I have been asked to reply

on behalf of the Department of Health.

The coalition agreement set out the Government's clear commitment to reforming the system of social care to provide much more control to individuals and their carers, and to ease the cost burden that they and their families face.

This commitment to reform is why we acted quickly to set up the Commission on Funding of Care and Support, which published its report in July 2011.

When the commission published its report, Government set out a clear timetable for assessing the impacts of the commission's recommendations, making the necessary trade-offs with other priorities for social care reform, and deciding on the best way forward. We said that we were working towards a White Paper on social care and a progress report on funding reform in spring 2012, and we remain committed to that timetable.

The commission's report has formed the basis of Government's recent engagement with stakeholders. This engagement exercise examined the impact of these recommendations, and brought them together with other priorities for reform from across the social care system to look at the trade-offs between them.

In addition to our work with social care stakeholders, the Department is looking in detail at the impact of the commission's recommendations. A full assessment of the recommendations will be included in the progress report, which we will publish in the spring. We are not able to pre-judge the contents of that report now by commenting in detail on the impact of the recommendations.

In the current social care system, people who can afford to pay are required to fund their own social care out of their income and assets. In some cases, people need long-term social care, and some of them will, over time, use up their assets to the point that they qualify for state support to fund their own care. At this point, the local authority will provide them with support to pay for care.

We do not centrally hold information on how many people spend down their assets and are subsequently supported by the state, nor do we know the total cost of supporting these people.

Data on local authority expenditure on social care are collected and published by the Health and Social Care Information Centre. Data on local authority expenditure on for 2001-02 to 2010-11 are provided in the tables which have been placed in the Library. The data for 2010-11 are provisional and subject to change. Final data for 2010-11 will be published in March 2012.

The care and support White Paper and progress report on funding reform, planned for spring 2012, will set out the Governments plans for transforming the care and support system.

To understand what the priorities for reform should be, the Government launched 'Caring for our future'. We worked with leaders from the care and support community, supported by expert reference groups, to seek a broad range of views from people who use care and support services, carers, local councils, care providers and the voluntary sector. Further details on the engagement, discussion leads and the output from key events can be found at:

www.caringforourfuture.dh.gov.uk

The Department is currently reflecting on the findings and will continue to work with stakeholders to develop policy, including associated costs and benefits, and to help us decide the approach to the care and support White Paper and progress report on funding reform.

Local authorities are responsible for decisions on spending on adult social care. At a national level, the NHS information Centre collects detailed information on Personal Social Services (PSS) expenditure through the Personal Social Services Expenditure return (PSSEX1). A copy of the most recent PSSEX1 report 'Personal Social Services Expenditure and Unit Costs: England 2010-11-Provisional Release' has been placed in the Library, and contains provisional details of 2010-11 expenditure.

The spending review outlined an additional £1 billion per annum by 2014-15 to be allocated within the national health service to be spent on measures that support social care. The Department collected information from primary care trusts in September 2011 to understand how the transfer of NHS money was progressing and on which services it was being used. The information suggests that the money is being used on a wide range of services. A full breakdown of this can be found in the NHS publication 'The Quarter', a copy of which has been placed in the Library.

The 'Vision for Adult Social Care: Capable Communities and Active Citizens' identifies the need for a capable and well-trained work force. The Department is working with Skills for Care to attract a diverse work force into the sector.

In May 2011, the Recruitment and Retention Strategy was produced jointly and promotes improved public awareness of social care careers and the opportunities on offer within the sector.

The "Vision for Adult Social Care: Capable Communities and Active Citizens" recognises the need for a diverse workforce that is capable and well trained. The Department, working with Skills for Care, jointly produced a Workforce Development Strategy in May 2011, which sets out broad areas for widening access to the knowledge, skills and capacity the workforce will need in the future.

The coalition agreement set out the Government's clear commitment to reforming the system of social care to provide much more control to individuals and their carers, and to ease the cost burden that they and their families face.

This commitment to reform is why we acted quickly to set up the Commission on Funding of Care and Support, which published its report in July 2011.

When the commission published its report, Government set out a clear timetable for assessing the impacts of the commission's recommendations, making the necessary trade-offs with other priorities for social care reform, and deciding on the best way forward. We said that we were working towards a White Paper on social care and a progress report on funding reform in spring 2012, and we remain committed to that timetable.

The commission's report has formed the basis of Government's recent engagement with stakeholders. This engagement exercise examined the impact of these recommendations, and brought them together with other priorities for reform from across the social care system to look at the trade-offs between them.

In addition to our work with social care stakeholders, the Department is looking in detail at the impact of the commission's recommendations. A full assessment of the recommendations will be included in the progress report, which we will publish in the spring. We are not able to pre-judge the contents of that report now by commenting in detail on the impact of the recommendations.

Information on the average charge for meals on wheels services is not collected centrally.

Data on local authority expenditure on social care is collected and published by the NHS Information Centre via the National. Adult Social Care Intelligence Service online analytical processing tool. Further information is available on the Information Centre website at:

www.nascis.ic.nhs.uk

Data, provided by the Information Centre, on local authority expenditure on meals for older people-aged 65 or over-for the years 2001-02 to 2010-11, has been placed in the Library.

Data on local authority expenditure on social care are collected and published by the Health and Social Care Information Centre. Data on local authority expenditure on equipment and adaptations and respite care has been placed in the Library. The data for 2010-11 are provisional and subject to change. Final data for 2010-11 will be published in March 2012.

Data are available for aids and adaptations from 2001-02 to 2010-11, but data on local authority expenditure on respite care has only started to be collected as a voluntary data item on the Personal Social Services Expenditure Return (PSSEX1) return in the last two years.

The current number of diabetic specialist nurses employed by the national health service is not collected centrally. The annual work force census does not separately identify specialist nurses.

It is for local NHS organisations, with their knowledge of the health needs of their local population to train and recruit the staff needed to best meet these needs.

The Department recognises chronic pain as a long-term condition, either in its own right or as a component of other long-term conditions. Everyone who suffers persistent pain should have a timely assessment in order to determine the cause of the pain-if a cause can be determined-and to advise on options for treatment, including self-help. Patients with refractory chronic pain will benefit from the care planning approach, but decisions should be taken on an individual basis depending on the severity of symptoms and any co-morbidities.

The prioritisation and development of potential indicators for inclusion in the Quality and Outcomes Framework (QOF) is the responsibility of the National Institute for Health and Clinical Excellence and its independent Primary Care QOF Indicator Advisory Committee.

The current osteoporosis indicators focus on the secondary prevention of fragility fractures and do not specify how patients at risk of fragility fracture should be identified.

The re-tender for the National Hip Fracture Database and the National Audit of Falls and Bone health in Older People includes a requirement to conduct a feasibility study regarding all non-hip fragility fractures. The feasibility study will allow a decision to be made regarding the future commissioning of such a database.

The Health and Social Care Bill makes provision for the National Institute for Health and Clinical Excellence (NICE) to produce Quality Standards that relate to social care, which would potentially include care homes. Our engagement exercise-Caring for Our Future: Shared ambitions for care and support-sought to understand people's priorities for reform to help inform the approach to be set out in the forthcoming White Paper on adult social care. Responses to the engagement in relation to quality welcomed planned work to extend NICE Quality Standards to social care, and highlighted the potential role clinical audit practice might play in driving up quality in the sector. The Government are now considering these proposals before they set out their plans in their White Paper on care and support.

The Department issued best practice guidance on social care needs assessment, "Prioritising need in the context of Putting People First: A whole system approach to eligibility for social care", to local authorities in 2010. A copy has already been placed in the Library and it is available on the Department's website at:

www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_113154

The guidance includes the following:

"Councils should identify any children or young people acting in a caring role and consider the impact on them. Community care packages should not rely on the input of an inappropriate level of care from a child or young person. In this respect, in addition to the provision of adult care assessment and support, councils should be prepared, to address their duty under the Children Act 1989 to safeguard and promote the welfare of children in their area. The Children Act 1989 also specifies the need to take the views and. interests of children into account, In discharging these duties, it is essential that Councils take account of the cumulative effects of responsibilities of family members within the household and where necessary, adult and children's services should work together to protect children from having to undertake unreasonable levels of care."

In the course of assessing an individual's needs, councils should recognise that adults who have parenting responsibilities for a child under 18-years may require help with these responsibilities.

Effective partnership working and integration are key enablers in delivering against the Quality, Innovation, Productivity and Prevention challenge within the national health service, and supporting improved efficiency within social care. This includes ensuring that people do not stay in hospital longer than they need to.

The Department has put in place practical measures to support social care services, in the context of a challenging local government settlement, and to encourage improved joint working between primary care trusts (PCTs) and local authorities. In 2011-12, £648 million has been allocated to PCTs to transfer to councils for spending on social care services that also benefit health. The Department has been clear that PCTs and local authorities will need to work together closely in order to agree appropriate areas of social care investment, taking account of joint priorities identified by the joint strategic needs assessment for their local populations. Evidence from a survey of PCTs suggests that this funding is being used both to prevent unnecessary admissions to hospital (through crisis response services for example); and to ensure people are able to leave hospital quickly (through intermediate care and re-ablement services for example).

A further £150 million (rising to £300 million in 2012-13) has been allocated to PCTs for the development. of post-discharge support and re-ablement services. There is local discretion over how this money is to be spent, but in a letter to the service the Department has been clear that:

"This funding is intended specifically to develop current reablement capacity in councils, community health services, the independent and voluntary sectors, with the objective of ensuring rapid recovery from an acute episode and reducing people's dependency on social care services following discharge".

Finally in addition to these funding streams, the Department announced on 3 January 2012 that it was making a further £150 million available to PCTs, to transfer to local authorities for spending on social care. The Department has set out that this funding should be used to target delayed transfers of care which are attributable to social care services.

The Department has not made estimates of the difference between the number of people eligible for social care support in England and those receiving formal support from public or private sector agencies.

The Department acknowledges that unmet need is difficult to precisely define and measure. The eligibility framework issued by the Department seeks to support councils in prioritising funding on those with the highest need. The Government are clear that everyone who thinks they may be in need of care and support is entitled to an assessment, and if this assessment concludes that services are required to meet the person's assessed needs and the person qualifies under the means-test, services must be provided.

The National Institute for Health and Clinical Excellence (NICE) is currently appraising ipilimumab (Yervoy) for the treatment of previously treated unresectable stage III or IV malignant melanoma and has not yet published its final guidance.

The manufacturer of ipilimumab has proposed a patient access scheme and the Department has agreed that the proposed scheme can be considered by NICE. NICE has indicated that the appraisal will now be referred back to its appraisal committee for further consideration.

NICE is an independent body and it would not be appropriate for Ministers to. intervene in an ongoing technology appraisal.

In the absence of final NICE guidance on a drug, it is for local primary care trusts (PCTs) to make funding decisions based on an assessment of the available evidence. Where a cancer drug is not routinely funded by a PCT, patients may be able to access the drug through the Cancer Drugs Fund.

The number of cases of melanoma in England and the estimated national health service expenditure on the treatment and management of skin cancer for the latest three-year period for which comparable data could be provided can be found in the following table.

The expenditure figures include both non-melanoma and malignant melanoma as it is not possible to break this figure down to identify expenditure on a particular type of skin cancer. It is also not currently possible to estimate expenditure on chemotherapy and radiotherapy by cancer type. Expenditure on these treatments is therefore included within the 'Cancers and Tumours-Other' category.

In addition, expenditure on some service areas or activities is excluded if it is not possible to make a reasonable estimation of expenditure by specific disease area. For this reason expenditure on general practitioner services, diagnostics and some outpatient services are excluded from estimates of expenditure on cancers and tumours.

Expenditure figures are from estimated England level programme budgeting data, which are calculated using primary, care trust and strategic health authority programme budgeting returns and Department resource accounts data. Figures also include an estimation of special health authority expenditure.