No such estimate has been made, however NHS England advise that work on travel times to and from the mainland, costs and the numbers of patients involved is part of the next stage of the work being undertaken to develop the new model of care for the Isle of Wight.

NHS England compiles and publishes monthly delayed transfers of care data. The data is available by each local authority and National Health Service trust, and includes the reason for the delay against a defined set of 10 categories. The data set is published in an online-only, interactive format.

Delays have multiple causes and as a result there is variation between local authorities. A wide-ranging package of support is in place to help areas improve transfers out of hospital and reduce delays, including work as part of Accident and Emergency Improvement Plans to understand and address delays in hospital discharge and promote good practice.

The NHS and local government have also developed new resources, including a high impact change model for reducing delayed transfers of care. In addition, the Emergency Care Improvement Programme provides tailored support to local systems to support rapid and sustained improvement in performance.

There are 44 Sustainability and Transformation Plans (STPs) covering the whole of England. STPs are being developed within their local area, with support from NHS England. The Department expects individual STPs to take account of challenges specific to their area including a rural population.

Proposals are at a draft stage but we expect all local leaders to be talking to the public and stakeholders regularly – it is vital that people are able to shape the future of their local services.

Directly comparable figures are not available, but it is clear that in the past two years there has been a substantial increase in delayed discharge figures attributable to social care at the trust, which this year were among the worst currently being recorded across the NHS.

How many patient-days of delayed discharge attributable to the levels of suitable social care available at the Royal Wolverhampton NHS Trust there were in (a) 2010 and (b) 2016.

The hon. Gentleman is right that budgets are part of the issue, which is why last week’s announcement about increased funding is important. However, funding alone does not explain the delayed transfers in Wolverhampton, which are five times worse than those of Telford, which is just down the road; twice as bad as Sandwell, which is very close; and, indeed, 30 times worse than the best performing councils, such as Newcastle, Knowsley and St Helens. With regard to his specific point about the vertically integrated pilot, this is a very exciting project and I commend the people of Wolverhampton for doing it. It is based on a model from Spain that has produced big results. We are watching it carefully and will support it as required.

Sadly, those figures are no surprise, despite the well-managed New Cross hospital, because central Government have cut Wolverhampton City

Council’s total income by almost 50% in the past six years. The primary care vertical integration pilot in Wolverhampton is a redesign of services so that a single organisation—the hospital trust—deals with patients from initial contact to ongoing management and end-of-life care. What steps is the Department of Health taking to support vertical integration as one potential way to improve care and lessen hospital admissions and delayed discharges?

NHS England involves patients, patient groups and the public at numerous stages of the process for developing clinical commissioning policies and service specifications that may be subject to a process of relative prioritisation.

Clinical policies and service specifications are developed by Clinical Reference Groups (CRGs), which are advisory groups and which include patients and patient representatives in their membership. Draft clinical policies and service specifications undergo a process of testing with registered stakeholders before they are submitted for a full public consultation. The CRG will consider the outcome of stakeholder testing and public consultation before submitting the final proposed document to NHS England for the purpose of relative prioritisation.

Recommendations on the relative prioritisation of new investments in specialised services are made by the Clinical Priorities Advisory Group, which is independently chaired and which includes patient and public voice representatives in its membership.

NHS England held a public consultation on ‘Developing a Method to Assist Investment Decisions in Specialised Commissioning’ between April and May 2016. The response to consultation can be found here:

https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/06/prioritisation-method-cons-response.pdf

We are committed to ensuring that patients with rare and ultra-rare diseases in England are able to access effective treatments.

The National Institute for Health and Care Excellence (NICE) has advised that the proposed arrangements are intended to provide clarity about the level of cost effectiveness below which funding will be made available, automatically and without delay, for highly specialised technologies that receive positive recommendations from NICE.

Subject to the outcome of the current consultation exercise, those products that have a value proposition of above £100,000 per quality-adjusted life year will be provided with a further opportunity to be considered for use in the National Health Service, through NHS England’s annual process for deciding which new treatments and services will be routinely commissioned.

Furthermore, the proposed changes are intended to clarify NICE’s existing responsibility to determine the period within which funding for recommended products needs to be made available by commissioners of services. This clarity should allow companies and commissioners to work on commercial arrangements in advance of and in parallel with the development of NICE technology appraisal and highly specialised technology guidance. In circumstances where this may not be possible, specific requests from commissioners to vary the timescale for the funding requirement will be considered by NICE.

We are committed to ensuring that patients with rare and ultra-rare diseases in England are able to access effective treatments.

The National Institute for Health and Care Excellence (NICE) has advised that the proposed arrangements are intended to provide clarity about the level of cost effectiveness below which funding will be made available, automatically and without delay, for highly specialised technologies that receive positive recommendations from NICE.

Subject to the outcome of the current consultation exercise, those products that have a value proposition of above £100,000 per quality-adjusted life year will be provided with a further opportunity to be considered for use in the National Health Service, through NHS England’s annual process for deciding which new treatments and services will be routinely commissioned.

Furthermore, the proposed changes are intended to clarify NICE’s existing responsibility to determine the period within which funding for recommended products needs to be made available by commissioners of services. This clarity should allow companies and commissioners to work on commercial arrangements in advance of and in parallel with the development of NICE technology appraisal and highly specialised technology guidance. In circumstances where this may not be possible, specific requests from commissioners to vary the timescale for the funding requirement will be considered by NICE.

We are committed to ensuring that patients with rare and ultra-rare diseases in England are able to access effective treatments.

The National Institute for Health and Care Excellence (NICE) has advised that the proposed arrangements are intended to provide clarity about the level of cost effectiveness below which funding will be made available, automatically and without delay, for highly specialised technologies that receive positive recommendations from NICE.

Subject to the outcome of the current consultation exercise, those products that have a value proposition of above £100,000 per quality-adjusted life year will be provided with a further opportunity to be considered for use in the National Health Service, through NHS England’s annual process for deciding which new treatments and services will be routinely commissioned.

Furthermore, the proposed changes are intended to clarify NICE’s existing responsibility to determine the period within which funding for recommended products needs to be made available by commissioners of services. This clarity should allow companies and commissioners to work on commercial arrangements in advance of and in parallel with the development of NICE technology appraisal and highly specialised technology guidance. In circumstances where this may not be possible, specific requests from commissioners to vary the timescale for the funding requirement will be considered by NICE.

We are committed to ensuring that patients with rare and ultra-rare diseases in England are able to access effective treatments.

The National Institute for Health and Care Excellence (NICE) has advised that the proposed arrangements are intended to provide clarity about the level of cost effectiveness below which funding will be made available, automatically and without delay, for highly specialised technologies that receive positive recommendations from NICE.

Subject to the outcome of the current consultation exercise, those products that have a value proposition of above £100,000 per quality-adjusted life year will be provided with a further opportunity to be considered for use in the National Health Service, through NHS England’s annual process for deciding which new treatments and services will be routinely commissioned.

Furthermore, the proposed changes are intended to clarify NICE’s existing responsibility to determine the period within which funding for recommended products needs to be made available by commissioners of services. This clarity should allow companies and commissioners to work on commercial arrangements in advance of and in parallel with the development of NICE technology appraisal and highly specialised technology guidance. In circumstances where this may not be possible, specific requests from commissioners to vary the timescale for the funding requirement will be considered by NICE.

Adult social care is largely delivered through an independent sector of care provider organisations that operate in a competitive market. As with any market, some providers enter and exit, which is an important mechanism for driving up quality and effectiveness. Market exits are regular occurrences and are handled effectively by local government.

It is of course vital that vulnerable people with care needs do not have their services interrupted if their care provider failed financially and services stop. The Care Act 2014 introduced new duties on local authorities and the Care Quality Commission (CQC) to protect and reassure people with care needs, their families and friends. The Act places a duty on all local authorities in England to temporarily step in and make sure all people in their area continue to have their needs met, regardless of who pays for their care. Recognising that local authorities might struggle if a significant provider were to fail, the CQC has a new function to oversee and monitor the financial sustainability of the largest and most difficult to replace providers. The oversight function provides an early warning to relevant local authorities in the event that one of these providers is likely to fail and their services cease.

Four Seasons Health Care is one of the providers that because of their size, is part of the CQC’s Market Oversight Scheme. CQC continues to monitor the finances of all of the providers in the scheme. Government has no powers to require a private company that is acting lawfully to change its financial approach.

The Care Act 2014 also places new duties on local authorities to promote their local market to ensure all service users have a choice of high quality services available.