Asked by: Baroness Shawcross-Wolfson (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government whether they intend that the 2026/27 NHS Payment Scheme consultation outcome in respect of guide prices for ADHD and autism assessments will be agreed to by Ministers before implementation.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
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.
Asked by: Baroness Shawcross-Wolfson (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what assessment they have made of NHS England's proposals in the consultation on the 2026/27 NHS Payment Scheme to set a £950 guide price for both adult and children and young people's autism assessments, given that children and young people's assessments includes additional components not required for adult assessments.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
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.
Asked by: Baroness Shawcross-Wolfson (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, in regard to the consultation on the 2026/27 NHS Payment Scheme, why NHS England have proposed the same guide price for adult and child autism assessments and different guide prices for child and adult attention deficit hyperactivity disorder assessments.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
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.
Asked by: Baroness Shawcross-Wolfson (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what steps they are taking to monitor the delivery of efficiency savings by NHS England, integrated care boards and NHS providers in order to fund the NHS Agenda for Change staff pay award 2026–27; and what steps they plan to take to ensure that those savings do not impact frontline services.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The Government has accepted the NHS Pay Review Body (NHSPRB) recommendation for a 2026/27 headline pay award, for all National Health Service staff on Agenda for Change (AfC), of a 3.3% pay rise effective from April 2026. We hugely appreciate the work of so many talented staff across the NHS. Accepting the recommendation gives NHS staff on AfC a deserved real terms pay rise.
The additional pressure above 2.5% affordability will be managed by the Department and the arms length bodies, including NHS England’s central budgets, but will not be paid for by cutting frontline services or an additional efficiency ask of integrated care boards and providers.
At the 2024 Autumn Statement and in our NHSPRB evidence, the Government reaffirmed its commitment to a 2% annual productivity growth target for the NHS and productivity is currently ahead of this target at 2.8% for the first seven months in this financial year. In 2025/26, systems have planned £11.1 billion of efficiencies and savings, or 7.1% of the total allocation. The planned efficiency and savings for the 2026/27 financial year will be finalised as part of the normal planning process that is currently underway.
Both efficiency and productivity performance is monitored on a monthly basis as part of our routine financial management to ensure the NHS lives within its budget.
Asked by: Baroness Shawcross-Wolfson (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what estimate they have made of the cash value of the productivity and efficiency savings to be made by NHS England, integrated care boards and NHS providers in order to fund the NHS Agenda for Change staff pay award 2026–27.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The Government has accepted the NHS Pay Review Body (NHSPRB) recommendation for a 2026/27 headline pay award, for all National Health Service staff on Agenda for Change (AfC), of a 3.3% pay rise effective from April 2026. We hugely appreciate the work of so many talented staff across the NHS. Accepting the recommendation gives NHS staff on AfC a deserved real terms pay rise.
The additional pressure above 2.5% affordability will be managed by the Department and the arms length bodies, including NHS England’s central budgets, but will not be paid for by cutting frontline services or an additional efficiency ask of integrated care boards and providers.
At the 2024 Autumn Statement and in our NHSPRB evidence, the Government reaffirmed its commitment to a 2% annual productivity growth target for the NHS and productivity is currently ahead of this target at 2.8% for the first seven months in this financial year. In 2025/26, systems have planned £11.1 billion of efficiencies and savings, or 7.1% of the total allocation. The planned efficiency and savings for the 2026/27 financial year will be finalised as part of the normal planning process that is currently underway.
Both efficiency and productivity performance is monitored on a monthly basis as part of our routine financial management to ensure the NHS lives within its budget.
Asked by: Baroness Shawcross-Wolfson (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government whether they still plan to increase the National Institute for Health and Care Excellence cost per quality-adjusted life years thresholds in April; and what steps they will take to implement that increase.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
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.
Asked by: Baroness Shawcross-Wolfson (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what assessment they have made of the number of National Institute for Health and Care Excellence appraisals which are paused pending increases in the cost per quality-adjusted life year threshold in April.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
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:
NICE anticipates that its cost-effectiveness threshold will increase in April 2026 and will provide a further update to stakeholders at that time.
Asked by: Baroness Shawcross-Wolfson (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what the cash value is of the productivity and efficiency savings they assumed in their submission to the NHS Pay Review Body for the NHS Agenda for Change staff pay award 2026–27; and whether they assumed those savings could be released (1) at the beginning of the financial year, or (2) during the financial year.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
At the 2024 Autumn Statement, the Government reaffirmed its commitment to a 2% annual productivity growth target for the National Health Service. This is a stretching but essential ambition to ensure the NHS can meet rising demand within a tight financial settlement and return to pre-pandemic productivity levels. Detail on this was provided as part of the pay review body written evidence to give context to the wider NHS England financial position against which decisions are set.
Currently NHS productivity is running ahead of the 2% target, and increased by 2.8% in the first seven months of this financial year. This builds on the 2.7% growth between the 2024/25 and 2023/24 financial years. Consequently, we remain confident in delivering the 2% target.
The pay review body evidence did not set an explicit efficiency target. In practice, efficiency savings as a percentage run well ahead of 2% because they including non-recurrent savings and technical efficiencies, for instance reductions in agency costs, that are outside of productivity calculations. In 2024/25, NHS systems planned what was then the most ambitious efficiency and savings measures to date, targeting £9.3 billion, the equivalent to 6.1% of their total allocation. In 2025/26, systems have planned £11.1 billion of efficiencies and savings, 7.1% of the total allocation. NHS England will finalise planned efficiency and savings for the 2026/27 financial year as part of the normal planning process that is currently underway. Efficiencies are delivered throughout the course of the financial year, rather than all upfront at the start of the year.
Asked by: Baroness Shawcross-Wolfson (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what estimate they have made of (1) the total cost of the 2026–27 pay award for NHS Agenda for Change staff in England, and (2) the cost of that award above the affordability assumption set out in their evidence to the NHS Pay Review Body.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The Government has accepted the NHS Pay Review Body recommendation for the 2026/27 headline pay award, for all National Health Service staff on Agenda for Change terms and conditions in England, of a 3.3% consolidated pay rise effective from April 2026.
The pay uplift is above the Office for Budget Responsibility’s forecast inflation of 2.2% for 2026/27 and delivers a real terms pay rise for NHS staff.
The total cost for the 2026/27 pay award is estimated to be £3,250 million, and the likely impact above the 2.5% affordability assumption is estimated to be approximately £800 million. However, the exact cost will vary depending on the workforce size and composition during the year.
This additional pressure above affordability will be managed by the Department and our arms length bodies, including NHS England central budgets, but the pay increases will not be paid for by cutting frontline services.
It is vital that pay awards are fair for both workers and the taxpayer, so public services can deliver high-quality services across the country.
Asked by: Baroness Shawcross-Wolfson (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the Written Answer by Baroness Merron on 2 February (HL13305), whether they expect a significant reduction in headcount in NHS England; and when they expect to reach their target for headcount reduction from the abolition of NHS England.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The Government’s ambition remains to reduce staff numbers by up to 50% across the Department of Health and Social Care, NHS England, and the integrated care boards. These reductions will be made by March 2028. NHS England’s voluntary redundancy scheme opened on 1 December and closed for applications on Tuesday 16 December. Colleagues have now been informed whether applications to the scheme were successful, however applications can be withdrawn at any time before final agreements are signed so we cannot yet confirm final numbers. The earliest date NHS England colleagues will start to leave under the scheme is 31 March. Our ambition is to let as many people leave voluntarily as possible and alongside ongoing recruitment controls and natural staff turnover, and we believe this will allow us to make significant progress towards the 50% headcount reduction.