Mark Hunter

The UN estimates that 6.4 million people are internally displaced in Syria and a further 1.8 million people internally displaced in Iraq. There are over 3.2 million Syrian refugees in neighbouring countries.

In the six months from 1 August 2014 to 31 January 2015 NHS Blood and Transplant held 10,854 whole blood collection sessions, an average of 418 sessions per week.

Peak and average waiting times nationally for the last six months are recorded as:

Source: NHS Blood and Transplant

Public Health England (PHE) has a comprehensive range of action aimed at reducing the incidence and mortality from liver disease. It monitors the incidence, mortality and outcomes of treatment for liver disease and the risk factors: alcohol obesity and hepatitis B and C. PHE has a wide range of action to tackle unhealthy alcohol consumption, obesity and viral hepatitis through strengthening local action, promoting healthy choices, and giving appropriate information to support healthier lives.

In response to the All Party Parliamentary Hepatology Group report PHE has committed to producing a PHE Liver Disease Framework. This will focus on public health action to tackle risk factors for liver disease and inequalities in relation to liver disease. Work has already begun to bring together expertise within PHE on the major risk factors for liver disease (alcohol, hepatitis B and C and obesity), data on liver disease and its risk factors and on death and dying from liver disease. PHE has also issued liver profiles to each local authority area, which include information about hepatitis C, as well as modelling tools to assist local commissioners in establishing need at local level. Many of the actions to tackle the major risk factors require a coordinated approach between PHE and NHS England.

NHS England is responsible for delivering improvements in outcomes against the NHS Mandate and in line with the NHS Outcomes Framework. NHS England is adopting a broad strategy for delivering improvements in relation to premature mortality, working with commissioners and PHE to support clinical commissioning groups in understanding where local challenges lie and in identifying the evidence in relation to the priorities for reducing mortality at a national level.

Improving Outcomes: A Strategy for Cancer (January 2011) is backed by an additional £750 million over the four year Spending Review period including over £450 million to achieve early diagnosis. The earlier diagnosis money is designed to support improved direct general practitioner (GP) access to four key diagnostic tests to support the diagnosis of brain tumours, bowel, lung, and ovarian cancers; and increased testing and treatment costs in secondary care. GPs are able to access these tests directly in cases where the two-week urgent referral pathway is not appropriate but a patient’s symptoms require further investigation. The intention is that more people presenting with relevant symptoms will be tested and at an earlier stage.

In 2012, the Department published ‘Direct access to diagnostic tests for cancer: best practice referral pathways for general practitioners’ to provide criteria for accessing these diagnostic tests. NHS England monitors the use of these diagnostic tests through the Diagnostic Imaging Dataset. We delivered a record 1.6 million diagnostic tests in July 2014 compared to 1.2 million in May 2010.

The earlier diagnosis money also supports centrally led Be Clear on Cancer (BCOC) symptom awareness campaigns to raise the public’s awareness of cancer symptoms and encourage people with persistent symptoms to go to the doctor. Since 2011 the Department and Public Health England (since 2013) in partnership with NHS England (including NHS Improving Quality) and other stakeholders have run national BCOC campaigns for bladder and kidney, bowel, breast and lung cancers; regional campaigns for ovarian, oesophagogastric cancers, and local pilot campaigns to raise awareness of four symptoms of unexplained bleeding, lump, pain, and weight loss; and awareness of skin and prostate cancers. As part of the BCOC campaign process, the Department, Public Health England, and NHS England have worked with Cancer Research UK and other partners to develop briefing sheets to support GPs and other healthcare professionals during the campaigns.

More generally, to increase awareness of cancer amongst GPs, the Department supported British Medical Journal (BMJ) Learning to develop and launch an on-line learning tool for GPs in 2012. The tool offers accredited professional development and includes four modules - tackling late diagnosis; risk assessment tools; cancer pathway and the role of primary care; and diagnosing osteosarcoma and brain tumours in children with an additional section on communication skills. The tool can be accessed at:

http://learning.bmj.com/learning/home.html.

In 2013, Macmillan Cancer Support, partly funded by the Department, piloted an electronic cancer decision support (CDS) tool for GPs to use in their routine practice. It is designed to help GPs recognise the symptoms of cancer and identify patients that they might not otherwise refer urgently for suspected cancer. The CDS covers lung, colorectal, oesophagogastric, ovarian and pancreatic cancers and a new symptom checker for melanoma. Following the pilot, Macmillan Cancer Support is now able to offer the tool, free of charge to all GPs in the United Kingdom.

In addition to this, since 2005, the Referral Guidelines for Suspected Cancer, published by the National Institute for Health and Care Excellence (NICE) has supported GPs to identify patients with the symptoms of suspected cancer and urgently refer them as appropriate. NICE is in the process of updating this guidance to ensure that it reflects the latest evidence and the anticipated publication date for the revised guidelines is May 2015.

Improving Outcomes: A Strategy for Cancer (January 2011) is backed by an additional £750 million over the four year Spending Review period including over £450 million to achieve early diagnosis. The earlier diagnosis money is designed to support improved direct general practitioner (GP) access to four key diagnostic tests to support the diagnosis of brain tumours, bowel, lung, and ovarian cancers; and increased testing and treatment costs in secondary care. GPs are able to access these tests directly in cases where the two-week urgent referral pathway is not appropriate but a patient’s symptoms require further investigation. The intention is that more people presenting with relevant symptoms will be tested and at an earlier stage.

In 2012, the Department published ‘Direct access to diagnostic tests for cancer: best practice referral pathways for general practitioners’ to provide criteria for accessing these diagnostic tests. NHS England monitors the use of these diagnostic tests through the Diagnostic Imaging Dataset. We delivered a record 1.6 million diagnostic tests in July 2014 compared to 1.2 million in May 2010.

The earlier diagnosis money also supports centrally led Be Clear on Cancer (BCOC) symptom awareness campaigns to raise the public’s awareness of cancer symptoms and encourage people with persistent symptoms to go to the doctor. Since 2011 the Department and Public Health England (since 2013) in partnership with NHS England (including NHS Improving Quality) and other stakeholders have run national BCOC campaigns for bladder and kidney, bowel, breast and lung cancers; regional campaigns for ovarian, oesophagogastric cancers, and local pilot campaigns to raise awareness of four symptoms of unexplained bleeding, lump, pain, and weight loss; and awareness of skin and prostate cancers. As part of the BCOC campaign process, the Department, Public Health England, and NHS England have worked with Cancer Research UK and other partners to develop briefing sheets to support GPs and other healthcare professionals during the campaigns.

More generally, to increase awareness of cancer amongst GPs, the Department supported British Medical Journal (BMJ) Learning to develop and launch an on-line learning tool for GPs in 2012. The tool offers accredited professional development and includes four modules - tackling late diagnosis; risk assessment tools; cancer pathway and the role of primary care; and diagnosing osteosarcoma and brain tumours in children with an additional section on communication skills. The tool can be accessed at:

http://learning.bmj.com/learning/home.html.

In 2013, Macmillan Cancer Support, partly funded by the Department, piloted an electronic cancer decision support (CDS) tool for GPs to use in their routine practice. It is designed to help GPs recognise the symptoms of cancer and identify patients that they might not otherwise refer urgently for suspected cancer. The CDS covers lung, colorectal, oesophagogastric, ovarian and pancreatic cancers and a new symptom checker for melanoma. Following the pilot, Macmillan Cancer Support is now able to offer the tool, free of charge to all GPs in the United Kingdom.

In addition to this, since 2005, the Referral Guidelines for Suspected Cancer, published by the National Institute for Health and Care Excellence (NICE) has supported GPs to identify patients with the symptoms of suspected cancer and urgently refer them as appropriate. NICE is in the process of updating this guidance to ensure that it reflects the latest evidence and the anticipated publication date for the revised guidelines is May 2015.

When considering project options, Managing Public Money requires departments to follow the appraisal techniques in the Green book (Appraisal and Evaluation in Central Government). The Green Book describes how the economic, financial, social and environmental assessments of a policy, programme or project should be combined.

Minimum Unit Pricing remains a policy under consideration but is not being taken forward at this time, while we continue to monitor the legal developments and the implementation of this policy in Scotland. In May 2014 we introduced a ban on alcohol sales below the cost of duty plus VAT. This fulfilled the Coalition Government's commitment and will stop the worst cases of very cheap and harmful alcohol sales.