Nuffield Orthopaedic Centre NHS Trust Mrs. May To ask the Secretary of State for Health what steps her Department is taking (a) to safeguard the future of Nuffield Orthopaedic Centre NHS Trust at Headington, Oxford and (b) to ensure that provisions for local services and specialist work can be maintained in the area. Ms Rosie Winterton It is the responsibility of primary care trusts and strategic health authorities (SHAs) to analyse their local situation and develop plans, in liaison with their local national health service trusts and primary care providers, to deliver high quality NHS services including orthopaedic services while maintaining financial balance. The Department is working with the Specialist Orthopaedic Alliance, specialist orthopaedic hospitals and their host SHA to reach a long-term sustainable solution to rewarding the work of specialist orthopaedic hospitals through payment by results.