No assessment has been made of the effect of the distance a cancer patient must travel from their homes to receive radiotherapy on the average survival rate period of those patients.

The National Radiotherapy Advisory Group (NRAG) report “Radiotherapy: developing a world class service for England”, published in 2007, stated that 45 minutes travel time should be seen as best practice, although it recognised that this is not achievable in all areas. The report also found the vast majority of the population already live within 45 minutes of a radiotherapy centre. A copy of this report has already been placed in the Library.

From April 2013 NHS England holds the direct commissioning responsibility for all radiotherapy services and provides assistance with patient transport where an individual may be too ill or have access needs that would make the use of their own, or public, transport inappropriate.

The Care Quality Commission (CQC) mortality outliers programme currently has 40 active mortality alerts. Between 22 January 2013 and 22 April 2013, 21 mortality alerts have been generated internally or received as part of the CQC mortality outliers programme. 17 alerts were received from the Dr Foster Unit at Imperial College, two mortality alerts were received from the Society for Cardiothoracic Surgery and two alerts were generated internally. CQC does not carry data numerating how many reviews are currently

under investigation in the NHS in England. No services are being or have been suspended during investigation of these mortality outlier alerts.

There is a separate review being undertaken by Professor Sir Bruce Keogh (Medical Director of NHS England) into 14 NHS trusts and foundation trusts that have been mortality outliers for the last two consecutive years. They are;

Colchester Hospital University NHS Foundation Trust;

Tameside Hospital NHS Foundation Trust;

Blackpool Teaching Hospitals NHS Foundation Trust;

Basildon and Thurrock University Hospitals NHS Foundation Trust;

East Lancashire Hospitals NHS Trust;

North Cumbria University Hospitals NHS Trust;

United Lincolnshire Hospitals NHS Trust;

George Eliot Hospital NHS Trust;

Buckinghamshire Healthcare NHS Trust;

Northern Lincolnshire and Goole Hospitals NHS Foundation Trust;

The Dudley Group NHS Foundation Trust;

Sherwood Forest Hospitals NHS Foundation Trust;

Medway NHS Foundation Trust; and

Burton Hospitals NHS Foundation Trust

The review began in February 2013 and will publish a public report summarising the findings and actions resulting from the 14 investigations before the summer.

In March further concerns arose in relation to outcomes from surgery at Leeds General Infirmary's child cardiac unit specifically. In response to the potentially serious concerns that were identified surgery was temporarily halted at Leeds until NHS England had been reassured that it was safe for surgery to continue. NHS England is continuing to work with Leeds General Infirmary to ensure that it can deliver sustainable improvements in outcomes for children undergoing heart surgery over the long-term.

The Care Quality Commission (CQC) mortality outliers programme currently has 40 active mortality alerts. Between 22 January 2013 and 22 April 2013, 21 mortality alerts have been generated internally or received as part of the CQC mortality outliers programme. 17 alerts were received from the Dr Foster Unit at Imperial College, two mortality alerts were received from the Society for Cardiothoracic Surgery and two alerts were generated internally. CQC does not carry data numerating how many reviews are currently

under investigation in the NHS in England. No services are being or have been suspended during investigation of these mortality outlier alerts.

There is a separate review being undertaken by Professor Sir Bruce Keogh (Medical Director of NHS England) into 14 NHS trusts and foundation trusts that have been mortality outliers for the last two consecutive years. They are;

Colchester Hospital University NHS Foundation Trust;

Tameside Hospital NHS Foundation Trust;

Blackpool Teaching Hospitals NHS Foundation Trust;

Basildon and Thurrock University Hospitals NHS Foundation Trust;

East Lancashire Hospitals NHS Trust;

North Cumbria University Hospitals NHS Trust;

United Lincolnshire Hospitals NHS Trust;

George Eliot Hospital NHS Trust;

Buckinghamshire Healthcare NHS Trust;

Northern Lincolnshire and Goole Hospitals NHS Foundation Trust;

The Dudley Group NHS Foundation Trust;

Sherwood Forest Hospitals NHS Foundation Trust;

Medway NHS Foundation Trust; and

Burton Hospitals NHS Foundation Trust

The review began in February 2013 and will publish a public report summarising the findings and actions resulting from the 14 investigations before the summer.

In March further concerns arose in relation to outcomes from surgery at Leeds General Infirmary's child cardiac unit specifically. In response to the potentially serious concerns that were identified surgery was temporarily halted at Leeds until NHS England had been reassured that it was safe for surgery to continue. NHS England is continuing to work with Leeds General Infirmary to ensure that it can deliver sustainable improvements in outcomes for children undergoing heart surgery over the long-term.

This information is not collected centrally.

The National Radiotherapy Advisory Group (NRAG) report, ‘Radiotherapy: developing a world class service for England’, published in 2007, stated that 45 minutes travel time should be seen as best practice, although it recognised that this is not achievable in all areas. The report also found the vast majority of the population already live within 45 minutes of a radiotherapy centre. A copy of this report has already been placed in the Library.

Since the publication of the NRAG report, the National Cancer Action Team, now part of NHS Improving Quality, 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.

The Department has not published any guidance on this matter.

Decisions about local NHS services are a matter for the local NHS. Vascular services are being reviewed locally across England in response to robust evidence, which shows that better patient outcomes are achieved when complex procedures, such as vascular surgery, are provided by units which treat higher volumes of patients.

The NHS Standards of Procurement which were published in May 2012, and are due to be refreshed in May 2013, were issued as guidance for trusts on how to improve their procurement performance. One of the Standard's includes the development of ‘user groups’ for clinical goods and services, which should in some cases include patient representation. It is the individual trusts that will decide when and under what circumstances this is appropriate and how to involve patient groups.

The Department has developed a National Stakeholder Forum as part of the Department's programme of work to engage with patient groups and other external stakeholders to strengthen the quality of their input into the development and implementation of health and social care policies.

The new system-wide Health and Care Voluntary Sector Strategic Partner programme for 2013-14 will enable a number of voluntary and community sector organisations to influence strategic decision-making by the Department, NHS England (the NHS Commissioning Board) and Public Health England.

There is a duty on clinical commissioning groups (CCGs) to promote the involvement of patients and carers in decisions which relate to their care or treatment, including diagnosis, care planning, treatment and care management.

A second duty relates to the requirement for CCGs to ensure public involvement and consultation in commissioning processes and decisions. CCGs must include a description of these arrangements their constitution.

Dr Poulter: The provision of NHS primary medical services under the violent patients' scheme was, up to 1 April 2013, the responsibility of primary care trusts (PCTs). The data requested are not routinely collected but it is possible to provide information from data, provided by PCTs, on recorded expenditure on such schemes.

As at December 2012, 117 out of 151 PCTs operated a violent patients' scheme. A list of those PCTs with arrangements for providing primary medical services to violent patients is in the following list. From 1 April 2013, the provision of primary medical services in England became the responsibility of NHS England.

PCTs with a violent patients' scheme prior to 1 April 2013

PCT name

Ashton, Leigh and Wigan PCT

Barking and Dagenham PCT

Barnet PCT

Barnsley PCT

Bassetlaw PCT

Bath and North East Somerset

PCT (PMS only)

Berkshire East PCT

Berkshire West PCT

Bexley NHS Care Trust PCT

Birmingham East and North PCT

Blackburn with Darwen Teaching Care Trust Plus PCT

Blackpool PCT

Bournemouth and Poole Teaching PCT

Bradford and Airedale Teaching PCT

Brent Teaching PCT

Brighton and Hove City Teaching PCT

Bristol PCT

Bromley PCT

Buckinghamshire PCT

Bury PCT

Central and Eastern Cheshire PCT

Central Lancashire PCT

City and Hackney Teaching PCT

Cornwall and Isles of Scilly PCT

County Durham PCT

Cumbria Teaching PCT

Derby City PCT

Derbyshire County PCT

Devon PCT

Doncaster PCT

Dudley PCT

East Lancashire Teaching PCT

East Sussex Downs and Weald PCT

Eastern and Coastal Kent PCT

Gateshead PCT

Great Yarmouth and Waveney PCT

Greenwich Teaching PCT

Hammersmith and Fulham PCT

Hampshire PCT

Haringey Teaching PCT

Harrow PCT

Hartlepool PCT

Hastings and Rother PCT

Herefordshire PCT

Hertfordshire PCT

Heywood, Middleton and Rochdale PCT

Isle of Wight NHS PCT

Islington PCT

Kensington and Chelsea PCT

Kingston PCT

Kirklees PCT

Knowsley PCT

Lambeth PCT

Leeds PCT

Leicester City PCT

Leicestershire County and Rutland PCT

Lincolnshire Teaching PCT

Liverpool PCT

Manchester PCT

Medway PCT

Mid Essex PCT

Milton Keynes PCT

Newham PCT

Norfolk PCT

North East Essex PCT

North East Lincolnshire Care Trust Plus PCT

North Lancashire Teaching PCT

North Lincolnshire PCT

North Somerset PCT

North Staffordshire PCT

North Yorkshire and York PCT

Northamptonshire Teaching PCT

Northumberland Care PCT

Nottingham City PCT

Nottinghamshire County Teaching PCT

Oldham PCT

Oxfordshire PCT

Peterborough PCT

Plymouth Teaching PCT

Portsmouth City Teaching PCT

Redcar and Cleveland PCT

Richmond and Twickenham PCT

Salford PCT

Sandwell PCT

Sefton PCT

Sheffield PCT

Shropshire County PCT

Solihull PCT

Somerset PCT

South Birmingham PCT

South Staffordshire PCT

South Tyneside PCT

Southampton City PCT

Southwark PCT

Stoke on Trent PCT

Suffolk PCT

Sunderland Teaching PCT

Surrey PCT

Sutton and Merton PCT

Swindon PCT

Tameside and Glossop PCT

Telford and Wrekin PCT

Torbay PCT

Tower Hamlets PCT

Trafford PCT

Walsall Teaching PCT

Waltham Forest PCT

Warrington PCT

Warwickshire PCT

West Essex PCT

West Kent PCT

West Sussex PCT

Westminster PCT

Wiltshire PCT

Wirral PCT

Wolverhampton City PCT

Worcestershire PCT

NHS England is committed to putting patients and their carers at the centre of everything it does. Patients, their relatives and carers, as well as patient groups, voluntary organisations and other representatives, have been heavily involved in helping to design and make decisions on key policy areas within NHS England to date. This will continue and strengthen as NHS England takes on its full responsibilities.

NHS England will develop a strategy to ensure that patients, are included in strategic decision-making, in partnership with voluntary organisations and other key partners, later this year.

Healthwatch is the new, independent, consumer champion for health and social care. Local Healthwatch organisations will give citizens and communities a stronger voice to influence and challenge how health and social care services are delivered. As a member of the health and wellbeing board, Local Healthwatch will ensure that what matters to local people is at the heart of the local decision-making processes. Local Healthwatch will gather views and experiences from local people on their health and care services and present this evidence to commissioners and providers of local services.

Healthwatch England, using evidence from local Healthwatches and other sources, will provide advice to the Secretary of State for Health, NHS England, Monitor, the Care Quality Commission and English local authorities.

Getting feedback from patients and using it to improve services is an important responsibility of all organisations providing NHS services. From 1 April 2013, the Friends and Family Test is now allowing all patients using acute inpatient and accident and emergency services to rate the care they received. Results will allow hospitals to be more responsive, patients to compare services and commissioners and the public to hold services to account.

This information is not held in the format requested.

A table listing first out-patient appointments by source of referral and by primary care trust has been placed in the Library. This is not exactly the same as individual patient referrals, as the same person may have attended more than one out-patient appointment in the same period.

Written Answers to Questions

Tuesday 23 April 2013

The information requested falls within the responsibility of the UK Statistics Authority. I have asked the authority to reply.

Letter from Glen Watson, dated March 2013:

As Director General for the Office for National Statistics, I have been asked to reply to your recent question to the Secretary of State for Health asking how many deaths occurred in 2012 in hospitals in England as a result of MRSA bacteraemia; and how many deaths in total are estimated to have occurred in hospitals in England during the same period. [151061]

In 2011 (the latest available year) there were 53 deaths in hospitals in England where the underlying cause was MRSA and a further 279 where MRSA was shown on the death certificate as a contributory factor. In the same period, there were 230,819 deaths in hospitals in England.¹

Further information on deaths involving MRSA is available at the link below. The next edition of the MRSA bulletin, based on 2012 data, is due to be published in August 2013.

http://www.ons.gov.uk/ons/rel/subnational-health2/deaths-involving-mrsa/2007-to-2011/index.html

The Health and Social Care Act 2012 will require clinical commissioning groups (CCGs) and the NHS Commissioning Board (NHS England) to involve patients and public in all aspects of the commissioning of health services from 1 April 2013. CCGs must set out how they will involve people in their planning, and then evidence that involvement in their Annual Reports. CCG boards will also have at least two lay members sitting on the Board, to secure strong patient and public voice in their decision making.

NHS England will shortly issue statutory guidance for CCGs on how they can promote the involvement of patients in decisions about their care and treatment, and ensure patients and the public are involved in the planning, development and delivery of health services.

The Patients and Information Directorate, within NHS England, will be working to empower the patient and public voice, within the commissioning process, through the intelligence it gathers from a comprehensive programme of patient and staff surveys, real-time patient feedback, and modern customer insight tools and techniques. NHS England will also be leading programmes of work to support CCGs and direct commissioners in effective public involvement in health service planning and commissioning decisions, working closely with the voluntary sector and other agencies such as Healthwatch and Health and Wellbeing Boards.

The report from the Confidential Inquiry into Premature Deaths of People with Learning Disabilities is an important document. This department commissioned research highlights the inequalities that people with learning disabilities face with regard to their health and care. It is not acceptable that people with learning disabilities are subject to these inequalities and have such a high risk of dying prematurely. That is why there is an indicator in the NHS Outcomes Framework relating to the premature mortality of people with learning disabilities. The recommendations of the Confidential Inquiry give a clear indicator of the areas that need to be addressed, and we will consider these findings carefully

with other partners who have an important role to play in addressing premature mortality, including the NHS Commissioning Board.

Under current rules, those wishing to register as a patient with a general practice for National Health Service primary medical services should approach the practice of their choice and ask to be registered. They are not required to prove residency in the United Kingdom or to hold a national insurance number.

However, we have recently reviewed the rules and practices around charging visitors and migrants for NHS care, including primary care. On Monday 25 March, we announced that we would consult shortly on a range of options, including ending free access to primary care for all visitors and tourists, and improving how the NHS can identify, charge and recover charges where they should apply.