Clinical commissioning groups will work with elected councillors, local authority commissioners and representatives of patients and the public through health and wellbeing boards to develop a comprehensive analysis of health and social care needs in each local area through Joint Strategic Needs Assessments (JSNAs), and to translate these into action through Joint Health and Wellbeing Strategies and their own commissioning plans. Health and wellbeing boards will promote joined up commissioning that will support integrated provision of services across the local health and social care system. This should mean that people who need both mental health and drug treatment services experience services that are better joined up and better meet their needs as individuals.

The implementation framework for 'No health without mental health' will set out what local organisations can do, both individually and in partnership, to better meet the needs of people with mental health problems, including people with complex needs and dual diagnosis.

The Department has no plans to specifically commission research into the efficacy of mindfulness-based therapies in the treatment of chronic pain and associated depression. However, the Department's National Institute for Health Research welcomes funding applications for research into any aspect of human health, including mindfulness-based therapies. These applications are subject to peer review and-judged in open competition, with awards being made on the basis of the scientific quality of the proposals made.

Data on out-patient activity for dementia are not routinely collected. However, in September 2011, the NHS Information Centre published the results of an audit of memory services for dementia which showed that 951 people per primary care trust on average accessed memory services in 2010-11, compared to 605 in 2008-09.

Information on in-patient admissions for dementia is shown in the following table:

Commissioning of adult social care services is devolved to local authorities, and it is for each local authority to negotiate and agree the fees paid to individual providers, reflecting local circumstances. In setting these fee levels, local authorities should have due regard to the actual costs of providing care.

The Department does not set or recommend rates at which local authorities contract with providers of care, and has therefore made no assessment of the cost of placing individual care users with independent providers.

In the most recent spending review, the Government recognised the pressures on the adult social care system within a challenging settlement for local government, and took the decision to prioritise adult social care by allocating an additional £7.2 billion to the system over the four years to 2014-15 to support local authorities in delivering social care. When combined with a rigorous local authority focus on efficiency, this additional £7.2 billion means that there is funding available to protect people's access to care and deliver new approaches to improve quality and outcomes.

Departmental officials have been in regular contact with officials from the devolved Administrations and will continue to work closely with them on this issue.

From April 2013, services will either be commissioned by clinical commissioning groups or by the NHS Commissioning Board. No final decisions have yet been taken on which services will be directly commissioned by the board. Work is in hand to define the list of services for direct commissioning and Ministers expect to be in a position to confirm those services in the summer.

In 'Improving outcomes: A Strategy for Cancer', published on 12 January 2011, we said that ensuring that patients have access to high quality modern radiotherapy techniques can deliver improved patients outcomes and that it was the Department's aspiration to ensure that intensity modulated radiotherapy was available in at least one centre per cancer network. This has now been achieved.

The National Radiotherapy Implementation Group (NRIG) is planning to publish a report on Image Guided Radiotherapy, setting out protocols for its use. This report will be available on the National Cancer Action Team (NCAT) website and NCAT will be providing an IGRT training programme for radiotherapy centres. NRIG is tasked with providing national support to local teams to implement national radiotherapy policy and to keep new and emerging radiotherapy techniques under review.

The National Radiotherapy Advisory Group (NRAG) report 'Radiotherapy: developing, a world class service for England', published in 2007, made a range of recommendations to improve and expand radiotherapy services in England. These included the extension of the 31-day cancer waiting time standard to include all radiotherapy treatments, the establishment and collection of the national radiotherapy dataset (RTDS) and that the number of radiotherapy fractions being delivered should be increased from 30,000 per million population per annum (as it stood at the time of the NRAG report) to. 40,000 by 2010-11.

The 31-day standard for all radiotherapy treatment has since been introduced and the RTDS is now in its second full years of data collection. Analysis of the RTDS shows that there were approximately 34,500 fractions per million head of population per annum in 2009-10. However, the data collection also suggests that NRAG had overestimated the number of fractions delivered at that time so the baseline was in fact lower than 30,000 per million per annum. The Cancer Outcomes Strategy made the commitment to undertake a detailed analysis of the RTDS data to ensure that the metrics in the NRAG report remain meaningful and current. NRIG has been tasked with undertaking that analysis, including a review of progress, and is due to report by the autumn.

NRIG has undertaken a major piece of work to bring together the experts to agree radiotherapy decision trees based on best practice prescribing of radiotherapy fractions. A toolkit has recently been made available to commissioners and providers of radiotherapy services to enable them to make assessments of local practice against agreed best practice. These assessments should inform demand planning and discussions about variations in services locally.

The Department does not collect this information centrally.

The National Diabetes Audit reports incidence of amputations for those practices participating in the audit. Information for 2005 to 2010 has been placed in the Library.

The nine health care checks for diabetes as recommended by the National Institute for Health and Clinical Excellence (NICE) are: HbA1c (a measurement of residual glucose), body mass index, blood pressure, urinary albumin, creatinine (a measure of kidney function), cholesterol, eye examinations, foot examinations and smoking status. NICE guidance recommends that diagnosed diabetes receive these nine health care checks (also known as care processes) annually. Primary care trusts (PCTs) are accountable for delivery of care and should be monitoring service delivery at local level.

There are two sources of data for assessing the extent to which the nine health care checks are provided: the National Diabetes Audit (NDA), and the Quality and Outcomes Framework (QOF) achievement data.

The NDA contains 81.1% of the 2.34 million people aged 17 years and over with diagnosed diabetes reported by the QOF. Results for all PCTs that submit data to the annual NDA can be accessed via the NDA dashboard on the following link:

www.ic.nhs.uk/services/national-clinical-audit-support-programme-ncasp/national-diabetes-audit/analysis-and-participation/2010-2011-analysis

Ranking of results is colour coded enabling easy comparison of performance between PCTs.

In addition, two maps in the NHS Atlas of Variation (2011) on the following link:

www.sepho.org.uk/extras/maps/NHSatlas2011/atlas.html

are specific to delivery of the nine care processes, and use data from the NDA. The Atlas shows that, depending on their PCX area, between 5.4% and 47.9% of people with Type 1 diabetes received all nine health care checks, and between 7% to 71.4% of those with Type 2 diabetes received all the nine health care checks.

The QOF achievement data show higher numbers of patients receiving each of the health care checks than does the NDA (when comparing the QOF and NDA figures for each of the tests separately). The QOF data tables for each QOF year including 2009-10 at national, strategic health authority and primary care trust levels are available at:

www.ic.nhs.uk/statistics-and-data-collections/audits-and-performance/the-quality-and-outcomes-framework/the-quality-and-outcomes-framework-2009-10

The differences may be ascribable to variations in scope and data assessment methodology. We intend to work with stakeholders to understand the reasons for the differences and to identify what needs to be done as a result.

The Department has made no assessment of recent research into the biological causes of chronic fatigue syndrome/myalgic encephalomyelitis.

It is for the local national health service to plan and deliver services according to local need. In 2007, the National Institute for Health and Clinical Excellence (NICE) issued a clinical guideline on the management of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). The guideline recommends the use of cognitive behaviour therapy and graded exercise in patients mildly or moderately affected by CFS/ME on the basis that these were the interventions for which there was the clearest research evidence of benefit. A number of other treatments, including particular drugs, vitamin supplements and complementary therapies, were not recommended because there was not enough evidence to suggest that they were effective. The guideline acknowledges that there is no one form of treatment to suit every patient, and that treatment and care should take into account the personal needs and preferences of the patient.

In terms of future provision, the health and social care reforms will support the improvement of outcomes for people living with CFS/ME and other neurological conditions. Improving quality and delivering better health outcomes for patients is the primary purpose of the NHS. Accountability throughout the system needs to be focused on the outcomes of care, rather than the processes. This focus on outcomes will start at a national level with the 2012-13 NHS Outcomes Framework, which defines and will enable measurement of the key outcomes that matter to patients.

All five domains within the NHS Outcomes Framework have relevance for people living with CFS/ME and other neurological conditions. Domain two-enhancing the quality of life for people with long-term conditions as a whole-is the most immediately relevant. This reflects the fact that increasing numbers of people have multiple long-term conditions, and it is not always helpful to see their care from the perspective of a single clinical pathway. Domain two seeks to capture how successfully the NHS is supporting people with long-term conditions to live as normal a life as possible and will be measured using three outcomes:

(i) feeling supported to manage their condition-this measures how well the NHS as a whole is doing in supporting people to look after themselves and handle the consequences of their conditions;

(ii) functional ability-this measures how well the person is able to live as normal a life as possible, and by looking at employment ties in well with the Department for Work and Pensions and the Government's wider policies about getting people, back to work; and

(iii) reduced time spent in hospital-this measures how successfully the NHS manages the condition(s) by looking at unnecessary hospital admissions and excessive length of stay.

It will be the responsibility of the NHS Commissioning Board to determine how to deliver the outcomes in the NHS Outcomes Framework. The board will use the Outcomes Framework and NICE Quality Standards to develop a Commissioning Outcomes Framework and together these will be the basis for clinical commissioning groups to be held to account. The board will also support commissioning by developing detailed commissioning guidance and tools such as standard contracts and tariffs.

The NHS Cervical Screening Programme is a population-based screening programme and women aged under 25 are not invited as experts advise that screening in this age group has no impact on rates of cervical cancer and can do more harm than good. There is no clinical indication for a cervical screening test, and it is best practice that tests should not be performed on women with symptoms.

If a woman has symptoms suggestive of cervical cancer, such as unusual bleeding after sexual intercourse or inbetween periods, she should be managed appropriately by her general practitioner (GP), which may include referral to a gynaecologist within two weeks for further investigation. This is set out in "Clinical practice guidelines for the assessment of young women aged 20-24 with abnormal vaginal bleeding", developed by the independent Advisory Committee on Cervical Screening and sent to all GPs in England by the Department in March 2010. The guidance has already been placed in the Library and can be found on the Department's website at:

www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_113478

Women aged under 25 who request cervical screening but do not have symptoms of the disease should be informed of what symptoms to look out for in the future and told they will receive their first invitation for cervical screening around their 25th birthday. If a GP is worried about an exceptional case in a woman aged under 25, such as a victim of child sex abuse or a former child prostitute, they are advised to contact the local screening service to arrange a screening test to be read in the laboratory if deemed clinically appropriate.

Offenders are entitled to expect, and receive, the same quality of treatments and services from the national health service as anyone else. All prisons have access to on-site health care teams, which can treat most mental health problems and issue prescriptions required by prisoners.

From 2013, the National Health Service Commissioning Board (NHSCB) will be responsible for commissioning of health services for those in custody. The NHSCB will assume commissioning responsibilities for mental health services for those in prison and other detained settings.

The National Institute for Health and Clinical Excellence updated its schizophrenia guidelines in 2009. They cover the care, treatment and support that adults, aged 18 and older, with schizophrenia should be offered. The guidelines recommended Cognitive Behavioural Therapy be offered, in an acute episode of schizophrenia. These guidelines apply to all adults, including prisoners.

The NHS is responsible for commissioning health care in prisons where prisoners are entitled to receive the same level of care as people in the community. The services provided are based on a health needs assessment undertaken by the NHS commissioner and the prison, but all prisons have access to mental health care delivered by primary care and specialist mental health services.

The information requested about schizophrenia services and morbidity is not collected centrally. However, a survey by the Office for National Statistics in 1997 estimated that around 90% of adult prisoners had at least one of the five disorders considered in the survey (personality disorder, psychosis, neurosis, alcohol misuse and drug dependence). This is an aggregate figure so the data will include adult prisoners with schizophrenia but the exact proportion of prisoners with schizophrenia is not known.

The Department is currently setting up an audit of the mental health needs of offenders, both in prison and where possible in community settings. A feasibility study for this work is due to start later this year and a fuller research study is expected to be commissioned in 2013.

We do not collect the information requested centrally. However, in 2009-10, the Department commissioned the National Health Service Information Centre to undertake a survey of carers in households as part of its Carers' Strategy programme. Over 2,000 carers were interviewed and were asked a question to establish why the people they cared for needed their help, including their health needs. 13% of the responses indicated that the cared for person required help 'for a mental health problem'.

The cross-Government mental health outcomes strategy No Health Without Mental Health, published in February 2011, sets out the Government's commitment to improving mental health and mental health services. The strategy implementation framework focuses on improving outcomes, quality and value for money, and on ensuring that people who use mental health services, their families and carers, are fully involved in all aspects of services.

We have made no estimate of the number of cancer patients in each primary care trust area in England who have to travel for more than 45 minutes in order to access their nearest radiotherapy treatment centre.

The National Radiotherapy Advisory Group (NRAG) report 'Radiotherapy: developing a world class service for England', published in 2007, provided clear guidance to support commissioners in the provision of radiotherapy services. The NRAG report recommended that, where possible, patients should not travel more than 45 minutes for radiotherapy treatment. A copy of this report has already been placed in the Library.

Since the publication of the NRAG report, the National Cancer Action Team has continued to provide advice to commissioners and providers to help them assess travel times for their patients and plan the location of new services.

Decisions regarding renewal of radiotherapy machines are taken locally and need to be assessed against local priorities. It is the responsibility of each individual organisation to ensure that it adopts good asset management and financial planning. However, national teams such as the National Cancer Action Team and NHS Improvement provide support to help providers plan for their equipment needs.

The Department has recently worked with NHS Supply Chain to launch a new procurement scheme that allows trusts to access high-value medical equipment at significantly discounted prices. The scheme allows NHS Supply Chain to purchase equipment up front through use of a central capital fund, and then pass on discounts to trusts. The scheme does not limit choice or supplier.

Within the Cancer Peer Review programme; the radiotherapy measures require local organisations to agree an equipment replacement programme with their cancer network. The outcome of the Peer Review programme is shared with commissioners.

We are committed to improving outcomes for all cancer patients, including those with pancreatic cancer. Achieving earlier diagnosis of cancer is key to our ambition to save an additional 5,000 lives a year from cancer by 2014-15 and we have provided more than £450 million over the spending review period to improve general practitioner (GP) access to key diagnostic tests; support campaigns to raise public awareness of the signs and symptoms of cancer and to encourage people to visit their GP when they have persistent symptoms; and to pay for more treatment and testing in secondary care.

We know that some types of cancer can be difficult diagnose, often because their symptoms are shared with more common, benign conditions. To better understand the barriers to early diagnosis and to discuss possible solutions, departmental officials met with a range of cancer charities during spring and summer 2011, including two pancreatic cancer charities. This work has been fed into the National Awareness and Early Diagnosis Initiative. I also met with Pancreatic Cancer UK on 17 December 2011 to hear their concerns in more detail and I will be attending the charity's early diagnosis workshop in June2012.

To further address the need to improve awareness of rarer cancers, such as pancreatic cancer, consideration also is being given to piloting a symptom-based approach awareness campaign covering multiple cancers. A final decision on campaign work in 2011-12 will be subject to funding and Efficiency and Reform Group approval.

We recognise the need to ensure that the care people receive at the end of life is compassionate, appropriate and supports the exercise of choice by care users. Improved access to social care and better integrated palliative care will be central to delivering improved choice, and this is an important part of the work we are doing to implement the Department's End of Life Care Strategy.

One of the recommendations of the independent Palliative Care Funding Review was that, once a patient reaches the end of life stage, and is put on the end of life care locality register, all health and social care should be funded by the state and be free at the point of delivery. We are testing all the recommendations of the review through the eight Palliative Care Funding pilots we have set up, which will inform the development of a new funding system for palliative care from 2015.

We have committed to publishing a social care White Paper shortly, alongside a progress report on funding reform. The Department jointly led the "Caring for our future" engagement last year, together with the care and support sector, which sought the views of people who use care and support services, carers, local councils, care providers and the voluntary sector, about the priorities for improving care and support. The White Paper will set out the Government's plans for transforming the care and support system.

With support from the National End of Life Care Programme, the Department piloted Electronic Palliative Care Co-ordination Systems (EPaCCS), formerly known as End of Life Care Locality Registers, in eight localities. Ipsos MORI was commissioned to undertake an evaluation of these pilots. Their report, "End of Life Locality Registers Evaluation: Final Report (June, 2011)" identified the key challenges to developing such a system and how these were addressed via a range of approaches and solutions. The evaluation report is available at:

www.endoflifecareforadults.nhs.uk/publications/localities-registers-report

When this report was published, only the Weston Area Health Trust and NHS South West pilot had outcomes data on the impact of the register. These early findings showed that, in tandem with other end of life care initiatives, particularly providing training in advance care planning, use of the register could significantly reduce deaths in hospital and enable many more people to die in their preferred place. Since then, the experiences of other EPaCCS implementers have reinforced these findings. The National End of Life Care Programme is currently collating outcomes data from all implementers, and will make these available to health and social care commissioners and providers to inform future service development.

The National End of Life Care Programme, with support from the Department, has been taking forward a range of other work to support the wider uptake of EPaCCS. It has led on the development of an End of Life Care Co-ordination: Core Content Information Standard, which was approved by the Information Standards Board on 20 March 2012. The standard will underpin the development and use of EPaCCS, and details are available at:

www.endoflifecareforadults.nhs.uk/strategy/strategy/coordination-of-care/end-of-life-care-information-standard

The National Programme is also working through the Quality, Innovation, Productivity and Prevention (QIPP) end of life care workstream, which identifies the importance of EPaCCS as a tool to support identification of people approaching the end of life and planning for their care, including advance care planning. In tandem with the Department's QIPP digital team, a series of events have been run around the country to share learning about EPaCCS, and to seek feedback on the technical work that can be undertaken nationally to support wider implementation.

Doctors are required to start with the immediate, direct cause of death and then go back through the sequence of events or conditions that led to death, until they reach the one that started the fatal sequence. This initiating condition will usually be selected as the underlying cause of death, according to the International Classification of Diseases coding rules.

People with multiple sclerosis do not die directly from the condition, but if they are severely affected the risk of dying from a multiple sclerosis related complication (like an infection) is greater. Research suggests that, on average, life expectancy of people with multiple sclerosis is around 10 years lower than that of the general population.

Offender Health has worked with Professor Martin Lombard, National Clinical Director for Liver Disease, to survey hepatitis C services in prisons in England. The aims of the survey were: to map existing service provision for prisoners in relation to hepatitis C testing and treatment; to develop a national database of services providing hepatitis C treatment for prisoners; and, to use the survey to develop a national hepatitis C prison network to share good practice across England and help to develop a model for the diagnosis and treatment of hepatitis C in prison.

A survey report is due to be published soon and is expected to demonstrate that prisons in England are providing access to screening and treatment for hepatitis C.

Information is not collected centrally about the number of people living with hepatitis C in England and is therefore not available in respect of prisoners in England with hepatitis C, or being screened for hepatitis C upon entering prison or for prisoners with hepatitis C who are undergoing treatment.

Offender Health have begun to collect quarterly data on the total number of tests carried out in prisons in England for Hepatitis C for the Prison Health Quality and Performance Indicators dataset. Data is available from April 2010 only and the number of tests performed per quarter in reporting prisons and the percentage of total new receptions to those prisons this figure represents is shown in the following table.

However, this data may not reflect the total number of tests performed on people in prison as testing may also be carried out in sexual health services for example, which is not captured in this dataset.