A range of approaches are in place to help diagnose people living with HIV as early as possible. The Government has mandated local authorities in England to commission comprehensive open access sexual health services, including free sexually transmitted infection testing and treatment. All parts of the country provide access to different HIV testing options such as HIV self- sampling services, or community HIV testing activities.

The National Health Service continues to provide world class treatment and care for people living with HIV. In 2017, 92% people living with HIV infection in the United Kingdom were diagnosed, 98% of people diagnosed were receiving treatment and 97% of people receiving treatment were virally suppressed.

The NHS Long Term Plan included an ambition that 75% of cancers will be diagnosed at stage 1 and 2 by 2028. The plan sets out a number of key steps to achieve this, including raising greater awareness of symptoms of cancer, accelerating access to diagnosis and treatment and maximising the number of cancers that we identify through screening. Meeting this ambition will also require the National Health Service to harness new technological advances to target at risk patients more effectively; directing our research and innovation effort to the areas where the data tells us we can have the biggest impact; and mobilising the NHS so that we can adopt proven new approaches more quickly.

In February 2019, NHS England announced that Targeted Lung Health Checks will be one of the first projects to roll out following the launch of the NHS Long Term Plan that was published in January 2019. The Targeted Lung Health Check programme will cover 10 initial sites covering 14 clinical commissioning groups until 2023 in areas that have been selected as they have some of the highest rates of lung cancer mortality. People aged 55-74 that have ever smoked will be invited to have a free lung check. Results from these initial sites will form the basis for a wider rollout across the country.

NHS England’s Strategic Direction for Sexual Assault and Abuse Services sets out a clear ambition and a programme of work to improve awareness and training across the workforce, so that victims and survivors will be better able to access specialised services, safeguarding will be enhanced, the quality of care received improved and ultimately patient experience and outcomes heightened.

I have not met with eating disorder units or discussed eating disorders with general practitioners to date.

National Institute for Health and Care Excellence (NICE) guidelines published in May 2017 state:

- Initial assessments in primary and secondary mental health care: Do not use single measures such as Body Mass Index (BMI) or duration of illness to determine whether to offer treatment for an eating disorder; and

- Inpatient and day patient treatment: Do not use absolute weight or BMI as a threshold when deciding whether to admit people with an eating disorder to day patient or inpatient care.

Commissioners and health professionals including general practitioners are expected to follow NICE guidelines when diagnosing and treating eating disorders. The NICE guidelines on eating disorders can be found on the NICE website at the following link:

https://www.nice.org.uk/guidance/ng69

Information concerning the number of people diagnosed with epilepsy in each of the last 10 years is not collected.

NHS England is responsible for securing high quality outcomes for people with long term conditions, including epilepsy. Prompt diagnosis, treatment and seizure control is key to improving outcomes for people with epilepsy. Once diagnosed and receiving the right anti-epileptic drugs the majority of people with epilepsy can achieve good seizure control. In its guideline, Epilepsies: diagnosis and management, published in 2012, the National Institute for Health and Care Excellence recommends the people having a first seizure should be seen as soon as possible by a specialist with training and expertise in epilepsy.

For those whose epilepsy cannot be satisfactorily controlled or whose condition cannot be appropriately diagnosed NHS England commissions specialised neurological services nationally:

www.england.nhs.uk/wp-content/uploads/2013/06/d04-neurosci-spec-neuro.pdf

NHS England has published adult and paediatric specifications setting out what providers must have in place to offer specialised care for patients with neurological problems, including epilepsy:

www.england.nhs.uk/wp-content/uploads/2013/06/e09-paedi-neurology.pdf

In addition, NHS England also commissions a national Children’s Epilepsy Surgery Service, designed to improve the uptake and access to surgery in those children for whom surgical control or amelioration for their epilepsy is a possibility:

www.england.nhs.uk/wp-content/uploads/2013/06/e09-child-epilepsy-surg.pdf

Regarding clinical audit, the Healthcare Quality Improvement Partnership commissions, develops and manages the National Clinical Audit and Patient Outcomes Programme (NCAPOP), on behalf of NHS England, Wales and other devolved administrations. Whilst there is no specific morbidity audit planned that covers all cases of epilepsy, the following NCAPOP audits and reviews are of relevance:

- The audit for paediatric epilepsy, which is being re-commissioned this year, looks at the quality of healthcare services for children and young people with epilepsy in the United Kingdom. The audit is managed by the Royal College of Paediatrics and Child Health and the first audit report can be found at the following link:

www.rcpch.ac.uk/news/variation-care-children-epilepsy-revealed-first-uk-wide-audit

- The 2013 review report into cases of mortality and prolonged seizures in children and young people with epilepsies that was managed by the RCPCH. The report is available at the following link:

www.rcpch.ac.uk/child-health-reviews-uk/programme-findings/programme-findings-chr-uk

- The recently commissioned National Mortality Case Record Review; Programme for England and Scotland which aims to improve understanding and learning about problems in care that may have contributed to a patient’s death:

www.rcplondon.ac.uk/news/rcp-hosts-pioneering-national-mortality-case-record-review-programme

- The Maternal, Newborn and Infant Clinical Outcome Review Programme will be undertaking a review of cases of mortality and morbidity for pregnant women with severe epilepsy that will report in December 2017. This will be carried out by MBRRACE-UK at The University of Oxford. Further information can be found at the following:

www.npeu.ox.ac.uk/mbrrace-uk/topic-proposals

Information concerning the number of people diagnosed with epilepsy in each of the last 10 years is not collected.

NHS England is responsible for securing high quality outcomes for people with long term conditions, including epilepsy. Prompt diagnosis, treatment and seizure control is key to improving outcomes for people with epilepsy. Once diagnosed and receiving the right anti-epileptic drugs the majority of people with epilepsy can achieve good seizure control. In its guideline, Epilepsies: diagnosis and management, published in 2012, the National Institute for Health and Care Excellence recommends the people having a first seizure should be seen as soon as possible by a specialist with training and expertise in epilepsy.

For those whose epilepsy cannot be satisfactorily controlled or whose condition cannot be appropriately diagnosed NHS England commissions specialised neurological services nationally:

www.england.nhs.uk/wp-content/uploads/2013/06/d04-neurosci-spec-neuro.pdf

NHS England has published adult and paediatric specifications setting out what providers must have in place to offer specialised care for patients with neurological problems, including epilepsy:

www.england.nhs.uk/wp-content/uploads/2013/06/e09-paedi-neurology.pdf

In addition, NHS England also commissions a national Children’s Epilepsy Surgery Service, designed to improve the uptake and access to surgery in those children for whom surgical control or amelioration for their epilepsy is a possibility:

www.england.nhs.uk/wp-content/uploads/2013/06/e09-child-epilepsy-surg.pdf

Regarding clinical audit, the Healthcare Quality Improvement Partnership commissions, develops and manages the National Clinical Audit and Patient Outcomes Programme (NCAPOP), on behalf of NHS England, Wales and other devolved administrations. Whilst there is no specific morbidity audit planned that covers all cases of epilepsy, the following NCAPOP audits and reviews are of relevance:

- The audit for paediatric epilepsy, which is being re-commissioned this year, looks at the quality of healthcare services for children and young people with epilepsy in the United Kingdom. The audit is managed by the Royal College of Paediatrics and Child Health and the first audit report can be found at the following link:

www.rcpch.ac.uk/news/variation-care-children-epilepsy-revealed-first-uk-wide-audit

- The 2013 review report into cases of mortality and prolonged seizures in children and young people with epilepsies that was managed by the RCPCH. The report is available at the following link:

www.rcpch.ac.uk/child-health-reviews-uk/programme-findings/programme-findings-chr-uk

- The recently commissioned National Mortality Case Record Review; Programme for England and Scotland which aims to improve understanding and learning about problems in care that may have contributed to a patient’s death:

www.rcplondon.ac.uk/news/rcp-hosts-pioneering-national-mortality-case-record-review-programme

- The Maternal, Newborn and Infant Clinical Outcome Review Programme will be undertaking a review of cases of mortality and morbidity for pregnant women with severe epilepsy that will report in December 2017. This will be carried out by MBRRACE-UK at The University of Oxford. Further information can be found at the following:

www.npeu.ox.ac.uk/mbrrace-uk/topic-proposals

The two main forms of inflammatory bowel disease (IBD) are Crohn’s disease and ulcerative colitis. Ulcerative colitis only affects the large intestine whereas Crohn's disease affects the whole of the digestive system.

The National Institute for Health and Care Excellence (NICE) guidance indicates that ulcerative colitis has an incidence in the United Kingdom of approximately 10 per 100,000 people annually, and a prevalence of approximately 240 per 100,000. This amounts to around 146,000 people in the UK with a diagnosis of ulcerative colitis. In addition to this, there are currently at least 115,000 people in the UK with Crohn's disease.

The Department does not hold information on diagnosis levels in Wales specifically; this is a matter for the devolved administration.

NICE published Crohn’s Disease Management in Adults, Children and Young People in October 2012 and Ulcerative Colitis Management in Adults, Children and Young People in June 2013. These set out best practice in the management of these conditions.

Treatment for both Crohn’s disease and ulcerative colitis is largely directed at symptom relief to improve quality of life, rather than cure. Management options include drug therapy, dietary and lifestyle advice and, in severe or chronic active disease, surgery. The aims of drug treatment are to reduce symptoms and maintain or improve quality of life.

It is for individual GP practices to ensure that their diagnostic equipment is fit for purpose.

The majority of GP Practices receive funding through three main income streams:

- Global Sum – covering the costs of running a general practice, including some essential GP services. This is calculated using the Carr-Hill formula that takes into account, for example, patient demographics, rurality and deprivation factors.

- The Quality and Outcome Framework (QOF), an optional incentive scheme for GPs.

- Enhanced services, setting out additional services that practices can choose to provide.

Additional payments are also made to practices, for example, seniority payments as well as payments associated with costs of providing premises.

Practices are then responsible for meeting the costs of their business, including funding and maintaining any equipment they may need.

It is too early to be able to assess progress against the ambition to save an additional 5,000 lives per year by 2014-15, to halve the gap between the survival estimates in England and those in the best countries in Europe. However, we do know that cancer survival and mortality rates continue to improve and we are developing proxy measures to assess progress in a more timely manner, particularly in terms of the proportion of cancers diagnosed at stages one and two and cancers diagnosed through emergency routes.

The National Health Service and Public Health Outcomes Framework indicators and the clinical commissioning group (CCG) Outcomes Indicator Set are starting to enable us to assess progress, at national and local level. For example, data on one-year survival from all cancers and one-year survival from breast, lung and colorectal cancer were published as part of the CCG outcomes indicator set for the first time on 19 June 2014.

The Cancer Outcomes Strategy is backed with more than £750 million over the four year Spending Review period, including over £450 million to achieve early diagnosis. The additional money is funding over 2 million extra tests over four years and gives general practitioners (GPs) access to non-obstetric ultrasound—to support diagnosis of ovarian cancer; flexible sigmoidoscopy—to support the diagnosis of bowel cancer; and brain magnetic resonance imaging scans—to support the diagnosis of brain cancer. NHS England monitors the use of these tests through the Diagnostic Imaging Dataset. On 22 May 2014, NHS England published ‘Provisional Monthly Diagnostic Imaging Dataset Statistics’ for the period from January 2013 to January 2014.

Over 34.2 million imaging tests were reported in England in the 12 months from February 2013 to January 2014. Over a quarter of all tests that may have been used to diagnose or discount cancer were requested by GPs under direct access arrangements.

The Mandate for the NHS for 2014-15 sets out an ambition for England to become one of the most successful countries in Europe at preventing premature deaths.

Tackling premature deaths from cancer will contribute to this. A range of work at national and local level is aimed at improving cancer survival. For example, results from the first national “Be Clear on Cancer” lung cancer campaign in 2012 showed that around 700 extra patients were diagnosed with lung cancer compared to the previous year. Approximately 400 of these patients had their lung cancer diagnosed at an early stage, with around 300 more patients having surgery, giving them a better chance of survival.

Work continues on extending and expanding the bowel, breast and cervical cancer screening programmes, and helping GPs to assess patients more effectively. The National Institute for Health and Care Excellence is in the process of updating the ‘Referral Guidelines for Suspected Cancer’ (2005) to ensure that it reflects latest evidence and can continue to support GPs to identify patients with symptoms of suspected cancer and urgently refer them as appropriate.