Baroness Shawcross-Wolfson

The Department for Health and Social Care answered the question for written answer (HL12852) on 26th January 2026.

Departments and agencies have delegated authority to determine their own practices and procedures for the recruitment of staff to the Civil Service, including the Senior Civil Service (SCS), as outlined in the Civil Service Management Code.

The Government People Group are collaborating with dedicated SCS Recruitment leads from the core Government departments to support them in sharing best practice and making relevant changes to their hiring practices, in line with the ambition set out in the Chief Secretary to the Prime Ministers’ speech of 20 January 2026.

Our approach to hiring for the Senior Civil Service (SCS) is changing to place greater value on frontline delivery, innovation, and private sector experience. Departments and agencies have authority to determine their practices and procedures for the recruitment of staff to the Civil Service, including the Senior Civil Service.

In accordance with the Civil Service Recruitment Principles, departments must provide all potential applicants with information about the nature and level of each role, criteria against which they will be assessed, and details of the selection process and the total remuneration available. However, there are no plans to publish internal-facing guidance to the public domain, as it constitutes HR-to-HR guidance designed for departments to integrate into their respective policies and processes.

Performance arrangements for members of the Senior Civil Service stem from a centrally set performance management framework, which makes clear that the objectives should be linked directly to the objectives of the department and minister they serve.

Underperformance is managed under the same framework, and triggered when individuals fail to meet the minimum standards or receive low performance ratings, with sustained poor performance escalated to a separate formal policy aligned with ACAS best practice.

Performance arrangements for members of the Senior Civil Service stem from a centrally set performance management framework, which makes clear that the objectives should be linked directly to the objectives of the department and minister they serve. These are then assessed by their line manager, throughout the performance year.

His Majesty’s Government is establishing the National School of Government and Public Services to strengthen the professional capability of the Civil Service.

The National School will serve over half a million civil servants. It will provide hundreds of thousands of hours of training as well as on-demand online learning. Training will be provided by a combination of civil service trainers, senior civil servants, and external providers and experts, including leading academic institutions.

We currently publish details of civil service training and will continue to do so as we expand the curriculum, focusing on priority skills including digital and AI. Further details of the proposed training curriculum will be published when the National School launches later in 2026.

The Government has established a baseline for the administrative burden of regulation on businesses of £22.4bn a year, and a resulting £5.6bn target. As set out in the technical annex to policy paper ‘A new approach to ensure regulators and regulation support growth’ (21^st October 2025), these estimates apply from the start of April 2025 and reflect all UK government regulation at the time, including since July 2024.

Where gross administrative burdens are added after April 2025, savings will be found in other areas, so the net administrative burden is reduced by £5.6bn by the end of this Parliament.

Government is making progress to reduce the administrative burden of regulation on businesses by 25% by the end of this Parliament.

As set out in the October Regulation Action Plan progress update, we have identified £1.5bn in gross administrative savings through measures like the Planning and Infrastructure Bill which is accelerating the delivery of 1.5m new homes and critical infrastructure, making annual savings of £272m; modernising corporate reporting requirements, making annual savings of £230m, and; providing access to data and speeding up work to operate and repair pipes and cables by establishing the National Underground Asset Register, saving £185m annually.

The Government has published a comprehensive Regulation Action Plan that sets out our plans to reform the regulatory system to unlock growth, boost innovation and reduce burdens on businesses across key sectors.

One of the key commitments in the Action Plan is the target to cut the administrative burden of regulation on business by 25%, or £5.6bn, by the end of the Parliament. This pledge will save businesses time and money and help create a regulatory environment that is targeted, proportionate, transparent and agile enough to support economic growth.

The Government is delivering a network of 50 Young Futures Hubs by March 2029. This is a cross-government priority, coordinated with the Department for Education and the Department of Health and Social Care.

While local authorities will decide on precise locations based on community needs, we expect co-location to be a key consideration where it improves accessibility and strengthens local support for young people.

Eight early adopters have been announced. The early adopter phase will look at how Young Futures Hubs interact with existing services, including Family Hubs.

The Childcare Review is currently in the early stages of cross government discussions to consider how the early education and childcare alongside family support works for families and children. We will also be working with stakeholders throughout the year to gather insights and build our evidence base. We aim to conclude the Review later this year.

As announced in the Autumn Budget 2025, the department will lead a review of childcare provision. This review aims to simplify the system for providers and families, improving access and strengthening the impact of government support. The review is expected to take place in 2026, and we will share more information in due course.

There have been steady increases over the last two decades in the number of children in receipt of Disability Living Allowance (DLAc), from 230,000 in May 2002 to 840,000 in May 2025, excluding Scotland claims. These increases are driven primarily by increases in the number of claimants with learning difficulties (including Autism Spectrum Disorder), hyperkinetic syndrome (including Attention Deficit Hyperactivity Disorder) and behavioural disorders which have increased from 48% of the caseload in May 2002 to 83% in May 2025.

This Government values the input of disabled people and people with health conditions, their representative organisations and people that support them. The Pathways to Work Green Paper launched a consultation which has now concluded. We are considering responses to the consultation.

We also have recently concluded the Access to Work Collaboration Committees, in which we engaged with a range of stakeholders, including disabled people’s organisation representatives and lived experience users, to provide discussion, experience, and challenge to the design of the future Access to Work Scheme.

Whilst the committees have now ended, we will seek opportunity to engage with stakeholders as we move forward with policy development, recognising the value of their input and expertise.

The findings from the consultation and Collaboration Committees will inform the chosen future direction of Access to Work. Once this is established we will set out our plans working closely with stakeholders to ensure an appropriate transition.

On 11th July 2025, we announced a WorkWell Primary Care Innovation Fund, which offered a portion of £1.5 million of single year funding to each of the fifteen WorkWell pilot sites to test innovative approaches to the fit note within primary care.

The funding is supporting local areas to boost capacity in primary care to provide better work and health support via the fit note process, with the longer term aims of reducing pressure on GPs and improving patients’ work and health outcomes.

Each of the 15 WorkWell Integrated Care Boards has received up to £100,000, with interventions running from October 2025 to March 2026. The locations of the sites are:

Birmingham and Solihull,

Black Country,

Bristol North Somerset and South Gloucestershire (BNSSG),

Cambridgeshire,

Cornwall and Isles of Scilly,

Coventry,

Frimley,

Greater Manchester,

Herefordshire,

Lancashire and South Cumbria,

Leicester, Leicestershire and Rutland (LLR),

North Central London,

North West London,

South Yorkshire, and

Surrey Heartlands.

One of the key aims of the funding is to build the evidence base for how the fit note process within primary care can be improved, and findings will inform future policy development. Most sites are using the funding to test new or additional roles within Primary Care Networks, including social prescribers, work and health coaches, or physiotherapists, to either issue the fit note instead of the GP or provide wraparound work and health support to the fit note recipient.

However, we know that we need to go further. The Keep Britain Working Review was clear that the fit note is ‘not working as intended’ and recommended that we test alternative approaches to the fit note, working with GPs and health services to explore improvements and replacements. We are currently considering how to respond to the Review’s recommendations on the fit note, and we will bring forward more information in due course.

Work has commenced on the Keep Britain Working Vanguard Phase following publication of the review’s final report in November. We are working with Sir Charlie Mayfield, Vanguard employers and regions to mobilise and design this next phase of work and establish effective ways of working. The vanguards will play a pivotal role in shaping how health issues and disabilities are managed in the workplace, building an evidence base and understanding of what works through effective partnership with employers.

As part of the Vanguard Phase, Sir Charlie Mayfield has agreed to establish and lead a Vanguard Taskforce/advisory board in partnership with Department for Work and Pensions, Department for Business and Trade, and Department of Health and Social Care. The Vanguard Taskforce will bring together a group of external experts from various sectors and organisations to provide external advice, and guidance to steer the Keep Britain Working Vanguard Phase. We are currently considering the Terms of Reference and potential membership of the taskforce.

The Workplace Health Intelligence Unit (WHIU) will serve as the central hub for delivery of the whole Vanguard Phase and to drive on-going work. We are currently working to establish the Intelligence Unit within Government and considering options for its design and details of its function. A comprehensive governance framework, incorporating the taskforce, will be established to ensure strategic oversight and accountability of the Unit as it is set up and developed.

Further information on the shape and remit of the Vanguard Taskforce and Workplace Health Intelligence Unit is expected in Spring 2026.

Work has commenced on the Keep Britain Working Vanguard Phase following publication of the review’s final report in November. We are working with Sir Charlie Mayfield, Vanguard employers and regions to mobilise and design this next phase of work and establish effective ways of working. The vanguards will play a pivotal role in shaping how health issues and disabilities are managed in the workplace, building an evidence base and understanding of what works through effective partnership with employers.

As part of the Vanguard Phase, Sir Charlie Mayfield has agreed to establish and lead a Vanguard Taskforce/advisory board in partnership with Department for Work and Pensions, Department for Business and Trade, and Department of Health and Social Care. The Vanguard Taskforce will bring together a group of external experts from various sectors and organisations to provide external advice, and guidance to steer the Keep Britain Working Vanguard Phase. We are currently considering the Terms of Reference and potential membership of the taskforce.

The Workplace Health Intelligence Unit (WHIU) will serve as the central hub for delivery of the whole Vanguard Phase and to drive on-going work. We are currently working to establish the Intelligence Unit within Government and considering options for its design and details of its function. A comprehensive governance framework, incorporating the taskforce, will be established to ensure strategic oversight and accountability of the Unit as it is set up and developed.

Further information on the shape and remit of the Vanguard Taskforce and Workplace Health Intelligence Unit is expected in Spring 2026.

The full responsibility for developing and setting the National Tariff, which is a set of rules, prices, and guidance that determine how providers of National Health Service funded healthcare are paid for the services they provide, was given to NHS England through the Health and Social Care Act 2012. The Health and Care Act 2022 confirmed this responsibility and renamed the ‘National Tariff’ to the ‘NHS Payment Scheme’. The legislation relating to the NHS Payment Scheme is set out in schedule 10 of the 2022 Act.

Under NHS England’s ‘Scheme of Delegation’, responsibility for approving the NHS Payment Scheme rests with the Chief Executive Officer of NHS England, delated to the Chief Financial Officer of NHS England. Ministerial agreement of the consultation is not currently a requirement of the regulations set out in the act.

NHS England will continue to work with policy teams at the Department and wider stakeholders to further develop currencies and consider appropriate payment options for attention deficit hyperactivity disorder and autism, in line with the overall direction set by ministers.

NHS England was advised by a number of clinicians, policy professionals, commissioners, and providers of attention deficit hyperactivity disorder (ADHD) and autism diagnostic assessment services prior to the publication of the NHS Payment Scheme consultation. All National Health Service providers, commissioners, and independent sector providers of NHS-funded autism and ADHD services were invited to an NHS Payment Scheme engagement session in September.

The statutory consultation for the NHS Payment Scheme 2026/27, which closed on 16 December 2025, provided an opportunity for all stakeholders to review the consultation guidance and provide comments and feedback. This consultation was open to the public, but NHS England specifically reached out to all NHS providers, commissioners, and independent sector providers of NHS-funded autism diagnostic assessment services and ADHD services to ensure they were aware and were able to respond to the NHS Payment Scheme consultation.

NHS England are currently reviewing this feedback to inform the final 2026/27 Payment Scheme.

NHS England was advised by a number of clinicians, policy professionals, commissioners, and providers of attention deficit hyperactivity disorder (ADHD) and autism diagnostic assessment services prior to the publication of the NHS Payment Scheme consultation. All National Health Service providers, commissioners, and independent sector providers of NHS-funded autism and ADHD services were invited to an NHS Payment Scheme engagement session in September.

The statutory consultation for the NHS Payment Scheme 2026/27, which closed on 16 December 2025, provided an opportunity for all stakeholders to review the consultation guidance and provide comments and feedback. This consultation was open to the public, but NHS England specifically reached out to all NHS providers, commissioners, and independent sector providers of NHS-funded autism diagnostic assessment services and ADHD services to ensure they were aware and were able to respond to the NHS Payment Scheme consultation.

NHS England are currently reviewing this feedback to inform the final 2026/27 Payment Scheme.

There are currently two appraisals paused, at the request of the company, until the National Institute for Health and Care Excellence (NICE) has the power to apply the new cost-effectiveness threshold:

• Vorasidenib for treating astrocytoma or oligodendroglioma with IDH1 or IDH2 mutations after surgery in people 12 years and over [ID6407]; and
• Ripretinib for treating advanced gastrointestinal stromal tumours after three or more treatments (review of TA881) [ID6496].

NICE anticipates that its cost-effectiveness threshold will increase in April 2026 and will provide a further update to stakeholders at that time.

The National Institute for Health and Care Excellence (NICE) currently assesses value for money for the National Health Service by applying a standard cost-effectiveness range of £20,000 to £30,000 per quality adjusted life year (QALY) gained over and above current treatments. As part of the landmark pharmaceuticals trade deal with the United States of America, it has been agreed that the cost-effectiveness threshold will be increased to £25,000 to £35,000 per QALY.

My Rt Hon. Friend, the Secretary of State for Health and Social Care, does not currently have the legal power to direct NICE to amend the cost-effectiveness threshold used in its technology appraisal or highly specialised technology programmes. The Government has therefore proceeded to amend the NICE regulations, to give ministers a limited power of direction to set the core cost-effectiveness threshold that NICE uses in the development of guidance, and remove the requirement for NICE to consult on methods changes where these result from a ministerial direction. The regulation change has been made by a statutory instrument which was laid before Parliament on 3 March 2026 and, subject to the will of Parliament, will come into force on 24 March 2026. In line with the United Kingdom-United States’ deal, NICE will implement the cost-effectiveness threshold increase in April 2026, following a direction from my Rt Hon. Friend, the Secretary of State for Health and Social Care.