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We would welcome any new technology that could improve the breast screening programme, however, this is a developing technology and we would need to consider the evidence of its effectiveness before it could be introduced into the screening programme.
Ann Keen: The extension of the breast screening programme age range will start from April 2008 and will be managed by National Health Service cancer screening programmes in partnership with local health services.
As with the previous age extension, increasing the upper age range limit to 70 years, this will take several years to implement fully, as more staff will need to be recruited and trained and more equipment purchased. Full implementation is expected by the end of 2012.
The necessary phasing in of this expansion will be carefully considered to ensure that the most useful epidemiological data can be gathered to inform future decisions about the breast screening programme.
Ann Keen: In March 2002 the International Agency for Research on Cancer (IARC) of the World Health Organisation (WHO) evaluated the evidence on breast cancer screening. They concluded that trials have provided sufficient evidence for the screening of women between 50 and 69 years, and that the reduction in mortality from breast cancer among women who chose to participate in screening programmes was estimated to be about 35 per cent. The IARC working group consisted of 24 experts from 11 countries.
We now want to extend the breast screening programme so that more women benefit and even more lives are saved. At present women are invited for screening seven times at three yearly intervals between
50 and 70. Over time, this will be extended to nine screening rounds between 47 and 73 years with a guarantee that women will have their first screening invitation before the age of 50.
This extension was recommended by the Cancer Reform Strategy (CRS) Breast Cancer Working Group, who carefully examined the emerging evidence on extending the programme below and above the current age ranges, and the recommendation was accepted by the CRS Advisory Board.
For bowel screening research undertaken in Nottingham and Funen in the 1980s showed that screening men and women aged 45 to 74 for bowel cancer using the faecal occult blood test (FOBt) could reduce the mortality rate from bowel cancer by 16 per cent. in those screened.
An independently evaluated pilot in Warwickshire and Scotland showed that this research can be replicated in an national health service setting. Based on the final evaluation report of the pilot and a formal options appraisal, the NHS bowel cancer screening programme in England is screening men and women aged 60 to 69.
Mr. Jamie Reed: To ask the Secretary of State for Health what assessment his Department has made of the likely effects of lowering the entry level age of the breast cancer screening programme. 
Ann Keen: The extension of the breast screening age range was recommended by the cancer reform strategy (CRS) Breast Cancer Working Group, which carefully examined the emerging evidence on extending the programme below and above the current age ranges, and the recommendation was accepted by the CRS Advisory Board.
Mr. Lansley: To ask the Secretary of State for Health what the planned start date is of the (a) National Cancer Survivorship Initiative and (b) National Cancer Equality Initiative; and what the expected cost is of each in each financial year for which estimates have been made. 
Ann Keen: The National Cancer director will lead the new National Cancer Survivorship Initiative (NCSI) in partnership with Macmillan Cancer Support and other cancer charities. The NCSI will consider a range of approaches to survivorship care and how these can best be tailored to meet individual patients' needs.
As part of this work, Macmillan Cancer Support will host a think tank event, Making the Cancer Survivorship Agenda a Reality, in March 2008. The key outcomes of the event will be to: identify key policy work streams and priorities; to agree stakeholder involvement for each of the policy work streams; and to produce a report outlining the outcome of the event for wider circulation.
The event will be co-chaired by the National Cancer director and the chief executive officer of Macmillan Cancer Support and will involve patients, health professionals, the voluntary sector, academics, research experts, international experts and Government.
In recognition of the challenge to reduce inequalities in cancer, the National Cancer director will begin a National Cancer Equality Initiative (NCEI), bringing together key stakeholders from the professions, voluntary sector, academia and equality groups to develop research proposals on cancer inequalities, test interventions and advise on the development of wider policy. The National Cancer director is currently discussing with key stakeholders how best to take the NCEI forward, and detailed work will begin in early 2008.
Mr. Jamie Reed: To ask the Secretary of State for Health by what means the NHS Cancer Reform Strategy will address inequalities between regions in cancer (a) diagnosis, (b) treatment and (c) survival rates. 
Ann Keen: The Cancer Reform Strategy (CRS), published on 3 December 2007, and the Equality Impact Assessment published alongside the strategy, set out a comprehensive series of measures to address inequalities between regions in cancer diagnosis, treatment and survival rates.
Socio-economic deprivation has a marked impact on cancer outcomes. Cancer mortality is more than 15 per cent. higher in spearhead primary care trusts (PCTs) than the national average. To address this regional variation, along with tackling other cancer inequalities, the Department will begin a national cancer equality initiative (NCEI), which will develop research proposals on cancer inequalities, test interventions and advise on the development of wider policy.
The Department will work through the NCEI with strategic health authorities (SHAs) and PCTs to agree challenging goals for reducing cancer mortality in every cancer network area by 2012. The National Audit Office is funding a dedicated post in the Cancer Action Team to drive forward equity issues.
the Government will continue to invest in social marketing initiatives at the national level to support people to stop smoking, especially with the free support available from the national health service. Social marketing initiatives will be focussed towards groups in our community with the greatest smoking prevalence;
commissioners in PCTs with low coverage levels for cancer screening will wish to develop targeted programmes that increase
the uptake of screening in poor communities. To incentivise services to encourage higher coverage for screening we will explore moving to an activity based system for funding screening services;
the Department is investing in a campaign that uses social marketing techniques to raise awareness of the signs and symptoms of breast, lung and bowel cancers and to encourage people who think they might have cancer to seek help earlier in 20 of the most deprived areas; and
the National Cancer Director will repeat his evaluation of National Institute for Health and Clinical Excellence (NICE) -approved cancer drug usage during 2008 to ensure that patients across the country continue to have access to drugs positively appraised by NICE.
Ann Keen: The Cancer Reform Strategy contains several actions that will improve cancer detection and recognises that primary care professionals have essential roles at all stages of the cancer care pathway, one of which being the diagnosis of cancer.
The audits will build on the significant events reviews already being undertaken by many general practitioners and will focus on aspects such as the number of visits to primary care with relevant symptoms before referral to hospital (delay pattern analysis).
The resultant information will inform both local practice learning as well as the national audit. The audit will be undertaken collaboratively by the Royal College of General Practice and the National Patient Safety Agency.
Some good work to raise cancer symptom awareness and encourage early presentation is already under way. The initiative, led by the National Cancer Director, will provide co-ordinated support to local health services to deliver effective interventions.
This is the single most important priority in primary care. The strategy sets out the mechanisms, such as developing and agreeing local protocols and commissioning diagnostic providers, that need to be put in place to improve access and increase capacity of diagnostic services.
(2) how many (a) private, (b) public and (c) voluntary sector care homes for the elderly were subject to regulation and inspection by the Commission for Social Care Inspection in each of the last five years. 
Mr. Ivan Lewis: We have been informed by the chair of the Commission for Social Care Inspection (CSCI) that it does not collect information on the proportion of private sector care homes owned by companies which own more than one home. CSCI inspects and regulates each individual service and not the organisation running the home.
The following table shows counts of the numbers of care homes regulated against the Care Homes Regulations 2001 and National Minimum Standards (NMS) for Care Homes for Older People year on year (which will be less than the total numbers of homes registered).
|Type of home|
|As at 31 March||Private||Local authority||Voluntary||NHS||Other( 1)|
|(1) CSCI inspects homes against the NMS for Care Homes for Younger Adults (aged 18-64) or the NMS for Care Homes for Older People. Homes are classified by CSCI as homes for younger adults or for older people depending on the set of NMS against which they are inspected. The decision about the set of standards used is based on the relative numbers of older people (aged 65 plus) or younger adults (aged 18-64) resident at the time of inspection.|
1. Homes chose how they are classified during the registration process. Other includes any form of ownership not covered by the principal four categories.
2. When the National Care Standards Commission (NCSC) database was established in 2002, the process of registration of homes was staggered. Local authority services were registered after private and voluntary services. The increase in numbers between 2002-03 and 2003-04 does not represent an increase in homes, but in the number registered with NCSC.
CSCI Registration and Inspection database.
Mr. Ivan Lewis: Data on care home closures prior to 2002 is not held centrally. We are informed by the Commission for Social Care Inspection (CSCI) that the number of homes de-registered in Suffolk since 2002-03 were as shown in the following table. De-registration is not the same as closure. It includes not only homes permanently closed, but also temporary closures, for example, while refurbishment takes place or while a new manager is appointed.
|Number of care homes de-registered in Suffolk|
CSCI Registration and Inspection database 2007 (data as at 4 November 2007).
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