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August 2021

In August 2021 we received 15 FOI requests. On this page you can find a full list of the requests we received, along with our response.
Clinical management

FOI 89260 Treatment pathway. Date requested 25 August 2021

Request received

Can you please provide me with your guidelines or treatment pathway for the pharmacological management of chronic kidney disease (CKD)?

Our response

The guideline for the management of CKD can be found on the Royal Cornwall Hospitals NHS Trust document library.

NHS Kernow is currently updating the renal resources pack, once approved this will be uploaded to our formulary website and will replace the 2016 version shown.

FOI 88980 wax removal services. Date requested 13 August 2021

Request received

  1. Have you developed a locally enhanced service which includes the provision of wax removal services?
  2. Do you stipulate that GP practices within your area to offer patients a wax removal service in line with NICE guidance, offered to those patients for whom the wax is affecting hearing or causing other symptoms, or needs to be removed so that the ear can be examined or an impression of the ear canal can be taken?
  3. How many patients received the following wax removal service in these ways in each of the last 5 years:
    • wax removal free of charge in GP practice
    • wax removal at a charge in GP practices
    • wax removal at ENT or in an audiology department
    • patient referred for private wax removal
    • patient offered no support for wax removal
  4. How many people have been on your waiting list for a referral to audiology at the beginning of the following financial years: 2020 to 2021, 2019 to 2020, 2018 to 2019, 2017 to 2018 and 2016 to 2017?
  5. In the most recent statistics you collected, what proportion of patients referred to audiology were waiting beyond the 18-week referral to treatment target? Please also provide the 7-week referral to treatment target set out in the commissioning services for people with hearing loss: A framework for clinical commissioning groups. Please state the time period your statistics refer to.
  6. When did you most recently change the guidance or stipulations for providers in your area on the way they should treat wax removal?

Our response

  1. No.
  2. None of the above. We require GP practices to refer patients who require wax removal to aural care but only if they meet the commissioning criteria set out in our commissioning policy. For patients who do not meet the commissioning criteria for referral to secondary care, there is no other commissioned service. Please note it is not possible to split out whether undertaken in ENT, audiology or our aural care department.
  3. This information is available direct from NHS England.
  4. As number 4.
  5. Our commissioning policy was updated in March 2021 but is currently being reviewed.
Continuing healthcare

FOI 89090 Complex neurological care. Date requested 18 August 2021

Request received

  1. Who is responsible for the commissioning of acquired brain injury (ABI) care within the CCG? Provide name, email and contact telephone number.
  2. ABI (including traumatic brain injury) details for 2019 to 2020 and 2020 to 2021:
    • Total number of placements commissioned during the respective financial year.
    • Number of above placements commissioned outside of the geography covered by the CCG during the respective financial year.
    • In instances where placements have been funded outside the CCG geography in the above 2 years, has this been due to lack of available appropriate care provision within the CCG boundary? Please state all occasions, some occasions or no (other reasons).
  3. Complex neurological care (excluding ABI data above). Including (but not limited to) care required due to spinal injury, Parkinson’s disease, multiple sclerosis, motor neurone disease, Huntington’s disease, cerebral palsy, epilepsy and stroke. For 2019 to 2020 and 2020 to 21 please supply
    • Total number of placements commissioned during the respective financial year.
    • Number of above placements commissioned outside of the geography covered by the CCG during the respective financial year.
    • In instances where placements have been funded outside the CCG geography in the above 2 years, has this been due to lack of available appropriate care provision within the CCG boundary? Please state all occasions, some occasions or no (other reasons).

Our response

  1. NHS Kernow does not release the names of employees below director level. John Groom, director for planned care. Call 01726 627800.
  2. 2019/2020: 19 and 2021/2021: 18. Regarding number of placements, NHS Kernow holds the information but the numbers are less than 10. Therefore the information cannot be disclosed as it could potentially identify the individuals involved, especially if combined with other data. This would constitute a breach of the Data Protection Act 2018. Therefore, this information is exempt from disclosure under section 40(2) of the Freedom of Information Act 2000 on the grounds that it is personal information. Where placements have been funded outside our geography it was on some occasions.
  3. NHS Kernow does not hold this information. Data is not recorded at the level required to provide an accurate answer to these questions. See above regarding number of placements. Where placements have been funded outside our geography it was on some occasions.

FOI 88880 Long term care. Date requested 2 August 2021

Request received

Please provide the following information you have pertaining to care provision for adults (aged 18 to 64).

  1. A list of every adult social care provider which serves adults funded by you and has over 5 adults under care. For each of these providers, please enter the number of adults as at 31 March 2021 placed within a supported living placement. Please repeat this for an equivalent week in 2019 and 2020, and if possible please provide a total number of adults placed across all providers (please fill in the table attached).
  2. The number of new joiners and leavers of adults in long term care in your CCG jurisdiction, over the last 3 years (between 1 April and 31 March for 2018 to 2019, 2019 to 2020 and 2020 to 2021) (please fill in the table attached). Points 1 and 2 are highest priority so please return your responses to those as soon as they are ready. If points 3 and 4 result in a greater administrative burden or cost of research, then we are happy for you to respond with answers to those points separately at a later date.
  3. Could you provide the total number of adults with learning disabilities in long term care, within your CCG jurisdiction as of 31 March 2021, by average weekly fee and cost of care and care setting (please fill in the table attached).
  4. The proportion of adults that you fund in supported living placements, that are also joint funded by a local authority (between 1 April and 31 March for 2018 to 20119, 2019 to 2020 and 2020 to 2021) (please fill in the table attached).

Our response

Our response to this request was provided as an attachment. Please email our FOI team for a copy of the response.

Information governance

FOI 89270 Cybersecurity. Date requested 31 August 2021

Request received

  1. In the past 3 years has your organisation:
    • Had any ransomware incidents? An incident where an attacker attempted to, or successfully, encrypted a computing device within your organisation with the aim of extorting a payment or action in order to decrypt the device? If yes, how many?
    • Had any data rendered permanently inaccessible by a ransomware incident (for example some data was not able to be restored from back up)?
    • Had any data rendered permanently inaccessible by a system or equipment failure (for example some data was not able to be restored from back up)?
    • Paid a ransom due to a ransomware incident or to obtain a decryption key or tool? If yes, was the decryption successful, with all files recovered?
    • Used a free decryption key or tool (for example from nomoreransom.org)? If yes was the decryption successful, with all files recovered?
    • Had a formal policy on ransomware payment? If yes please provide, or link, to all versions relevant to the 3-year period.
    • Held meetings where policy on paying ransomware was discussed?
    • Paid consultancy fees for malware, ransomware, or system intrusion investigation? If yes at what cost in each year?
    • Used existing support contracts for malware, ransomware, or system intrusion investigation?
    • Requested central government support for malware, ransomware, or system intrusion investigation?
    • Paid for data recovery services? If yes at what cost in each year?
    • Used existing contracts for data recovery services?
    • Replaced IT infrastructure such as servers that have been compromised by malware? If yes at what cost in each year?
    • Replaced IT endpoints such as PCs, Laptops, Mobile devices that have been compromised by malware? If yes at what cost in each year?
    • Lost data due to portable electronic devices being mislaid, lost or destroyed? If yes how many incidents in each year?
  2. Does your organisation use a cloud based office suite system such as Google Workspace (formerly G Suite) or Microsoft’s Office 365? If yes is this system’s data independently backed up, separately from that platform’s own tools?
  3. Is an offsite data back-up a system in place for the following? Offsite backup is the replication of the data to a server which is separated geographically from the system’s normal operating location site.
    • Mobile devices such as phones and tablet computers
    • Desktop and laptop computers
    • Virtual desktops
    • Servers on premise
    • Co-located or hosted servers
    • Cloud hosted servers
    • Virtual machines
    • Data in software as a services applications
    • ERP or finance system
    • We do not use any offsite back-up systems
  4. Are the services in question 3 backed up by a single system or are multiple systems used?
  5. Do you have a cloud migration strategy? If so is there specific budget allocated to this?
  6. How many software as a services applications are in place within your organisation? If so, how many have been adopted since January 2020?

Our response

In response to question 1, NHS Kernow can neither confirm nor deny whether information is held under section 31(3) of the Freedom of Information Act (FOIA). Section 31(3) of the FOIA allows a public authority to neither confirm nor deny whether it holds information where such confirmation would be likely to prejudice any of the matters outlined in section 31(1). This includes information the disclosure of which would or would be likely to prejudice the prevention or detection of crime.
As section 31(3) is a qualified exemption, it is subject to a public interest test for determining whether the public interest lies in confirming whether the information is held or not.

Factors in favour of confirming or denying the information is held

NHS Kernow considers that to confirm or deny whether the requested information is held would indicate the prevalence of cyber-attacks against our information and communications technology (ICT) infrastructure. It could also reveal details about our information security systems. NHS Kernow recognises that answering the request would promote openness and transparency regarding the organisations ICT security.

Factors in favour of neither confirming nor denying the information is held

Cyber-attacks, which may amount to criminal offences for example under the Computer Misuse Act 1990 or the Data Protection Act 2018, are rated as a tier 1 threat by the UK Government. NHS Kernow, like any organisation, may be subject to cyber-attacks. Since it holds large amounts of sensitive, personal and confidential information, maintaining the security of this information is extremely important.

In this context, we consider that confirming or denying whether the requested information is held would provide information about our information security systems and resilience to cyber-attacks. There is a very strong public interest in preventing the NHS Kernow’s information systems from being subject to cyber-attacks. Confirming or denying the type of information requested would be likely to prejudice the prevention of cybercrime, and this is not in the public interest.

If NHS Kernow were ether to confirm or deny the existence of the requested information, the disclosure would be likely to prejudice the effective conduct of public affairs for the organisation, the NHS or any other government department. As such, this conflicts with section 36(2c) of the FOIA.

Balancing the public interest factors

NHS Kernow has considered that if it were to confirm or deny whether it holds the requested information, it would enable potential cyber attackers to ascertain how and to what extent we are able to detect and deal with security attacks. NHS Kernow’s position is that complying with the duty to confirm or deny whether the information is held would be likely to prejudice the prevention or detection of crime, as the information would assist those who want to attack NHS Kernow’s ICT systems. Disclosure of the information would assist a hacker in gaining valuable information as to the nature of NHS Kernow’s systems, defences and possible vulnerabilities. This information would enter the public domain and set a precedent for other similar requests. Which would, in principle, result in NHS Kernow being a position where it would be more difficult to refuse information in similar requests. To confirm or deny whether the information is held is likely to enable hackers to obtain information in mosaic form combined with other information to enable hackers to gain greater insight than they would ordinarily have, which would facilitate the commissioning of crime such as hacking itself and also fraud. This would impact on NHS Kernow’s operations including its front line services. The prejudice in complying with section 1(1)(a) FOIA is real and significant as to confirm or deny would allow valuable insight into the perceived strengths and weaknesses of NHS Kernow’s ICT systems.

For question 2, NHS Kernow have started the process of adopting the NHS Digital backed N365 (a variant of Office 365). It is currently in deployment and set up phase and not our primary source of data storage. Backup solutions are being assessed.

Our response to question 3 is below:

  • It is dependent on the application used as to the level and location of back up.
  • It is dependent on the application used as to the level and location of back up.
  • Not applicable.
  • No.
  • By definition these are offsite.
  • By definition these are offsite.
  • Not applicable.
  • Not applicable.
  • As hosted these are by definition these are offsite.
  • Not applicable.

Question 4: Single.
Question 5: No.
Question 6: None.

Mental health and learning disabilities

FOI 88940 Out of area costs. Date requested 6 August 2021

Request received

Can you please provide both the number of inpatients sent out-of-area and the average cost per day (or week if daily information is not available) for the following areas:

  1. Neurorehabilitation (ABI Level 3)
  2. Psychiatric intensive care unit
  3. General adult mental health
  4. Rehabilitation and recovery
  5. Neuropsychiatry
  6. Autism spectrum disorder (ASD) speciality units
  7. General learning disability
  8. Complex learning disability (additional diagnosis such as autism)
  9. General learning disability care home services
  10. Complex learning disability (additional diagnosis such as autism) care home services

I would like the information provided for financial years 2018 to 2019, 2019 to 2020 and 2020 to 21.

Our response

NHS Kernow does not hold all the information requested as our system does not record the conditions as described in your request.

Services provided by NHS Trusts are commissioned on a block contract basis and not on a tariff basis. Therefore we do not hold this information and you may wish to contact Royal Cornwall Hospitals NHS Trust and Cornwall Partnership NHS Foundation Trust.

For some of the services due to the case numbers being less than 5, the information cannot be disclosed as it could potentially identify the individuals involved, especially if combined with other data, this would constitute a breach of the Data Protection Act 2018. Therefore, this information is exempt from disclosure under section 40(2) of the Freedom of Information Act 2000 on the grounds that it is personal information.

Rehabilitation and recovery independent sector providers:

  • 2018 to 2019: average cost per day was £439.84 and 9 patients in year.
  • 2019 to 2020: average cost per day was £436.32 and 7 patients in year.
  • 2020 to 2021: average cost per day was £429.56 and 16 patients in year.
Miscellaneous

FOI 89150 Fertility clinic spend. Date requested 19 August 2021

Request received

  1. How much was spent in the 2020 to 2021 on materials used to facilitate masturbation in your fertility clinics, this specifically includes pornographic magazines.
  2. If the information is available, please specify which pornographic magazines which were purchased for this purpose.

Our response

NHS Kernow is a clinical commissioning group responsible for the planning and commissioning of health care services. NHS Kernow does not hold the information. This may be available from the service provider Royal Cornwall Hospitals NHS Trust.

FOI 89080 payments to charities and organisations. Date requested 17 August 2021

Request received

Please provide the following information for 2018 to 2019, 2019 to 20 and 2020 to 21.

  1. The value of grants made to each of the organisations listed below. Please provide the information for each of the 3 financial years separately, and list all grants separately.
  2. The value of loans made to each of the organisations listed below. Please provide the information for each of the 3 financial years separately and list all loans separately.

The payments made to charities and third sector organisations relate to the following only:

  • Operation Black Vote
  • UK Black Pride
  • Mermaids
  • Ozanne Foundation
  • Gendered Intelligence
  • British Medical Association
  • ActionAid UK
  • Hope Not Hate
  • Led by Donkeys
  • Extinction Rebellion
  • Migrants Organise
  • CLASS
  • Black Lives Matter
  • Action on Smoking and Health
  • Action on Smoking and Health Scotland
  • Action on Smoking and Health Wales
  • Breath 2025
  • Association of Directors of Public Health
  • Improving Performance in Practice (previously Public Management Associates)

Our response

NHS Kernow has not made any grants, loans or payments to any of the organisations listed.

Organisation

FOI 89050 Agency spend. Date requested 17 August 2021

Request received

  1. Could you please provide your total off-framework agency spend between 1 March 2020 to 31 March 2021 for nurses (all bands and specialties). GPs and nurse practitioners (all types and seniorities).
  2. Same question as above but for between 1 April 2021 to present day.
  3. Please provide the hourly charge rate for staff groups and specialties supplied to your hospital or trust by off-framework recruitment agencies between the beginning of April 2021 to present day. Please answer individually and specify if the charge rate was for a day, night, Saturday, Sunday or bank holiday shift.
  4. Who is responsible for approving the use of healthcare recruitment agencies for temporary staff? Please provide their work email address and work phone number (or extension if unable to provide a direct line).
  5. Who is responsible for approving the use of healthcare recruitment agencies for permanent staff? Please provide their work email address and work phone number (or extension if unable to provide a direct line).
  6. Please can you confirm the total number of unfilled shifts between 1 August 2020 to present day 2021 for nurses (all bands and specialties), healthcare assistants, doctors (all bands and specialties) and GPs, advance nurse practitioners and nurse practitioners.

Our response

NHS Kernow is a clinical commissioning group responsible for the planning and commissioning of health care services. Agency doctors and nurses are not used by NHS Kernow. Royal Cornwall Hospitals NHS Trust and Cornwall Partnership NHS Foundation Trust may be able to provide the information requested.

Contact details:

FOI 88960 structure. Date requested 12 August 2021

Request received

  1. How many analyst team members does your clinical commissioning group (CCG) employ? Which systems do they use to source their data?
  2. Do you employ the following roles within your CCG?
    • Chief system integration officer or director
    • Director of digital products and improvement analytics
    • Director of partnerships and digital lead
    • Head of digital solutions and adoption director
    • Head of digital innovation director
    • Director of digital transformation (or deputy or associate)
    • Director for system strategy (or deputy or associate)
    • Director of integration (or deputy or associate)
    • Director of system partnerships (or deputy or associate)
  3. Do you have specific plans for integrating data between primary, community and secondary care for the following?
    • shared care records
    • joint care plans
    • connected care plans
    • other data integration plans
  4. Do you have a baseline mapping of your system digital infrastructure in place?
  5. Do you have a public facing digital strategy?
  6. Do you use patients know best or other system? If so how many patients do you have registered on this or other system? If other system, please name the system?

Our response

  1. NHS Kernow employs 10 analysts. NHS Kernow use NHS Digital for data together with the following systems. This is not an exhaustive list or in any particular order.
    • secondary user service
    • healthcare evaluation data
    • emergency care data set
    • community services data set
    • mental health minimum data set
    • improving access psychological therapies
    • IMS Maxime
    • Foundry
    • Tableau
    • EMIS
    • TPP
  2. No.
  3. Yes, as a system we do have plans, but they are only at the planning stage. Information governance how we use the data, for what, by whom and when needs to be given careful consideration and will enable the direction of integration across the system.
    • Yes, a system is currently being implemented by Cornwall IT Services across Royal Cornwall NHS Hospital Trust and Cornwall Partnership NHS Foundation Trust.
    • Yes, this will follow after the implementation of the shared care record.
    • No.
    • Yes, as a system we do have plans, but they are only at the planning stage. Information governance how we use the data, for what, by whom and when needs to be given careful consideration and will enable the direction of integration across the system.
  4. Cornwall IT Services manage the digital transformation programme on behalf of the Cornwall and Isles of Scilly health and care partnership.
  5. No.
  6. No. Not that NHS Kernow is aware of.

FOI 88970 ICS. Date requested 11 August 2021

Request received

  1. 1. How many analyst team members does your ICS employ?
  2. Which systems do they use to source their data?
  3. Do you have specific plans for integrating data between primary, community and secondary care?
    • Shared care records?
    • Joint care plans?
    • Connected care plans?
    • Or other data integrations plans?
  4. Do you have a baseline mapping of your system digital infrastructure in place?
  5. Do you have a public facing digital strategy?
  6. Do you use patients know best or other system?
  7. Do you employ the following roles within your ICS or STP?
    • Chief system integration officer or chief integration director
    • Director of digital products and improvement analytics (or deputy or associate)
    • Director of partnerships and digital lead (or deputy or associate)
    • Head of digital solutions and adoption (director)
    • Head of digital innovation (director)
    • Director of digital transformation (or deputy or associate)
    • Director for system strategy (or deputy or associate)
    • Director of integration (or deputy or associate)
    • Director of system partnerships (or deputy or associate)

Our response

  1. The ICS dose not employ any analysts, each sovereign organisation employs analysts within their business intelligence teams. However, the analysts work together through the joint intelligence group. The group comprises analysts from public health, adult social care, children’s and families, Royal Cornwall Hospital NHS Trust, Cornwall Partnership NHS Foundation Trust, NHS Kernow Clinical Commissioning Group and Kernow Community Interest Company. The group also collaborates with NHS Devon Clinical Commissioning Group, Penchord, Academic Health Science Network and the University of Exeter, as well as the SWIRN NHS group.
  2. The ICS and STP use NHS Digital for data together with the following systems. This is not an exhaustive list or in any particular order.
    • secondary user service
    • healthcare evaluation data
    • emergency care data set
    • community services data set
    • mental health minimum data set
    • improving access psychological therapies
    • IMS Maxime
    • Foundry
    • Tableau
    • EMIS
    • TPP
  3. Yes, as a system we do have plans, but they are only at the planning stage. Information Governance – how we use the data, for what, by whom and when needs to be given careful consideration and will enable the direction of integration across the system.
    • Yes.
    • Yes, this will form part of electronic health records and electronic patient records systems.
    • No.
    • Cornwall IT Services (CITS) manage the digital transformation programme on behalf of the Cornwall and Isles of Scilly health and care partnership.
  4. CITS manage the digital transformation programme on behalf of the Cornwall and Isle of Scilly health and care partnership.
  5. No, not at this time.
  6. No. Not applicable.
  7. No.

FOI 88930 Service specs. Date requested 9 August 2021

Request received

Please provide me with:

  1. Commissioned service specification for the minor injury units throughout Cornwall
  2. Performance measures for the minor injury units throughout Cornwall
  3. Performance against key performance measures for the past 36 months for the minor injury units throughout Cornwall
  4. Allocated budget for the delivery of the minor injury units throughout Cornwall
  5. Commissioned service specification of the acute care at home service in Cornwall
  6. Performance measures for the acute care at home service throughout Cornwall
  7. Performance against key performance measures for the past 36 months for the acute care at home service throughout Cornwall
  8. Allocated budget for the delivery of the acute care at home service throughout Cornwall
  9. Commissioned service specification of the community nursing service in Cornwall
  10. Performance measures for the community nursing service throughout Cornwall
  11. Performance against key performance measures for the past 36 months for the community nursing service throughout Cornwall
  12. Allocated budget for the delivery of the community nursing service throughout Cornwall

Our response

  1. Please email our FOI team for a copy of the service specification for minor injury units.
  2. Please email our FOI team for a copy of the performance measures for minor injury units.
  3. Activity levels are monitored in relation to these services, and details are attached. Operational performance of the minor injury units is discussed on a daily basis.
  4. From July 2017 the minor injury unit services in Cornwall were commissioned to a value of £6.3M. Royal Cornwall NHS Hospital Trust (RCHT) are commissioned to provide these services as part of the overall emergency department since 1 July 2017. RCHT have decided to subcontract the services to Cornwall Partnership NHS Foundation Trust (CFT) who deliver through community services.
  5. Please email our FOI team for a copy of the service specification of the acute care at home service.
  6. Activity levels are monitored in relation to these services, though there are no specific performance measures that are used for monthly reporting. Operational performance of the acute care at home service is discussed on a regular basis.
  7. Please see above.
  8. There is no specific allocation of budget, by NHS Kernow, to each of these service lines. CFT are commissioned to provide adult community services for a block sum value.
    • 2018 to 2019: £72,187M
    • 2019 to 2020: £80.273M
    • 2020 to 2021: £89.546M
  9. NHS Kernow does not have a community nursing service in Cornwall. Please email our FOI team for a copy of the community matron service and district nursing services specification.
  10. Activity levels are monitored in relation to these services, and details are attached. Operational performance of the community matron service and district nursing service are discussed on a regular basis.
  11. As above.
  12. Please see answer 8.

FOI 88950 ICS structure. Date requested 5 August 2021

Request received

Please provide the name of the individual and their ICS job title. In cases where there are multiple leads, please include the names of all individuals.

Our response

Cornwall and Isles of Scilly integrated care system (ICS) is in development. The timeline is dependent on legislation but is expected to be formed by April 2021. Therefore, not all roles have been appointed to.

ICS lead: Kate Shields, accountable officer for NHS Kernow from 16 August 2021
Chair: John Govett, designate chair
Lead for workforce: Not yet confirmed
Lead for finance: Not yet confirmed, job title will be chief finance officer
Medical lead: Not yet confirmed, job title will be chief medical officer
Nursing lead: Not yet confirmed, job title will be chief nursing officer
Lead for continuing healthcare: Not yet confirmed
Chief operating officer: Not known
IT, technology or digital lead: Not yet confirmed
Procurement lead: Not known
Transformation lead: Carolyn Andrews, ICS transformation and programme director
Portfolio and programme lead: Carolyn Andrews, ICS transformation and programme director
Local workforce action board chair: Now the people board. Carolyn Andrews, interim people board chair

FOI 88860 Structure. Date requested 2 August 2021

Request received

Can I ask how many dedicated dementia beds that there are in Cornwall Care Homes?

Our response

NHS Kernow does not hold the information requested because care home beds are commissioned on an individual care needed basis.

Further information about dementia beds in Cornwall care homes can be found on the Care Quality Commission website.

Prescribing and pharmacies

FOI 89250 Vitamin B12 injections. Date requested 21 August 2021

Request received

Please can you confirm if all B12 deficient patients in Cornwall across your 59 GP practices were stopped from receiving their vitamin B12 injections? Can I ask if this position still stands in Cornwall? Are new patients being given B12 injections or are all being given oral tablets now?

Our response

The British Society for Haematology released guidance on vitamin B12 replacement during the COVID-19 pandemic. This may be helpful as it gives guidance on when oral cyanocobalamin tablets may be an appropriate alternative due to the pandemic. There is also further guidance from the Specialist Pharmacy Service on prescribing considerations and formulations of oral vitamin B12.

From open prescribing figures, it can be seen that hydroxocobalamin 1mg/ml solution for injection has been prescribed throughout the pandemic for patients at practices in NHS Kernow, 29,962 items have been issued in the last 12 months.

From further review of figures at clinical commissioning group level, data from open prescribing shows NHS Kernow prescribed 3,523 hydroxocobalamin 1mg/ml injections in January 2020, before the pandemic. Compared to 1,772 prescriptions in May 2020, which was during the first lockdown.

For information, a longer-term comparison of data over the last 3 years shows 3,118 hydroxocobalamin 1mg/ml injections were prescribed in NHS Kernow in June 2019, 2,246 in June 2020 and 2,914 in June 2021.

Data for cyanocobalamin 1mg tablets shows no prescribing in June 2019, 157 items in June 2020 and 114 items in June 2021. There are other strengths of cyanocobalamin available dependent on the indication for treatment, for example, cyanocobalamin 50microgram tablets. Data for cyanocobalamin 50microgram tablets shows NHS Kernow prescribed 401 items in June 2019, 1,014 in June 2020 and 1,078 in June 2021.

This data demonstrates that some patients were switched from hydroxocobalamin injections to cyanocobalamin tablets during the pandemic, which was in line with the guidance linked above and to reduce need for patients to visit their GP practice during the pandemic.

Although prescribing of hydroxocobalamin injection reduced during the pandemic and some patients changed to cyanocobalamin tablets, some patients continued injections. Oral vitamin B12 replacement may not have been suitable for all patients depending on indication for treatment. Data also demonstrates patients are still being prescribed injections currently.

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