Data collected by NHS Digital through the Learning Disability Services Monthly Statistics – England Commissioner Census (Assuring Transformation) - January 2017, showed that at the end of January there were 1,565 patients who had a length of stay of over a year in a specialist hospital.

Assuring Transformation is a commissioner based return of data for patients in a hospital setting with learning disabilities and/or autism. The collection covers England but includes patients whose care is commissioned in England and provided elsewhere in the United Kingdom.

Information concerning the total number of people with dropped foot receiving functional electrical stimulation (FES) is not collected and no specific assessment has been made of the availability of this treatment for dropped foot. Data are only available for FES devices that are surgically implanted during an admitted episode of patient care. The majority of FES devices provided are those that are worn and attached with electrodes to the skin. These are usually provided in outpatient settings, where data are not collected.

The number of finished admission episodes (FAEs) with a primary diagnosis for dropped ankle and foot with a primary or secondary procedure of insertion/application of functional electrical stimulation in England from 2010-11 to 2015-16 can be found in the following table. It should be noted that FAEs do not represent the number of patients, as a person may have more than one admission within the period.

Source: Hospital Episode Statistics (HES), NHS Digital

In 2009 the National Institute for Health and Care Excellence (NICE) published interventional procedure (IP) guidance to support clinicians and commissioners on the use of FES for drop foot of central neurological origin. The guidance advised that evidence on the safety and efficacy FES appeared adequate to support its use, subject to appropriate arrangements being in place for clinical governance, consent and audit. NICE IP guidance makes recommendations on whether procedures are safe and effective, but does not provide guidance on whether the procedure should be funded in the National Health Service.

National Health Service carers are defined on a basis consistent with that of healthcare assistants used in the Cavendish Review (DH, 2012). Staff included as carers for this query are Healthcare assistants, Nursing assistants / auxiliaries and Nursing assistants /practitioners.

In November 2016, 5,731 (4.4%) NHS carers working in NHS Trusts and clinical commissioning groups declared their nationality as other European Union nationals, excluding the United Kingdom. This is out of a total headcount of 131,006.

The November data is the most recent data available.

The potential effect on nationals and productivity of leaving the EU will be dependent on the outcome of negotiations. My Rt. hon. Friend the Prime Minister has been clear that she wants to protect the status of EU nationals already living here. It is the Government’s aim to get the best settlement for the UK in all areas including the healthcare system.

Public spending on adult social care as proportion of gross domestic product spent was approximately 1.1% in 2010/11, and approximately 1% for each year between 2011/12 and 2015/16.

The attached table sets out the relevant internationally comparable data on expenditure published by the Organisation for Economic Co-operation and Development (OECD). Social care is defined in different ways in different countries. The OECD has therefore developed a comparable measure of “long-term care,” which includes some elements the Department would classify as health care and therefore the OECD estimate is slightly different from the above. The OECD’s long-term care data is only available for the United Kingdom in 2013 and 2014.

NHS England has a statutory duty to carry out an annual performance assessment of each clinical commissioning group (CCG) and in 2016/17 it has introduced the CCG Improvement and Assessment Framework.

The Framework assesses CCGs against a range of indicators which consider their financial performance, delivery of commitments, improved health outcomes for their populations and whether they are well led organisations. This provides assurance that CCGs are well led, effective commissioning organisations. There is also a strong focus on improvement and, where necessary, NHS England is supported by legislation in exercising formal powers of direction if it is satisfied that a CCG is failing or is at risk of failing to discharge its functions.

CCGs should pay regard to the National Institute for Health and Care Excellence (NICE) Clinical Guidelines and Quality Standards, when planning and delivering services, as part of their general duty to secure a continuous improvement in quality. However, while England does have a duty of regard in relation to quality standards prepared by NICE, these are not mandatory. CCGs cannot ignore NICE guidance without having a clear clinical case for doing so, as they are based on the best available evidence. In the event of this happening there would have to be a clear documented rationale signed off through CCG governance.

The information requested is shown in the following table. Information is provided for the total of isotretinoin, of British National Formulary (BNF) 13.6.2, and is shown by the brand Roaccutane and the non-branded isotretinoin.

Source: Prescription Cost Analysis system data provided by NHS Digital

¹Total figure may not sum due to rounding

A list of visits to mental health and other health services undertaken by my Rt. hon. Friend the Secretary of State is attached.

It is not possible to provide a definitive breakdown of all mental health services visited as they may be co-located with other services and were not recorded separately. We have marked mental health services only visits with an asterisk.

The available information on the number of prescription items for sleeping tablets (hypnotics) prescribed in National Health Service organisations in the Liverpool area and NHS regions, and dispensed in the community each month is in the attached table.

Information is not collected at constituency level.

There are a range of drugs that can be used for anxiety states, including beta-blockers and some anti-depressants, but there is no information on which indication a medicine is actually used for. Medicines for the alleviation of anxiety states are under British National Formulary (BNF) 4.1.2 Anxiolytics and this has been interpreted as the anti-anxiety medicine information requested.

Information on the number of prescription items for anxiolytics based on BNF classifications is shown in the attached table. Monthly data is only available for a 60 month rolling period with the earliest available month from November 2011.

In November 2006, the National Institute for Health and Care Excellence (NICE) published a clinical guideline on ‘Dementia: supporting people with dementia and their carers in health and social care’. It offers best practice advice on the care of people with dementia and on support for their carers including on the use of antipsychotics.

The Department funded the Royal College of Nursing (RCN) to produce ‘Antipsychotic drugs in dementia: a best practice guide’ which was published in May 2012. This includes guidance on what practitioners need to consider in the prescribing of antipsychotic drugs to people with dementia.

The Department commissioned the Dementia Core Skills Education and Training Framework which was published in October 2015. Developed in collaboration by Skills for Health, Health Education England and Skills for Care, the Framework is a comprehensive resource which sets out the essential skills and knowledge needed for all staff working with people with dementia in health and social care settings, including information on the use of antipsychotic medication.

The Challenge on Dementia 2020 is clear there must be continuing action at a local level in England to ensure antipsychotic drugs are prescribed appropriately and that person centred responses are used in response to behavioural and psychological symptoms of dementia, also referred to as behaviours that challenge.

Information is not collected centrally on the number of people prescribed medicines or the medical condition being treated. Information is not available on the dose prescribed for the patient as they could have multiple daily administrations, more than once a day or more than one tablet at a time.

Information is not collected centrally on the number of prescriptions issued. However, information is available on the number of prescription items dispensed.

The number of prescription items written in the United Kingdom and dispensed in the community in England 2010-15, as classified by British National Formulary section 4.2 is shown in the table below.

Source: Prescription Cost Analysis provided by NHS Digital.

In 2014/15 specialised services expenditure was classified firstly against highly specialised services and secondly the relevant programme of care (POC). In 2015/16 the analysis was classified primarily against the POC.

For 2014/15 this resulted in higher reporting of highly specialised services and lower reporting of programme of care spend compared to 2015/16.

Information is not collected centrally on the number of people prescribed medicines or the medical condition being treated. Information is not available on the dose prescribed for the patient as they could have multiple daily administrations, more than once a day or more than one tablet at a time.

Information is not collected centrally on the number of prescriptions issued. However, information is available on the number of prescription items dispensed.

The number of prescription items written in the United Kingdom and dispensed in the community in England 2010-15, as classified by British National Formulary section 4.2 is shown in the table below.

Source: Prescription Cost Analysis provided by NHS Digital.

Information is not collected centrally on the number of people prescribed medicines or the medical condition being treated. Information is not available on the dose prescribed for the patient as they could have multiple daily administrations, more than once a day or more than one tablet at a time.

Information is not collected centrally on the number of prescriptions issued. However, information is available on the number of prescription items dispensed.

The number of prescription items written in the United Kingdom and dispensed in the community in England 2010-15, as classified by British National Formulary section 4.2 is shown in the table below.

Source: Prescription Cost Analysis provided by NHS Digital.

The outturn for specialist commissioning of eating disorder units in 2014-15 and 2015-16 was as follows:

Note that the outturns for 2014-15 and 2015-16 are not directly comparable due to differences in data reporting.

Data on the number of items prescribed for antidepressants and dispensed in the community in England for 2010 – 2015 is provided in the attached table.

The data available is at prescription item level by presentation. The presentation will state the strength but not the dose prescribed for the patient as they could have multiple daily administrations, more than once a day or more than one tablet at a time.

The outturn for specialist commissioning of tier four children and adolescent mental health services (CAMHS) in 2014-15 and 2015-16 is recorded below.

Note that due to changes in how highly specialised services were classified in the two different years outturn is not directly comparable.

Where UK Visas and Immigration makes an assessment that asylum seekers qualify for support under Part VI of the Immigration and Asylum Act 1999, it issues HC2 certificates, conferring entitlement to Help with Health Costs via the NHS Low Income Scheme.

Asylum seekers who are not supported by UK Visas and Immigration can apply, via a HC1 application form, to the NHS Business Services Authority (NHSBSA) for a HC2 certificate.

We do not have information on how long it has taken UK Visas and Immigration to issue HC2 certificates to asylum seekers. For the NHSBSA, since 2010 over 99% of all HC1 claims, including those made by asylum seekers, have been processed within 15 days. The table below provides the relevant percentage rates for each full financial year since 2010.

Planned spend for secure inpatient mental health services is based on contracts negotiated during the planning round so by default NHS England only set plans at the level of total mental health spend (at provider level) not at individual service line level. However, the outturn for specialised commissioning of secure inpatient mental health services is contained within the below table.

The following table outlines outturn and planned spend (which reflects the budgeted spend) in programme allocation growth in the periods 2014-15 and 2015-16. Figures are recorded in cash growth and not real growth terms: