May I first say to my hon. Friend how very sorry I am, as I am sure the whole House is, for the loss of her son Ben? She is a passionate advocate for this work, and I also thank the Aortic Dissection Charitable Trust. She is completely right that accurate and fast diagnosis and treatment is crucial, which is why I am pleased that the National Institute for Health Research is looking to do further work in this area, and my right hon. Friend the Secretary of State for Health and Social Care will meet her at his earliest convenience.

T-cell Lymphomas are recognised as a rare form of cancer that require pan regional arrangements for referral and treatment. Cancer Alliances have pathways in place to support diagnosis as part of their skin cancer pathways. NHS England and NHS Improvement are continuing to work with providers of specialised services to deliver best-quality evidence-based care and treatment for patients living with rare cancers.

The NHS Long Term Plan committed the Government to reviewing the commissioning arrangements for a range of services including sexual and reproductive health, to ensure that they can deliver the best outcomes for the people who need them. The Department confirmed in 2019 that local authorities will continue to be responsible for commissioning sexual and reproductive health services, but that they must work much more closely with the National Health Service to deliver joined-up care for patients and to embed prevention into the full range of health and other public services.

The Department are currently considering a range of options for where Public Health England’s wider public heath functions, including supporting the commissioning and delivery of sexual and reproductive health services, could sit in the future as part of the reform to the public health system. We will be engaging in more detail on these issues and setting out next steps on the reform programme over the coming months.

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.

Individual National Health Service trusts are responsible for their own procurement activity and are supported by collaborative procurement organisations working at regional and national level.

The Department launched a Procurement Efficiency Programme (Better Procurement Better Value Better Care) in August 2013, further details of which can be found at:

https://www.gov.uk/government/publications/improving-procurement-in-the-nhs

This programme focussed on the need to improve local capability, data and leadership in the longer term and the need to drive £1.5-£2 billion of efficiency savings in the immediate term. As part of this efficiency programme the Department is working with NHS trusts and collaborative procurement organisations to determine the most effective procurement approaches going forward.

In considering the commissioning and provision of secondary care, it is for commissioners and clinicians locally to design and deliver the models of care that are going to provide the best outcomes for patients.

NHS England has published a Five Year Forward View which describes the vision for the future of the NHS, including increasing the involvement of General Practitioners in the provision of services traditionally placed in secondary care through ‘Multispecialty Community Providers’ and ‘Primary and Acute Care Systems’. A copy of the Five Year Forward View is attached.

My hon. Friend is absolutely right about that. The whole world was shocked by the attack on Malala, but what was remarkable was the response in Pakistan from women who felt horrified on her behalf. The fact that she has made such a stand is incredibly important. She is a source of joy to all of us with her recovery. She is a source of pride for us because she came to the United Kingdom to get the best health care in the world for her recovery. And she is a source of inspiration to everyone all over the world, youngsters and parents alike, because of her commitment to education.

My hon. Friend has mentioned the issue to me before, and I am happy to look into it in detail for her.