The information requested is currently being collated and will be placed in the Library as soon as it is available.

While it is the responsibility of newly qualified social workers to find employment for themselves arid the responsibility of employers to recruit, the Department funds Skills for Care to provide a programme to enable newly qualified social workers to make the transition to the world of work in adult services.

The Department continues to support the work of the social work reform board and their programme to make social work a more attractive profession.

The Skills for Care framework for Newly Qualified Social Workers (NQSWs) recognise that NQSWs need a range of support at different stages of their careers. They need:

Support to build on the expertise and knowledge they, have developed on. qualifying programmes and how to apply this to a practice setting as a qualified worker;

Good quality induction to the profession and to their organisation;

Access to the correct type and level of quality supervision; and

A structured process of continued professional development which supports them to develop their career beyond the first year in practice and to meet registration and post-registration training and learning requirements.

It also recognises that managers need support so that they can provide the most appropriate environment possible for NQSWs and, in particular, meet their supervision and ongoing development needs.

This Government take the issue of eating disorders, especially among young people, very seriously.

NICE guidance, 'Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa arid related eating disorders' was published in 2004 and is due for review in January 2014. Early intervention is essential for those with eating disorders and we have been clear that general practitioners are expected to use NICE guidance when choosing the most appropriate treatments, from physical and psychological treatments to medicines.

There are no specific targets in respect of the prevention of eating disorders, nor has the Department set aside a specific budget. The Government Equalities Office have begun a campaign which aims to reduce the burdens that popular culture places on an individual's well-being and self-esteem. The Government have convened a group of experts to identify non-legislative solutions to tackling low levels of body confidence. This includes representatives from health care, fashion, beauty, media, advertising, and the voluntary sector.

Decisions about the provision of local health services, including cancer services, are a matter for the local national health service. As such, no assessment has been made by the Department.

A number of proposals are in development following an independent review of the future configuration of cancer services in the Liverpool area, commissioned by the Merseyside and Cheshire NHS Cancer Network on behalf of the Merseyside and Cheshire primary care trusts.

The outline business case for the proposals is at an early stage. Investment figures will be identified through the development of the business case.

There are already local arrangements for the contracting of these services. Specialist centres can use the opportunity to include people in clinical trials, so that we can demonstrate that this is a worthwhile treatment for many cancers. At present, the evidence suggests that it is beneficial only in the case of inoperable lung cancers. I hope that, as we progress, we shall be able to demonstrate that this is not the only technology, and that CyberKnife is a brand, not-

House adjourned without Question put (Standing Order No. 9(7)).

No. Many points have been put to me, and to be fair, I now need to respond to them.

Currently, eight centres are active in providing these services, but I recognise and appreciate the work my hon. Friend has done, and we will certainly need to review carefully the information she has presented tonight.

CyberKnife can deliver only SBRT and cannot deliver conventional radiotherapy. Large, expensive radiotherapy delivery systems such as these are purchased by public tender. After vigorous and rigorous evaluation of the many different systems available to deliver this treatment, many hospitals around the country have chosen systems provided by other manufacturers, as they enable them to provide flexible, accurate and cost-effective radiotherapy and radio-surgery services. The promotion of CyberKnife over other alternatives does a disservice to other manufacturers that are successful in providing equipment to trusts, and distorts the nature of the debate.

Let me be clear: timely access to high-quality radiotherapy for cancer patients in this country should improve cancer outcomes and survival. That is why we have made a commitment to expand radiotherapy capacity by investing about £150 million more over the next four years. That will increase the utilisation of existing equipment, support additional services and ensure that all high-priority patients with a need for proton-beam therapy get access to it abroad.

Significant progress has been made in improving radiotherapy services since the publication of the National Radiotherapy Advisory Group report in 2007. The collection of the radiotherapy dataset, which the hon. Member for Easington (Grahame M. Morris) talked about, has enabled us to establish more accurately than ever before the measure of the number of patients being treated with radiotherapy, and to identify and address unacceptable and inexplicable variations around the country. Almost all patients referred for radiotherapy treatment receive that treatment within the waiting time standards. This improvement in waiting times, compared with historical waiting times, saves lives each year. New modelling tools have been developed that allow local services to model the needs of their populations and to predict demand and ensure that they have capacity to treat all patients who will benefit from the treatment without unnecessary delay as demand changes over the years.

However, there can be absolutely no room for complacency, and we realise that more work needs to be done to identify why the variations that the hon. Member for Easington has talked about in terms of referral rates in some parts of the country have existed. The dataset shows that some variations in access rates between cancer networks persist, and there is currently lower uptake in certain parts of the north that cannot be explained by variations in cancer incidence. That new dataset allows local commissioners to examine their referral practices in detail, and I understand that networks in the north-east are looking at capacity and travel times to start to address the concerns that the hon. Gentleman has brought to the House tonight.

Access to advanced radiotherapy techniques needs to be improved, particularly intensity modulated radiotherapy. Experts estimate that around a third of all treatments given with the intention of cure should be delivered by IMRT. Some centres are already delivering at that rate,

but many are far below it. All centres have equipment that is capable of delivering that technique and a national training programme has been rolled out. We now need to ensure that IMRT, as well as image guided radiotherapy, is offered to all patients who might benefit.

As we have heard, radiotherapy treatment involves the delivery of a dose of radiation to a cancer tumour. That dose is delivered to each patient in fractions or treatments and the number of fractions delivered varies with the type of cancer. The ultimate goal in radiotherapy is to deliver the treatment to the tumour with pinpoint accuracy, thus sparing surrounding tissue and requiring as few fractions, or treatments, as possible-in other words, to treat and cure more cancers with shorter courses of radiotherapy and fewer side effects. For that reason, radiotherapy is continuously evolving with innovations and the development of new techniques and technologies that move us increasingly closer to that goal, but those new developments need to be evaluated in clinical studies.

It is a challenge for providers and commissioners to keep up with the evolving nature of radiotherapy treatment and to ensure the evaluation and adoption of new techniques. The royal colleges and other professional bodies provide guidance to their members to assist the continuous update of clinical practice. Commissioners in turn need to ensure that they are aware of sources of updated guidance. The radiotherapy community in this country can be rightly proud of its ability to deliver clinical studies and explore the use of delivering radiotherapy in fewer fractions. Indeed, the role of the Royal College of Radiologists and the National Radiotherapy Implementation Group in producing such guidance is absolutely crucial.

Let me come back to stereotactic body radiotherapy, which is an important example of specialist radiotherapy technique. It allows radiotherapy to be given to smaller target areas in higher doses with fewer treatments. Its greatest potential is in its possible use as an alternative to surgery and, because of its precision, to treat and potentially cure cancers that would otherwise be untreatable. However, as has been mentioned, it is regarded as a novel technique and it provides a very high dose of radiation per treatment. With conventional radiotherapy, a patient might receive their dose over 20 to 25 visits, but with SBRT that dose is delivered in five or six. More treatments need to be delivered within clinical studies so that clinicians can carefully follow up in both the short and long term to confirm the efficacy of the treatment and study any side effects. Side effects have been mentioned in the context of drugs, but we need to be conscious that there can also be side effects from radiotherapy and not be so anxious to expose people to risks if we are not confident. We should apply the standards of clinical trials to this area. It would be wrong for this Government to promote any form of treatment before the evidence has been collected. Evidence is about more than just making speeches in the House-it is also about looking at the clinical evidence.

All new techniques, including advanced radiotherapy, need to be justified on the grounds of cost and clinical effectiveness. Last year, the National Radiotherapy Implementation Group, published guidance, which has been mentioned, on the use of SBRT, including a clinical evidence review, and concluded that there is a substantial

evidence base for the clinical effectiveness of SBRT in early stage lung cancer for patients who are unsuitable for surgery.

There are about 1,000 patients in the country who would benefit from that sort of procedure. There are ongoing clinical trials examining the use of the technique for other cancers, but they have yet to confirm its benefits for those cancers. For that reason, the national radiotherapy implementation group recommended that any patient receiving SBRT should receive it in a clinical study to enable the evidence to grow, and at specialised centres treating high volumes of patients with the necessary quality assurance safeguards in place. The implementation of the recommendations cannot be rushed, and the welfare of patients should be paramount in the introduction and use of novel techniques. Staff must therefore be thoroughly trained in this technique.

My hon. Friend asked me to consider a number of issues. I will certainly undertake to examine the tariff programme to establish what more can be done to expedite it, but I should point out that it is no small task to introduce new tariffs in the NHS. In 2012-13 we are mandating the use of the necessary resource groups and currencies in regard to contracting for external beam radiotherapy, and that is an essential first step. I hope that when my hon. Friend has a chance to sit down with officials, they will be able to talk in more detail about

the work that is being undertaken to make progress with the implementation of tariffs.

It is possible that there will be a significant increase in demand for this treatment in the coming decades, but many tumours will continue to be treated better with conventional radiotherapy, and in particular with intensity-modulated and image-guided radiotherapy techniques.

We have had a good debate so far, and I congratulate my hon. Friend the Member for Wells (Tessa Munt) on securing it and on providing an opportunity for us to draw attention to radiotherapy services in the NHS. I want to try to answer as many questions as I can. I understand that my hon. Friend will meet Department officials to discuss some of her concerns further. I hope that if any issues are not covered, they can be explored further there.

Radiotherapy is an extremely important form of treatment for cancer, which often does not get the attention it deserves. This debate has, I think, helped in that regard. It is more targeted than chemotherapy and less invasive than surgery, with new, faster and more precise technologies reducing side-effects and improving outcomes for patients. Radiotherapy is a significant component in the treatment of 40% of patients cured of cancer and for 16% of cures overall. It is also extremely cost-effective in comparison to other curative cancer treatments. Spending is at around £325 million a year-just 5% of the total spend on cancer.

For these reasons, I very much welcome the opportunity presented by this debate to correct a number of inaccuracies that have appeared in the press on this subject. Claims have been made that patients are being denied life-saving treatments because of the lack of access to CyberKnife. Those claims are both inaccurate and alarming, and I think they must cause great anxiety to patients. The truth is that CyberKnife is not a form of treatment, but a brand name of a particular type of equipment that delivers stereotactic body radiotherapy or SBRT. It is not the only technology available, as I shall explain further in a moment.

My hon. Friend talked about the figures, and I repeat the fact that one in four radiotherapy centres currently has equipment-not CyberKnife in every case-that is capable of providing SBRT. I understand, and this bears out my hon. Friend's figures-

The number of registered social workers employed by local authorities is not centrally collected.

However, the Health and Social Care Information Centre collects and publishes data relating to the number of social workers who are directly employed by social services departments within councils with social services responsibilities in England. It is not known whether these social workers are registered.

The following table shows the number of whole-time equivalent (WTE) social workers employed by councils in England during the period 2009 to 2010 as at 30 September 2010.

Data for 2011 are expected to be published on 29 March 2012. These data will be sourced from the National Minimum Data Set for Social Care and so will not be comparable with previous years.

The Secretary of State for Health, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), has held no discussions about cyberknife with his counterpart in Northern Ireland and the Department holds no information concerning the referral of patients from Northern Ireland for cyberknife treatment in England.

Cyberknife is the manufacturer's name for a machine. The treatment it delivers is stereotactic ablative radiotherapy (previously known as stereotactic body radiotherapy). There are a number of different machines capable of delivering this treatment in use around the country that offer greater functionality.

Hospital episode statistics (HES) data available to the Department identify the treatments that the national health service provides but do not record the brand of equipment used. In addition to this, on the vast majority of cases, stereotactic ablative radiotherapy cannot be identified from other forms of radiotherapy treatment using HES data.

The Department has not issued guidance to primary care trusts specifically on the procurement of drugs for the treatment of mental health conditions.

The Quality, Innovation, Productivity and Prevention Medicines Use and Procurement workstream aims to influence clinicians and managers to work together to improve the productivity and quality of prescribing in the national health service. Under this workstream, the Department has produced a provider checklist of 50 efficiency measures to help strategic health authorities and primary care trusts deliver safer, more cost-effective prescribing. The schemes are real life examples taken from many NHS organisations in England. Three of the 50 schemes, relate specifically to mental health. They advise that primary care prescribing costs may be reduced if local NHS organisations draw up guidelines to support the lowest acquisition cost of antidepressant/antipsychotic medicines. The guidance is clear that this must not impact on individual patient choice and should be in line with National Institute for Health and Clinical Excellence (NICE) guidance. None relate specifically to procurement.

Much of the NICE'S guidance on mental health will include something on the most appropriate drugs to use in clinical practice. NICE has produced commissioning guides for some of its mental health clinical guidelines. However, this cannot be interpreted as guidance on procurement.

"Six years on: delivering the Diabetes National Service Framework", the last review of the National Services Framework (NSF) was published in 2010-a copy has been placed in the Library. Predictably, there have been developments in the evidence for optimal care for people with diabetes since the publication of the NSF for Diabetes in 2001 and, with this in mind, further reviews will be dependent on other influences such as the Quality Standard for Diabetes (2011). Our intention is to wait for the National Audit Office to publish its report on the management of adult diabetes services in the national health service before considering next steps.

I have been asked to reply

on behalf of the Department of Health.

The information requested is not collected centrally.

National health service primary care trusts are responsible for commissioning health care in prisons and the NHS employs the majority of psychiatrists who work in prisons. Mental health care in prisons is provided by multi-professional teams using a number of different models according to the range of needs within the prison population. No national assessment has been made of the adequacy of the number of psychiatrists working in prisons.

We know that urgent reform of the care and support system is needed to provide people with more choice and control and to reduce the insecurity that they and their families face.

The Government are taking decisive steps so people can plan and prepare for their care needs, access high quality care when they need it, and exercise choice and control over the care they receive.

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

It remains our intention to legislate as soon as possible afterwards.

This information is not held centrally. The Government's mental health strategy 'No Health without Mental Health', supported by best practice guidance, set out this Government's expectation that people should receive services locally as far as possible and commissioners should develop systems to enable this, working closely with service users with mental health problems, family carers and service providers.

We know that when patients receive treatment for long periods at a distance from home, this makes it difficult to maintain social networks and friendships. In addition, there is research which demonstrates the poor value for money of out of area treatments (OATs). That is why one of the. Quality, Innovation, Productivity and Prevention programmes for mental health commissioners is about improving quality and value through reducing inappropriate use of OATs.

Primary care trusts (PCTs) self assess their spend on those mental health OATs which were outside of planned commissioning intentions, or not based on a sound clinical case for a placement. PCTs then analyse their unintended or inappropriate spend, benchmark with other comparable PCTs and devise a local action plan to address this.

Health and well-being boards will be a forum for the national health service, local authorities and communities to exercise shared leadership in arriving at a joint understanding of local needs, including the needs of local children, and a shared strategy to address those needs. The director of children's services will be a statutory member of the health and well-being board-as part of effective joint working, we would expect directors of children services to share data such as the number of children with children in need status, and other relevant information with the board, to ensure that the needs of local children are fully taken into account.

Statutory guidance issued by the Department for Education, "Working together to safeguard children", states that Joint Strategic Needs Assessments (JSNAs) should include the needs of children with children in need status, which will in turn inform the joint health and well-being strategy which drives local commissioning. The Department for Education, will shortly be consulting on revisions to this guidance.

The JSNA core dataset brings together a list of indicators which local partners may wish to draw on when performing JSNAs. The Government are developing statutory guidance and wider resources to support health and well-being boards in performing JSNA and developing joint health and well-being. strategies within the modernised health and care system. As part of this work, we will explore with health and well-being board early implementers and other partners what further resources they would find supportive, including in relation to signposting to a wide range of helpful evidence sources.

Between her appointment in April 2008 until 1 February 2012 the National Clinical Director for Diabetes, Dr Rowan Hillson, has attended 32 events on the parliamentary estate:

three in the House of Lords;

22 in the House of Commons;

six at Portcullis House; and

one in Westminster Hall.

The planning and delivery of services is a matter for local commissioners and providers.

Considerable improvements in hearing services have been made over recent years including reduced waits for assessment and treatment of hearing problems. Action taken to support the delivery of services for people with tinnitus includes:

publication of "Provision of Services for Adults with Tinnitus-A Good Practice Guide" by the Department of Health in January 2009-this guide provided practical evidence-based advice on how to improve access to, and experience of, tinnitus services. This document has been placed in the Library.

publication of "Shaping, the Future: Strengthening the evidence to transform audiology services" by NHS Improvement in March 2011-this report demonstrates the potential to improve both clinical outcomes and patient experience for people with hearing problems while improving national health service efficiency. It includes examples of several trusts that have successfully tested the introduction of direct access tinnitus services. This document has been placed in the Library.

In addition, from 15 August to 14 October 2011 the National Institute for Health and Clinical Excellence (NICE) and the National Quality Board ran an engagement exercise on the development of a library of NICE Quality Standard topics for the NHS. The list of proposed Quality Standard topics included tinnitus. An announcement on next steps will be made in due course.

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

To understand what the priorities for reform should be, the Government launched "Caring for our future" in autumn 2011. 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

During the engagement and since it formally ended, Ministers have met with a range of organisations about reform of care and support.

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

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 the 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.

Recently published data shows that the number of patients experiencing delayed discharge from hospital has fallen to its lowest level since this data has been collected. In December 2011, 3,659 patients experienced a delayed transfer of care, a 5.6% fall on the same month last year. This suggests that additional funding provided by the Government to promote joint working between health, and social care services is having a positive impact in reducing costs to the NHS.

Skills for Care estimate there are 1.77 million jobs in adult social care. The proportion of jobs filled by women is estimated to be 83%⁽¹⁾.

^{(1 )}Skills for Care NMDS-SC November 2011.