Society.

The British Thoracic Society guideline for the use of longterm macrolides in adults with respiratory disease suggests that patients who are able to expectorate should be considered for testing for non-tuberculous mycobacteria prior to starting long-term macrolide therapy. A copy of the guideline is attached. NHS England and NHS Improvement do not hold data on the number of tests undertaken.

From 1 April, free access to asymptomatic and symptomatic tests for the public in England will end. The Government will continue to provide free symptomatic testing for patients in hospital, for whom a test is required for clinical management or to support treatment pathways and those eligible for COVID-19 treatments due to their higher risk of getting seriously ill from COVID-19.

Patients in this higher risk cohort will be contacted directly and sent lateral flow device tests for symptomatic testing and guidance on how to reorder tests. Asymptomatic lateral flow device testing will continue in some high-risk settings where infection can spread rapidly while prevalence is high.

Breast cancer screening providers are being encouraged to work with Cancer Alliances, Primary Care Networks and National Health Service regional teams to promote the uptake of breast screening services and ensure local populations can access services. NHS England and NHS Improvement have allocated £22 million for replacement mobile breast screening units and £50 million to increase capacity and activity in England.

Breast screening information leaflets have been developed with contributions from women representing a wide range of backgrounds and ages. These leaflets are available both in hard copy and online in the 10 most requested languages. An easy read version of the guide to breast screening has also been developed. In addition, an animation about screening programmes for women, featuring breast screening and guidance for screening services on reducing inequalities in the programme is available.

A separate leaflet is provided for women aged 71 years old and over which explains that although they no longer receive routine invitations, breast screening can be requested every three years.

I think all noble Lords would agree with the noble Baroness that it is important we have speedy diagnosis. On the specific question, I will check and get back to her.

We have issued online guidance on 11 October which states that individuals who have COVID-19 symptoms should stay at home and a polymerase chain reaction (PCR) test. Anyone subsequently notified by NHS Test and Trace or local authority contact tracer that they have tested positive is legally required to self-isolate. Employees should notify their employer in such circumstances.

An individual can return to work, after the end of their self-isolation period if their symptoms have gone or if the only symptoms they have are a cough or anosmia, which can last for several weeks. There is no requirement to return a negative PCR test in order to end self-isolation. Individuals who still have a high temperature or are otherwise unwell should stay at home and seek medical advice.

The diagnosis of influenza is generally made using clinical symptoms in primary care settings and can only be confirmed by laboratory testing. Rapid testing should be undertaken in all people with complicated influenza which often takes place in hospital. The Department is exploring potential options to expanding winter virus testing via home or community testing.

We have not made a specific assessment. However, the diagnosis of influenza is generally made using clinical symptoms in primary care settings then confirmed by laboratory testing. Rapid testing for complicated influenza often takes place in hospitals. The treatment of influenza can involve antiviral medication and/or hospital admission. As a preventative measure, priority groups most at risk and frontline health and adult social care workers are eligible for a free influenza vaccine to protect them and prevent onward transmission to vulnerable members of the community.

My Lords, I take my hat off to the London School of Hygiene & Tropical Medicine, which runs an extremely exciting trial. In fact, the Secretary of State is visiting this very afternoon in order to get an update on that trial. Dogs can be used as a way of screening crowds in such places as airports and high-density venues. The validation of that method has not been proven yet, but I am personally extremely hopeful and remain grateful to those involved in the pilot.

As part of our concerted national efforts to respond to the COVID-19 outbreak, we are doing everything we can to ensure patients continue to have access to COVID-19 test equipment and medicines in all scenarios. This includes holding stockpiles of a variety of medicines currently and potentially used in treating patients with COVID-19, to help ensure there is uninterrupted supply over the coming months.

The Department has well-established procedures to deal with shortages and works closely with industry, the National Health Service and others in the supply chain to address supply disruption events that arise, regardless of the cause.

All National Health Service and social care staff, including nurses, can apply for a test if they are experiencing symptoms using digital portal. The employer referral portal allows employers to refer essential workers who are self-isolating either because they or member(s) of their household have COVID-19 symptoms, for testing.

Asymptomatic care home staff are now eligible for testing through the ‘whole home’ testing portal.

The Government’s response is built around protecting those who are most vulnerable in our society. Testing is a crucial part of the United Kingdom’s response to the COVID-19 pandemic and we are working on multiple fronts to deliver additional testing capacity into the system.

As we have moved from ‘contain’ and into the ‘delay’ phase of COVID-19, Public Health England, together with NHS England and the Department, has agreed we will need to prioritise testing for those most at risk of severe illness from the virus. Our aim is to save lives, protect the most vulnerable, and relieve pressure on the National Health Service.

As a result, tests will primarily be given to:

- all patients in critical care for pneumonia, acute respiratory distress syndrome (ARDS) or flu like illness; and

- all other patients requiring admission to hospital for pneumonia, ARDS or flu-like illness

The Government is looking at wider testing for those in less critical states. As announced on 27 March, the Government is working with industry, philanthropy and universities to significantly scale up testing.

The UK National Screening Committee completed a public consultation on 4 November 2017 on whether a proposal for a practical evaluation of Severe Combined Immunodeficiency (SCID) was supported. It has since recommended a practical evaluation of SCID screening to be undertaken in the National Health Service. This evaluation will be considered as part of the 2019/20 funding decisions.

Public Health England, Her Majesty’s Prison and Probation Service and NHS England introduced ‘opt-out’ testing for blood-borne viruses, including hepatitis C, in prisons in the first National Partnership Agreement published in 2013 with phased implementation through a series of pathfinder prisons in three successive phases. Full implementation across the whole adult prison estate in England was concluded in financial year 2017/18, as described in the 2015 Second National Partnership Agreement. A copy of the National Partnership Agreement between: The National Offender Management Service, NHS England and Public Health England for the Co-Commissioning and Delivery of Healthcare Services in Prisons in England 2015-2016 is attached.

All new consenting eligible adult receptions to prisons in England are now offered a hepatitis C test on an opt-out basis within 72 hours of reception in accordance with published national guidance; this usually occurs at second reception health screening. The standard for patients testing positive for hepatitis C is referral to specialists for assessment within a maximum of 18 weeks from referral.

The noble Baroness is absolutely right. Early diagnosis is absolutely critical. We have made huge progress. The WHO guidelines aim for 90% of people with HIV to be diagnosed. We are at 87%. Sweden is the only country in the world that has hit the 90% target. I point to the It Starts With Me programme, which is based around individual responsibility and is co-ordinated by the Terrence Higgins Trust, which is making great progress.

NHS England is working with key partners to ensure better co-ordination and integration of all services with the aim of delivering person-centred and coordinated care which is tailored to the needs and preferences of the individual, their carer and family.

In particular, to encourage better practice in the caring for heart failure patients, NHS England has established a best practice tariff for acute heart failure. It is also working with Health Education England to explore ways of improving the provision of and increasing access to echocardiography, which is used for the diagnosis of heart failure.

To help the NHS understand what a good quality service looks like, the National Institute for Health and Care Excellence (NICE) publish quality standards which define best practice within a topic area and it has published quality standards for acute and chronic heart failure. NHS England expects all commissioners and providers to take account of quality standards in the services that are delivered to patients.

NICE has developed a commissioning toolkit for the use of natriuretic peptides assessment in primary care for suspected heart failure. It has also produced guidance on acute heart failure and chronic heart failure, both of which cover the use of natriuretic peptides.

NICE guidance and quality standards are published online only, but due to the complexity and length of their content, they cannot be included as attachments.

NHS England is encouraging clinical commissioning groups to work with local practices to target people at risk of atrial fibrillation (AF). Innovative approaches such as pulse testing at flu clinics and by some dentists are being used to identify AF in older people. The NHS Health Check programme’s best practice guidance also recommends a pulse check is carried out as part of the process of taking a blood pressure reading. People found to have an irregular pulse rhythm should be referred to the general practitioner for further investigation.

The National Institute for Health and Care Excellence (NICE) published an updated guideline on AF in June 2014. This offers evidence-based advice on the care and treatment of people with AF and includes recommendations on diagnosis. In July 2015 NICE also published a quality standard on AF.

In addition to its clinical guideline on AF, NICE has published technology appraisal guidance on a number of new oral anticoagulants (NOACs), approving them for certain patients.

There is a legal requirement on commissioners to provide funding for treatments and drugs recommended in NICE technology appraisal guidance within three months of the guidance being published.This is enshrined in the NHS Constitution as a right to NICE-approved drugs.

A consensus statement by the NICE Implementation Collaborative was published alongside NICE’s updated guideline in June 2014. This addresses some of the barriers to implementing NICE’s recommendations on prescribing NOACs.

The need to reduce variation and strengthen compliance of the uptake of NICE technology appraisals was identified in Innovation Health and Wealth, published in December 2011. In response, NHS England and the Health and Social Care Information Centre now publishes on a quarterly basis an Innovation Scorecard to enable commissioners to benchmark their own position and increase transparency to patients and the public. This assists the NHS in the identification of variation and the adoption of treatments such as NOACs that are recommended in NICE technology appraisals. In addition, NHS England advises that it expects practitioners to consider anticoagulant treatments in line with NICE guidelines.

Some progress is being made. The uptake of NOACs across England has doubled in recent years from 45,708 per 100,000 of the resident population in 2013-14 to 126,845 in 2014-15.

No assessment has been made of the number of strokes related to AF could be prevented each year through the roll-out of Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation in primary care. However, in 2014, an economic analysis estimated that if all eligible patients at high risk were managed according to the NICE AF guidelines, an additional 11,600 AF related strokes per year could be avoided.

Copies of the guidance referred to have been placed in the Library.

I shall have to take advice on the second question posed by the noble Baroness, which I do not know the answer to. But in answer to her first question, an estimated 107,800 people were living with HIV in the UK in 2013, of whom 24% were unaware of their infection, remain at risk of infecting others and are unable to benefit from effective treatment. That is why it is so very important that we target the at-risk communities to urge them to get tested, either in a clinic or through self-testing kits, which are now legal.

It is the responsibility of general practitioners, using their clinical judgment and supported by relevant guidance, to arrange for the appropriate tests to be carried out on patients presenting symptoms of iron-deficiency anaemia. No consideration has been given to whether any cost savings and reduction in patient admissions could result from increased testing.

Part of the work programme of NHS England's Molecular Diagnostic Testing Group will be to assure that quality standards are set for molecular testing across the National Health Service in partnership with key stakeholders such as the Royal College of Pathologists and others.