NHS England is taking forward the new national review of congenital heart disease services.

My hon. Friend will be aware that NHS England has published its early thinking on the way forward in improving these services. This paper is available at:

www.england.nhs.uk/wp-content/uploads/2013/07/180713-item13.pdf

We are advised by NHS England that its aim is to develop a process which is robust, transparent and inclusive, particularly in the use of evidence and data. It is too soon to describe the exact process, or what account will be taken of the current location of other specialist services. Information will be gathered from a wide variety of sources as the review seeks to deliver an effective and equitable solution in the interests of securing the best outcomes for all patients.

The Secretary of State for Health, my right hon. Friend the Member for South West Surrey (Mr Hunt), has received no representations on the use of interventional lung assist devices in transplants for cystic fibrosis patients.

The pilot of the original NHS Bowel Cancer Screening Programme (NHS BCSP) showed that men were less likely than women to complete a testing kit. That is why the Department funded the Men's Health Forum (MHF) to undertake a three year study on the uptake of bowel cancer screening in men. The project culminated in the report, 'Slow on the uptake? Encouraging male participation in the NHS Bowel Cancer Screening Programme'. The report can be found by doing a search on the Men's Health Forum website.

The main recommendations of the report were about the importance of general practitioner and other primary care staff and the importance of spouses and partners in men's decision-making about the test and whether they should complete a testing kit. Based on their report the MHF has developed an intervention to go with invitations to men urging them to talk to somebody before deciding whether or not to do the test.

This idea has been taken up by the NHS BCSP in Manchester, who have developed the leaflet—'Thinking about bowel cancer screening? Don't just think. Talk about it'. The MHF report has also been shared widely around other local NHS BCSPs, and has been presented to the National Cancer Equality Initiative and the Bowel Screening Advisory Committee.

Going forward, addressing inequalities in cancer screening will be a matter for Public Health England (PHE), the expert national public health agency which fulfils the Secretary of State's statutory duty to protect health and address inequalities, and executes his power to promote the health and wellbeing of the nation.

NHS Cancer Screening Programmes, now part of the PHE Health and Wellbeing Directorate, are contributing to work to ensure that health equity is integrated within screening programmes, and to identify and promote areas of good practice to achieve this.

NHS England is responsible for commissioning specialist endocrinology and diabetes services for children and young people as part of its specialised services. This service includes the provision of insulin pumps and replacement pumps where clinically appropriate.

Access to state-funded medical treatment in European Economic Area (EEA) countries is provided for under the terms of a valid European Health Insurance Card and this includes access to oxygen services. However, due to the nature of these services, it is necessary for residents of EEA countries to reserve provision of the oxygen equipment they will require, during the temporary visit to the other country, in advance of their departure from their home country. This can be done by contacting the Department's Public Enquiry Centre who hold contact telephone numbers for all EEA countries.

The United Kingdom also has reciprocal health care agreements with countries outside the EEA, such as Australia and New Zealand, and these provide cover for the cost of pre-existing conditions. However, individuals are still required to secure provision in advance on a personal basis in accordance with the provisions of the country they wish to visit, initially, through the embassy of the country concerned.

There are no current plans to add to the number of health care agreements which the UK has with non-EEA countries and any additional EEA countries will be a matter for the European Union as a whole.

Government does not set policy for domestic or international airlines. The Department has, however, been working closely with the British Lung Foundation (BLF) to help educate airlines in understanding patient requirements and providing them with on-board oxygen at no additional cost.

We are aware, through recent engagement with patients and the BLF, that patients are now more able to travel locally and abroad due to the recent enhancements made to the contracts for home oxygen in England (and Wales). The Department has had feedback from a recent engagement event that patients on oxygen want to be able to do more in terms of travel, and we will continue to work with NHS England and home oxygen suppliers in this area.

Access to state-funded medical treatment in European Economic Area (EEA) countries is provided for under the terms of a valid European Health Insurance Card and this includes access to oxygen services. However, due to the nature of these services, it is necessary for residents of EEA countries to reserve provision of the oxygen equipment they will require, during the temporary visit to the other country, in advance of their departure from their home country. This can be done by contacting the Department's Public Enquiry Centre who hold contact telephone numbers for all EEA countries.

The United Kingdom also has reciprocal health care agreements with countries outside the EEA, such as Australia and New Zealand, and these provide cover for the cost of pre-existing conditions. However, individuals are still required to secure provision in advance on a personal basis in accordance with the provisions of the country they wish to visit, initially, through the embassy of the country concerned.

There are no current plans to add to the number of health care agreements which the UK has with non-EEA countries and any additional EEA countries will be a matter for the European Union as a whole.

Government does not set policy for domestic or international airlines. The Department has, however, been working closely with the British Lung Foundation (BLF) to help educate airlines in understanding patient requirements and providing them with on-board oxygen at no additional cost.

We are aware, through recent engagement with patients and the BLF, that patients are now more able to travel locally and abroad due to the recent enhancements made to the contracts for home oxygen in England (and Wales). The Department has had feedback from a recent engagement event that patients on oxygen want to be able to do more in terms of travel, and we will continue to work with NHS England and home oxygen suppliers in this area.

Access to state-funded medical treatment in European Economic Area (EEA) countries is provided for under the terms of a valid European Health Insurance Card and this includes access to oxygen services. However, due to the nature of these services, it is necessary for residents of EEA countries to reserve provision of the oxygen equipment they will require, during the temporary visit to the other country, in advance of their departure from their home country. This can be done by contacting the Department's Public Enquiry Centre who hold contact telephone numbers for all EEA countries.

The United Kingdom also has reciprocal health care agreements with countries outside the EEA, such as Australia and New Zealand, and these provide cover for the cost of pre-existing conditions. However, individuals are still required to secure provision in advance on a personal basis in accordance with the provisions of the country they wish to visit, initially, through the embassy of the country concerned.

There are no current plans to add to the number of health care agreements which the UK has with non-EEA countries and any additional EEA countries will be a matter for the European Union as a whole.

Government does not set policy for domestic or international airlines. The Department has, however, been working closely with the British Lung Foundation (BLF) to help educate airlines in understanding patient requirements and providing them with on-board oxygen at no additional cost.

We are aware, through recent engagement with patients and the BLF, that patients are now more able to travel locally and abroad due to the recent enhancements made to the contracts for home oxygen in England (and Wales). The Department has had feedback from a recent engagement event that patients on oxygen want to be able to do more in terms of travel, and we will continue to work with NHS England and home oxygen suppliers in this area.

Access to state-funded medical treatment in European Economic Area (EEA) countries is provided for under the terms of a valid European Health Insurance Card and this includes access to oxygen services. However, due to the nature of these services, it is necessary for residents of EEA countries to reserve provision of the oxygen equipment they will require, during the temporary visit to the other country, in advance of their departure from their home country. This can be done by contacting the Department's Public Enquiry Centre who hold contact telephone numbers for all EEA countries.

The United Kingdom also has reciprocal health care agreements with countries outside the EEA, such as Australia and New Zealand, and these provide cover for the cost of pre-existing conditions. However, individuals are still required to secure provision in advance on a personal basis in accordance with the provisions of the country they wish to visit, initially, through the embassy of the country concerned.

There are no current plans to add to the number of health care agreements which the UK has with non-EEA countries and any additional EEA countries will be a matter for the European Union as a whole.

Government does not set policy for domestic or international airlines. The Department has, however, been working closely with the British Lung Foundation (BLF) to help educate airlines in understanding patient requirements and providing them with on-board oxygen at no additional cost.

We are aware, through recent engagement with patients and the BLF, that patients are now more able to travel locally and abroad due to the recent enhancements made to the contracts for home oxygen in England (and Wales). The Department has had feedback from a recent engagement event that patients on oxygen want to be able to do more in terms of travel, and we will continue to work with NHS England and home oxygen suppliers in this area.

Access to state-funded medical treatment in European Economic Area (EEA) countries is provided for under the terms of a valid European Health Insurance Card and this includes access to oxygen services. However, due to the nature of these services, it is necessary for residents of EEA countries to reserve provision of the oxygen equipment they will require, during the temporary visit to the other country, in advance of their departure from their home country. This can be done by contacting the Department's Public Enquiry Centre who hold contact telephone numbers for all EEA countries.

The United Kingdom also has reciprocal health care agreements with countries outside the EEA, such as Australia and New Zealand, and these provide cover for the cost of pre-existing conditions. However, individuals are still required to secure provision in advance on a personal basis in accordance with the provisions of the country they wish to visit, initially, through the embassy of the country concerned.

There are no current plans to add to the number of health care agreements which the UK has with non-EEA countries and any additional EEA countries will be a matter for the European Union as a whole.

Government does not set policy for domestic or international airlines. The Department has, however, been working closely with the British Lung Foundation (BLF) to help educate airlines in understanding patient requirements and providing them with on-board oxygen at no additional cost.

We are aware, through recent engagement with patients and the BLF, that patients are now more able to travel locally and abroad due to the recent enhancements made to the contracts for home oxygen in England (and Wales). The Department has had feedback from a recent engagement event that patients on oxygen want to be able to do more in terms of travel, and we will continue to work with NHS England and home oxygen suppliers in this area.

The Department has no such plans. From February 2007, responsibility for sustaining the legacy of the National Defibrillator Programme was devolved to national health service ambulance trusts. Ambulance trusts install automatic external defibrillators where they are most needed.

The papers prepared by the Advisory Group for National Specialised Services (AGNSS) and the National Specialised Commissioning Group relating to (a) paediatric cardiac surgery, (b) cardiac transplants and (c) extra-corporeal membrane oxygenation, together with the paper from AGNSS to the Joint Committee of Primary Care Trusts of 23 April, have all been released following Freedom of Information requests.

The papers prepared by the Advisory Group for National Specialised Services (AGNSS) and the National Specialised Commissioning Group relating to (a) paediatric cardiac surgery, (b) cardiac transplants and (c) extra-corporeal membrane oxygenation, together with the paper from AGNSS to the Joint Committee of Primary Care Trusts of 23 April, have all been released following Freedom of Information requests.

The cost and benefits of the national health service acquiring two proton beam therapy (PBT) facilities hosted at University College London Hospital and Christie NHS Foundation Trust have been based on the best available international information and a market testing exercise. The approach taken has followed the Treasury guidance to mitigate financial risk while providing good value for money. The risk inherent in a project of this size and complexity has to be balanced against the loss of potential benefits to patients by not providing this treatment.

The modelling to demonstrate the benefits of PBT used the best available alternatives currently offered as a comparator, including intensity modulated radiation therapy (IMRT), if it was clinically indicated. PBT is fundamentally different to other forms of radiotherapy (including IMRT, stereotactic ablative radiotherapy and radiosurgery) in that the treatment beam can be focused deep within the body to an accuracy of less than one millimetre. This makes it particularly suitable for the treatment of tumours close to vital organs, especially in small children. The best expert evidence available has suggested that the benefit PBT will have over conventional radiotherapy for the tumour sites we have considered is unlikely to reduce, even with developments that are currently in the pipeline. Some countries, including Germany and Japan, have investigated using heavy ions as a form of radiotherapy. This approach uses PBT accelerator technology, but is still in the experimental stage. The NHS has not considered investing in this technology as the results are currently mixed. Benefits of heavy ion technology would be for a different group of patients.

The cost and benefits of the national health service acquiring two proton beam therapy (PBT) facilities hosted at University College London Hospital and Christie NHS Foundation Trust have been based on the best available international information and a market testing exercise. The approach taken has followed the Treasury guidance to mitigate financial risk while providing good value for money. The risk inherent in a project of this size and complexity has to be balanced against the loss of potential benefits to patients by not providing this treatment.

The modelling to demonstrate the benefits of PBT used the best available alternatives currently offered as a comparator, including intensity modulated radiation therapy (IMRT), if it was clinically indicated. PBT is fundamentally different to other forms of radiotherapy (including IMRT, stereotactic ablative radiotherapy and radiosurgery) in that the treatment beam can be focused deep within the body to an accuracy of less than one millimetre. This makes it particularly suitable for the treatment of tumours close to vital organs, especially in small children. The best expert evidence available has suggested that the benefit PBT will have over conventional radiotherapy for the tumour sites we have considered is unlikely to reduce, even with developments that are currently in the pipeline. Some countries, including Germany and Japan, have investigated using heavy ions as a form of radiotherapy. This approach uses PBT accelerator technology, but is still in the experimental stage. The NHS has not considered investing in this technology as the results are currently mixed. Benefits of heavy ion technology would be for a different group of patients.

There have been no occasions, since the inception of the Safe and Sustainable review for children's services in England, during which the NHS chief executive and the chief executive of Birmingham Children's Hospital have emailed, corresponded or met to discuss the future of children's cardiac or extra corporeal membrane oxygenation services in England.

In October we announced that there would be guaranteed access to innovative radiotherapy where it is clinically appropriate, safe and cost effective from 1 April 2013. From this date onwards, radiotherapy will be planned and paid for nationally by the NHS Commissioning Board (NHS CB), so the same commissioning policies will apply across the country and cancer patients will be considered for the most appropriate radiotherapy treatment regardless of where they live.

Funding compatible with the cancer drug fund will not be required to deliver this guarantee. We have committed to establish a £15 million Radiotherapy Innovation Fund, available until the end of the current financial year, aimed at helping radiotherapy centres that are not delivering treatment using intensity modulated radiotherapy (IMRT), or are not doing as much as they should, to develop the capacity and capability to deliver at the appropriate level from April 2013.

From that point onwards, the NHS CB will be responsible for commissioning radiotherapy services and will provide access to radiotherapy, including IMRT, stereotactic ablative radiotherapy and stereotactic radiosurgery where it is clinically appropriate, safe and cost-effective.

The criteria for allocation of the fund have not yet been finalised. There is likely to be a fixed sum allocated to all centres so all hospitals with radiotherapy centres will benefit. Bids will be sought for the remainder of the fund. While the priority for the fund will be IMRT, bids relating to preparing to deliver appropriate levels of other advanced technologies, particularly image guided radiotherapy, may be considered from radiotherapy centres where IMRT is already being delivered at appropriate levels.

The radiotherapy innovation fund is a revenue fund and cannot be used to purchase equipment that requires capital funding. Providers are responsible for maintaining and replacing high value equipment. Trusts need to prioritise their investments and ensure that they have sufficient equipment to provide high quality, safe and cost-effective services for patients.

To encourage the national health service to update the existing medical technology infrastructure, the Department established a £300 million fund in March this year to bulk purchase medical equipment and achieve better prices for the NHS. The fund is operated by NHS Supply Chain.

The radiotherapy innovation fund is a revenue fund and cannot be used to purchase equipment that requires capital funding. The fund is not accessible by patients, it is aimed at helping radiotherapy centres that are not delivering treatment using intensity modulated radiotherapy (IMRT), or are not doing as much as they should, to develop the capacity and capability to deliver at the appropriate level from April 2013.

The criteria for allocation of the fund have not yet been finalised. There is likely to be a fixed sum allocated to all centres so all hospitals with radiotherapy centres, including those in the north-east, will benefit. Bids will be sought for the remainder of the fund. While the

priority for the fund will be IMRT, bids relating to other advanced technologies, particularly image guided radiotherapy, may be considered from radiotherapy centres where IMRT is already being delivered at appropriate levels.

Providers are responsible for maintaining and replacing high value equipment. Trusts need to prioritise their investments and ensure that they have sufficient equipment to provide high quality, safe and cost-effective services for patients.

To encourage the national health service to update the existing medical technology infrastructure, the Department established a £300 million fund in March this year to bulk purchase medical equipment and achieve better prices for the national health service. The fund is operated by NHS Supply Chain.

As part of the national support also being provided to radiotherapy centres, teams of experts will be visiting those delivering IMRT at low levels to help them develop robust action plans for delivery from April 2013. During these visits, local teams will also be able to seek assistance from the experts in developing business cases for other appropriate equipment they may need.

We have committed to establish a £15 million Radiotherapy Innovation Fund from October 2012 to enable providers to prepare to deliver from April 2013 certain advanced radiotherapy to all patients who might benefit.

The radiotherapy fund is a revenue fund and cannot be used to purchase equipment that requires capital funding. The fund is not accessible by patients, it is aimed at helping radiotherapy centres that are not delivering treatment using Intensity Modulated Radiotherapy (IMRT), or are not doing as much as they should, to develop the capacity and capability to deliver at the appropriate level from April 2013.

The criteria for allocation of the fund have not yet been finalised. There is likely to be a fixed sum allocated to all centres so all hospitals with radiotherapy centres will benefit. Bids will be sought for the remainder of the fund. While the priority for the fund will be IMRT, bids relating to other advanced technologies, particularly Image Guided Radiotherapy, may be considered from radiotherapy centres where IMRT is already being delivered at appropriate levels.

Providers are responsible for maintaining and replacing high value equipment. Trusts need to prioritise their investments and ensure that they have sufficient equipment to provide, high quality, safe and cost effective services for patients.

To encourage the national health service to update the existing medical technology infrastructure, the Department established a £300 million fund in March this year to bulk purchase medical equipment and achieve better prices for the NHS. The fund is operated by NHS Supply Chain.

As part of the national support also being provided to radiotherapy centres, teams of experts will be visiting those delivering IMRT at low levels to help them develop robust action plans for delivery from April 2013. During these visits, local teams will also be able to seek assistance from the experts in developing business cases for other appropriate equipment they may need.

The Department has asked the National Radiotherapy Implementation Group (NRIG), which includes representatives of the professional bodies and Cancer Research UK (CRUK), to finalise criteria that will mean that funding is allocated proportionately and will be used to ensure that advanced techniques are available for patients. Based on this work, the Department will allocate the funding. NRIG is also developing a programme of national support including visits from expert teams and national training aimed at clinical teams. CRUK is providing project management support for this work.

Almost all radiotherapy machines in this country are able to deliver treatment using IMRT. However, a survey undertaken earlier this year reported that only four of the 50 radiotherapy centres in England were delivering inverse planned IMRT at the level recommended in NRIG guidance of 24%.

The National Cancer Director, Professor Sir Mike Richards, has commissioned NRIG to produce a report setting out the state of radiotherapy in England in 2012. This report, which will be published shortly, will include survey data showing the wide variation in IMRT activity around the country and identify the centres with the lowest activity.

The Department has no current plans to collect data on insulin pump use in England. Insulin pumps and their consumables are non-prescription items and not currently captured in the annual Prescribing for Diabetes in England dataset.

The Association of British Clinical Diabetologists recently commissioned an insulin pump audit. This showed that there are at least 11,985 people over the age of 18-years-old and at least 4,447 people 17-years-old or younger using an insulin pump in England. Insulin pump therapy is a viable treatment for approximately 12% of adults and children aged over 12-years-old and 33% of children under the age 12 years, who have type 1 diabetes.