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1 Sep 2008 : Column 1693Wcontinued
The Government will build a Coalition for Better Health to work in partnership with the many other organisations outside Government that seek to promote healthier lifestyles. The Coalition for Better Health will first focus on tackling obesity and we expect
partner organisations to include health, non-Government organisations, the food industry, the fitness industry, employers and others.
Mr. Lansley: To ask the Secretary of State for Health what assessment his Department has made of the level of rurality of different primary care trust areas. 
Mr. Bradshaw: The Department has not made any assessment of the level of rurality of primary care trusts. However, the Department for Environment, Food and Rural Affairs did publish such a classification of the then 303 primary care and care trusts in England in 2005, based on research led by Birkbeck college at the university of London.
Mr. Lansley: To ask the Secretary of State for Health what information he plans to be included in the Patients Prospectus, as referred to on page 40 of High Quality Care for All, Cm 7432; whether (a) professional, (b) patient and (c) other groups will contribute to the information included in the Patients Prospectus; whether the information included in the Patients Prospectus will be disease-specific; and if he will make a statement. 
Ann Keen: The Patients Prospectus aims to empower and support people with long term conditions to understand and exercise their choice around support for self care so that they can better control their condition and ultimately improve their quality of life. The Prospectus will be a national product, generic and will cover the four pillars of our existing policy on support for self care (information, tools, skills and support networks) together with healthy lifestyle choices. A wide range of stakeholders, including patients, clinicians, third sector representatives and staff from national health service organisations and local government are involved in developing the content, which will be launched first on NHS Choices in the autumn.
Mr. Lansley: To ask the Secretary of State for Health if he will publish the anticipated trajectory of the number of people (a) being offered and (b) accepting a personalised care plan over the next five years, as referred to on page 41 of High Quality Care for All, Cm 7432; how he plans to monitor uptake of personalised care plans; what information will be included in personalised care plans; and if he will make a statement. 
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. Planned trajectories for the uptake of care plans will be decided locally. Information included in care plans will also be decided locally using recommended minimum standards.
To ask the Secretary of State for Health when he plans to have developed the Commissioning for Quality and Innovation scheme, as referred to on page 42 of High Quality Care for All, Cm 7432, whether he will consult on a draft of the scheme; how often he expects to alter the incentives in the scheme;
whether the incentives in the scheme will be determined (a) nationally and (b) locally; which organisation will evaluate the scheme; what conditions will be prioritised in the scheme; whether the scheme will cover community services; and if he will make a statement. 
Mr. Bradshaw: High Quality Care For All outlined the commitment to make payments to hospitals reflect the quality of care given to patients through a Commissioning for Quality and Innovation (CQUIN) scheme. Over the next few months, we will be working with stakeholders and national health service colleagues to develop a national enabling framework for the scheme. These discussions will include the scope of the framework, both in terms of services and specialties covered, and how the incentives will work. We will then clarify the framework later this year. The CQUIN scheme will commence from 2009 and evaluation will be subject to a competitive tender process.
Mr. Lansley: To ask the Secretary of State for Health for what reasons primary care trusts will have local discretion in choosing which Never Events to prioritise in their annual operating plans, as referred to on page 45 of High Quality Care for All, Cm 7432, when he expects the National Patient Safety Agency to publish a list of Never Events; whether he expects the National Patient Safety Agency to consult publicly on the list; and if he will make a statement. 
Ann Keen: The National Patient Safety Agency (NPSA) will work with interested Primary Care Trusts (PCTs) and wider stakeholders (including patients and members of the public) to draw up a list of Never Events. This list will be published later in the year and will be available for PCTs to use in their operating plans from April 2009. The incidence of each of these events will vary between PCTs and therefore it will be important that PCTs have the flexibility to prioritise and select the events which will have the most impact on their own health population. The Department also anticipates that, over time, PCTs will expand their list of Never Events and the NPSA will keep under review the national list to incorporate more events that PCTs are able to use as we continue to learn from safety incidents and develop evidence-based interventions to prevent them happening again.
Mr. Lansley: To ask the Secretary of State for Health when he plans to introduce NHS Evidence, as referred to on page 49 of High Quality Care for All, Cm 7432. 
Dawn Primarolo: The first release of the NHS Evidence Service is scheduled for April 2009.
Mr. Lansley: To ask the Secretary of State for Health (1) in what ways integrated care organisations will be rewarded for delivering better health outcomes amongst registered patients for groups of GP practices, as referred to on page 65 of High Quality Care for All, Cm 7432; 
(2) what assessment he has made of the effects on competition in referrals to secondary care resulting from the creation of integrated care organisations, as referred to on page 65 of High Quality Care for All, Cm 7432. 
Mr. Bradshaw: The Next Stage Review and the Primary and Community Care Strategy announced that the Department would pilot models of integrated care. A prospectus inviting pilots to submit applications against pre-agreed selection criteria will be published over the summer. This will also set out funding available for the pilots to support set up costs and project management.
The pilots will be evaluated and the criteria will include the delivery of better health outcomes, patient satisfaction, and the effects of competition and choice.
Mr. Lansley: To ask the Secretary of State for Health in what ways practice-based commissioning has not lived up to its aspirations, as referred to on page 65 of High Quality Care for All, Cm 7432. 
Mr. Bradshaw: Practice-based commissioning (PBC) has the potential to transform healthcare services, allowing clinicians to develop better services for patients in local communities. However as noted by the Audit Commissions report on PBC, Putting Commissioning into Practice (November 2007), while there are examples of PBC thriving in a growing number of areas, the scale of service redesigns undertaken have been limited in comparison with the potential impact of PBC. High Quality Care for All signals the Departments intention to intensify its implementation programme and as PBC matures locally, we expect to see more ambitious redesign of local services undertaken.
Mr. Lansley: To ask the Secretary of State for Health whether the standard contract for community services, as referred to on page 64 of High Quality Care for All, Cm 7432, will be available for commissioners to utilise for the 2009-10 financial year; whether all (a) commissioners and (b) providers of community services will be required to use the standard contract for community services; and if he will make a statement. 
Mr. Bradshaw: The standard contract for community services is being tested in all strategic health authority areas for implementation from April 2009. From this date all primary care trusts (PCTs) taking the lead role in awarding new contracts for community services will use the standard contract. The contract will apply to all relevant providers, including the third and independent sectors, and it will also be used as a service level agreement for PCT provider organisations. Where there is a legally binding contract in place which commenced prior to 1 April 2009, and is not due to expire until after this date, this agreement will remain in force until the expiry date unless otherwise agreed by both parties.
Mr. Lansley: To ask the Secretary of State for Health if he will place in the Library a copy of the work led by Sir Ian Carruthers on innovative delivery models, as referred to on page 63 of High Quality Care for All, Cm 7432. 
Mr. Bradshaw: As part of the national health service next stage review process, Sir Ian Carruthers examined the drivers of change for delivery models with a particular emphasis on rural settings. This work will be published in due course.
Mr. Lansley: To ask the Secretary of State for Health when he plans to publish advice on the range of options for the governance of community health services, as referred to in paragraph 15, page 62 of High Quality Care for All, Cm 7432. 
Mr. Bradshaw: We are developing a legal and governance framework for new organizational models, which we expect to issue later this year.
Mr. Lansley: To ask the Secretary of State for Health which primary care trusts have established arms length provider organisations, as referred to on page 62 of High Quality Care for All, Cm 7432; and in which areas the NHS is exploring (a) community foundation trusts and (b) social enterprises for community services. 
Mr. Bradshaw: The Department does not collect comprehensive information on arms length provider organisations or on primary care trusts exploring social enterprises as an organisational model for community services.
We are working with six community foundation trust pilots, covering Ashton, Leigh and Wigan, Middlesbrough, Redcar and Cleveland, Liverpool, Oldham, South Birmingham and Cambridgeshire
We are also supporting four social enterprise pathfinders that are primary care trust provider arms exploring the potential for separation and the development of a social enterprise model. These are Hull, Milton Keynes, Surrey and the Forest of Dean.
Mr. Lansley: To ask the Secretary of State for Health before which financial year he first expects to publish details of (a) the tariff uplift and (b) efficiency gains on a multi-year basis, as referred to page 52 of High Quality Care for All, Cm 7432. 
Mr. Bradshaw: It is anticipated that projections for multi-year tariff uplift and efficiency gains will be announced later in the year, at the same time as the publication of the NHS Operating Framework for 2009-10.
Mr. Lansley: To ask the Secretary of State for Health what the expected timeframe is for (a) developing acceptable methodologies for drawing up information on clinical effectiveness and (b) publishing this information, as referred to on page 51 of High Quality Care for All, Cm 7432. 
Mr. Bradshaw: Clinical effectiveness is one of the principal elements of the quality of health services. Therefore, information on clinical effectiveness will form part of the full set of quality measures for acute patient care that are being identified by the Department. Officials have begun identifying measures from existing sources in the national health service, other health-related organisations and internationally. The first set of national quality measures will be assessed for robustness, accuracy and relevance and improvement will be supported by a National Quality Board and strategic health authority-based quality observatories.
Discussion with clinical staff and expert bodies on the initial set of measures identified by the Department will take place in the autumn. This will ensure that
measures are drawn up in partnership with clinical and expert stakeholders prior to the announcement of the national set of measures alongside the next NHS operating framework.
In partnership with Royal Colleges and specialist associations, work will shortly commence to develop further generations of more sensitive and specific measures of care quality and outcomes. These will exploit new sources of data and research evidence, and will deliver better indicators for clinicians to use locally over coming years.
Mr. Lansley: To ask the Secretary of State for Health when he next plans to review the Quality and Outcomes Framework of the General Medical Services contract to be reviewed; whether he plans to bring forward proposals to make the process for developing and reviewing indicators in the Quality and Outcomes Framework more (a) independent and (b) transparent, as referred to on page 51 of High Quality Care for All, Cm 7432; what plans he has for the National Institute for Health and Clinical Excellence to lead on the (i) development and (ii) review of indicators in the Quality and the Outcomes Framework; whether he plans new indicators of prevention and clinical effectiveness to be added to offset the reduction in process and organisational indicators, as referred to on page 51 of High Quality Care for All, Cm 7432; and if he will make a statement. 
Mr. Bradshaw: Our Vision for Primary and Community Care published on 3 July as part of NHS Next Stage Review proposes a new strategy for developing the Quality and Outcomes Framework, including an independent and transparent process for developing and reviewing indicators. The report states our intention to:
discuss with the National Institute for Health and Clinical Excellence and with stakeholders including patient groups and professional bodies how this new process should work;
discuss how to reduce the number of organisational or process indicators, and refocus resources on new indicators for prevention and clinical effectiveness; and
explore the scope to give greater flexibility to primary care trusts to work with primary healthcare teams to select quality indicators (from a national menu) that reflect local health improvement priorities.
Some of these matters are subject to the outcome of negotiations with general practitioner representatives and therefore it is not appropriate to set out details in advance of those negotiations. We will discuss with professional and patient groups and other stakeholders how the new process should work.
Mr. Lansley: To ask the Secretary of State for Health what assessment he has made of the impact on competition in referrals to secondary care resulting from the integration of community providers with NHS acute trusts, as referred to on page 44 of NHS Next Stage Review: Our vision for primary and community care. 
We have reviewed the potential impact on choice and competition of arrangements where NHS foundation trusts hold contracts for list-based primary medical care and we issued guidance in The NHS in England: The operating framework for 2008/9 Annex D
Principles and rules for co-operation and competition copies of which have already been placed in the Library. The guidance sets out the safeguards that primary care trusts, as commissioners of services, should apply both in considering whether to award primary care contracts to secondary care providers and through the contracts for such services. These principles and safeguards apply to any service that involves referrals from community providers to secondary care.
Mr. Lansley: To ask the Secretary of State for Health in what ways his Department plans to assess the prevalence of illness amongst the populations served by different GP practices, as referred to on page 40 of NHS Next Stage Review: Our vision for primary and community care. 
Mr. Bradshaw: Our Vision for Primary and Community Care published on 3 July as part of NHS Next Stage Review states "we will work to ensure that QOF rewards better reflect the prevalence of illness amongst the populations served by different GP practices".
We are currently discussing with the British Medical Association changes to the prevalence formula which weights Quality and Outcome Framework payments according to prevalence of disease as measured through Quality Management System, which receives data extracted from general practitioner clinical systems.
Mr. Lansley: To ask the Secretary of State for Health what the planned timescale is for exploring the use of patient-reported outcome measures in the Quality and Outcomes Framework, as referred to on page 45 of NHS Next Stage Review: Our vision for primary and community care; whether he plans these patient-reported outcome measures to be disease-specific; and if he will make a statement. 
Mr. Bradshaw: We will be exploring with the profession the feasibility of developing indicators based on Patient Reported Outcome Measures (PROMs) for the Quality and Outcomes Framework. These may include PROMs for specific disease areas depending on the evidence base for such indicators.
Mr. Lansley: To ask the Secretary of State for Health what greater freedoms he expects to provide to practice-based commissioners which can show they can take on increased responsibility, as referred to on page 52 of NHS Next Stage Review: Our vision for primary and community care. 
Mr. Bradshaw: Greater freedoms in managing resources will become available to practice-based commissioners who can demonstrate an ability to undertake increased responsibility. The precise nature of these freedoms, including their application, will be developed this autumn in consultation with primary care trusts and practice-based commissioners.
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