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Commissioners of cancer services will be subject to the wider assurance system being developed under the world class commissioning programme and managed by the strategic health authorities. The Healthcare Commission will also provide an independent assessment of provider and commissioner health care organisations to ensure that they are providing a high standard of care.
Mr. Baron: To ask the Secretary of State for Health further to the publication of the Cancer Reform Strategy, what the timetable is for making changes to payment by results taking account of findings from the review of payment by results and cancer. 
Ann Keen: The review is not yet complete, and has yet to produce final recommendations. The initial findings of the review were incorporated into the Cancer Reform Strategy, and are reflected in paragraphs 9.32-9.34. Work on a timetable for changes to payment by results for cancer services will be undertaken once the final recommendations of the review have been received and considered. We expect the recommendations to be received shortly.
Mr. Baron: To ask the Secretary of State for Health further to the publication of the Cancer Reform Strategy, when he plans to publish the first annual report on progress towards objectives contained in the strategy. 
Mr. Baron: To ask the Secretary of State for Health further to the publication of the Cancer Reform Strategy, when he expects the National Cancer Director to publish his evaluation of the National Institute for Health and Clinical Excellence approved cancer drug usage. 
Ann Keen: As set out in the Cancer Reform Strategy, the National Cancer Director will repeat his evaluation of NICE approved cancer drug usage during 2008. It is expected that the evaluation report will be published before the end of the year.
To ask the Secretary of State for Health further to the publication of the Cancer Reform
Strategy, what new funding he plans to make available for cancer services in each of the next five years. 
Ann Keen: Alongside the Cancer Reform Strategy, we have published an Impact Assessment (IA) that sets out our estimated costs of implementing the strategy in each year. A copy of the IA is available in the Library. The funding to meet these expected costs is mainly being provided through primary care trusts (PCT) general allocations, with some costs met centrally. PCT allocations are not broken down into funding streams for individual services, and it is for the national health service to decide locally how best to deliver the outcomes set out in the strategy, and the actual level of resources required to do so.
Mr. Baron: To ask the Secretary of State for Health further to the publication of the Cancer Reform Strategy, when he plans to ensure that expenditure which does not benefit patients is eliminated; and by what means. 
Ann Keen: The Cancer Reform Strategy provides advice, support and examples of best practice to local commissioners and providers on how to deliver high quality, cost-effective cancer services and how cancer expenditure should be prioritised.
Chapter 10 of the strategy highlights factors that local commissioners should consider when making decisions about cancer expenditure, to reduce inefficiencies and allow for reinvestment of expenditure in local cancer services.
Mr. Lansley: To ask the Secretary of State for Health pursuant to the answer of 14 January 2008, Official Report, columns 997-8W, on cancer: health services, how many finished consultant episodes there were for (a) all cancer treatments, (b) radiotherapy treatment for cancer and (c) chemotherapy treatment for cancer (i) between October 2005 and September 2006 and (ii) between October 2006 and September 2007; 
Ann Keen: The Department currently only collects figures on the number of finished consultant episodes (FCEs), we do not have figures for the total number of cancer patients treated with radiotherapy and/or chemotherapy.
|2005-06 (OPCS 4.2 codes)||2006-07 (OPCS 4.3 and 4.2 codes)|
An FCE is defined as a period of admitted patient care under one consultant within one health care provider. The figures do not represent the number of patients, as a person may have more than one episode of care within the year.
Cancer treatments i.e. radiotherapy and chemotherapy could take place in other settings, for example a patient could be classed as a regular attender or these treatments may occur in out-patients.
Diagnosis (Primary Diagnosis)
The primary diagnosis is the first of up to 14 (seven prior to 2002-03) diagnosis fields in the HES data set and provides the main reason why the patient was in hospital.
Primary diagnosis codes used for cancer and neoplasms: C00-D48
As well as the primary diagnosis, there are up to 13 (six prior to 2002-03) secondary diagnosis fields in HES that show other diagnoses relevant to the episode of care, Secondary diagnosis codes used for Radiotherapy session: Z51.0
Secondary diagnosis codes used for Chemotherapy session: Z51.1
Changes to Coding ClassificationsOPCS4
Operative procedure codes were revised for 2006-07. 2006-07 data use OPCS4.3 codes, whereas earlier data use OPCS4.2 codes. All codes that were in OPCS4.2 remain in OPCS4.3, however the OPCS4.3 codes enable the recording of interventions and procedures which were not possible in OPCS4.2. In particular OPCS 4.3 codes additionally includes high cost drugs and diagnostic imaging, testing and rehabilitation. You may also find that some activity may have been coded under different codes in OPCS4.2. These changes need to be borne in mind when analysing time series and may explain any growth over time. More information about OPCS4 changes are available on the Connecting for Health website www.connectingforhealth.nhs.uk.
The main procedure/intervention is the first recorded procedure or intervention in the HES data set and is usually the most resource intensive procedure or intervention performed during the episode.
As well as the main operative procedure, there are up to 11 (three prior to 2002-03) secondary operation fields in HES that show secondary or additional procedures performed on the patient during the episode of care.
HES are compiled from data sent by over 300 national health service trusts, and primary care trusts in England. Data are also received from a number of independent sector organisations for activity commissioned by the English NHS. The Information Centre for health and social care liaises closely with these organisations to encourage submission of complete and valid data and seeks to minimise inaccuracies and the effect of missing and invalid data via HES processes. While this brings about improvement over time, some shortcomings remain.
Figures have not been adjusted for shortfalls in data (i.e. the data are ungrossed).
Hospital Episode Statistics (HES), The Information Centre for health and social care
Mr. Baron: To ask the Secretary of State for Health further to the publication of the Cancer Reform Strategy, when he expects good psychological support services to be available throughout the cancer journey; by what means he plans to monitor progress towards this objective; and what sanctions will be imposed on NHS organisations which do not make sufficient progress. 
Ann Keen: The Cancer Reform Strategy said that it is important for all service providers to have established pathways to enable patients to access specialist psychological support as and when they need it. Commissioners will need to ensure that adequate provision is available so that all patients, families and carers can access the appropriate psychological support for them. This will include establishing service level agreements with local mental health services for more advanced support.
Providing support for patients experiencing distress is a key component of the role of the cancer nurse specialist. Yet delivering this effectively will require appropriate training and support. Commissioners should work collaboratively to ensure that this is available.
Commissioners should specify to providers through robust service specifications their requirements around psychological support for cancer patients, their families and carers, which should be measurable and monitored through the quality monitoring of contracts at primary care trust level.
Mr. Lansley: To ask the Secretary of State for Health (1) if he will provide an update on the progress made by cancer networks in implementing the National Institute for Health and Clinical Excellence's guidance on Improving Outcomes in Urological Cancers, published in September 2002, setting out (a) which cancer networks have agreed an action plan with the Department of Health and (b) the expected date for full implementation in each cancer network; 
(2) with reference to the Answer of 16 April 2007 to the hon. Member for Tyne Bridge, Official Report, column 325W, on Cancer: Urinary System, if he will place in the Library copies of the action plans submitted to his Department by strategic health authorities which demonstrate how they will implement the guidance on improving outcomes in urological cancers; which cancer networks reported at December 2006 that the guidance on Improving Outcomes in urological cancers would not be fully implemented by December 2007; what series of measures incorporated into the Manual of Cancer Services 2004 were translated from the Improving Outcomes in urological cancers guidance; and if he will make a statement. 
Ann Keen: As at 31 June 2007 the following cancer networks had action plans agreed by the national health service cancer action team for implementing the urological cancers improving outcomes guidance:
South East London
South West London
North East London
Number and Yorkshire Coast
Greater Manchester and Cheshire
Lancashire and South Cumbria
Merseyside and Cheshire
Central South Coast
Surrey, West Sussex and Hampshire
Avon, Somerset and Wiltshire
Derby and Burton
Northamptonshire and Rutland
North of England (formerly Cancer Care Alliance and Northern)
Anglia (formerly Norfolk and Waveney and West Anglia)
Essex (formerly Mid Anglia and South Essex)
The reporting system in use in December 2006 did not provide sufficient information to identify with confidence those networks that did not expect to achieve full implementation of the urological cancers guidance by December 2007. A stock take therefore took place in Spring 2007 to strengthen the information base and subsequent data collections.
14 networks were already reporting implementation of this guidance;
Nine networks were reporting that they were on schedule for implementation by 31 December 2007;
Six networks were reporting that they were not on schedule to implement the guidance by 31 December 2007 (Humber and Yorkshire Coast, Yorkshire, Central South Coast, Mid Trent, Greater Midlands and Surrey, West Sussex and Hampshire)
One network was still to submit an approved plan (Kent)
The cancer action team continue to work closely with cancer networks on this matter. In addition, the Department's Recovery and Support Unit is liaising with SHAs where deadlines are unlikely to be met to ensure recovery plans are in place.
SHAs have recently submitted information confirming the position for 31 December 2007. This is currently being analysed and will provide a clearer national position including the expected implementation date for any networks that had not fully implemented this guidance by the end of 2007.
Ann Keen: Women invited to participate in the National Health Service Cervical Screening Programme need to understand the potential benefits and harms in doing so and to be able to make an informed choice about whether or not they wish to take part in the Programme.
This is why all eligible women receive a national information leaflet on cervical screening, Cervical ScreeningThe Facts. This leaflet is included with each screening invitation and contains comprehensive and understandable information about cervical screening. It can be viewed at:
The Cancer Reform Strategy noted concerns about the fall in the number of young women taking up their invitation to be screened. That is why the NHS Cancer Screening Programme have commissioned the Improvement Foundation to undertake work at a local level targeting this age group. The lessons learned from this work, due in 2009, will be shared with strategic health authorities and local screening programmes to develop best practice.
The NHS Cancer Screening Programmes press office is developing an information pack to be issued to all local screening programmes and also developing a public relations strategy, including articles in appropriate media publications, posters etc. In addition, Cancer Research UK have commissioned research on this issue, which we will monitor closely and will share the findings.
Continued local action in this area is also essential and we will continue to monitor levels of cervical screening coverage through the Office for National Statistics/Information Centre for health and social care annual cervical screening statistical bulletin.
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