The Department has placed no restrictions on patients accessing treatments for advanced (stage 4) melanoma.

The National Institute for Health and Care Excellence (NICE) has published guidance on the following treatments for melanoma. National Health Service commissioners are legally required to fund drugs and treatments recommended by NICE for eligible patients within three months of final guidance.

¹ pembrolizumab within its licensed indication was appraised across two separate appraisals.

NHS England has advised that it has carefully translated the evidence base on which NICE has based its recommendations of clinical and cost effectiveness into practical clarifications which directly relate to how the recommended drug indication is incorporated into known treatment pathways in use in England.

Each set of clarifications is in keeping with the NICE recommendations within the marketing authorisation of the relevant drug.

The treatment criteria for both Cancer Drugs Fund and baseline-funded drug indications are set out in the National Cancer Drugs Fund List which is available at:

https://www.england.nhs.uk/wp-content/uploads/2016/12/national-cdf-list-v1-15.pdf

The Department has placed no restrictions on patients accessing treatments for advanced (stage 4) melanoma.

The National Institute for Health and Care Excellence (NICE) has published guidance on the following treatments for melanoma. National Health Service commissioners are legally required to fund drugs and treatments recommended by NICE for eligible patients within three months of final guidance.

¹ pembrolizumab within its licensed indication was appraised across two separate appraisals.

NHS England has advised that it has carefully translated the evidence base on which NICE has based its recommendations of clinical and cost effectiveness into practical clarifications which directly relate to how the recommended drug indication is incorporated into known treatment pathways in use in England.

Each set of clarifications is in keeping with the NICE recommendations within the marketing authorisation of the relevant drug.

The treatment criteria for both Cancer Drugs Fund and baseline-funded drug indications are set out in the National Cancer Drugs Fund List which is available at:

https://www.england.nhs.uk/wp-content/uploads/2016/12/national-cdf-list-v1-15.pdf

The National Institute for Health and Care Excellence (NICE) has recommended a number of drugs for use in the treatment of melanoma. National Health Service patients have a right in the NHS Constitution to drugs and treatments that have been recommended by NICE, where clinically appropriate.

NHS England has advised that it has carefully translated the evidence base on which NICE has based its recommendations of clinical and cost effectiveness for drugs and treatments for melanoma into practical clarifications which directly relate to how the recommended drug indication is incorporated into known treatment pathways in use in England.

Each set of clarifications is in keeping with the NICE recommendations within the marketing authorisation of the relevant drug.

The treatment criteria for both Cancer Drugs Fund and baseline-funded drug indications are set out in the National Cancer Drugs Fund List which is available at:

https://www.england.nhs.uk/wp-content/uploads/2016/12/national-cdf-list-v1-15.pdf

Discussions are taking place with NHS regional and National Cancer Research Institute experts on melanoma on formulating chemotherapy algorithms for the treatment of advanced or metastatic melanoma. These discussions relate in part to the drug treatment of brain metastases and the need to preserve recruitment to clinical trials and whether the qualifications that NHS England has applied in terms of treatment criteria for melanoma drugs within their respective marketing authorisations should be changed.

The information requested is not available centrally. It may be obtained from Derbyshire Healthcare NHS Foundation Trust. We have written to Richard Gregory, Chair of the Trust, informing him of the hon. Member’s enquiry. He will reply shortly and a copy of the letter will be placed in the Library.

National Health Service patients’ right in the NHS Constitution to drugs and treatments recommended in National Institute for Health and Care Excellence (NICE) technology appraisal and highly specialised technology guidance, where clinically appropriate, is underpinned by the legal requirement for NHS commissioners to fund such treatments, normally within three months of NICE issuing its final guidance.

We have been actively exploring options to implement the Government’s manifesto commitment to press for a total ban on ivory sales and early next year we will consult on our proposal to ban sales of ivory that is less than 70 years old as of March 2017. As part of this, we plan to seek evidence on options and impacts of taking further action.

The Clinical Commissioning Group Improvement and Assessment Framework (CCG IAF) contains two recognised evidence-based measures of whether patients with diabetes are being supported to successfully manage their condition. These are the achievement of the National Institute for Health and Care Excellence (NICE) treatment targets, which cover blood sugar, blood pressure and cholesterol control, and participation in structured education programmes.

These measures were selected to reflect matters highlighted by the Public Accounts Committee (PAC) in January 2016 in its report on the management of adult diabetes services. The purpose of the CCG IAF is to highlight the key areas where clinical commissioning groups (CCGs) need to make improvements. The number of CCGs in need of improvement against these two indicators is consistent with the findings of the PAC.

The NHS Operational Planning and Contracting Guidance 2017-2019 included an announcement that NHS England intends to launch a major programme of investment in the treatment and care of people with diabetes. As part of this, CCGs will be able to bid for additional funding of around £40 million per year for priorities which include improvements in relation to the achievement of the treatment targets and attendance at structured education programmes.

As part of its statutory duty to perform an annual assessment of clinical commissioning groups (CCGs), NHS England will publish its 2016/17 annual assessment of the six clinical priority areas within the CCG Improvement and Assessment Framework in July 2017, which include diabetes. All indicators that are available are updated as frequently as possible; the diabetes indicators are based on annual data.

The mandate to NHS England requires it to develop the Clinical Commissioning Group Improvement and Assessment Framework (CCG IAF) and its supporting indicators in 2016-17, and in subsequent years to improve CCG performance against the indicators by 2020. This includes a specific reference to diabetes. NHS England is being held to account for achieving the deliverables in the 2016-17 mandate through regular assurance and accountability meetings with senior Departmental officials and my Rt. hon. Friend the Secretary of State. NHS England has completed the development of the framework and established baseline data for each group of indicators. In subsequent years, NHS England will be held to account for supporting CCGs to deliver improvements in the CCG IAF indicators.

NHS England will work with health communities/clinical commissioning groups (CCGs) in need of improvement against CCG Improvement and Assessment Framework indicators to mutually identify the nature of the change needed and the type of support required to achieve this. A key focus of improvement will be to support CCGs and providers to locally map their services against nationally recognised best practice diabetes pathways and to identify where local pathways need to change in order to improve outcomes. NHS England is developing plans for additional support to be available from 2017/18 onwards:

- The NHS Operational Planning and Contracting Guidance 2017-2019 included an announcement that NHS England intends to launch a major programme of investment in the treatment and care of people with diabetes, for which CCGs will be able to bid for additional funding of approximately £40 million per year, focused on the key areas of diabetes care where improvements in outcomes will be most beneficial.

- A Diabetes CCG Improvement and Assessment Framework Independent Panel has been developed, chaired by the Chief Executive of Diabetes UK and includes panel members with a wide range of other diabetes clinical expertise. This will consider CCG positions in relation to the diabetes Improvement and Assessment Framework indicators and advise on actions to support improvement.

- Sustainability and Transformation Plans (STPs). As part of supporting the development of STPs, a “How to” guide for diabetes has been issued which sets out advice the actions which CCGs can take to support improvements.

- NHS England regional teams: NHS England has funded diabetes programme leads within each of the National Health Service regions to work with CCGs to support improvement.

The information requested is not available. HM Revenue and Customs does not collect data on VAT and Customs Duty from traders to this level of detail.

The National Audit Office uses its resources to provide direct support to Parliament and stands ready to support parliamentary scrutiny of Brexit. In my humble view, there should be more, not less, parliamentary scrutiny of Brexit. The NAO is keeping in close touch with Departments as their preparations for exiting the EU develop. This will be a major task for Departments and is likely to include additional work for the NAO, not least the audit of the new Department for Exiting the European Union.

The NAO’s scrutiny will focus initially on the capacity and capability of Departments to deliver an effective and efficient exit process. The NAO will work with all Departments to assess the potential impact of exiting the European Union on their financial performance and position. The NAO is already the auditor of the new Department for Exiting the European Union and will work with it and the Treasury to ensure efficiency.

I am grateful to my hon. Friend for raising that matter. The conference was superbly successful and some real steps were taken towards improving awareness of the importance of preserving endangered species, the elephant in particular. In this country, we have announced our intention to ban the trade in post-1947 ivory—that is 70 years—and we will consult on that shortly to consider how we implement that and what further steps can be taken to meet our manifesto commitment.

I agree with my hon. Friend that those employees are often particularly responsible and have particular needs, if they have caring responsibilities. That is why the Government recognise the benefits of

flexible working. We extended the right of workers to request flexible working from June 2014. We have also introduced older claimant champions in jobcentres, and we are working with employers to help to highlight the benefits of employing older workers. Aviva, which I have mentioned in the context of Andy Briggs, is launching a new pilot scheme this Friday specifically to support carers. I very much hope that other companies will follow its example.

My hon. Friend raises a very important and controversial issue. The protection of wildlife in Africa is a priority for the Government, and we have a strategy to address it. Tourism is of course important across Africa. I have visited not just Kenya, but Sierra Leone, another country that needs to get back to investing in tourism, and that is something we can help with in the long run.

The Government is committed to making sure that vulnerable and intimidated victims and witnesses get the support they need and have the confidence to come forward. A range of measures already exist to help reduce their anxiety, including giving evidence through live-link to the courtroom from a different room in the court, or away from the court building altogether, and the use of a Registered Intermediary. We doubled the number of Registered Intermediaries at the end of 2015 to increase the number available to help vulnerable and intimidated victims and witnesses give evidence.

We are also rolling out recorded pre-trial cross-examination in the Crown Courts from next year so that vulnerable witnesses do not have to give their evidence at trial. In addition to this, we are requiring publicly-funded advocates in sexual offences cases to undertake specialist training on working with vulnerable victims and witnesses.

The roll-out of pre-trial cross examination for all vulnerable witnesses, including children, will commence in January 2017. The roll-out across all Crown Courts should be complete by the end of the year.