Department of Health and Social Care

The Government is working towards introducing legislation to enable hub and spoke dispensing between different legal entities in 2025. This change will be enabled via amendments to both primary and secondary legislation, and is subject to the usual parliamentary processes.

The Department welcomes knowledge sharing across the sector and officials will consider the report in future policy development. Under the Health and Social Care Act 2008, care providers are required to provide sufficient numbers of suitably qualified, competent, skilled, and experienced staff to meet the needs of the people using the service.

We now have a national career framework for adult social care, the Care Workforce Pathway, which is linked to several existing competency frameworks, including the dementia training standards framework. The Department developed the pathway in partnership with Skills for Care, representatives from the adult social care workforce, and people who draw on care and support.

The Department has also launched a new Level 2 Adult Social Care Certificate qualification which links to outcomes in the Care Workforce Pathway. This contains the baseline knowledge required to provide quality care and will make sure that those who are starting out their careers in care have an informed awareness of dementia.

The National Health Service in England invests £3 billion on dentistry every year. The responsibility for commissioning primary care, including dentistry, to meet the needs of the local population has been delegated to all integrated care boards (ICBs) across England. The NHS Norfolk and Waveney ICB has committed to investing £6.7 million in dental services for 2024/25.

Patients in England are not registered with a National Health Service dental practice, although many NHS dental practices do tend to see patients regularly. There is no geographical restriction on which practice a patient may attend. Dental practices may operate local waiting list arrangements.

The responsibility for commissioning primary care, including dentistry, to meet the needs of the local population has been delegated to all integrated care boards (ICBs) across England. For the Basingstoke constituency, this is the NHS Hampshire and Isle of Wight ICB.

Data on the number of urgent care courses of treatment is published annually. The latest data, for 2023/24 is available at the following link:

https://www.nhsbsa.nhs.uk/statistical-collections/dental-england/dental-statistics-england-202324

The Government is committed to tackling the challenges for patients trying to access National Health Service dental care with a rescue plan to provide 700,000 more urgent dental appointments and recruit new dentists to the areas that need them most. To rebuild dentistry in the long term, we will reform the dental contract with the sector, with a shift to focus on prevention and the retention of NHS dentists. We are working to ensure patients can start to access 700,000 additional urgent dental appointments as soon as possible, targeting areas that need them most.

The Department does not hold the data requested.

The following table shows the percentage of patients in England who waited longer than four hours in accident and emergency, in September, October, and November of 2023 and 2024:

Source: NHS England, available at the following link:
https://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/

The Department does not hold the information requested. The Nursing and Midwifery Council (NMC) publishes the number of United Kingdom trained nursing associates joining their register for the first time in England, which will be a close proxy for the number completing training. The following table shows the number of UK trained nursing associates joining the NMC register in England for the first time, in each if the last six financial years:

Source: Nursing and Midwifery Council, March 2024 Annual Data Report.

Over 1.5 million hard-working people make up the National Health Service workforce, and supporting them is at the core of delivering on our mission to build an NHS fit for the future. That is why the Government accepted all the 2024/25 pay review bodies’ recommendations for NHS staff in England.

Furthermore, we have already remitted the pay review bodies and submitted written evidence for 2025/26. This is the earliest written evidence that has been published for many years, meaning the pay setting process is on track this year. This paves the way for pay settlements to be agreed earlier.

NHS England continues to lead on a range of initiatives to boost retention of existing staff and ensure that the NHS remains an attractive career choice for new recruits.

There has been no estimate made of the financial savings to the United Kingdom when a fully trained healthcare worker is recruited from overseas to work in the National Health Service.

The Department does not hold the information requested. Whilst the Higher Education Statistics Agency publishes data on the number of students completing higher education courses in the United Kingdom, it does not publish data in a detailed enough way to allow for the identification of nursing associates completing subsequent registered nursing training.

The Nursing and Midwifery Council publishes information on their register, including the number of nursing associates across the UK who have added nursing or midwifery registration status. The following table shows the number of nursing associates adding nursing or midwifery register status, in each of the last five financial years:

Source: Nursing and Midwifery Council, March 2024 Annual Data Report.

Ketamine does not have a marketing authorisation in the United Kingdom for use in the treatment of any mental health conditions. Esketamine nasal spray, an isomer of ketamine, is licensed for treatment-resistant depression that has not responded to at least two different antidepressants in the current moderate to severe depressive episode in adults, and for the treatment of adults with a moderate to severe episode of major depressive disorder, as acute short-term treatment for the rapid reduction of depressive symptoms, which, according to clinical judgement, constitutes a psychiatric emergency.

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for developing authoritative, evidence-based recommendations for the National Health Service on whether new, licenced medicines represent a clinically and cost-effective use of resources.

The NICE has been unable to recommend esketamine for treatment-resistant depression due to uncertainties in its clinical and cost-effectiveness. It is not therefore routinely funded by the NHS in England for any indication.

The NICE was unable to make recommendations on the use of esketamine nasal spray for the treatment of major depressive disorder because the marketing authorisation holder did not provide an evidence submission.

As set out in the published Terms of Reference, the Leng review will be an end-to-end review of the Physician Associate and Anaesthesia Associate professions, covering selection and recruitment, training, day to day work, scope of practice, oversight, supervision, and professional regulation.

As part of the deal agreed between the Government and the British Medical Association (BMA) Resident Doctors Committee, the Government has committed to work in partnership with the BMA and other health organisations to review the current system of training and rotational placements for resident doctors. This work is being taken forward outside the Leng Review.

The levels of remuneration for resident doctors are not in scope of the review, as the Review Body on Doctors' and Dentists' Remuneration advises the Government on rates of pay for doctors and dentists.

The Higher Education Statistics Agency publishes data on the number of students qualifying from higher education courses in the United Kingdom, and this includes information on a broad ranges of undergraduate nursing courses. The published data is not detailed enough to allow for the reliable identification of all students completing courses which specifically lead to registered nursing status.

As a proxy for the number of students completing nursing courses each year, the Nursing and Midwifery Council (NMC) publishes information on the number of UK trained nurses joining their register for the first time, who are resident in England. The following table shows the number of UK trained nurses joining the NMC register in England for the first time, each financial year from 2018/19 to 2023/24:

Source: Nursing and Midwifery Council, March 2024 Annual Data Report

A national pause was introduced in 2018 for the use of vaginally inserted mesh to treat prolapse and the use of a retropubic sub-urethral mesh sling to treat stress urinary incontinence. Conditions were put in place for this pause, and NHS England continues to monitor the progress on meeting these conditions.

In response to the recommendations from the Independent Medicines and Medical Devices Safety review, the Department and the National Health Service have taken steps to improve the collection and monitoring of outcome data. The Pelvic Organ Prolapse and Stress Urinary Incontinence registry will be launched in early 2025. NHS England is extending the registry to be United Kingdom-wide and improving the recording of patient outcomes and experience. The Department has also commissioned, through the National Institute for Health and Care Research, a £1.56 million study to develop a patient reported outcome measures for prolapse, incontinence, and mesh complication surgery. This will improve collection of short- and long-term data on patient outcomes.

To provide support for women who have experienced complications from pelvic mesh implants, NHS England has established nine specialist mesh centres across England. These ensure that women in every region of England with complications of mesh inserted for urinary incontinence and vaginal prolapse get the right support. Each mesh centre is led by a multi-disciplinary team to ensure patients get access to the specialist care and treatment that they need, including pain management and psychological support. As health is a devolved matter, these centres do not cover Northern Ireland.

The UK National Screening Committee (UK NSC) last reviewed screening for sudden cardiac death (SCD) in people under the age of 39 years old in 2019, and concluded that screening should not be offered. Further information on this review is available at the following link:

https://view-health-screening-recommendations.service.gov.uk/sudden-cardiac-death/

Research showed that the current tests are not accurate enough to use in young people without symptoms, and that treatments and interventions were not based on good scientific evidence to prevent SCD.

To stop SCDs in young people, the current consensus is to focus on rapid identification and care of people who are likely to be at risk of SCD due to a family link or because they have had symptoms, and to train people to carry out cardiopulmonary resuscitation and to use defibrillators.

NHS England has published guidance for inherited cardiac conditions which requires services to investigate patients with previously undiagnosed cardiac disease, suggestive symptoms, or from families with sudden unexplained deaths. Where a genetic variation is identified, cascade testing is offered to relatives based on risk.

We are aware that the UK NSC has received a submission via its annual call process to consider SCD screening in young people aged 14 to 35 years old who engage in sport. The UK NSC is currently reviewing all annual call proposals. More information on the annual call process can be found here:

https://www.gov.uk/government/publications/uk-nsc-annual-call-submitting-a-screening-proposal/uk-nsc-annual-call-how-to-submit-a-proposal

The height of state school pupils in Reception and Year 6 is measured in the National Child Measurement Programme (NCMP). The following table shows the average height in centimetres of boys and girls aged five and 11 years old, in the academic years from 2008 to 2024:

Source: data is from the NCMP, with further information available at the following link:
https://www.gov.uk/government/statistics/obesity-profile-november-2024-update

Height data has not been published for the years 2005 to 2008. Height data by ethnic group of pupil is not available, but is due to be published by the Department on 4 February 2025, and will be available at the following link:

https://www.gov.uk/government/statistics/announcements/obesity-profile-february-2025-update

The Department for Education publishes information on the number of state school pupils by ethnicity. This information can be found in the Schools, pupils, and their characteristics publication on GOV.UK website, which is based on January school census data. Statistics from May 2010 onwards are available at the following link:

https://www.gov.uk/government/collections/statistics-school-and-pupil-numbers

Data is not published for Reception and Year 6 children specifically. Statistics from 2005 to 2009 are available at the following link:

https://www.gov.uk/government/publications/schools-pupil-and-their-characteristics-2002-to-2009-data

Based on advice from the UK National Screening Committee, NHS England committed in the Long Term Plan to extend the age range of people eligible for bowel screening using the FIT home testing kit from age 60 down to age 50.

The age extension for bowel screening is already underway. NHS England started in April 2021 with the 56-year-old cohort and, based on modelling and clinical advice, has planned to gradually reduce to age 50 by 2025. This has been done to ensure that screening centres could manage any required increase in colonoscopy capacity.

We currently do not screen those younger than 50 years old for breast cancer due to the lower risk of women under this age developing breast cancer, and the fact that women below 50 years old tend to have denser breast tissue, which reduces the ability of getting an accurate mammogram. It may also increase the risk of overtreatment and distress for women who do not have breast cancer, but who would be subject to invasive and painful medical treatments and diagnostic tests.

United Kingdom guidelines recommend that women with a moderate or high risk of breast cancer, because of their family history, should start having screening mammograms every year in their forties. National Institute for Health and Care Excellence guidance on the management of people with a family history of breast cancer was introduced in 2004, and has changed over time. The current version of this guidance is available at the following link:

https://www.nice.org.uk/guidance/cg164

There is a large trial, Age Extension, which is exploring whether an additional screen before 50 years old would meet the UK National Screening Committee’s criteria. Results are expected in 2026.

The Mid and South Essex NHS Foundation Trust is in segment four of the NHS Oversight Framework. This means that the trust is in receipt of national mandated support via NHS England’s Recovery Support Programme (RSP), led by senior and multidisciplinary teams to help embed sustainable quality and financial improvements.

RSP governance and oversight is well established, and Department officials meet with NHS England and the Care Quality Commission monthly to assess the progress and developments within the programme. This helps to ensure effective lines of communication and enables us to continue to assure that organisations are receiving appropriate support.

NHS England commissions gender services for children and young people in line with its interim service specification for children and young people with gender incongruence.

Children and young people are cared for holistically by specialist multi-disciplinary teams based in specialist children's hospitals. The multi-disciplinary team should include expertise in paediatrics, psychological health, and neurodevelopmental conditions.

Each child or young person will have a tailored individual care plan to meet their needs. Depending on individual need, the gender service for children and young people will provide psychosocial and clinical interventions, including support for the family. Further information from the interim service specification is available at the following link:

https://www.england.nhs.uk/publication/interim-service-specification-for-specialist-gender-incongruence-services-for-children-and-young-people/

Funding decisions for health services in England are made by integrated care boards and are based on the clinical needs of their local population. Organisations are expected to commission fertility services in line with National Institute for Health and Care Excellence (NICE) guidelines. The NICE is currently reviewing the fertility guidelines and will consider whether the current recommendations for access to National Health Service-funded treatment are still appropriate. We expect this review to be published in 2025. NHS England will also be providing advice on this issue to inform the Government’s considerations of future policy options.

The Department has not written to the National Health Service trusts on the use of sex-specific language in NHS guidance. The Government understands the need for health information to be as clear as possible and to use language that appropriately reflects sex, as defined as a protected characteristic in the Equality Act 2010.

The Government has not carried out an assessment of the costs to the National Health Service of treating birth defects resulting from cousin marriage.

We will continue to work with the NHS as it delivers its three-year maternity and neonatal plan to grow our maternity workforce, develop a culture of safety, and ensure women and babies receive safe, personalised, and compassionate care.

In relation to the number of Government procurement cards held by staff within the core Department, I refer the Hon. Member for Islington South and Finsbury to the answer given on 18 January 2024 to Question PQ8714.

In addition, the following table shows the number of cards held by the Department’s two executive agencies, the UK Health Security Agency (UKHSA) and the Medicines and Healthcare products Regulatory Agency (MHRA), in 2022 and 2023:

On 20 November 2024, the Government announced that it had commissioned an independent review of physician associates (PAs) and anaesthesia associates (AAs), led by Professor Gillian Leng CBE. The review will consider the safety of the roles, and their contribution to multidisciplinary healthcare teams.

As set out in the published Terms of Reference, the review will be an end-to-end review of the PA and AA professions, covering selection and recruitment, training, day to day work, scope of practice, oversight, supervision, and professional regulation. The review will report in spring 2025.

NHS England has issued guidance on the deployment of PAs and AAs in the National Health Service, which describes the expectations of how organisations providing NHS care should deploy them, so that they can contribute to the delivery of safe and effective healthcare in a supportive environment. This guidance remains in place whilst the review is ongoing, and is available at the following link:

https://www.england.nhs.uk/long-read/summary-of-existing-guidance-on-the-deployment-of-medical-associate-professions-in-nhs-healthcare-settings/

In the meantime, regulation with the General Medical Council has begun, and will help to ensure patient safety and professional accountability.

The Medicines and Healthcare products Regulatory Agency (MHRA) headcount stands at 1,452 employees. The MHRA has a Head of Diversity and Staff Engagement, and a Diversity and Staff Engagement Coordinator, who are focussed on diversity, equality, and inclusion for half of their full-time equivalent (FTE) hours, with the remaining half of their FTE hours focussed on other human resources portfolio priorities.

As part of the work to develop a 10-Year Health Plan, we will carefully be considering policies, including those that impact teenagers and young adults with cancer, with input from the public, patients, health staff, and our partners, as we develop the plan.

We have also launched a significant public engagement process, and we would encourage all those with an interest in the way teenagers and young adults with cancer receive care, and who are aged 16 years old or over, to take part in that process, so that we can fully understand what is not working as well as it should and what the potential solutions are. This can be done via the online portal, which is available at the following link:

https://change.nhs.uk/en-GB/

We plan to run engagement events with children and young people in the new year and are working with the Royal College of Paediatrics and Child Health, the Children’s Commissioner, the National Children’s Bureau, and other partners to ensure we hear from children affected by ill health.

Following publication of the 10-Year Health Plan, the Department will publish a National Cancer Plan. We are committed to ensuring that the needs of children and young people with cancer are carefully considered in the National Cancer Plan, and will set out further details in due course.

In order to maximise our potential to be a world leader and develop a more competitive, efficient and accessible clinical research system, the Department is committed to implementing recommendations from the Lord O'Shaughnessy independent review of commercial clinical trials in full.

As part of the work to develop a 10-Year Health Plan, we will carefully be considering policies, including those that impact teenagers and young adults with cancer, with input from the public, patients, health staff, and our partners, as we develop the plan.

We have also launched a significant public engagement process, and we would encourage all those with an interest in the way teenagers and young adults with cancer receive care, and who are aged 16 years old or over, to take part in that process, so that we can fully understand what is not working as well as it should and what the potential solutions are. This can be done via the online portal, which is available at the following link:

https://change.nhs.uk/en-GB/

We plan to run engagement events with children and young people in the new year and are working with the Royal College of Paediatrics and Child Health, the Children’s Commissioner, the National Children’s Bureau, and other partners to ensure we hear from children affected by ill health.

Following publication of the 10-Year Health Plan, the Department will publish a National Cancer Plan. We are committed to ensuring that the needs of children and young people with cancer are carefully considered in the National Cancer Plan, and will set out further details in due course.

In order to maximise our potential to be a world leader and develop a more competitive, efficient and accessible clinical research system, the Department is committed to implementing recommendations from the Lord O'Shaughnessy independent review of commercial clinical trials in full.

As part of the work to develop a 10-Year Health Plan, we will carefully be considering policies, including those that impact teenagers and young adults with cancer, with input from the public, patients, health staff, and our partners, as we develop the plan.

We have also launched a significant public engagement process, and we would encourage all those with an interest in the way teenagers and young adults with cancer receive care, and who are aged 16 years old or over, to take part in that process, so that we can fully understand what is not working as well as it should and what the potential solutions are. This can be done via the online portal, which is available at the following link:

https://change.nhs.uk/en-GB/

We plan to run engagement events with children and young people in the new year and are working with the Royal College of Paediatrics and Child Health, the Children’s Commissioner, the National Children’s Bureau, and other partners to ensure we hear from children affected by ill health.

Following publication of the 10-Year Health Plan, the Department will publish a National Cancer Plan. We are committed to ensuring that the needs of children and young people with cancer are carefully considered in the National Cancer Plan, and will set out further details in due course.

In order to maximise our potential to be a world leader and develop a more competitive, efficient and accessible clinical research system, the Department is committed to implementing recommendations from the Lord O'Shaughnessy independent review of commercial clinical trials in full.

As part of the work to develop a 10-Year Health Plan, we will carefully be considering policies, including those that impact teenagers and young adults with cancer, with input from the public, patients, health staff, and our partners, as we develop the plan.

We have also launched a significant public engagement process, and we would encourage all those with an interest in the way teenagers and young adults with cancer receive care, and who are aged 16 years old or over, to take part in that process, so that we can fully understand what is not working as well as it should and what the potential solutions are. This can be done via the online portal, which is available at the following link:

https://change.nhs.uk/en-GB/

We plan to run engagement events with children and young people in the new year and are working with the Royal College of Paediatrics and Child Health, the Children’s Commissioner, the National Children’s Bureau, and other partners to ensure we hear from children affected by ill health.

Following publication of the 10-Year Health Plan, the Department will publish a National Cancer Plan. We are committed to ensuring that the needs of children and young people with cancer are carefully considered in the National Cancer Plan, and will set out further details in due course.

In order to maximise our potential to be a world leader and develop a more competitive, efficient and accessible clinical research system, the Department is committed to implementing recommendations from the Lord O'Shaughnessy independent review of commercial clinical trials in full.

As part of the work to develop a 10-Year Health Plan, we will carefully be considering policies, including those that impact teenagers and young adults with cancer, with input from the public, patients, health staff, and our partners, as we develop the plan.

We have also launched a significant public engagement process, and we would encourage all those with an interest in the way teenagers and young adults with cancer receive care, and who are aged 16 years old or over, to take part in that process, so that we can fully understand what is not working as well as it should and what the potential solutions are. This can be done via the online portal, which is available at the following link:

https://change.nhs.uk/en-GB/

We plan to run engagement events with children and young people in the new year and are working with the Royal College of Paediatrics and Child Health, the Children’s Commissioner, the National Children’s Bureau, and other partners to ensure we hear from children affected by ill health.

Following publication of the 10-Year Health Plan, the Department will publish a National Cancer Plan. We are committed to ensuring that the needs of children and young people with cancer are carefully considered in the National Cancer Plan, and will set out further details in due course.

In order to maximise our potential to be a world leader and develop a more competitive, efficient and accessible clinical research system, the Department is committed to implementing recommendations from the Lord O'Shaughnessy independent review of commercial clinical trials in full.

The Government is committed to tackling the retention and recruitment challenges that face the National Health Service. NHS England is leading a range of initiatives to boost retention of existing staff and ensure that the NHS remains an attractive career choice for new recruits. This includes building a compassionate and inclusive culture, supporting staff wellbeing, and promoting flexible working opportunities.

Targeted retention work for midwives is being undertaken by NHS England and led by the Chief Nursing Officer. This includes a midwifery and nursing retention self-assessment tool, mentoring schemes, strengthened advice and support on pensions and flexible retirement options, and the publication of menopause policies and guidance. NHS England has also invested in unit-based retention leads who focus on retention and provide pastoral support to midwives. This initiative, alongside investment in workforce capacity, has seen a reduction in vacancy, leavers, and turnover rates.

The refreshed Long Term Workforce Plan will deliver the transformed health service that we will build over the next decade and will ensure that patients get the treatment they need, when and where they need it, including those at the end of their lives. In the development of the plan, we will engage with a range of stakeholders to ensure their needs are considered.

The refreshed Long Term Workforce Plan will deliver the transformed health service that we will build over the next decade and will ensure that patients get the treatment they need, when and where they need it, including those at the end of their lives. In the development of the plan, we will engage with a range of stakeholders to ensure their needs are considered.

The Department and NHS England recognise the need for patients who are ready to go home to be discharged as quick as possible, both for their benefit and to improve the efficiency of hospitals. Information on the average wait time for hospital patients to be provided with medication at the point of discharge is not held centrally by NHS England, and it is the responsibility of individual trusts to monitor discharge and medication efficiency. To support hospitals on improving processes, guidance has been published, which is available at the following link:

https://www.england.nhs.uk/urgent-emergency-care/improving-hospital-discharge/

The Department and NHS England recognise the need for patients who are ready to go home to be discharged as quick as possible, both for their benefit and to improve the efficiency of hospitals. Information on the average wait time for hospital patients to be provided with medication at the point of discharge is not held centrally by NHS England, and it is the responsibility of individual trusts to monitor discharge and medication efficiency. To support hospitals on improving processes, guidance has been published, which is available at the following link:

https://www.england.nhs.uk/urgent-emergency-care/improving-hospital-discharge/

The Nursing and Midwifery Council (NMC) is the regulator of nurses and midwives in the United Kingdom, and nursing associates in England. The NMC is independent of the Government, directly accountable to Parliament, and is responsible for operational matters concerning the discharge of its statutory duties.

The Department has no current plans to launch an independent review, but we expect the NMC to ensure swift and robust action is taken to deliver against the 36 recommendations set out in the Independent Culture Review report.

Decisions on whether new medicines should be routinely funded by the National Health Service in England are made on the basis of recommendations from the National Institute for Health and Care Excellence (NICE), following an evaluation of a treatment’s costs and benefits. These are very difficult decisions to make, and it is important that they are made independently, and on the basis of the available evidence.

The NICE published guidance in July 2024 on the use of Enhertu for the treatment of HER-2 low metastatic and unresectable breast cancer, and was unfortunately unable to recommend it for routine NHS funding. I understand that the NICE and NHS England have sought to apply as much flexibility as they can in their considerations of Enhertu for HER2-low breast cancer, and have made it clear to the companies that their pricing of the drug remains the only obstacle to access.

Earlier this year, ministers met with the manufacturers of Enhertu, AstraZeneca, and Daiichi Sankyo, to encourage them to re-engage in commercial discussions with NHS England. Despite the NICE and NHS England offering unprecedented flexibilities, the companies were unable to offer Enhertu at a cost-effective price. The NICE’s guidance will therefore remain unchanged. Although the deadline for a rapid review has now passed, the NICE has reassured me that the door remains open for the companies to enter into a new NICE appraisal, if they are willing to offer Enhertu at a cost-effective price.

Up to the end of 2023/24, the Queen Elizabeth Hospital King's Lynn NHS Foundation Trust has received £3.2 million in funding to support the development of the business case for their New Hospital Programme scheme.

Information on local plans is not collected centrally by the Department. National Health Service organisations are responsible for their own recruitment, and for developing their own workforce plans based on local service needs. At a national level, we are committed to training the staff the NHS needs, and will work closely with partners in education to do this.

NHS England continues to lead on a range of initiatives to boost retention of existing staff and ensure that the NHS remains an attractive career choice for new recruits. This includes a strong focus on improving organisational culture, supporting staff health and wellbeing, and promoting flexible working opportunities. It is continually reviewing the effectiveness of these and their impact on the workforce.

The data requested is not held centrally.

The Department regularly engages with and consults stakeholders, including providers and people with lived experience of care and support services, to ensure that a wide range of views are taken into account through all stages of the policy life cycle. This includes holding regular meetings and provider forums, working with partners in the sector, and also running formal public consultations, as necessary.