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Anne Milton: To ask the Secretary of State for Health what discussions he has had with the Healthcare Commission on (a) increasing the level of data collection on lung cancer and (b) including outcome data on lung cancer as part of the annual healthcheck. 
Ann Keen: The National Clinical Audit Support program (NCASP), which is part of the Information Centre for health and social care, and the Royal College of Physicians manage the National Lung Cancer Audit (LUCADA). They have proposed that the Healthcare Commission include specific participation in the national cancer audits, including the LUCADA, as part of the annual health check. They have also recommended key performance measures including: data completeness; histological confirmation rates; and key treatment rates (such as surgical resection).
NCASP provided data on crude treatment rates on lung cancer as part of the annual health check in 2007. Case-mix adjusted data on treatment rates and survival should be available by hospital in the next annual report, due to be published at the end of this year.
Anne Milton: To ask the Secretary of State for Health what steps he is taking to include indicators of quality of care and clinical outcomes for lung cancer patients in the commissioning process. 
Ann Keen: The Cancer Network teams will act as agents for commissioners and, in line with world class commissioning, will maintain dialogues with clinical teams and users, driving high quality care. The networks will also engage with providers to ensure required clinical outcomes are achieved and to drive continuous improvement.
Anne Milton: To ask the Secretary of State for Health (1) what percentage of trusts participated in the National Lung Cancer Audit for 2007; what steps he has taken to encourage trusts and cancer networks to participate in the National Lung Cancer Audit for 2008; and what sanctions he is able to place on trusts which do not participate in the audit; 
The Information Centre for health and social care (IC) gives strong encouragement to hospitals and networks to participate in the national lung cancer audit. However, participation in national audits is not mandatory and so there are no sanctions that can be placed on trusts that do not participate in the National Lung Cancer Audit. Participation is encouraged by the National Cancer Peer Review Process and is used by the Healthcare Commission as evidence of compliance with Core Standards.
Reports on audit participation in previous years have been provided to strategic health authorities, and copies of the last annual report were sent to the chief executives of all trusts that treat lung cancer patients. The IC has developed local action plans to help improve data quality and outcomes, and these have been sent to trusts and cancer networks.
Sir Peter Soulsby: To ask the Secretary of State for Health what steps he is taking to increase awareness of the symptoms of lung cancer among (a) healthcare professionals and (b) members of the public. 
Ann Keen: In December 2007, the Cancer Reform Strategy (copies of which have already been placed in the Library) established the National Awareness and Early Detection Initiative, led by the National Cancer Director. In order to co-ordinate a programme of activity to support local interventions to increase cancer symptom awareness among healthcare professionals and the general public, the initiative is bringing together and collaborating with representatives of local authorities, the Department, the National Cancer Research Institute, cancer charities and patient representatives. The initiative, which is in the early stages of development, will co-ordinate a programme of activity to support local interventions to increase cancer symptom awareness. We will be involving professionals such as pharmacists and social workers, as we develop the initiative.
In 2005, the National Institute for Health and Clinical Excellence published updated guidance for general practitioners and primary healthcare professionals on when a patient should be urgently referred to a specialist for investigation of suspected cancer. The National Cancer Research Institute will be exploring how to further support healthcare professionals in spotting potential cancer symptoms.
We will be establishing a national audit in primary care of all patients newly diagnosed with cancer to understand more about the nature and extent of delays in cancer diagnosis. Its findings will be used to decide how best to provide more support to primary care professionals to ensure early diagnosis of cancer.
In addition, the Departments Lung Cancer Awareness Month Working Group has revised its key messages about the signs and symptoms of lung cancer. It is strongly promoting the message that early detection of lung cancer can save lives.
Sir Peter Soulsby: To ask the Secretary of State for Health what funding has been provided from the NHS research and development budget into research into lung cancer in each financial year since 1997-98; what research has been funded by such expenditure; and if he will make a statement. 
Ann Keen: Over the last 10 years, the main part of the Departments research and development budget has been allocated to and managed by national health service organisations. Those organisations have accounted for their use of the allocations they have received from the Department in an annual research and development report. The reports identify total, aggregated expenditure on national priority areas, including cancer. They do not provide details of research into particular cancer sites.
The National Cancer Research Institute (NCRI), a United Kingdom wide partnership between Government, charities and industry, makes cancer research information available online via the International Cancer Research Portfolio database at:
The NCRI report Lung Cancer research in the UK 2006 offered an analysis of the reasons for the historically low levels of investment in lung cancer research and made proposals for increasing its scale. Copies of this report have been placed in the Library.
Mr. Stephen O'Brien: To ask the Secretary of State for Health pursuant to the answer of 23 June 2008, Official Report, columns 116-7W, on medical records: data protection, what his definition of a health community is. 
Mr. Bradshaw: In my previous answer, the term local health community was used to designate all clinicians, managers and other staff of general practitioner practices, primary care trusts and national health service trusts involved in the management and provision of NHS health care for patients within a geographical area agreed by the constituent organisations.
Dr. Gibson: To ask the Secretary of State for Health how many recommendations the National Commissioning Group has made on national funding for ultra-orphan therapies; whether his Department may overturn any decisions made by the National Specialised Commissioning Group on the funding of ultra orphan therapies; and if he will make a statement. 
Ann Keen: The National Commissioning Group (NCG) met in June and made a recommendation to the National Specialised Commissioning Group (NSCG) that the service for patients with paroxysmal nocturnal haemoglobinuria met their criteria for national commissioning. This application includes treatment of the condition with a newly licensed ultra-orphan drug, eculizumab. The NSCG will make recommendations about additions to the national commissioning portfolio at its meeting in July.
Dr. Gibson: To ask the Secretary of State for Health (1) what systems his Department has in place to prevent geographical variations in prescribing of novel and unique drug therapies for rare disorders which are not appraised by the National Institute of Health and Clinical Excellence; and if he will make a statement; 
In December 2006, the Government re-issued Good Practice Guidance on Managing the Introduction of New Healthcare Interventions and links to NICE Technology Appraisal Guidance to the local national health service, which states that funding for treatments should not be withheld simply because guidance from the national Institute for Health and Clinical Excellence (NICE) is unavailable but that decisions should be
made on the basis of the available evidence. The Guidance also suggests alternative sources of information for NHS organisations to consult in the absence of NICE guidance. Copies of the guidance have already been placed in the Library.
The draft NHS constitution makes clear the patient's right to expect local decisions on funding for drugs for which NICE guidance is not available to be made rationally following proper consideration of the evidence. Where the local NHS decides not to fund a treatment, the patient and clinician can expect an explanation. To underpin this, the Government will require primary care trusts to put in place clear and transparent arrangements both for local decision-making on funding of new drugs and for considering exceptional funding requests, and to publish information on those arrangements.
NICE has already appraised a number of orphan drugs but a separate appraisal system for ultra-orphan drugs has not been established. This position is kept under review in the context of other developments relating to the Government's policy on new drugs.
Dr. Gibson: To ask the Secretary of State for Health by what procedures and under what authority specialist commissioning groups assess funding for ultra-orphan therapies; and if he will make a statement. 
Dawn Primarolo: specialised commissioning groups (SCGs) are joint-committees of primary care trusts (PCTs) and draw their authority to commission healthcare services from that of their constituent PCTs. The responsibility for considering the funding of new drugs or treatments rests with individual PCTs and SCGs. Commissioners must balance local pressures and priorities for existing services and new developments, taking account of the available evidence of cost and clinical effectiveness.
Mr. Stephen O'Brien: To ask the Secretary of State for Health on what dates the Spine functionality has failed (a) locally and (b) nationally; and for how long the failure lasted in each case. 
Mr. Bradshaw: The 'spine' is the colloquial name given to the national database of key information about patients' health and care. It forms the core of the NHS Care Records Service. It also supports other key elements of the national programme for IT (NPfIT), such as choose and book, the electronic prescriptions service, the summary care record and 'GP to GP' record transfer, each of them using the spine's messaging functionality as part of their own services.
Reports of service incidents for investigation fall into five levels of severity, ranging from those which have a significant adverse impact on the provision of the service (severity 1), to those comprising mere cosmetic flaws, for example on-screen misalignment of data (severity 5). They may involve intermittent failures or be unnoticed by the user since other, associated application functionality is unaffected. Similarly, the service incidents that do occur do not usually affect all users and may be quite localised.
A breakdown of reported incidents by date and whether these were a result of a national service incident or were as a result of local circumstances, together with
the period of service interruption, could be provided only at disproportionate cost. There is no evidence of any service incident having had a material impact on the quality of patient care.
The service availability levels required under the spine contract are exceptionally demanding compared with those for information technology systems that preceded NPfiT. Since the first spine applications went live in July 2004, overall service availability has typically been continuously either at 100 per cent, or very close to 100 per cent, across the whole range of spine services. Details of service availability for spine services, measured against contracted target availability, is routinely published, and updated weekly, on the NHS Connecting for Health website at:
Mr. Vaizey: To ask the Secretary of State for Health (1) what steps he plans to take to ensure that patients and clinicians at the Nuffield Orthopaedic Centre are consulted on proposals put forward by the South Central Strategic Health Authority to merge the Nuffield Orthopaedic Centre with another health organisation; 
(2) what assessment the South Central strategic health authority has made of the (a) clinical and (b) financial effects of a merger of the Nuffield Orthopaedic Centre with another health organisation. 
Mr. Ivan Lewis [holding answer 7 July 2008]: Decisions about the future of the Nuffield Orthopaedic Centre NHS Trust are a matter for the local national health service. The information requested about South Central strategic health authoritys (SHAs) assessment of the clinical and financial effects of a merger between the Nuffield Orthopaedic Centre and another health organisation is not collected centrally.
The SHA has advised that it is committed to working with its partners in the local health care economy to identify a model which secures the future delivery of the Nuffield Orthopaedic Centre NHS Trust services. The hon. Member may therefore wish to raise these issues with the chief executive of South Central strategic health authority.
NHS organisations have a legal obligation to involve and consult patients and the public in the planning of services, development of proposals for change and consideration of proposals affecting the operation of services. Separately, where it is agreed that the proposals to reconfigure services include any significant change to the way services are provided, local trusts have a duty to consult with the relevant overview and scrutiny committee (OSC). Following the consultation period, the NHS organisations will have to make a decision on the best way forward. Local OSCs have the power to review and scrutinise health services from the perspective of their local populations, and can refer proposals to the Secretary of State if they believe the plans are not in the interests of the health service. Ultimately, however, the configuration of health care services in a particular area is a decision that needs to be taken at a local level.
Mr. Stephen O'Brien: To ask the Secretary of State for Health what response he plans to make to the recommendations contained in the report from the Organ Donation Taskforce; and whether he has made an estimate of the (a) costs and (b) number of intensive care beds associated with implementation. 
Ann Keen: The Government are committed to implementing the Organ Donation Taskforce recommendations and have allocated £11 million for 2008-09 to support this work. This includes funding for the reimbursement of trusts facilitating donation. Funding for years 2009-10 and 2010-11 will be agreed as part of the normal annual business planning process.
A Programme Delivery Board, Chaired by Professor Sir Bruce Keogh (NHS Medical Director) and comprising of key organ donation stakeholder organisations, has been established to determine how each of the Organ Donation Taskforce recommendations can be taken forward and evaluate the resources required. The estimation of the numbers of intensive care beds associated with implementation will be conducted as part of this work.
Mr. Jenkins: To ask the Secretary of State for Health what the average waiting time for radiotherapy treatment in South Staffordshire NHS primary care trust area was in the latest period for which figures are available. 
Ann Keen: Information about average waiting times for different types of cancer treatment, including radiotherapy, is not collected centrally. Cancer waiting times standards were introduced for all cancer patients from December 2005. They are a maximum wait of 31 days from diagnosis to first cancer treatment and a maximum wait of 62 days from urgent referral for suspected cancer to first cancer treatment. In the last quarter (January to March 2008), performance against these standards in England was 99.5 per cent. and 96.8 per cent. respectively.
Dr. Stoate: To ask the Secretary of State for Health what arrangements he has made to monitor the implementation of individual care plans for people with long-term conditions outlined in the Our Health, Our Care, Our Say White Paper; and what incentives he plans to introduce for the implementation of such plans. 
Ann Keen: The Department is currently developing a range of options to measure and incentivise the delivery and impact of care planning including the use of patient surveys to monitor patient experience at a local level.
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