Before a medical examination to assess fitness for entry into the services, candidates are asked to declare any family history of Tuberculosis, Diabetes, Mental Health Disorders, High Blood Pressure, Heart Disease and any other serious illness. While a family history of obesity and epilepsy is not specifically asked about, it may be declared under ‘any other serious illnesses'.

If there is a concern that the family history may include conditions with a significant hereditary component, such as Anderson-Fabry's disease, and where there is a strong likelihood of it being passed through the family to the candidate, further inquiry will be undertaken to define the likelihood of the inherited disease manifesting during service. If there is such a risk, the candidate may be referred for a further specialist opinion or rejected for entry, irrespective of whether they have signs, symptoms or a formal diagnosis of a disease at the time of the medical.

The Department relies on family history as a screening tool and does not ask for genetic data or require genetic testing. However, should a candidate declare previous genetic testing for a condition then that information would be factored into a fitness decision as relevant to the candidate's health in the future.

We are currently considering the advice that we received on 28 March 2013 from the Human Fertilisation and Embryology Authority and will respond in due course.

In March 2013, the Department published “Living Well for Longer: A call to action to reduce avoidable premature mortality”, a copy of which has already been placed in the Library. This outlines our ambition to cut avoidable deaths from the five major causes—cancer, heart, stroke, respiratory and liver disease—and to make life expectancy in England among the best in Europe. The call to action will be followed by an action plan in the autumn that details system-wide commitments, building on the Department's published strategies and national ambitions on specific diseases and associated risk factors. In April 2013, responsibility for supporting population level health transferred to local government as part of the Health and Social Care Act 2012 reforms. The Public Health Outcomes Framework

will track improvements in improving and protecting the nation's health and includes a number of mortality indicators including one on “Mortality from causes considered preventable”.

The Shropshire and Staffordshire area team does not hold a budget for specialised commissioning.

NHS England is responsible for commissioning specialised services. The prime objective of NHS England is to drive improvement in the quality of the NHS services, and the Government will hold them to account for this through the NHS Mandate.

NHS England is implementing a single operating model for the commissioning of 143 specialised services. This replaces the previous arrangements whereby 10 regional organisations were responsible for commissioning specialised services and where there was wide variation in the range, quality and access to specialised services that were commissioned.

Single nationally agreed service specifications are being developed for each of the 143 services to ensure that patients have equitable access to high quality services, regardless of where they live in England.

The Shropshire and Staffordshire area team does not hold a budget for specialised commissioning.

NHS England is responsible for commissioning specialised services. The prime objective of NHS England is to drive improvement in the quality of the NHS services, and the Government will hold them to account for this through the NHS Mandate.

NHS England is implementing a single operating model for the commissioning of 143 specialised services. This replaces the previous arrangements whereby 10 regional organisations were responsible for commissioning specialised services and where there was wide variation in the range, quality and access to specialised services that were commissioned.

Single nationally agreed service specifications are being developed for each of the 143 services to ensure that patients have equitable access to high quality services, regardless of where they live in England.

The Shropshire and Staffordshire area team does not hold a budget for specialised commissioning.

NHS England is responsible for commissioning specialised services. The prime objective of NHS England is to drive improvement in the quality of the NHS services, and the Government will hold them to account for this through the NHS Mandate.

NHS England is implementing a single operating model for the commissioning of 143 specialised services. This replaces the previous arrangements whereby 10 regional organisations were responsible for commissioning specialised services and where there was wide variation in the range, quality and access to specialised services that were commissioned.

Single nationally agreed service specifications are being developed for each of the 143 services to ensure that patients have equitable access to high quality services, regardless of where they live in England.

The Shropshire and Staffordshire area team does not hold a budget for specialised commissioning.

NHS England is responsible for commissioning specialised services. The prime objective of NHS England is to drive improvement in the quality of the NHS services, and the Government will hold them to account for this through the NHS Mandate.

NHS England is implementing a single operating model for the commissioning of 143 specialised services. This replaces the previous arrangements whereby 10 regional organisations were responsible for commissioning specialised services and where there was wide variation in the range, quality and access to specialised services that were commissioned.

Single nationally agreed service specifications are being developed for each of the 143 services to ensure that patients have equitable access to high quality services, regardless of where they live in England.

The Shropshire and Staffordshire area team does not hold a budget for specialised commissioning.

NHS England is responsible for commissioning specialised services. The prime objective of NHS England is to drive improvement in the quality of the NHS services, and the Government will hold them to account for this through the NHS Mandate.

NHS England is implementing a single operating model for the commissioning of 143 specialised services. This replaces the previous arrangements whereby 10 regional organisations were responsible for commissioning specialised services and where there was wide variation in the range, quality and access to specialised services that were commissioned.

Single nationally agreed service specifications are being developed for each of the 143 services to ensure that patients have equitable access to high quality services, regardless of where they live in England.

Between 1 January and 31 December 2012, 37,609 (0.40%) incidences of abscesses were recorded in pig heads at post mortem inspection by the Food Standards Agency (FSA) in Great Britain and by the Department of Agriculture and Rural Development (DARD) in Northern Ireland.

All carcases and accompanying offal are inspected without delay after slaughter. These include visual inspection of the head and throat of domestic swine with incision and examination of the submaxillary lymph nodes; and visual inspection of the mouth, fauces and tongue. The competent authority may decide, on the basis of epidemiological or other data from the holding, that certain fattening pigs housed under controlled housing conditions in integrated production systems since weaning, need only undergo visual inspection.

Abscesses in pigs heads identified by FSA or DARD during the inspection procedure are removed by food business operator staff, along with affected lymph nodes, under supervision, and rejected for human consumption. Heads are then disposed off as a category 2 by-product by the food business operator, with verification of disposal carried out by FSA or DARD inspectors.

In July 2012 the National Health Service Commissioning Board (NHS CB) published a report entitled “The Way Forward: Strategic Clinical Networks”. This report explained how the NHS CB had come to the decision on the four priority areas it would support through strategic clinical networks, and how these networks would be supported by the NHS CB.

The NHS CB has made clear that as priorities change, or should the work of one of the initial strategic clinical networks conclude, the board will identify new conditions or patient groups that would benefit from a strategic clinical network approach.

The Department does not maintain an annual record of the cost to the national health service of treating people with smoking-related diseases.

However, the estimated cost to the NHS of treating smoking-related illnesses in 2006-07 was £2.7 billion. Further information about NHS costs relating to smoking is set out in paragraph 2.10 of “Healthy Lives, Healthy People: A Tobacco Control Plan for England”, published in March 2011.

The cost of tobacco use are much greater than just the cost to the NHS. In 2010, the report “Cough up: balancing tobacco income and costs in society”, Policy Exchange, London, estimated that the wider cost to society of tobacco use is almost £14 billion per annum.

A copy of the Tobacco Control Plan and the Policy Exchange’s report have already been placed in the Library.

It is for the NHS Commissioning Board (NHS CB) and local commissioners to determine how best they can improve outcomes in respiratory disease for local populations. The Government's mandate to the NHSCB asks it to ensure the NHS makes progress against all the outcomes in the NHS Outcomes Framework, which includes an indicator on reducing mortality from respiratory disease in under 75s.

The NHS CB is currently establishing its work programme for 2013 and we are confident that it is aware of the need to support local commissioners in determining how best to secure those improvements and reduce variation in services for respiratory disease.

The National Specialised Commissioning Team hosted by London Strategic Health Authority is responsible for commissioning this highly specialised service for people with Type 1 Gaucher disease and it might, therefore, be more appropriate for its officials to meet this group.

The Advisory Group for National Specialised Services (AGNSS) has no direct commissioning responsibility, but is an independent stakeholder advisory group. The NHS Commissioning Board will be responsible for commissioning highly specialised services from 1 April 2013.

The National Specialised Commissioning Team hosted by London Strategic Health Authority is responsible for commissioning this highly specialised service for people with Type 1 Gaucher disease and it might, therefore, be more appropriate for its officials to meet this group.

The Advisory Group for National Specialised Services (AGNSS) has no direct commissioning responsibility, but is an independent stakeholder advisory group. The NHS Commissioning Board will be responsible for commissioning highly specialised services from 1 April 2013.

It is for the NHS Commissioning Board to determine how it will structure national clinical leadership and advice within the Board. Further announcements on staffing structures within the Board are to be made shortly.

The Health Protection Agency (HPA) has assessed “the impact on health of emissions to air from municipal waste incinerators”. The agency concluded that modern, well managed incinerators make only a small contribution to local concentrations of air pollutants. It stated that it is possible that such small additions could have an impact on health but such effects, if they exist, are likely to be very small and not detectable.

The HPA has also considered “the impact on health of emissions from landfill sites”. It concluded that a well-managed modern landfill site does not pose a significant risk to human health.

Both documents can be found on the HPA's website at:

www.hpa.org.uk/webc/HPAwebFile/HPAweb_ C/1251473372218

www.hpa.org.uk/webc/HPAwebFile/HPAweb_ C/1309969974126

We are currently consulting with the NHS Commissioning Board on the list of services which will be directly commissioned by the Board from 1 April 2013. Included within that list are services for people with Lysosomal Storage Disorders such as Hunter's Syndrome. These commissioning arrangements are not dependent on the existence of the independent stakeholder Advisory Group for National Specialised Services which currently advises Ministers on the specialised services to be commissioned on a national basis.

Between 2007 and 2011, 97 cases of “Mycobacterium bovis” were reported in England and Wales, as shown in the following table.

Of the cases reported, 38 had contact with cattle recorded.

From the 97 cases reported; 42 reported consumption of raw (or directly from farm) dairy products in their lifetime. Of these, only two reported consumption since

1995. The Health Protection Agency does not collect data on whether or not the dairy products consumed were from infected cattle.

The two most likely mechanisms of transmission to humans are (a) by ingestion of the organism in contaminated dairy products or (b) by inhalation of the organism expelled from the lungs of an infected cow.

The usual practice of the Department's National Institute for Health Research (NIHR) is not to ring-fence funds for expenditure on particular topics: research proposals in all areas compete for the funding available. The NIHR welcomes funding applications for research into any aspect of human health, including sepsis. These applications are subject to peer review and judged in open competition, with awards being made on the basis of the scientific quality of the proposals made. In all disease areas, the amount of NIHR funding depends on the volume and quality of scientific activity.

Examples of current NIHR investment in sepsis research include:

a £2.7 million trial of the clinical and cost-effectiveness of early protocolised resuscitation for emerging septic shock;

a trial of vasopressin versus noradrenaline as initial therapy in septic shock, supported by a £1.1 million clinician scientist award and a £0.2 million grant through the Research for Patient Benefit programme;

a £0.4 million doctoral research fellowship studying how risks associated with neutropenic sepsis are conveyed to and interpreted by patients undergoing chemotherapy; and

a £0.3 million project to develop a point of care test for sepsis based on calcium-induced turbidity in blood.