Lord Hunt of Kings Heath

Ofqual conducted a public consultation from 15-29 April, seeking views on aspects of the proposed assessment arrangements for GCSEs, AS and A levels, including standardisation of centre assessment grades. Ofqual received over 12,500 responses to their consultation, and on 22 May they published their decisions.

Ofqual have decided not to include the trajectory of exam centres’ results in the statistical standardisation process. This is due to potential unfairness caused by the unreliability of any trajectory predictions and the disadvantage that this might cause students in those centres with stable results.

Whilst this is a matter for Ofqual as the independent regulator of qualifications, I am satisfied that Ofqual’s approach is the best solution given these extraordinary circumstances.

We are working with Public Health England to update the School Food Standards in relation to sugar and fibre.

On 7 May and 6 November 2019, we brought together an advisory group comprising of key stakeholders in the food, nutrition and health sectors. These stakeholders hold a wide breadth of knowledge and expertise in relation to school food. This was to discuss the proposed updates to the standards; we are considering those views and the next steps.

We will release more information on our plans for the update shortly.

Birmingham City University, of which The Royal Birmingham Conservatoire is a part, is registered with the Office for Students (OfS) in the approved (fee cap) category of the OfS’s register. It is funded by government, via the OfS, in a way that is consistent with the approach the OfS takes to other such providers, including those in London. While the Secretary of State for Education issues strategic guidance to the OfS, including its funding priorities, the OfS is ultimately responsible for funding decisions. The OfS is planning to review its funding method, including for specialist providers, and will consult on those changes in due course.

We do not have any plans to review the remit of the OfS in relation to their funding powers.

Birmingham City University, of which The Royal Birmingham Conservatoire is a part, is registered with the Office for Students (OfS) in the approved (fee cap) category of the OfS’s register. It is funded by government, via the OfS, in a way that is consistent with the approach the OfS takes to other such providers, including those in London. While the Secretary of State for Education issues strategic guidance to the OfS, including its funding priorities, the OfS is ultimately responsible for funding decisions. The OfS is planning to review its funding method, including for specialist providers, and will consult on those changes in due course.

We do not have any plans to review the remit of the OfS in relation to their funding powers.

Securing further improvement in the quality of the children’s social care system is a priority. We welcome the contribution both of these reports make to these efforts. Whilst local authorities are responsible for the deployment of child and family social workers, the government is continuing to invest in practice improvement. This includes our £84 million investment in the Strengthening Families, Protecting Children programme; and securing better research and evidence about practice and the social work workforce such as through the What Works for Children’s Social Care. Our large-scale longitudinal study of child and family social workers will provide significant insights into the experience of child and family social workers and will help both the government and employers identify priorities for action.

Securing further improvement in the quality of the children’s social care system is a priority. We welcome the contribution both of these reports make to these efforts. Whilst local authorities are responsible for the deployment of child and family social workers, the government is continuing to invest in practice improvement. This includes our £84 million investment in the Strengthening Families, Protecting Children programme; and securing better research and evidence about practice and the social work workforce such as through the What Works for Children’s Social Care. Our large-scale longitudinal study of child and family social workers will provide significant insights into the experience of child and family social workers and will help both the government and employers identify priorities for action.

The following table shows the number of cases notified in each of the previous five years under NHS Resolution’s clinical negligence indemnity schemes. This data excludes those cases falling under the Existing Liabilities Scheme for General Practice as this scheme mainly covers inherited liabilities.

Information on the number of cases in each category which then lead to a compensation payment is not held in the format requested and could only be obtained at disproportionate cost.

Official statistics on National Health Service referral to treatment (RTT) waiting times published by NHS England and NHS Improvement show there were 304,044 patients waiting one year or more for treatment in England in January 2021. Tables showing the number of patients in each sustainability and transformation partnership and acute trust who have waited in excess of 52 weeks is attached due to the size of the data. Information for integrated care system areas is not held in the format requested. The information relating to other time periods is not held in the format requested.

NHS England and NHS Improvement will be including this data as part of their official published RTT monthly data collection for 2021-22. This will show the number of patients

waiting for over a year into weekly time bands, from 52-53 weeks to more than 104 weeks. This information will become available from June 2021.

Official statistics on National Health Service referral to treatment (RTT) waiting times published by NHS England and NHS Improvement show there were 304,044 patients waiting one year or more for treatment in England in January 2021. Tables showing the number of patients in each sustainability and transformation partnership and acute trust who have waited in excess of 52 weeks is attached due to the size of the data. Information for integrated care system areas is not held in the format requested. The information relating to other time periods is not held in the format requested.

NHS England and NHS Improvement will be including this data as part of their official published RTT monthly data collection for 2021-22. This will show the number of patients

waiting for over a year into weekly time bands, from 52-53 weeks to more than 104 weeks. This information will become available from June 2021.

Official statistics on National Health Service referral to treatment (RTT) waiting times published by NHS England and NHS Improvement show there were 304,044 patients waiting one year or more for treatment in England in January 2021. Tables showing the number of patients in each sustainability and transformation partnership and acute trust who have waited in excess of 52 weeks is attached due to the size of the data. Information for integrated care system areas is not held in the format requested. The information relating to other time periods is not held in the format requested.

NHS England and NHS Improvement will be including this data as part of their official published RTT monthly data collection for 2021-22. This will show the number of patients

waiting for over a year into weekly time bands, from 52-53 weeks to more than 104 weeks. This information will become available from June 2021.

The Healthcare Safety Investigation Branch (HSIB) can investigate individual safety concerns in care homes if the patient’s care is National Health Service-funded and the referral meets their investigation criteria.

The Care Quality Commission (CQC) monitors, inspects and regulate services to ensure they meet fundamental standards of quality and safety, while the local authority takes the lead in safeguarding cases. As part of this, the CQC inspects and rates residential care homes and nursing homes, which includes assessing how safe care homes are and taking action to protect people from harm and to hold those responsible for poor care to account. There are cases where both agencies may be involved. Complaints can also be investigated by the Health and Safety Executive, Health Service Ombudsman or Local Government Ombudsman.

The Healthcare Safety Investigation Branch (HSIB) conducts independent investigations of patient safety concerns in National Health Service-funded care across England. Currently, it can investigate patient safety concerns in care homes if the patient’s care is NHS-funded and meets the HSIB’s criteria for its national investigations. There are also plans in place to amend the NHS Health and Care Bill to extend the HSIB’s remit to identify and address patient safety risks in the provision of NHS services and other healthcare services in England.

The Public Contract Regulations (PCR) 2015 form part of the procurement landscape alongside the NHS (Procurement, Patient Choice and Competition) (No.2) Regulations 2013 (PPCCR). Made under Section 75 of the Health and Social Care Act 2012, the PPCCR apply to NHS England and NHS Improvement and clinical commissioning groups and are enforced by NHS England and NHS Improvement. Commissioners should ensure that they comply with both regimes when procuring healthcare services.

Regulation 68 of the PCR allows contracting authorities to determine the most economically advantageous tender and the lowest cost by using a life-cycle costing approach which includes all costs over the life cycle of works, supplies or services. Life-cycle costing is the key principle behind value based procurement. NHS Supply Chain has undertaken eight pilot studies with National Health Service trusts to assess how value based procurement can drive sustainable increased savings and improve patient outcomes in the NHS. The findings will be published later in the year and will then then be presented to and discussed with the NHS.

The infection prevention and control (IPC) principles within the current guidance apply to healthcare staff in all healthcare settings, but do not apply to adult social care settings in England. The relevant guidance for workers in adult social care is the ‘How to Work Safely’ guidance documents, which must be followed to minimise the risk of transmission.

The evidence base and core principles informing the IPC guidance are the same as those that inform the 'How to Work Safely’ guidance for adult social care. The difference being in the implementation stage, where the many distinct adult social care settings require balanced risk assessments to be undertaken.

Copies of the guidances Personal protective equipment (PPE) – resource for care workers delivering homecare (domiciliary care) during sustained COVID-19 transmission in the UK and Personal protective equipment (PPE) – resource for care workers working in care homes during sustained COVID-19 transmission in England are attached.

The National Health Service is currently consulting on the proposal for a new provider selection regime. The new regime is intended to provide significantly more flexibility to make decisions about arranging health care services in a streamlined way, including without competitive tendering, where this can be shown to be in the best interests of patients, taxpayers and the population. The new regime will be supported by regulations and statutory guidance, which will be informed by the results of the consultation. All other procurement will continue to be subject to Cabinet Office procurement processes.

The Department has made no such comparison or assessment. All United Kingdom marketing authorisation holders of liothyronine are obliged to ensure that the product complies with the minimum standard as specified in the British Pharmacopoeia monograph for liothyronine tablets. Liothyronine on the market in European Union Member States may not comply with the updated British Pharmacopoeia monograph and therefore would not be considered therapeutically equivalent. Therefore, price comparisons would not be ‘like for like’.

In the UK, several marketing authorisations have been granted for liothyronine since 2016 and the reimbursement price has slowly been reducing as a direct response to more competition in the market.

Following extensive engagement with front line staff, NHS England and NHS Improvement recently issued a suite of online products to support excellence in infection prevention and control measures. These products propose actions to tackle fatigue, including creating a culture of kindness and support, an environment which allows staff to speak up and a focus on changing behaviours in non-clinical areas, where staff have been found to be at greater risk of contracting COVID-19.

The National Health Service has put in place a national health and wellbeing offer, which will be maintained during 2021/22 and includes access to a confidential helpline and text service, a range of apps and an online portal of guidance and materials. The content of this offer will continue to be refreshed, based on staff feedback, usage rates and evidence of outcomes.

In November 2020, funding of £15 million was announced to establish 40 mental health and wellbeing hubs nationally. Twenty-two hubs are now active with the remaining due to mobilise by spring 2021. The NHS People Plan also puts health and wellbeing at its core. This includes a new wellbeing guardian role which will ensure board level scrutiny of health and wellbeing support for staff; continued support for staff to get to work and free car parking; a focus on healthy working environments and safe spaces for staff to rest and recuperate; and support to take breaks and annual leave.

Following extensive engagement with front line staff, NHS England and NHS Improvement recently issued a suite of online products to support excellence in infection prevention and control measures. These products propose actions to tackle fatigue, including creating a culture of kindness and support, an environment which allows staff to speak up and a focus on changing behaviours in non-clinical areas, where staff have been found to be at greater risk of contracting COVID-19.

The National Health Service has put in place a national health and wellbeing offer, which will be maintained during 2021/22 and includes access to a confidential helpline and text service, a range of apps and an online portal of guidance and materials. The content of this offer will continue to be refreshed, based on staff feedback, usage rates and evidence of outcomes.

In November 2020, funding of £15 million was announced to establish 40 mental health and wellbeing hubs nationally. Twenty-two hubs are now active with the remaining due to mobilise by spring 2021. The NHS People Plan also puts health and wellbeing at its core. This includes a new wellbeing guardian role which will ensure board level scrutiny of health and wellbeing support for staff; continued support for staff to get to work and free car parking; a focus on healthy working environments and safe spaces for staff to rest and recuperate; and support to take breaks and annual leave.

A comprehensive package of health and wellbeing services are in place for National Health Service staff, including helplines for counselling and support and free access to well-being apps. An extra £30 million has been invested in enhanced mental and occupational health support services and mental health hubs offering outreach and assessment services to help frontline staff receive rapid access to evidence based mental health services.

No such intervention has taken place. Several marketing authorisations have been granted for liothyronine since 2016 and the reimbursement price has been reducing as a direct response to more competition in the market.

We will work with partners to develop a transparent process to co-ordinate the development, dissemination and implementation of national guidance across the healthcare system to minimise the risk of nosocomial transmission of COVID-19. This includes agreeing roles and responsibilities, a clear process and timescales with NHS England and NHS Improvement, Public Health England and other system partners for infection prevention and control guidance development or review at a national and system level.

Individual National Health Service organisations are responsible for implementing infection prevention and control measures in line with Public Health England’s national infection prevention and control (IPC) guidance to minimise in-hospital transmission of COVID-19 and support patient safety. The actions each organisation undertakes to meet the national IPC guidance must take into account the design of their estate and interactions between staff in both clinical and non-clinical areas.

NHS England and NHS Improvement’s ten key actions for boards on IPC and testing published on 17 November and revised on 23 December, emphasises the importance of organisations ensuring that their staff practise good hygiene, maintain social distancing, avoid car sharing, wear appropriate personal protective equipment at work including face masks in non-clinical settings and minimise movement between COVID-19 and non-COVID-19 areas. A copy of these actions is attached.

Individual National Health Service organisations are responsible for implementing infection prevention and control measures in line with Public Health England’s national infection prevention and control (IPC) guidance to minimise in-hospital transmission of COVID-19 and support patient safety. The actions each organisation undertakes to meet the national IPC guidance must take into account the design of their estate and interactions between staff in both clinical and non-clinical areas.

NHS England and NHS Improvement’s ten key actions for boards on IPC and testing published on 17 November and revised on 23 December, emphasises the importance of organisations ensuring that their staff practise good hygiene, maintain social distancing, avoid car sharing, wear appropriate personal protective equipment at work including face masks in non-clinical settings and minimise movement between COVID-19 and non-COVID-19 areas. A copy of these actions is attached.

The current National Health Service infection prevention control principles recommend healthcare settings undertake a series of interventions to reduce the risk of transmission of infection, including on cleaning and decontamination of the environment and shared equipment and on ventilation.

In addition, the Health Technical Memorandum (HTM) 03-01: Specialised ventilation for healthcare premises is currently being updated and is going through final draft review and approval processes as is normal for all technical guidance. HTMs give comprehensive advice and guidance on the design, installation and operation of specialised building and engineering technology used in the delivery of healthcare.

The Department has worked closely with system partners to give careful consideration to the recommendations made and have accepted those recommendations that have been directed at the Department. Detailed actions outlining how the Department intends to implement the recommendations, are set out in our response to the report which is expected to be published by the Healthcare Safety Investigation Branch in due course.

The High Court ruling of 1 December 2020 is subject to ongoing legal proceedings and as such we are unable to comment.

The Care Quality Commission (CQC) shared the report on Tavistock and Portman NHS Foundation Trust Gender Identity Services (GIDS) with the Department prior to publication. The Department welcomes the report and is aware that the CQC will follow its normal process of monitoring and further inspection activity to further review the GIDS.

The CQC continues engagement with NHS England and NHS Improvement on their independent review of gender services for children and young people, led by Dr Hillary Cass on how care can be enhanced. The review will report later in the year. This report will cover issues such as how and when young people are referred to specialist services, clinical decisions around how doctors and healthcare professionals support and care for patients with gender dysphoria.

Liothyronine is an unbranded generic medicine. The Department relies on competition between suppliers of unbranded generic medicines to keep prices down. Concerns about potential drug pricing abuses are a matter for the Competition and Markets Authority (CMA). With regards to liothyronine, in 2016 the CMA opened its investigation into allegations that the National Health Service was charged excessive and unfair prices for liothyronine by Advanz. In July 2020 it issued a supplementary statement of objections stating that the CMA continues provisionally to find that Advanz breached United Kingdom and European Union competition law from at least 1 January 2009 to at least 31 July 2017 by charging excessive and unfair prices for liothyronine in the UK.

Liothyronine was previously a single source generic product. However, several marketing authorisations have been granted for liothyronine since 2016 and the reimbursement price has slowly been reducing as a direct response to more competition in the market.

The High Court ruling of 1 December 2020 is subject to ongoing legal proceedings and as such we are unable to comment.

The Care Quality Commission (CQC) shared the report on Tavistock and Portman NHS Foundation Trust Gender Identity Services (GIDS) with the Department prior to publication. The Department welcomes the report and is aware that the CQC will follow its normal process of monitoring and further inspection activity to further review the GIDS.

The CQC continues engagement with NHS England and NHS Improvement on their independent review of gender services for children and young people, led by Dr Hillary Cass on how care can be enhanced. The review will report later in the year. This report will cover issues such as how and when young people are referred to specialist services, clinical decisions around how doctors and healthcare professionals support and care for patients with gender dysphoria.

The High Court ruling of 1 December 2020 is subject to ongoing legal proceedings and as such we are unable to comment.

The Care Quality Commission (CQC) shared the report on Tavistock and Portman NHS Foundation Trust Gender Identity Services (GIDS) with the Department prior to publication. The Department welcomes the report and is aware that the CQC will follow its normal process of monitoring and further inspection activity to further review the GIDS.

The CQC continues engagement with NHS England and NHS Improvement on their independent review of gender services for children and young people, led by Dr Hillary Cass on how care can be enhanced. The review will report later in the year. This report will cover issues such as how and when young people are referred to specialist services, clinical decisions around how doctors and healthcare professionals support and care for patients with gender dysphoria.

The High Court ruling of 1 December 2020 is subject to ongoing legal proceedings and as such we are unable to comment.

The Care Quality Commission (CQC) shared the report on Tavistock and Portman NHS Foundation Trust Gender Identity Services (GIDS) with the Department prior to publication. The Department welcomes the report and is aware that the CQC will follow its normal process of monitoring and further inspection activity to further review the GIDS.

The CQC continues engagement with NHS England and NHS Improvement on their independent review of gender services for children and young people, led by Dr Hillary Cass on how care can be enhanced. The review will report later in the year. This report will cover issues such as how and when young people are referred to specialist services, clinical decisions around how doctors and healthcare professionals support and care for patients with gender dysphoria.

NHS England and NHS Improvement have published a range of online only guidance and resources to support healthcare professionals, carers and those less accustomed to providing end of life care in a variety of settings including in-home care.

In addition, local areas provide access to medication and equipment, direct and specialist support, and education and training for care home staff. Supporting this, NHS England and NHS Improvement have also supplied pulse oximeters and iPads to care homes to enable them to connect better with general practice.

NHS England and NHS Improvement collect and publish data relating to the numbers of patients diagnosed in the community with COVID-19 and subsequently admitted to hospital or admitted to hospital and diagnosed with COVID-19 within eight days of admission. However, due to the incubation period of the virus and local differences in application of testing protocols, it is not possible to definitively determine how many of these patients contracted the virus whilst in hospital.

The information is not held in the format requested.

The Department is still assuring the information that local authorities have provided on the final expenditure against the initial fund, which ran from May to September 2020. However, on 27 July, we published data that shows that 18.7% of the funding spent by 23 July was allocated to paying staff to self-isolate following a positive COVID-19 diagnosis, totalling over £47 million.

NHS Resolution has continued to increase the use of mediation and alternative dispute resolution to avoid the need for formal proceedings. NHS Resolution settles a majority of claims without court proceedings - in 2019/20, this was 75.1%. Less than 1% of all claims proceed to trial and NHS Resolution achieves a judgement in favour of the National Health Service in 75.3% of that subset of claims. NHS Resolution also negotiates large-scale contracts for its legal services, including fixed and capped fee arrangements, competitive hourly rates and performance management, ensuring value for money and a high quality service.

The board of the Tavistock and Portman NHS Foundation Trust will meet to formally agree a remedial plan that responds to the various concerns. In the interim, the Chief Executive of the Trust has publicly acknowledged the need for improvements in the service and has announced plans for bringing in senior clinical expertise from outside the service to help implement change.

This information is not held centrally.

In 2016, the Care Quality Commission (CQC) reviewed capacity and consent for young people during its inspection across the variety services provided by the Tavistock and Portman NHS Foundation Trust. To sufficiently assess capacity and consent for puberty-blocking treatment, a specific assessment by the CQC was required to identify practices at Tavistock and Portman NHS Foundation Trust, University College London Hospitals, and Leeds General Infirmary. This took place between September and November 2020 in response to concerns identified by the CQC and the subsequent reports will be published in due course.

From early 2019, the CQC has been monitoring the Trust’s action plan which includes capacity and consent for puberty-blocking treatment and has requested specific information from the trust on this topic.

NHS England is the responsible commissioner for the Gender Identity Development Service (GIDS). In response to the recent High Court ruling regarding treatment pathways at the GIDS, NHS England is considering the future data reporting requirements for the service. These considerations will also be informed by the planned publication of a report by the Care Quality Commission following its inspection of the GIDS in November 2020.

NHS England is the responsible commissioner for the Gender Identity Development Service (GIDS). In response to the recent High Court ruling regarding treatment pathways at the GIDS, NHS England is considering the future data reporting requirements for the service. These considerations will also be informed by the planned publication of a report by the Care Quality Commission following its inspection of the GIDS in November 2020.

NHS England is the responsible commissioner for the Gender Identity Development Service (GIDS). In response to the recent High Court ruling regarding treatment pathways at the GIDS, NHS England is considering the future data reporting requirements for the service. These considerations will also be informed by the planned publication of a report by the Care Quality Commission following its inspection of the GIDS in November 2020.

The pre-print of the outcome of a research study titled Short-term Outcomes of Pubertal Suppression in Selected Cohort of 12-15 Year Old Young People with Persistent Gender Dysphoria in the UK was published in December 2020. The final peer-reviewed version of the study is planned for publication during 2021.

An increase in wounds in younger patients is likely to be related to an increase in the prevalence of co-morbidities in a younger population, as chronic wounds are usually due to co-morbidities that affect wound healing, such as patients with diabetes, arterial disease and venous disease.

NHS England and NHS Improvement fund the National Wound Care Strategy Programme which is developing a number of quality improvement initiatives to prevent wounds and improve wound healing. NHS England and NHS Improvement also continue to prioritise diabetes prevention, including through The NHS Long Term Plan, which commits to fund a doubling of the NHS Diabetes Prevention Programme over the next five years, including a new digital option to widen patient choice and target inequality. Preventing diabetes and other co-morbidities is key to reducing the prevalence of wounds in adults.

NHS Resolution negotiates large-scale contracts for legal services, using its position as a bulk purchaser to obtain the best expertise, including some of the recognised leaders in their field. The contracts include fixed and capped fee arrangements and competitive hourly rates, ensuring value for money. NHS Resolution manages their legal panel through service level agreements, which ensures a high quality of service is provided to the National Health Service. Most claims are settled without court proceedings or going to trial. Less than 1% of claims proceed to trial and in the majority of those claims, 75.3%, NHS Resolution successfully achieves a judgement in favour of the NHS.

The National Wound Care Strategy Programme (NWCSP) was commissioned by NHS England and NHS Improvement and launched in September 2018 to scope the development of a wound care national strategy for England that focuses on improving care relating to pressure ulcers, lower limb ulcers and surgical wounds. It addresses unwarranted variation in United Kingdom wound care services by proposing a move towards clinical pathways that flow across different provider organisations to better meet the needs of patients.

This will improve patient care through quicker diagnosis and access to appropriate treatment, leading to improved healing rates and reduced recurrence rates. Better healing and reduced recurrence will reduce overall prevalence of wounds, patient suffering, expenditure on inappropriate and ineffective treatments and the amount of clinical time spent on wound care. This will reduce the overall annual cost of wound care to the National Health Service. In the last 12 months, the NWCSP has audited the quality of care in secondary care pressure ulcer patients and published lower limb recommendations alongside a case for implementation. The surgical wounds recommendations have been finalised and are being published ahead of the implementation strategy. In 2021 the NWCSP will move into implementation while continuing to develop the resources and evidence to support this work.

The National Wound Care Strategy Programme (NWCSP) was commissioned by NHS England and NHS Improvement and launched in September 2018 to scope the development of a wound care national strategy for England that focuses on improving care relating to pressure ulcers, lower limb ulcers and surgical wounds. It addresses unwarranted variation in United Kingdom wound care services by proposing a move towards clinical pathways that flow across different provider organisations to better meet the needs of patients.

This will improve patient care through quicker diagnosis and access to appropriate treatment, leading to improved healing rates and reduced recurrence rates. Better healing and reduced recurrence will reduce overall prevalence of wounds, patient suffering, expenditure on inappropriate and ineffective treatments and the amount of clinical time spent on wound care. This will reduce the overall annual cost of wound care to the National Health Service. In the last 12 months, the NWCSP has audited the quality of care in secondary care pressure ulcer patients and published lower limb recommendations alongside a case for implementation. The surgical wounds recommendations have been finalised and are being published ahead of the implementation strategy. In 2021 the NWCSP will move into implementation while continuing to develop the resources and evidence to support this work.

The National Wound Care Strategy Programme (NWCSP) was commissioned by NHS England and NHS Improvement and launched in September 2018 to scope the development of a wound care national strategy for England that focuses on improving care relating to pressure ulcers, lower limb ulcers and surgical wounds. It addresses unwarranted variation in United Kingdom wound care services by proposing a move towards clinical pathways that flow across different provider organisations to better meet the needs of patients.

This will improve patient care through quicker diagnosis and access to appropriate treatment, leading to improved healing rates and reduced recurrence rates. Better healing and reduced recurrence will reduce overall prevalence of wounds, patient suffering, expenditure on inappropriate and ineffective treatments and the amount of clinical time spent on wound care. This will reduce the overall annual cost of wound care to the National Health Service. In the last 12 months, the NWCSP has audited the quality of care in secondary care pressure ulcer patients and published lower limb recommendations alongside a case for implementation. The surgical wounds recommendations have been finalised and are being published ahead of the implementation strategy. In 2021 the NWCSP will move into implementation while continuing to develop the resources and evidence to support this work.

Following its inspection of Tavistock and Portman NHS Foundation Trust’s specialist community mental health services for children and young people in January 2016, the Care Quality Commission (CQC) rated the core service as good. All CQC reports undergo a robust internal quality assurance process, as well as factual accuracy checks by the provider. In addition to this, the CQC’s ratings review team will consider any challenges from providers in regard to published ratings.

As part of the CQC's regulatory model, the CQC monitors providers on an ongoing basis. This activity helps the CQC to understand which services are progressing well and which are not and informs decisions about which core services are inspected and how frequently. The CQC have undertaken monitoring activity with Tavistock and Portman NHS Foundation Trust since the 2016 inspection.

The Department is working intensively with the Ministry of Justice, other Government departments and NHS Resolution to address the costs of clinical negligence claims. We will publish a consultation on the next steps in 2021.

The Department has no plans to implement the NHS Redress Act 2006 and has not made a recent assessment of the effectiveness of the Act in resolving clinical negligence claims.

The Department is working intensively with the Ministry of Justice, other Government departments and NHS Resolution to address the costs of clinical negligence claims. We will publish a consultation on the next steps in 2021.

The Department has no plans to implement the NHS Redress Act 2006 and has not made a recent assessment of the effectiveness of the Act in resolving clinical negligence claims.

Following the most recent published inspection of Tavistock and Portman NHS Foundation Trust between August and September 2018, the Care Quality Commission (CQC) rated specialist community mental health services for children and young people as good overall, but found that there was still some room for improvement to ensure that each young person had an up-to-date recorded risk assessment.

The CQC also highlighted in their inspection report that some staff also needed to complete mandatory training on clinical risk assessment. These risks were included in the action plan issued to the trust by the CQC, which highlighted where improvement was required.

The Tavistock and Portman NHS Foundation Trust is primarily a psycho-social service that focuses on enabling the young person to choose the path which best suits their needs.

In September 2020, NHS England and NHS Improvement, who commission the service, announced that Dr Hilary Cass will lead an independent review into gender identity services for children and young people.

The review will be wide-ranging in scope looking into several aspects of gender identity services, with a focus on how care can be improved for children and young people including key aspects of care such as how and when they are referred to specialist services, and clinical decisions around how doctors and healthcare professionals support and care for patients with gender dysphoria.

The independent review will present recommendations to NHS England and NHS Improvement’s Quality and Innovation Committee.

The board of the Tavistock and Portman NHS Foundation Trust will meet to formally agree a remedial plan that responds to the various concerns. In the interim, the Chief Executive of the Trust has publicly acknowledged the need for improvements in the service and has announced plans for bringing in senior clinical expertise from outside the service to help implement change.

NHS England and NHS Improvement have recently updated their specialised commissioning service specification for managing difficult and severe asthma. A copy of the service specification is attached.

Strict regulatory controls govern medicinal products for human use including their manufacture, distribution, retail sale and supply and advertisement.

Prescription-only medicines cannot be advertised direct to the public and an advertisement offering to sell or supply a prescription-only medicines directly to a patient would be likely to contravene the requirements of the Human Medicines Regulations 2012.

Any report of non-compliant activity relating the advertising of a POM would be investigated by the Medicines and Healthcare products Regulatory Agency and necessary action would be taken.

Ensuring patients have access to the medicines they need is vital. The Department brought this matter to the attention of the Competition and Markets Authority (CMA) who opened an investigation.

Essential Pharma has now agreed to continue supplying Priadel to the National Health Service and we have agreed revised prices with the company. This means patients can continue to access this important treatment as normal without the need for widespread systematic switching. The CMA has received a proposed commitment from Essential Pharma that it will continue to supply Priadel for a minimum of five years, thereby securing the long-term availability of this crucial medicine.

We continue to communicate the most up to date information with the NHS, including general practices and mental health trusts and further updates are expected to be issued shortly. As supplies of Priadel remained available no central helpline was considered.

Ensuring patients have access to the medicines they need is vital. The Department brought this matter to the attention of the Competition and Markets Authority (CMA) who opened an investigation.

Essential Pharma has now agreed to continue supplying Priadel to the National Health Service and we have agreed revised prices with the company. This means patients can continue to access this important treatment as normal without the need for widespread systematic switching. The CMA has received a proposed commitment from Essential Pharma that it will continue to supply Priadel for a minimum of five years, thereby securing the long-term availability of this crucial medicine.

We continue to communicate the most up to date information with the NHS, including general practices and mental health trusts and further updates are expected to be issued shortly. As supplies of Priadel remained available no central helpline was considered.

Ensuring patients have access to the medicines they need is vital. The Department brought this matter to the attention of the Competition and Markets Authority (CMA) who opened an investigation.

Essential Pharma has now agreed to continue supplying Priadel to the National Health Service and we have agreed revised prices with the company. This means patients can continue to access this important treatment as normal without the need for widespread systematic switching. The CMA has received a proposed commitment from Essential Pharma that it will continue to supply Priadel for a minimum of five years, thereby securing the long-term availability of this crucial medicine.

We continue to communicate the most up to date information with the NHS, including general practices and mental health trusts and further updates are expected to be issued shortly. As supplies of Priadel remained available no central helpline was considered.

Ensuring patients have access to the medicines they need is vital. The Department brought this matter to the attention of the Competition and Markets Authority (CMA) who opened an investigation.

Essential Pharma has now agreed to continue supplying Priadel to the National Health Service and we have agreed revised prices with the company. This means patients can continue to access this important treatment as normal without the need for widespread systematic switching. The CMA has received a proposed commitment from Essential Pharma that it will continue to supply Priadel for a minimum of five years, thereby securing the long-term availability of this crucial medicine.

We continue to communicate the most up to date information with the NHS, including general practices and mental health trusts and further updates are expected to be issued shortly. As supplies of Priadel remained available no central helpline was considered.

NHS Resolution negotiates large-scale contracts for defendant legal services, using its position as a bulk purchaser to obtain the best expertise, including support for NHS Resolution’s work to learn from claims to improve safety, at value for money for the National Health Service. The contracts include fixed and capped fee arrangements and competitive hourly rates.

In response to increases in claimant legal costs and their tendency in low-value claims to be disproportionally high relative to damages awarded, we will consult shortly on a new claims-handling process and fixed costs for clinical negligence claims of up to £25,000 drawing on the Civil Justice Council’s recommendations published in October 2019.

No specific assessment or plans have been made.

No specific assessment or plans have been made.

The National Institute for Health Research (NIHR) is helping researchers develop high-quality research proposals in this scientifically challenging area. To encourage such proposals, in April 2018 we called on the research community specifically for brain tumour research funding applications. There was an immediate increase in proposals which continue to be assessed by review panels of scientific experts and involving patients and public. We are relying on researchers to submit research proposals in this difficult area of research, with a number of research applications currently under consideration. The NIHR system uses a gold standard of peer review, essential in identifying and funding only those research proposals that are of high quality. An assessment of the success rate of applications to the NIHR on brain tumour research compared to all other areas grouped together reveals little difference.

The NIHR is also working with the Tessa Jowell Brain Cancer Mission towards funding a workshop for researchers to support them in submitting higher quality research. Additionally, through the Less Survivable Cancers Taskforce, the NIHR is working closely with NHS England, NHS Improvement and the National Cancer Research Institute to consider ways of increasing the number of high-quality research applications.

The National Institute for Health Research (NIHR) is helping researchers develop high-quality research proposals in this scientifically challenging area. To encourage such proposals, in April 2018 we called on the research community specifically for brain tumour research funding applications. There was an immediate increase in proposals which continue to be assessed by review panels of scientific experts and involving patients and public. We are relying on researchers to submit research proposals in this difficult area of research, with a number of research applications currently under consideration. The NIHR system uses a gold standard of peer review, essential in identifying and funding only those research proposals that are of high quality. An assessment of the success rate of applications to the NIHR on brain tumour research compared to all other areas grouped together reveals little difference.

The NIHR is also working with the Tessa Jowell Brain Cancer Mission towards funding a workshop for researchers to support them in submitting higher quality research. Additionally, through the Less Survivable Cancers Taskforce, the NIHR is working closely with NHS England, NHS Improvement and the National Cancer Research Institute to consider ways of increasing the number of high-quality research applications.

The National Institute for Health Research (NIHR) is helping researchers develop high-quality research proposals in this scientifically challenging area. To encourage such proposals, in April 2018 we called on the research community specifically for brain tumour research funding applications. There was an immediate increase in proposals which continue to be assessed by review panels of scientific experts and involving patients and public. We are relying on researchers to submit research proposals in this difficult area of research, with a number of research applications currently under consideration. The NIHR system uses a gold standard of peer review, essential in identifying and funding only those research proposals that are of high quality. An assessment of the success rate of applications to the NIHR on brain tumour research compared to all other areas grouped together reveals little difference.

The NIHR is also working with the Tessa Jowell Brain Cancer Mission towards funding a workshop for researchers to support them in submitting higher quality research. Additionally, through the Less Survivable Cancers Taskforce, the NIHR is working closely with NHS England, NHS Improvement and the National Cancer Research Institute to consider ways of increasing the number of high-quality research applications.

Decisions about surgical funding are made by clinical experts and therefore it would not be appropriate for Government to intervene.

Surgical treatment for individuals can be considered for pectus deformity if a clinician believes that a treatment or service, not routinely offered by the National Health Service, is the best treatment for their patient. In this case the clinician can, on behalf of their patient, make an individual funding request which takes into account individual clinical circumstances - for example, exceptional circumstances either in terms of clinical presentation or the ability of a patient to benefit.

NHS England has not issued any clinical guidance to doctors to assess the severity of pectus deformity or on the non-surgical options for pectus deformity treatment.

Decisions about surgical funding are made by clinical experts and therefore it would not be appropriate for Government to intervene.

Surgical treatment for individuals can be considered for pectus deformity if a clinician believes that a treatment or service, not routinely offered by the National Health Service, is the best treatment for their patient. In this case the clinician can, on behalf of their patient, make an individual funding request which takes into account individual clinical circumstances - for example, exceptional circumstances either in terms of clinical presentation or the ability of a patient to benefit.

NHS England has not issued any clinical guidance to doctors to assess the severity of pectus deformity or on the non-surgical options for pectus deformity treatment.

Any decision to fund surgery and make commissioning decisions by assessing needs, planning and prioritising is a matter for NHS England and NHS Improvement. It would therefore not be appropriate for the Government to influence their ‘Commissioning through Evaluation’ programme, which enables new clinical patient data to be collected for treatments that show significant promise.

NHS England and NHS Improvement advise that if new evidence on the surgical treatment for pectus deformity is presented, their current policy can be reviewed.

Health is a devolved matter in the United Kingdom and each of the devolved administrations has established its own systems and processes for determining which at and how healthcare services will be available. In England, specialised services and treatments are the responsibility of NHS England and NHS Improvement and decisions are made in accordance with their published processes.

NHS England and NHS Improvement’s position on surgery for pectus deformity is set out in their clinical commissioning policy from February 2019. Their conclusion is that there is not enough evidence to routinely commission the intervention, although this policy will be reviewed when warranted by the receipt of new information.

National Health Service providers have worked hard to recover as much elective activity as possible whilst preparing for winter, making full use of available capacity. The Prime Minister has announced £3 billion of extra funding to support the NHS this winter and this includes ensuring the retention of the Nightingale hospital surge capacity and continued access to independent hospitals capacity to help meet patient demand. Essential care should only be postponed if a clinician and patient agree it is in the patient’s best interest.

Supporting the NHS workforce is crucially important and testing of staff remains a top priority. All NHS staff are eligible for priority testing for COVID-19, access is provided through pillar 1 testing and there is capacity within trusts to ensure staff can get tested.

To support the wider wellbeing of NHS staff the NHS People Plan published in July sets out our vision and immediate actions to make the NHS the best place to work, where our NHS people are valued and supported.

NHS England and NHS Improvement published a clinical commissioning policy in February 2019 about surgical treatment for patients with physical complications arising from pectus deformity. Following a review of clinical practice and options for treatment, they determined that there is insufficient evidence to routinely commission a surgical intervention. However, this policy states that if new evidence is presented, the position can be reviewed.

It is right that decisions about either further research required or surgical funding are made by clinical experts. The position for commissioning surgery for individuals is for clinicians to make an individual funding request where they feel it is clinically appropriate - for example because of exceptional circumstances in terms of either clinical presentation or the ability of a patient to benefit.

NHS England and NHS Improvement published a clinical commissioning policy in February 2019 about surgical treatment for patients with physical complications arising from pectus deformity. Following a review of clinical practice and options for treatment, they determined that there is insufficient evidence to routinely commission a surgical intervention. However, this policy states that if new evidence is presented, the position can be reviewed.

It is right that decisions about either further research required or surgical funding are made by clinical experts. The position for commissioning surgery for individuals is for clinicians to make an individual funding request where they feel it is clinically appropriate - for example because of exceptional circumstances in terms of either clinical presentation or the ability of a patient to benefit.

The Care Quality Commission (CQC) have used the word ‘gender’ instead of ‘sex’ in their Equality, Diversity and Human Rights Policy and Principles of Workforce Equality Monitoring since these documents were introduced in 2011. These documents were reviewed by the CQC’s Staff Equality Networks and approved by the CQC’s Joint Negotiating and Consultation Committee, including trade union representatives and senior CQC managers, alongside external, national union officers, and were signed-off by the CQC Board at that time.

The CQC complete Equality Impact Assessments for new Human Resources policies, but this use of wording did not arise as an issue of concern at the time, has not been subject to a specific assessment and was not the subject of legal advice at the time. Government Legal Services have now reviewed our use of the word gender in these documents and confirmed that this meets the requirements of the Equality Act 2010.

The CQC are committed to equality and human rights throughout their work, and this approach underpins the way in which they register and inspect services. The decision has no impact on the CQC’s ability to ensure that health and social care services provide people with safe, effective, compassionate, high-quality care.

The Care Quality Commission (CQC) have used the word ‘gender’ instead of ‘sex’ in their Equality, Diversity and Human Rights Policy and Principles of Workforce Equality Monitoring since these documents were introduced in 2011. These documents were reviewed by the CQC’s Staff Equality Networks and approved by the CQC’s Joint Negotiating and Consultation Committee, including trade union representatives and senior CQC managers, alongside external, national union officers, and were signed-off by the CQC Board at that time.

The CQC complete Equality Impact Assessments for new Human Resources policies, but this use of wording did not arise as an issue of concern at the time, has not been subject to a specific assessment and was not the subject of legal advice at the time. Government Legal Services have now reviewed our use of the word gender in these documents and confirmed that this meets the requirements of the Equality Act 2010.

The CQC are committed to equality and human rights throughout their work, and this approach underpins the way in which they register and inspect services. The decision has no impact on the CQC’s ability to ensure that health and social care services provide people with safe, effective, compassionate, high-quality care.

The Care Quality Commission (CQC) have used the word ‘gender’ instead of ‘sex’ in their Equality, Diversity and Human Rights Policy and Principles of Workforce Equality Monitoring since these documents were introduced in 2011. These documents were reviewed by the CQC’s Staff Equality Networks and approved by the CQC’s Joint Negotiating and Consultation Committee, including trade union representatives and senior CQC managers, alongside external, national union officers, and were signed-off by the CQC Board at that time.

The CQC complete Equality Impact Assessments for new Human Resources policies, but this use of wording did not arise as an issue of concern at the time, has not been subject to a specific assessment and was not the subject of legal advice at the time. Government Legal Services have now reviewed our use of the word gender in these documents and confirmed that this meets the requirements of the Equality Act 2010.

The CQC are committed to equality and human rights throughout their work, and this approach underpins the way in which they register and inspect services. The decision has no impact on the CQC’s ability to ensure that health and social care services provide people with safe, effective, compassionate, high-quality care.

The NHS England and NHS Improvement online publication Clinical Commissioning Policy relating to surgery for pectus deformity (all ages) sets out the policy position for commissioning surgery for pectus deformity.

NHS England has concluded that there is not sufficient evidence to support the routine commissioning of surgical treatment for pectus deformity.

NHS England is always willing to look at new evidence and, where appropriate, consider revising policy positions. NHS England and NHS Improvement have been working with clinicians and the National Institute for Health Research to identify ways to close the gaps in the current evidence base, for example through formal research.

The NHS England and NHS Improvement online publication Clinical Commissioning Policy relating to surgery for pectus deformity (all ages) sets out the policy position for commissioning surgery for pectus deformity.

NHS England has concluded that there is not sufficient evidence to support the routine commissioning of surgical treatment for pectus deformity.

NHS England is always willing to look at new evidence and, where appropriate, consider revising policy positions. NHS England and NHS Improvement have been working with clinicians and the National Institute for Health Research to identify ways to close the gaps in the current evidence base, for example through formal research.

In 2018 the Government announced £40 million over five years for brain tumour research as part of the Tessa Jowell Brain Cancer Mission through the National Institute for Health Research (NIHR).

The NIHR is taking action to help researchers develop high-quality research proposals in this scientifically challenging area. To encourage such proposals, we released a public announcement to the research community in April 2018, which makes clear our desire to receive brain tumour research funding applications. This led to an immediate increase in proposals, which continues to be assessed by relevant review panels of scientific experts. We are relying on researchers to submit research proposals in this difficult area of research.

Clinical support is ongoing linked to individual treatment plans and children will be seen regularly by specialists. This is to check their progress and how well they are recovering from treatment. It is also to check that they don’t have any long-term problems from treatment.

By 2021, where appropriate every person diagnosed with cancer, including children and young adults, will have access to personalised care, including needs assessment, a care plan and health and wellbeing information and support. This will be delivered in line with the National Health Service Comprehensive Model for Personalised Care. This will empower people and their families to manage their care and the impact of their cancer and maximise the potential of digital and community-based support.

The Department, working with Public Health England and the National Health Service, continue to closely monitor the emerging domestic and international evidence, and keep our policies under continuous review. Throughout the pandemic, it has continued to be our priority to ensure that people are discharged safely from hospital to the most appropriate place and that they receive the care and support they need.

All individuals must be tested, and receive their result, prior to discharge from hospital to a care home. Building on the commitments of the Adult Social Care Winter Plan, we are working with the Care Quality Commission and the NHS to ensure that anyone testing positive is discharged to a designated setting that is assured to be able to provide safe care. No care home should be forced to admit an existing or new resident to the care home if they do not feel they can provide the appropriate care.

The Department has noted the findings from this small observational study and is considering carefully all available evidence around the potential of different drugs for use in treating COVID-19, including from clinical trials in the United Kingdom and overseas.

The COVID-19 Therapeutics Taskforce is responsible for the end-to-end-provision of treatments, from clinical trials to delivery of treatments at scale to the patient population. The taskforce is closely monitoring positive signals from clinical trials to ensure that any products deemed safe and effective in treating COVID-19 can rapidly be brought into wider use across the National Health Service in the UK. The taskforce will continue to monitor lithium carbonate as further trial results become available.

Representatives from Asthma UK and the British Lung Foundation are closely involved in the work on respiratory care within NHS England and NHS Improvement. Alison Cook, Director of External Affairs, Asthma UK and British Lung Foundation Partnership, co-chairs the National Delivery Board for Respiratory Disease and are represented on our expert advisory and working groups. In addition, there are meetings every two weeks to update on communications and relevant projects.

The report, published by Asthma UK and the British Lung Foundation, has been noted by officials. The recommendations within the report are welcomed, as there is currently working on going in these areas.

General practitioners and their teams have played and continue to play a crucial role in our response to the COVID-19 pandemic and in ensuring that people can get the care they need - between March and August 122.8 million appointments took place in general practice.

Available data indicates that there were over 2.5 million online consultations submissions and over 195,000 video consultations. While appointment numbers dipped at the outset of the pandemic, activity has now returned to pre-COVID-19 levels.

The Department welcomes the report by the Faculty of Dental Service of the Royal College of Surgeons. The main recommendations in the report are in line with actions that have already been taken.

National Health Service dental services will remain open and offering face to face care during this new period of increased restrictions. This is in line with the wider drive to ensure as much healthcare as possible remains available during this period.

A dedicated personal protective equipment (PPE) portal has been developed to deliver PPE, needed as a result of the COVID-19 pandemic, free of charge to providers of NHS services, including NHS dental contractors. As of 4 November, over 5,100 NHS dental and orthodontic providers in England have registered with the PPE portal and over 36 million items have been delivered.

The Government has no plans.

Overall, the outcome data shows that maternity and neonatal services are making clear progress to achieve the Maternity Safety Ambition for a 20% reduction in these outcomes by 2020 and a 50% reduction by 2025. Since 2010, there has been a 25% reduction in the stillbirth rate, a 26% reduction in the neonatal mortality rate for babies born over the 24-week gestational age of viability and a 14% reduction in the maternal mortality rate.

According to a definition developed to monitor the ambition, the brain injury rate fell to 5.1 per 1,000 births in 2017, after rising from 4.9 to 5.4 per 1,000 births between 2012 and 2014. The rate of term infants with hypoxic ischaemic encephalopathy fell by 11.8% between 2014 and 2017.

There are no current plans to make Care Quality Commission (CQC) inspectors/staff eligible for regular asymptomatic testing as they do not meet the definition for the pilots that we are rolling out in Northamptonshire, Cambridgeshire and Peterborough.

The definition of those eligible states “‘An individual who visits care homes two or more times each week and where carrying out their role requires them to be within one metre of residents.”

The CQC’s inspectors/staff are not considered eligible for the testing pilot as they do not need to be within one metre of residents to carry out their role.

Our testing policy is based on clinical advice on relative priorities and available testing capacity and our testing policies continue to be reviewed on an ongoing basis.

The Care Quality Commission’s (CQC) mission to keep people safe is always at the heart of its decisions. The CQC has taken the decision not to publish location level death data without context, since this would not provide an assessment of quality or safety of individual homes currently facing an unprecedented challenge. Where the CQC has concerns about quality or safety, it will inspect the service and publish their findings. It has recently written to all adult social care providers to remind them that they have a duty to be transparent and share appropriate information with families about outbreaks and deaths. The CQC is keeping its current position not to disclose provider-level deaths data under review.

We have met our 7 September target - we have provided testing kits to all care homes for older people and people with dementia who have registered for regular retesting kits. We are also contacting the small number of remaining care homes who have not registered to encourage them to do so.

All other adult care homes have been able to place orders for test kits from 31 August. Over 2,000 specialist homes have registered for retesting.

We have the capacity to send out over 100,000 test kits to care homes each day across the country, prioritising high priority outbreak areas and areas of concern.

Under the Care Act 2014, local authorities are required to shape their local markets, and ensure that people have a range of high quality, sustainable and person-centred care and support options available to them, and that they can access the services that best meets their needs.

Elements of the Buurtzorg model have previously been tested in England. In 2017 a coalition of partners agreed to work together to design and deliver a project to test a Buurtzorg inspired model of working. Tests concluded that a purist model of the Buurtzorg Model in the health and social care system was not practical, but work has been undertaken to implement some of the core elements of the model.

No assessment has been made of the Local Cornerstone Year Two Report 2019, published by Cornerstone in April 2019.

Under the Care Act 2014, local authorities are required to shape their local markets, and ensure that people have a range of high quality, sustainable and person-centred care and support options available to them, and that they can access the services that best meets their needs.

Elements of the Buurtzorg model have previously been tested in England. In 2017 a coalition of partners agreed to work together to design and deliver a project to test a Buurtzorg inspired model of working. Tests concluded that a purist model of the Buurtzorg Model in the health and social care system was not practical, but work has been undertaken to implement some of the core elements of the model.

No assessment has been made of the Local Cornerstone Year Two Report 2019, published by Cornerstone in April 2019.

National Health Service legal costs do not include staff and office costs incurred in connection with clinical negligence cases.

We are compliant with the requirements of data protection legislation, ensuring data is used in a safe, secure and legal way. As such, we are completing all necessary Data Protection Impact Assessments in order to meet our obligations to do so, under the General Data Protection Regulation as implemented by the Data Protection Act 2018.

The National Institute for Health and Care Excellence (NICE) is considering discounting in its ongoing methods review for both technology appraisals and highly specialised technologies. This includes consideration of different discount rates, including reference-case and non-reference-case, and the circumstances in which they might be considered.

As of May 2019, nine pieces of technology appraisal (TA) guidance and three pieces of highly specialised technologies (HST) guidance include discussions about discounting, specifically the appropriateness of using non-reference-case discount rates.

Non-reference-case rates were considered appropriate in one TA (TA538) and partially in one HST evaluation (HST7). Where non-reference-case discounting was not accepted, the committee’s considerations varied according to the circumstances of the individual appraisals; common themes included whether the technology aligned with the intention of the non-reference-case discounting criteria, uncertainties about long-term health effects, and whether the treatment would restore patients to ‘full or near full health’.

The discount rates applied by NICE in its health technology assessments are specified in its methods guides. These specify that the reference case discount rate is 3.5% per year for costs and health effects; a non-reference-case discount rate of 1.5% per year for costs and health effects may be considered in specific circumstances.

Sensitivity analyses using rates of 1.5% for both costs and health effects may be presented alongside the reference-case analysis. In certain cases, cost-effectiveness analyses are very sensitive to the discount rate used, and in these circumstances a non-reference-case discount rate for costs and outcomes may be considered.

NICE is considering whether there is a case for change in discounting in its ongoing methods review for both technology appraisals and highly specialised technologies.

The National Institute for Health and Care Excellence (NICE) is considering discounting in its ongoing methods review for both technology appraisals and highly specialised technologies. This includes consideration of different discount rates, including reference-case and non-reference-case, and the circumstances in which they might be considered.

As of May 2019, nine pieces of technology appraisal (TA) guidance and three pieces of highly specialised technologies (HST) guidance include discussions about discounting, specifically the appropriateness of using non-reference-case discount rates.

Non-reference-case rates were considered appropriate in one TA (TA538) and partially in one HST evaluation (HST7). Where non-reference-case discounting was not accepted, the committee’s considerations varied according to the circumstances of the individual appraisals; common themes included whether the technology aligned with the intention of the non-reference-case discounting criteria, uncertainties about long-term health effects, and whether the treatment would restore patients to ‘full or near full health’.

The discount rates applied by NICE in its health technology assessments are specified in its methods guides. These specify that the reference case discount rate is 3.5% per year for costs and health effects; a non-reference-case discount rate of 1.5% per year for costs and health effects may be considered in specific circumstances.

Sensitivity analyses using rates of 1.5% for both costs and health effects may be presented alongside the reference-case analysis. In certain cases, cost-effectiveness analyses are very sensitive to the discount rate used, and in these circumstances a non-reference-case discount rate for costs and outcomes may be considered.

NICE is considering whether there is a case for change in discounting in its ongoing methods review for both technology appraisals and highly specialised technologies.

The National Institute for Health and Care Excellence (NICE) is considering discounting in its ongoing methods review for both technology appraisals and highly specialised technologies. This includes consideration of different discount rates, including reference-case and non-reference-case, and the circumstances in which they might be considered.

As of May 2019, nine pieces of technology appraisal (TA) guidance and three pieces of highly specialised technologies (HST) guidance include discussions about discounting, specifically the appropriateness of using non-reference-case discount rates.

Non-reference-case rates were considered appropriate in one TA (TA538) and partially in one HST evaluation (HST7). Where non-reference-case discounting was not accepted, the committee’s considerations varied according to the circumstances of the individual appraisals; common themes included whether the technology aligned with the intention of the non-reference-case discounting criteria, uncertainties about long-term health effects, and whether the treatment would restore patients to ‘full or near full health’.

The discount rates applied by NICE in its health technology assessments are specified in its methods guides. These specify that the reference case discount rate is 3.5% per year for costs and health effects; a non-reference-case discount rate of 1.5% per year for costs and health effects may be considered in specific circumstances.

Sensitivity analyses using rates of 1.5% for both costs and health effects may be presented alongside the reference-case analysis. In certain cases, cost-effectiveness analyses are very sensitive to the discount rate used, and in these circumstances a non-reference-case discount rate for costs and outcomes may be considered.

NICE is considering whether there is a case for change in discounting in its ongoing methods review for both technology appraisals and highly specialised technologies.

NHS Resolution handles clinical negligence claims on behalf of National Health Service organisations and independent sector providers of NHS care in England.

NHS Resolution has provided information on the number of clinical negligence claims settled in 2018/19 and 2019/20 with or without damages, which is attached due to the size of the data.

It is of vital importance that the health and care sector is able to access the data it needs to respond to COVID-19. A Control of Patient Information Notice was issued to require a range of organisations to share and process data for COVID-19 purposes. This should include sharing data with public health teams responding to COVID-19.

The Notice only applies to data processed for COVID-19 purposes and organisations must also meet other regulatory and legal requirements such as the General Data Protection Regulation.

Public Health England is making available to all local authorities information on positive tests

for COVID-19. Public Health England also routinely shares personal data with local authorities to manage and control local clusters and outbreaks of certain infectious diseases.

Those who have received a shielding patient letter remain in the Clinically Extremely Vulnerable category and should continue to follow the updated guidance for the clinically extremely vulnerable.

If incidence does not rise, from 1 August the Government will further relax advice to those shielding, bringing it in line with the advice to those who are clinically vulnerable. This means that if they are unable to work from home but can work on site, they should do so, provided the business is COVID-safe.

We have made no estimate of the numbers of people shielding who will be working from home, returning to work outside their home, and not able to work due to the nature of their job, on 1 August.

We are continuing to monitor the prevalence of COVID-19 in the community. If the R rate or level of COVID-19 in the community start to rise as a result of the recent relaxation of wider lockdown measures or other factors, then it may be necessary to advise that more restrictive measures should be taken again in order for people at highest risk from COVID-19 to keep themselves safe.

The National Health Service has asked service providers, including general practitioners, to undertake a series of actions to support people who have been asked to shield. This includes ensuring every shielding individual has a named care coordinator to help them with their healthcare and any changing or emerging health needs.

The data is not available in the format requested.

Data is collected on hospital admissions from care homes and will be published for April 2020 at the end of June 2020. Data is also collected for the number of people who have died in hospital from COVID-19 and this is reported online by NHS England on a daily basis. However, we are not able to correlate the two data sets in the format requested.

The data is not available in the format requested.

To provide a more comprehensive response to a number of outstanding Written Questions, this has been answered by an information factsheet PPE - note for House of Lords which is attached, due to the size of the data. A copy has also been placed in the Library.

To provide a more comprehensive response to a number of outstanding Written Questions, this has been answered by an information factsheet PPE - note for House of Lords which is attached, due to the size of the data. A copy has also been placed in the Library.

To provide a more comprehensive response to a number of outstanding Written Questions, this has been answered by an information factsheet PPE - note for House of Lords which is attached, due to the size of the data. A copy has also been placed in the Library.

No data is collected centrally on the number of available National Health Service appointments in dental practices. Routine dental care has been restarted but safety of clinicians and patients is the priority. As with almost all areas of healthcare the infection prevention and control requirements of the pandemic period mean that at least initially dentists will be able to deliver fewer treatments per day. NHS England and NHS Improvement has been clear that dentists should only increase service as fast as is compatible with maximising safety.

Most high street dentists purchase personal protective equipment (PPE) via dental wholesalers which supply a range of equipment needed by dentists including PPE. During the COVID-19 pandemic the Government is working closely with industry, the National Health Service, social care providers and the army to ensure that PPE is delivered to those who need it. Our priority is ensuring the safety of patients and all health care workers, including dentists. This includes supporting dental wholesalers to stock the equipment needed by general dental practice to safely support practices to restart face to face dental care.

NHS England and NHS Improvement took steps to minimise any impact of the suspension of routine dentistry at the peak of the pandemic by setting up urgent dental centres to deliver treatment urgently needed. Urgent dental treatment has therefore been available throughout the pandemic period through the over 600 such centres set up. These centres continue to operate through the restart period ensuring that patients who need urgent treatment can receive it.

On 2 June, NHS England published data that showed 22,497 patients were discharged from hospitals in England to registered care homes and hospices between 19 March 2020 and 16 April 2020. We do not currently have access to data post-16 April 2020. The data is based on day of discharge and excludes privately funded people discharged from privately run hospitals to care homes.

It is our priority to ensure that everyone is discharged safely from hospital and to the most appropriate available place.

NHS England is the data controller for data processed in the NHS COVID-19 Data Store. Data is de-identified by National Health Service staff before the data is analysed on Palantir's platform. As such, no identifiable data is being accessed for modelling for NHS England. Data is only processed under instruction by NHS England and Palantir cannot use the data for its own purposes.

All data in the NHS COVID-19 Data Store is under NHS England and NHS Improvement’s control. All data held in the NHS COVID-19 Data Store remains under the control of the NHS at all times and is being processed in accordance with the law.

The Government’s overall ambition is to ensure that everyone who needs a test can get one. Increasing testing capacity is a top priority and we are working around the clock and across the country to protect the vulnerable, support the National Health Service and save lives.

NHS staff can be tested in the NHS workplace, or by using the online portal to book a test at a Regional Testing Site, or by ordering a home testing kit.

Reaching a daily testing capacity of 200,000 was an important milestone, but this is by no means the end of our ramping up of testing. We plan further increases through the summer and into the autumn through a combination of improvements to existing labs, new partnerships and bringing on board novel tests.

The UK Influenza Pandemic Preparedness Strategy 2011 identified that up to 50% of the workforce may require time off at some stage over the entire period of an influenza pandemic, with 15-20% of staff absent on any given day. However, some small organisational units (five to 15 staff) or small teams within larger organisational units where staff work in close proximity are likely to suffer higher percentages of staff absences, with potentially 30-35% absent on any given day.

Each Government department is responsible for ensuring its own preparedness, and that of the sectors for which it is responsible, to manage the impacts of a pandemic. The Cabinet Office and the Department of Health and Social Care have supported departments to assess and improve the resilience of their sectors to operate in a pandemic, particularly in respect to a reduced workforce.

Data is de-identified by National Health Service staff before it is inputted into the NHS Data Store.

NHS England is the data controller for data processed in the NHS Data Store. Palantir Technology UK is engaged by NHS England under contract as a data processor. As a data processor, the organisation does have access to the data but can only process it under instruction from NHS England.

The lessons from Exercise Cygnus continue to inform our preparedness, including strengthening health, care and voluntary sector plans to surge and flex beyond normal capacity.

Government departments and agencies are working with organisations across the voluntary and charity sector to ensure the sector’s valuable expertise contributes to better outcomes for people affected by the crisis.

The Government Office for Science currently publishes the latest estimate of the United Kingdom-wide range for R on a weekly basis. Because outbreaks in care homes, hospitals and the community are interlinked, the Scientific Advisory Group for Emergencies (SAGE) and its subgroups do not calculate them separately. The current range is estimated to be 0.7-1.0 and is based on latest data available to determine infection and transmission rates.

The Government is committed to publishing the scientific evidence that has informed the SAGE’s advice. These papers are being published in batches. The latest batches were released on 20 May and 22 May and the next batch will be published in due course. The full list of papers reviewed to date is available in an online only format on GOV.UK. This list will be updated to reflect papers considered at recent and future meetings.

Palantir has been contracted by NHS England to work on the NHS Data Store. The contract will be published in due course.

A Data Protection Impact Assessment has been carried out for the NHS Data Store and is being published in due course by NHS England.

NHS England and the Department have been working closely with the Information Commissioner’s Office during the COVID-19 crisis.

To provide a more comprehensive response to a number of outstanding Written Questions, this has been answered by an information factsheet Testing – note for House of Lords which is attached, due to the size of the data. A copy has also been placed in the Library

Exercise Cygnus was a national level pandemic influenza exercise involving Ministers and officials from the Department of Health and Social Care; other Government departments; devolved administrations; NHS England; Public Health England and local agencies.

As is usual for emergency preparedness exercises, participants were debriefed and outcomes evaluated at the conclusion of the exercise. The lessons identified from Exercise Cygnus continue to be considered by the Government and a range of stakeholders, including expert advisory groups and local emergency planners. We have drawn on all the levers that the Government has to help social care providers look after the people in their care.

Working across Government and with stakeholders, the lessons from Exercise Cygnus have informed our preparedness, such as development of draft legislation support to the response to a future influenza pandemic, and strengthening health, care and voluntary sector plans to surge and flex beyond normal operations. Learning the lessons from preparedness exercises, as well as other sources of expertise has ensured that the United Kingdom remains well prepared for infectious disease outbreaks.

Working across Government and with stakeholders, the lessons from Exercise Cygnus have informed our preparedness, such as development of draft legislation support to the response to a future influenza pandemic, and strengthening health, care and voluntary sector plans to surge and flex beyond normal operations. Learning the lessons from preparedness exercises, as well as other sources of expertise has ensured that the United Kingdom remains well prepared for infectious disease outbreaks.

Working across Government and with stakeholders, the lessons from Exercise Cygnus have informed our preparedness, such as development of draft legislation support to the response to a future influenza pandemic, and strengthening health, care and voluntary sector plans to surge and flex beyond normal operations. Learning the lessons from preparedness exercises, as well as other sources of expertise has ensured that the United Kingdom remains well prepared for infectious disease outbreaks.

Public Health England (PHE) is monitoring the evidence on nutrition and COVID-19 and seeking the advice of the Scientific Advisory Committee on Nutrition (SACN) as appropriate. PHE is carrying out a rapid review of recent evidence relating to vitamin D and the prevention of acute respiratory tract infections for SACN to consider at its meeting in June 2020.

The lessons identified from Exercise Cygnus continue to be considered by the Government and a range of stakeholders, including expert advisory groups and local emergency planners.

Working across Government and with stakeholders the lessons from Exercise Cygnus, along with expert advice, have informed our preparedness. Developments include strengthening health and care sector plans to surge and flex systems and resources beyond normal operations and stockpiling personal protective equipment specifically for an influenza pandemic.

Plans for the discharge of patients who no longer need acute care follow the ‘Discharge to Assess’ model; wherever possible, people who are clinically ready will be supported to return to their place of residence, where assessment of longer-term needs will take place. The safety of residents and staff is always a priority and patients should not be discharged unless it is clinically safe to do so.

COVID-19 hospital discharge service requirements was published on 19 March 2020. These requirements follow the ‘Discharge to Assess’ model. A copy is attached.

The lessons identified from Exercise Cygnus continue to be considered by the Government and a range of stakeholders, including expert advisory groups and local emergency planners.

Working across Government and with stakeholders the lessons from Exercise Cygnus, along with expert advice, have informed our preparedness. Developments include strengthening health and care sector plans to surge and flex systems and resources beyond normal operations and stockpiling personal protective equipment specifically for an influenza pandemic.

Plans for the discharge of patients who no longer need acute care follow the ‘Discharge to Assess’ model; wherever possible, people who are clinically ready will be supported to return to their place of residence, where assessment of longer-term needs will take place. The safety of residents and staff is always a priority and patients should not be discharged unless it is clinically safe to do so.

COVID-19 hospital discharge service requirements was published on 19 March 2020. These requirements follow the ‘Discharge to Assess’ model. A copy is attached.

The lessons identified from Exercise Cygnus continue to be considered by the Government and a range of stakeholders, including expert advisory groups and local emergency planners.

Working across Government and with stakeholders the lessons from Exercise Cygnus, along with expert advice, have informed our preparedness. Developments include strengthening health and care sector plans to surge and flex systems and resources beyond normal operations and stockpiling personal protective equipment specifically for an influenza pandemic.

Plans for the discharge of patients who no longer need acute care follow the ‘Discharge to Assess’ model; wherever possible, people who are clinically ready will be supported to return to their place of residence, where assessment of longer-term needs will take place. The safety of residents and staff is always a priority and patients should not be discharged unless it is clinically safe to do so.

COVID-19 hospital discharge service requirements was published on 19 March 2020. These requirements follow the ‘Discharge to Assess’ model. A copy is attached.

The lessons identified from Exercise Cygnus continue to be considered by the Government and a range of stakeholders, including expert advisory groups and local emergency planners.

Working across the Government and with stakeholders, the lessons from Exercise Cygnus have informed our preparedness, including strengthening health sector plans to surge and flex systems and resources beyond normal operations, and stockpiling personal protective equipment specifically for a pandemic influenza, informed by expert advice.

The safety of residents and staff is always a priority and patients should not be discharged unless it is clinically safe to do so. We have provided extensive support and guidance to care homes throughout the COVID-19 pandemic. We have also provided local authorities with £3.2 billion to help them deal with the impacts of COVID-19, as well as £1.3 billion to enhance the National Health Service discharge process.

We have established the Capacity Tracker as the single mechanism across the country to report bed vacancies and help manage demand and monitor workforce pressures in care homes during this incident. We strongly encourage care homes to contribute regularly to this tracker.

This is an unprecedented global pandemic and we will continue to review our guidance and national support in line with the latest scientific advice.

The lessons identified from Exercise Cygnus continue to be considered by the Government and a range of stakeholders, including expert advisory groups and local emergency planners.

Working across the Government and with stakeholders, the lessons from Exercise Cygnus have informed our preparedness, including strengthening health sector plans to surge and flex systems and resources beyond normal operations, and stockpiling personal protective equipment specifically for a pandemic influenza, informed by expert advice.

The safety of residents and staff is always a priority and patients should not be discharged unless it is clinically safe to do so. We have provided extensive support and guidance to care homes throughout the COVID-19 pandemic. We have also provided local authorities with £3.2 billion to help them deal with the impacts of COVID-19, as well as £1.3 billion to enhance the National Health Service discharge process.

We have established the Capacity Tracker as the single mechanism across the country to report bed vacancies and help manage demand and monitor workforce pressures in care homes during this incident. We strongly encourage care homes to contribute regularly to this tracker.

This is an unprecedented global pandemic and we will continue to review our guidance and national support in line with the latest scientific advice.

The lessons learned from Exercise Cygnus continue to be considered by the Government and a range of stakeholders, including expert advisory groups and local emergency planners in reviewing response plans. As part of the Pandemic Influenza Preparedness Programme we maintain national stocks of clinical countermeasures for a future influenza pandemic with arrangements in place for how these would be distributed in an emergency. The content of the stockpiles is informed by scientific and clinical advice and kept under review. The Department receives advice on these matters from Public Health England and various independent Government advisory committees including NERVTAG and the Joint Committee on Vaccination and Immunisation.

Project OASIS is a combined effort between NHSX and the jHub to create a much clearer picture of the public’s experience with COVID-19 by incorporating data from third party symptom tracker apps commonly used by the public with the National Health Service’s own internal data. The data will be used by the NHS to understand the spread of COVID-19 at a national and local level.

At the point that the OASIS platform began ingesting data there were seven app providers that had committed to provide data. Following discussions with the King’s College London team, NHSX has been working with Health Data Research UK (HDR) to onboard the data from the C-19 Covid Symptom Tracker (Zoe app) into project OASIS. These discussions are at the final stages as at 20 May 2020. When this is agreed HDR will be added as a contributor to project OASIS on the NHSX website.

National Health Service dentistry was reorganised in late March along with other NHS primary care services to minimise face to face care to contain the spread of COVID-19 during the peak of the pandemic. Dentists were asked to suspend all routine treatment and instead to offer urgent advice and, where required, prescriptions for antibiotics by telephone. Urgent treatment was made available through urgent dental centres (UDCs) set up in each NHS region.

As of 25 May, there are currently over 550 UDCs open. Patients are triaged into UDCs by their own dentistry or through NHS 111. The UDCs are expected to provide, where urgently needed, the full range of dental treatment normally available on the NHS.

The NHS England and NHS Improvement guidance issued from the Chief Dental Officer on 25 March applied directly only to NHS dental care. When providing private care dentists should consider any advice or guidance issued by regulators, the relevant professional body, Chief Professional Officers, or the NHS, as appropriate. All official guidance should be considered in delivery of private or NHS treatment but guidance issued to the NHS is only binding for NHS care.

NHS England and NHS Improvement announced on 28 May that NHS dentistry outside urgent care centres will begin to restart from 8 June with the aim of increasing levels of service as fast as is compatible with maximising safety

Whilst NHSX has been approached by a number of symptom trackers and products with regards to funding we do not fund products in this space. Any trackers that we do work with are providing their data for free through project OASIS, a project between NHSX and the jHub.

The United Kingdom Government’s response to the COVID-19 pandemic has been guided by the advice of the Scientific Advisory Group for Emergencies (SAGE) with the sole purpose of minimising loss of life. The Government has published the scientific evidence relied on by SAGE which can be found online via GOV.UK.

The report by the Nuffield Council on Bioethics Ethical considerations in responding to the COVID-19 pandemic has not been formally considered or assessed by SAGE. However, individual contributors to SAGE may consider a range of evidence for their own work.

No assessment has been made. All English ambulance services have adopted the Ambulance Response Programme model, and report data at trust level against the Ambulance Quality Indicators. There is no central data collection at clinical commissioning group level and no further assessment will be made, as it is a matter for local commissioners.

The costs NHS Resolution incur in 2019-20 in relation to general practitioner (GP) indemnity (including oversight arrangements prior to establishment of the Existing Liabilities Scheme for General Practice in April) will be reported in the 2019-20 annual accounts of NHS Resolution, once the audit process for the costs is complete.

An Impact Assessment was carried out for the introduction of the state indemnity scheme for general practice. The state scheme provides the best balance of costs, benefits and risks as it provides a more affordable system that can reduce costs for GPs and remove a barrier to GP recruitment; gives the Department more control over the impact of increases in the cost of clinical negligence on GP incomes; and in moving discretionary cover to the Government brings arrangements into line with the position of clinicians in National Health Service trusts.

The agreement with the Medical Protection Society (MPS) is such that the MPS will contribute a certain amount of assets for the relevant liabilities. The price paid was agreed via commercial negotiations. Through negotiations, the Department has been guided by the need to act fairly and prudently when managing the public purse.

The Department currently has no plans to publish the terms of the agreement with the Medical Protection Society covering National Health Service clinical negligence claims made against their general practitioner members in respect of liabilities arising before 1 April 2019, which is subject to confidentiality provisions.

The costs NHS Resolution incur in 2019-20 in relation to general practitioner (GP) indemnity (including oversight arrangements prior to establishment of the Existing Liabilities Scheme for General Practice in April) will be reported in the 2019-20 annual accounts of NHS Resolution, once the audit process for the costs is complete.

An Impact Assessment was carried out for the introduction of the state indemnity scheme for general practice. The state scheme provides the best balance of costs, benefits and risks as it provides a more affordable system that can reduce costs for GPs and remove a barrier to GP recruitment; gives the Department more control over the impact of increases in the cost of clinical negligence on GP incomes; and in moving discretionary cover to the Government brings arrangements into line with the position of clinicians in National Health Service trusts.

The agreement with the Medical Protection Society (MPS) is such that the MPS will contribute a certain amount of assets for the relevant liabilities. The price paid was agreed via commercial negotiations. Through negotiations, the Department has been guided by the need to act fairly and prudently when managing the public purse.

The Department currently has no plans to publish the terms of the agreement with the Medical Protection Society covering National Health Service clinical negligence claims made against their general practitioner members in respect of liabilities arising before 1 April 2019, which is subject to confidentiality provisions.

The latest National Health Service financial forecasts show NHS Crawley Clinical Commissioning Group (CCG) is forecasting a deficit of approximately £13 million and NHS Horsham and Mid Sussex CCG is forecasting a deficit of approximately £33.5 million. These figures include receipt of Commissioner Sustainability Funding.

The NHS England and NHS Improvement Clinically-led Review of Access Standards is still underway. The existing National Health Service performance standards remain in place, and the Government will respond to the recommendations of the review once it has concluded.

The English ambulances services whose 90^th percentile response time for category 2 calls was within 40 minutes in 2018-19 are shown in the following table.

The 90^th centiles for 2018-19 are an estimated position based on monthly aggregated data. Until 9 October 2018, Isle of Wight Ambulance Service continued to use the old Red 1/Red 2/Green categories operationally, and then assign each incident to the new categories C1 to C4 for data reporting. As such, its response times reflected the old category used for each incident, rather than the new category assigned to.

No assessment has been made. All English ambulance services have adopted the Ambulance Response Programme model, and report data at trust level against the Ambulance Quality Indicators. There is no central data collection at clinical commissioning group level and no further assessment will be made, as it is a matter for local commissioners.

No assessment has been made. All English ambulance services have adopted the Ambulance Response Programme model, and report data at trust level against the Ambulance Quality Indicators. There is no central data collection at clinical commissioning group level and no further assessment will be made, as it is a matter for local commissioners.

Crawley Clinical Commissioning Group (CCG) will merge with the Horsham and Mid Sussex CCG to form a new West Sussex CCG from 1 April 2020. The directions needed to be reviewed before the merger date and reapplied to the new entity if necessary, or they would lapse as the existing CCG legal entities would cease.

Following a review, NHS England concluded that the CCGs had addressed the directions as written. However, there remained a significant financial challenge.

The new leadership in the CCGs, together with the other partners, have created a recovery board to develop and deliver a financial recovery strategy and plan for these CCGs and their successor. As a result, NHS England has decided that legal directions can be removed.

Clinical commissioning groups (CCGs) are the only National Health Service organisation which legal directions can be applied to. There are currently five CCGs subject to NHS England directions. These are NHS Vale of York CCG, NHS Wirral CCG, NHS Cambridge and Peterborough CCG, NHS Shropshire CCG and NHS Southport and Formby CCG.

NHS Vale of York CCG planned for a deficit of approximately £19 million, and the latest published forecasts say they expect to meet this plan.

NHS Wirral CCG planned to break even, and the latest published forecasts say they expect to meet this plan.

NHS Cambridge and Peterborough CCG planned for a deficit of approximately £75 million, and the latest published forecasts say they expect to meet this plan.

NHS Shropshire CCG planned for a deficit of approximately £23 million, and the latest published forecast said they would meet that plan.

NHS Southport and Formby CCG planned to break even, and the latest published forecast said they would meet that plan.

The costs of the establishment of Clinical Negligence Scheme for General Practice will be reported in the 2019-20 annual accounts of NHS Resolution, once the audit process for the costs is complete.

No assessment has been made. All English ambulance services have adopted the Ambulance Response Programme model, and report data at trust level against the Ambulance Quality Indicators. There is no central data collection at clinical commissioning group level and no further assessment will be made, as it is a matter for local commissioners.

The Joint Ambulance Improvement Programme is taking forward the recommendations in Lord Carter of Coles’ report Operational productivity and performance in English NHS Ambulance Trusts: Unwarranted variations.

The Department is working with the Ministry of Justice, other Government departments and NHS Resolution, looking at a wide range of options to address the drivers of cost of clinical negligence claims. We will update Parliament in due course.

NHS Resolution handles clinical negligence claims on behalf of National Health Service organisations and independent sector providers of NHS care in England.

NHS Resolution does not hold the information requested and does not make estimates of how much the additional costs of section 2(4) are when settling the payment of clinical negligence claims.

The Department is working with the Ministry of Justice, other Government departments and NHS Resolution, looking at a wide range of options to address the drivers of cost of clinical negligence claims.

We will update Parliament in due course.

No patient data is being shared with Amazon as part of this agreement. The collaboration with Amazon simply connects people to medically verified information on a range of different medical conditions, symptoms and treatments which is already freely available online through the National Health Service website. Use of Amazon Alexa is just an alternative mechanism for accessing that information.

The agreement with Amazon clearly stipulates that neither party is liable for any loss of data. The data referred to in this agreement is the medically verified NHS information that is already freely available on the NHS website. It does not concern patient data, as this is not being shared with Amazon. There is no significant risk for the NHS concerning the loss, destruction, corruption, desegregation or damage of this data.

This agreement with Amazon will help people manage their own healthcare more effectively, reaching a far greater number of citizens. This will enable people to take better control of their own healthcare needs, thereby potentially helping with prevention and early diagnosis.

The clinically-led review of National Health Service access standards is ongoing. NHS England and NHS Improvement’s final recommendations to the Government are due by the spring.

The clinically-led review of National Health Service access standards is ongoing. NHS England and NHS Improvement’s final recommendations to the Government are due by the spring.

The clinically-led review of National Health Service access standards is ongoing. NHS England and NHS Improvement’s final recommendations to the Government are due by the spring.

Data on Early Intervention in Psychosis (EIP) services is included in the NHS Mental Health Dashboard, which brings together data from across mental health services to measure performance. The most recent Dashboard shows that 18% of EIP services nationally and 6% of services in the East of England region achieved level-3 National Institute for Health and Care Excellence concordance in 2018/19.

NHS England and NHS Improvement’s East of England Regional Team is supporting these services to move towards a standalone model and is committed to achieving the NHS Long Term Plan goal of having 95% of services operating at level 3 by 2023/24.

Data on Early Intervention in Psychosis (EIP) services is included in the NHS Mental Health Dashboard, which brings together data from across mental health services to measure performance. The most recent Dashboard shows that 18% of EIP services nationally and 6% of services in the East of England region achieved level-3 National Institute for Health and Care Excellence concordance in 2018/19.

NHS England and NHS Improvement’s East of England Regional Team is supporting these services to move towards a standalone model and is committed to achieving the NHS Long Term Plan goal of having 95% of services operating at level 3 by 2023/24.

The National Institute for Health and Care Excellence (NICE) technology appraisal guidance process was introduced in 1999. We have interpreted this question as referring to individual medicines distinguished by their generic names. It should be noted that the number of medicines is not the same as the number of products. The figures given also differ from volumes of prescriptions or spending.

Out of 2,538 medicines used in the National Health Service in 2018/19, including medicines prescribed by general practitioners and used in hospitals, 1,799 (71%) had a best estimate launch date in the United Kingdom pre-dating the NICE appraisal process.

The NHS does not have unlimited resources and NHS commissioners have to make difficult decisions about commissioning care. In the absence of a positive technology appraisal or highly specialised technology recommendation by NICE, NHS commissioners should make funding decisions on individual treatments based on an assessment of the available evidence. This is reflected in the NHS Constitution as a right to expect local decisions on funding of other drugs and treatments to be made rationally following a proper consideration of the evidence.

A survey undertaken in 2016/17 by the European Centre for Disease Control to detect the number of healthcare associated infections (HCAIs), estimated the number in England to be much lower than those in this report at approximately 206,000. Public Health England is developing robust methodologies that will enable greater certainty in estimates of the numbers and costs of HCAIs.

While there have been year-on-year reductions in MRSA and C. difficile; E. coli, MSSA, Klebsiella and Pseudomonas infections have increased. From April 2020, the NHS will introduce an annual national reduction target for these bloodstream infections.

NHS England and NHS Improvement take a systematic approach to the prevention of infections with a sustained focus at national level. Action on HCAIs forms part of wide- ranging commitments made in the NHS Long Term Plan for preventing ill health among the National Health Service workforce.

The United Kingdom’s national action plan on antimicrobial resistance has a strong focus on infection prevention and control and includes the commitment to support research that will help target front line interventions.

A survey undertaken in 2016/17 by the European Centre for Disease Control to detect the number of healthcare associated infections (HCAIs), estimated the number in England to be much lower than those in this report at approximately 206,000. Public Health England is developing robust methodologies that will enable greater certainty in estimates of the numbers and costs of HCAIs.

While there have been year-on-year reductions in MRSA and C. difficile; E. coli, MSSA, Klebsiella and Pseudomonas infections have increased. From April 2020, the NHS will introduce an annual national reduction target for these bloodstream infections.

NHS England and NHS Improvement take a systematic approach to the prevention of infections with a sustained focus at national level. Action on HCAIs forms part of wide- ranging commitments made in the NHS Long Term Plan for preventing ill health among the National Health Service workforce.

The United Kingdom’s national action plan on antimicrobial resistance has a strong focus on infection prevention and control and includes the commitment to support research that will help target front line interventions.

A survey undertaken in 2016/17 by the European Centre for Disease Control to detect the number of healthcare associated infections (HCAIs), estimated the number in England to be much lower than those in this report at approximately 206,000. Public Health England is developing robust methodologies that will enable greater certainty in estimates of the numbers and costs of HCAIs.

While there have been year-on-year reductions in MRSA and C. difficile; E. coli, MSSA, Klebsiella and Pseudomonas infections have increased. From April 2020, the NHS will introduce an annual national reduction target for these bloodstream infections.

NHS England and NHS Improvement take a systematic approach to the prevention of infections with a sustained focus at national level. Action on HCAIs forms part of wide- ranging commitments made in the NHS Long Term Plan for preventing ill health among the National Health Service workforce.

The United Kingdom’s national action plan on antimicrobial resistance has a strong focus on infection prevention and control and includes the commitment to support research that will help target front line interventions.

A survey undertaken in 2016/17 by the European Centre for Disease Control to detect the number of healthcare associated infections (HCAIs), estimated the number in England to be much lower than those in this report at approximately 206,000. Public Health England is developing robust methodologies that will enable greater certainty in estimates of the numbers and costs of HCAIs.

While there have been year-on-year reductions in MRSA and C. difficile; E. coli, MSSA, Klebsiella and Pseudomonas infections have increased. From April 2020, the NHS will introduce an annual national reduction target for these bloodstream infections.

NHS England and NHS Improvement take a systematic approach to the prevention of infections with a sustained focus at national level. Action on HCAIs forms part of wide- ranging commitments made in the NHS Long Term Plan for preventing ill health among the National Health Service workforce.

The United Kingdom’s national action plan on antimicrobial resistance has a strong focus on infection prevention and control and includes the commitment to support research that will help target front line interventions.

No formal assessment has been made of the report by NHS Health Scotland on minimum unit pricing (MUP) of alcohol. The Scottish Government is taking forward a comprehensive evaluation of the impact of introducing MUP. The Scottish legislation also includes a sunset clause and the Scottish Government are required to present a report on the impact of MUP to their Parliament five years after implementation which will be published in 2023.

There are no plans for the introduction of MUP in England. The Government will continue to monitor the progress of MUP in Scotland and will consider available evidence of its impact, including the report by NHS Scotland.

This is the answer for HL1750.

The clinically-led review of National Health Service access standards is ongoing. The NHS is currently trialling how these might work and any recommended changes will be based on clinical evidence to ensure the best outcome for patients. NHS England and NHS Improvement’s final recommendations to the Government are due by the spring.

No formal assessment has been made of the report by NHS Health Scotland on minimum unit pricing (MUP) of alcohol. The Scottish Government is taking forward a comprehensive evaluation of the impact of introducing MUP. The Scottish legislation also includes a sunset clause and the Scottish Government are required to present a report on the impact of MUP to their Parliament five years after implementation which will be published in 2023.

There are no plans for the introduction of MUP in England. The Government will continue to monitor the progress of MUP in Scotland and will consider available evidence of its impact, including the report by NHS Scotland.

No formal assessment has been made of the report by NHS Health Scotland on minimum unit pricing (MUP) of alcohol. The Scottish Government is taking forward a comprehensive evaluation of the impact of introducing MUP. The Scottish legislation also includes a sunset clause and the Scottish Government are required to present a report on the impact of MUP to their Parliament five years after implementation which will be published in 2023.

There are no plans for the introduction of MUP in England. The Government will continue to monitor the progress of MUP in Scotland and will consider available evidence of its impact, including the report by NHS Scotland.

This is the answer for HL1750.

The clinically-led review of National Health Service access standards is ongoing. The NHS is currently trialling how these might work and any recommended changes will be based on clinical evidence to ensure the best outcome for patients. NHS England and NHS Improvement’s final recommendations to the Government are due by the spring.

Several factors have contributed to the increase in sexually transmitted infections (STIs) seen in England over the last decade. These include better detection through policies that increase testing among those most at risk of STIs and behavioural changes that increase the risk of transmission of STIs.

Sexually transmitted infections and screening for chlamydia in England, 2018, published in June 2019, accompanies the most recent annual official statistics release of data about sexually transmitted infections in England. The report states that the total number of sexual health screens (tests for chlamydia, gonorrhoea, syphilis and HIV) has increased over the last five years (22%; from 1,603,744 in 2014 to 1,955,108 in 2018). The report considers the role of sexual behaviours such as an increase in partner numbers and condomless intercourse in the increases seen. A copy of the report is attached.

No specific assessment has been made. Local authorities in England are mandated to provide comprehensive open access sexual health services including access to the full range of contraception and sexually transmitted infection testing and treatment.

Work on the development of a new national sexual and reproductive health strategy is underway with the Department working with Public Health England, NHS England and NHS Improvement, local government and other partners. Details of the strategy’s scope will be announced in due course.

The Department invests over £1 billion a year in health research through the National Institute for Health Research (NIHR). The NIHR supports a broad range of research on sexually transmitted infections through both its infrastructure and research programmes. This investment includes the NIHR Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, a partnership between Public Health England and University College London. Research at the unit is wide-ranging and includes behavioural studies relating to prevention and partner notification, plus research to assess the feasibility of routine testing in primary care settings.

We recognise that robust data collection will enable policy makers, commissioners and providers to better identify potential health risks and provide targeted prevention and early intervention work.

Organisations are required to comply with the National Data Opt-out by 31 March 2020.

Local health and adult social care organisations as Data Controllers are required to assure themselves that they are complying with the opt out requirements. This requirement is set out in Information Standards Notice DCB3058. Organisations are also obligated to ensure the organisation’s privacy notice reflects that they apply the opt out.

Organisations must confirm their compliance with the opt out when submitting their annual Data Security and Protection (DSP) toolkit return. All organisations that have access to National Health Service patient data and systems must use this toolkit to provide assurance that they are practising good data security and that personal information is handled correctly. Information on which organisations have achieved ‘standards met’ on the DSP toolkit will be published in due course by NHS Digital.

Preventing and controlling the spread of healthcare associated infections continues to be a priority for this Government and we welcome this study’s contribution to the evidence base.

As the authors of the report highlight, a number of the model inputs are assumptions or uncertain values. Application of appropriate methodology is important in gaining unbiased estimates of the key cost and health parameters attributable to length of stay and mortality attributable to infection; Public Health England is collaborating with academia to develop such methodologies. This will enable greater certainty in estimates of the cost and outcomes attributable to these infections.

NHS England and NHS Improvement continues to work to prevent, diagnose and treat infection appropriately, reducing the burden and the costs of healthcare associated infection in our trusts and in the community and maintaining the low level of Methicillin-Resistant Staphylococcus Aureus and Clostridium difficile (C. difficile) infections since 2012.

The United Kingdom’s national action plan for antimicrobial resistance, published on 24 January 2019, includes a strengthened focus on infection prevention and control and sets an ambition to halve levels of healthcare associated Gram-negative blood stream infections by 2023-24.

We have made no such assessment.

NHS England and NHS Improvement along with NHS Clinical Commissioners’ latest guidance for clinical commissioning groups, taking into account comments from the British Thyroid Association, was published in June 2019. The National Institute for Health and Care Excellence also published guidelines in November 2019 stating that liothyronine should not be offered routinely for primary hypothyroidism, either alone, or in combination with levothyroxine.

Representatives of NHS England and NHS Improvement and NHS Clinical Commissioners met with representatives from the Thyroid Trust, Healthwatch England, Lord Hunt of Kings Heath and Lord Borwick of Hawkshead on 13 February 2020. NHS England and NHS Improvement will clarify guidance within the National Health Service system. This guidance will set out that the recommendation of the clinical working group was that liothyronine should not be routinely prescribed in primary care; but there may be circumstances where prescribing of the medication is clinically appropriate for individual patients as determined by endocrinologists providing NHS services, after a carefully audited trial of at least three months duration of the medicine.

Work on the development of a new national sexual and reproductive health strategy is underway, with the Department working with Public Health England, NHS England and NHS Improvement, local government and other partners. Initial engagement with stakeholders has already taken place and we are also considering the responses to the Green Paper Advancing our Health along with suggestions for priority areas for the new strategy we received through the consultation process. Details of the strategy’s scope, plans for more formal engagement with external organisations, timing of publication and implementation will be announced in due course.

NHS Resolution has a responsibility to settle justified clinical negligence and other claims against the National Health Service in England fairly and swiftly, and to defend against unjustified claims, to protect NHS resources.

The majority of claims are resolved through alternative dispute resolution, without any formal proceedings being issued and the number of claims moving into formal litigation has continued to drop in recent years, from a litigation rate of 34% in 2016-17 to 31% in 2018-19.

The Department holds NHS Resolution to account for its performance and is satisfied with the progress NHS Resolution is making on delivering on its strategic aims, including its efforts to avoid unnecessary litigation.

Commissioning social care services is a matter for local authorities who are best placed to understand the needs of local people and communities, and how best to meet them. The Department therefore has no plans to discuss with Derbyshire County Council its proposals to close a number of direct care homes for older people, including Ladycross Care Home. We therefore have also not made an assessment of the impact of these closures on the health and well-being of residents, or of suitable alternatives for residents. The Department does support local authorities by funding a number of sector-led improvement activities. These are delivered in partnership with the Local Government Association and Association of Directors of Adult Social Services.

In addition, we are providing councils with access to an additional £1.0 billion for adults and children’s social care next year through the new social care grant and the ability to raise over £500 million from the additional 2% precept. This is on top of £2.5 billion of existing grants provided by the Government.

Derbyshire County Council is set to receive an additional £15.7 million from the new Social Care Grant and could raise up to £7.5 million of additional funding specifically for adult social care in 2020-21 through the precept.

Commissioning social care services is a matter for local authorities who are best placed to understand the needs of local people and communities, and how best to meet them. The Department therefore has no plans to discuss with Derbyshire County Council its proposals to close a number of direct care homes for older people, including Ladycross Care Home. We therefore have also not made an assessment of the impact of these closures on the health and well-being of residents, or of suitable alternatives for residents. The Department does support local authorities by funding a number of sector-led improvement activities. These are delivered in partnership with the Local Government Association and Association of Directors of Adult Social Services.

In addition, we are providing councils with access to an additional £1.0 billion for adults and children’s social care next year through the new social care grant and the ability to raise over £500 million from the additional 2% precept. This is on top of £2.5 billion of existing grants provided by the Government.

Derbyshire County Council is set to receive an additional £15.7 million from the new Social Care Grant and could raise up to £7.5 million of additional funding specifically for adult social care in 2020-21 through the precept.

Commissioning social care services is a matter for local authorities who are best placed to understand the needs of local people and communities, and how best to meet them. The Department therefore has no plans to discuss with Derbyshire County Council its proposals to close a number of direct care homes for older people, including Ladycross Care Home. We therefore have also not made an assessment of the impact of these closures on the health and well-being of residents, or of suitable alternatives for residents. The Department does support local authorities by funding a number of sector-led improvement activities. These are delivered in partnership with the Local Government Association and Association of Directors of Adult Social Services.

In addition, we are providing councils with access to an additional £1.0 billion for adults and children’s social care next year through the new social care grant and the ability to raise over £500 million from the additional 2% precept. This is on top of £2.5 billion of existing grants provided by the Government.

Derbyshire County Council is set to receive an additional £15.7 million from the new Social Care Grant and could raise up to £7.5 million of additional funding specifically for adult social care in 2020-21 through the precept.

Commissioning social care services is a matter for local authorities who are best placed to understand the needs of local people and communities, and how best to meet them. The Department therefore has no plans to discuss with Derbyshire County Council its proposals to close a number of direct care homes for older people, including Ladycross Care Home. We therefore have also not made an assessment of the impact of these closures on the health and well-being of residents, or of suitable alternatives for residents. The Department does support local authorities by funding a number of sector-led improvement activities. These are delivered in partnership with the Local Government Association and Association of Directors of Adult Social Services.

In addition, we are providing councils with access to an additional £1.0 billion for adults and children’s social care next year through the new social care grant and the ability to raise over £500 million from the additional 2% precept. This is on top of £2.5 billion of existing grants provided by the Government.

Derbyshire County Council is set to receive an additional £15.7 million from the new Social Care Grant and could raise up to £7.5 million of additional funding specifically for adult social care in 2020-21 through the precept.

Commissioning social care services is a matter for local authorities who are best placed to understand the needs of local people and communities, and how best to meet them. The Department therefore has no plans to discuss with Derbyshire County Council its proposals to close a number of direct care homes for older people, including Ladycross Care Home. We therefore have also not made an assessment of the impact of these closures on the health and well-being of residents, or of suitable alternatives for residents. The Department does support local authorities by funding a number of sector-led improvement activities. These are delivered in partnership with the Local Government Association and Association of Directors of Adult Social Services.

In addition, we are providing councils with access to an additional £1.0 billion for adults and children’s social care next year through the new social care grant and the ability to raise over £500 million from the additional 2% precept. This is on top of £2.5 billion of existing grants provided by the Government.

Derbyshire County Council is set to receive an additional £15.7 million from the new Social Care Grant and could raise up to £7.5 million of additional funding specifically for adult social care in 2020-21 through the precept.

Commissioning social care services is a matter for local authorities who are best placed to understand the needs of local people and communities, and how best to meet them. The Department therefore has no plans to discuss with Derbyshire County Council its proposals to close a number of direct care homes for older people, including Ladycross Care Home. We therefore have also not made an assessment of the impact of these closures on the health and well-being of residents, or of suitable alternatives for residents. The Department does support local authorities by funding a number of sector-led improvement activities. These are delivered in partnership with the Local Government Association and Association of Directors of Adult Social Services.

In addition, we are providing councils with access to an additional £1.0 billion for adults and children’s social care next year through the new social care grant and the ability to raise over £500 million from the additional 2% precept. This is on top of £2.5 billion of existing grants provided by the Government.

Derbyshire County Council is set to receive an additional £15.7 million from the new Social Care Grant and could raise up to £7.5 million of additional funding specifically for adult social care in 2020-21 through the precept.

Clinical commissioning groups (CCGs) are legally responsible, as data controllers in their own right, to abide by data protection legislation when processing any data. The Department does not assess their operation of data protection legislation.

CCGs are the responsible commissioner for the prescription of liothyronine and it is for CCGs to have regard to guidance set out by the National Institute for Health and Care Excellence (NICE) and NHS England and NHS Improvement.

To assess the causes of the decline in uptake of vaccinations, Public Health England (PHE) undertakes annual surveys of parents and adolescents to understand how knowledge, beliefs and attitudes towards immunisation, vaccine safety and disease severity influence vaccine uptake decision-making.

PHE believes that the causes of the decline in vaccine include access to services and inconsistencies in reminder communications from healthcare professionals. More information on the survey can be found in the attached National Audit Office report, Investigation into pre-school vaccinations.

The Government is committed to improving the uptake of vaccinations which is why we will shortly be publishing a vaccine strategy.

The NHS Long Term Plan set out a clear commitment to improve uptake of vaccinations and a range of action has been taken. This has included expanding key childhood vaccination programmes. All primary school children are now eligible for their seasonal flu vaccination through the National Health Service school vaccination programme after it was extended to include year 6 this season. NHS Digital is due to publish the annual vaccine uptake data, collected by Public Health England, for 2019/20 in September 2020, which will give some indication of whether these interventions have started to be effective.

General practice plays an invaluable role in the delivery of vaccination services, especially for children. During 2019, NHS England and NHS Improvement undertook the most significant review of vaccination and immunisation payment mechanisms since 1990. The findings of this extensive review identified a range of effective interventions. The recent update to the general practitioner (GP) contract confirmed the interventions will see the biggest reforms to the payment and incentive system in 30 years to support GP practices improve vaccination coverage.

Public Health England reports childhood vaccination coverage statistics for England. In 2018/19 there were 94,342 children aged five years who did not have a record of receiving both doses of the Measles Mumps Rubella (MMR) vaccine. Of these, 55,916 children had received dose one of MMR and 38,426 had no record of receiving MMR.

NHS England and NHS Improvement are aware of and have considered the study referenced. The findings are being taken into account alongside other evidence in understanding the impact on patient care, the environmental impact and the costs involved in a change in the mix of inhalers to lower carbon alternatives.

As set out in the NHS Long Term Plan, the National Health Service restated its commitment to the carbon targets in the UK Government Climate Change Act 2008, reducing carbon emissions, on a 1990 baseline, by:

- 34% by 2020; and

- 51% by 2025

In particular, the NHS Long Term Plan commits that a substantial reduction in the carbon impact of inhalers and anaesthetics over 10 years, will contribute to the overall NHS carbon reduction targets. The propellants used in pressurised inhalers are potent greenhouse gases.

The appropriateness of parking is the responsibility of the local National Health Service trust.

NHS organisations have autonomy to make decisions that best suit their local circumstances.

The appropriateness of parking is the responsibility of the local National Health Service trust.

NHS organisations have autonomy to make decisions that best suit their local circumstances.

As announced in the Prevention Green Paper, Advancing our health: prevention in the 2020s published in July 2019, the Government is committed to publishing a national Vaccine Strategy which will be available shortly. As part of this strategy, we are considering a wide array of options, including rolling out text reminder services to families, to increase our vaccination uptake rates and ensure they reach the 95% standard set for the majority of vaccine programmes.

England’s national vaccination programme is well-regarded globally, with uptake levels for most of our pre-school vaccinations above 90%. Parental attitudinal surveys conducted by Public Health England demonstrate that there is high confidence in our vaccine programmes and that 94% of parents rate the National Health Service as the most trusted source of information on immunisation.

However, despite a recent uptick in vaccination uptake rates, the Department remains concerned about the slow and steady decline in vaccine uptake rates since 2013. Whilst the impact of anti-vaccination messaging on uptake is hard to quantify, we take the issue of misinformation about vaccines extremely seriously. We are working across Government and with social media companies on innovative ways to tackle the proliferation of anti-vaccine messaging on their sites and ensuring that reputable sources are the most prominent.

The Department is aware that effective reminder systems are likely to be a key factor in improving vaccine uptake. This was highlighted in the January 2019 Royal Society for Public Health report Moving the Needle, which noted that such services are desired by 80% of United Kingdom adults surveyed. As such, the Department is considering options for improved, and more consistent, methods for reminding parents of vaccination appointments, including rolling out a text reminder service, as announced by the Secretary of State for Health and Social Care in November 2019.

More widely, the Government is committed to publishing a national Vaccine Strategy as announced in July 2019 as part of the Prevention Green Paper, Advancing our health: prevention in the 2020s. The strategy, which will be published shortly, carefully considers an array of options to improve our vaccine uptake rates.

As announced in the June 2019 Prevention Green Paper, Advancing our health: prevention in the 2020s, the Government is committed to publishing a Vaccine Strategy, which considers a range of actions to address access to vaccination services as an important factor in improving vaccine uptake.

In addition, the NHS Long Term Plan committed to a fundamental review of general practitioner (GP) vaccination and immunisation standards, funding and procurement, alongside a review of GP access. Interim findings of this work were published on 25 October and are being fed into the ongoing GP contract negotiations.

The Department has no plans to publish at this time.

The agreement with Amazon to provide medically verified National Health Service information from the NHS website, through its voice assistant Alexa, will help people become more informed about a range of medical conditions, their symptoms, and their potential treatments. Greater access to that information from the NHS will help people manage their own healthcare more effectively, reaching a far greater number of United Kingdom citizens, which could help with prevention and early diagnosis.

Significantly, it will help those who rely on voice-activated technology, such as elderly people or blind and visually impaired people, to access expert, accurate and safe medical information from the NHS.

NHS Resolution handles clinical negligence claims on behalf of National Health Service organisations and independent sector providers of NHS care in England.

The following table shows settled clinical negligence claims in financial years 2017/18 and 2018/19.

Note:

The percentage figures in the table may not add to exactly 100% due to rounding.

The majority of medicines are dispensed in England every day without issue, with over two million prescription items dispensed each day. However, the production of medicines is complex and highly regulated, and materials and processes must meet rigorous safety and quality standards. Supply problems can affect a wide range of drugs and can arise for various reasons, such as manufacturing issues, problems with the raw ingredients and batch failures.

The Department has well established processes to manage and mitigate supply problems that may arise at any one time and works closely with the Medicines and Healthcare Regulatory Authority (MHRA), the pharmaceutical industry, NHS England and NHS Improvement and others operating in the supply chain, to help prevent shortages and to ensure that the risks to patients are minimised when they do arise.

Where issues do arise, the Department will use a host of tools which might include working with the MHRA to expedite regulatory procedures, working with manufacturers to manage remaining supplies and expedite the delivery of further stock and commissioning clinical advice on alternative options from specialist clinicians.

Furthermore, the team routinely works with specialist importer companies to obtain unlicensed products from abroad to help to manage supply issues affecting the National Health Service.

Occasionally the team will work with wholesalers and suppliers to put demand management processes in place to ensure the equitable distribution of stock throughout the country as this ensures the NHS can continue to access the medicines it requires.

The majority of medicines are dispensed in England every day without issue, with over two million prescription items dispensed each day. However, the production of medicines is complex and highly regulated, and materials and processes must meet rigorous safety and quality standards. Supply problems can affect a wide range of drugs and can arise for various reasons, such as manufacturing issues, problems with the raw ingredients and batch failures.

The Department has well established processes to manage and mitigate supply problems that may arise at any one time and works closely with the Medicines and Healthcare Regulatory Authority (MHRA), the pharmaceutical industry, NHS England and NHS Improvement and others operating in the supply chain, to help prevent shortages and to ensure that the risks to patients are minimised when they do arise.

Where issues do arise, the Department will use a host of tools which might include working with the MHRA to expedite regulatory procedures, working with manufacturers to manage remaining supplies and expedite the delivery of further stock and commissioning clinical advice on alternative options from specialist clinicians.

Furthermore, the team routinely works with specialist importer companies to obtain unlicensed products from abroad to help to manage supply issues affecting the National Health Service.

Occasionally the team will work with wholesalers and suppliers to put demand management processes in place to ensure the equitable distribution of stock throughout the country as this ensures the NHS can continue to access the medicines it requires.

The majority of medicines are dispensed in England every day without issue, with over two million prescription items dispensed each day. However, the production of medicines is complex and highly regulated, and materials and processes must meet rigorous safety and quality standards. Supply problems can affect a wide range of drugs and can arise for various reasons, such as manufacturing issues, problems with the raw ingredients and batch failures.

The Department has well established processes to manage and mitigate supply problems that may arise at any one time and works closely with the Medicines and Healthcare Regulatory Authority (MHRA), the pharmaceutical industry, NHS England and NHS Improvement and others operating in the supply chain, to help prevent shortages and to ensure that the risks to patients are minimised when they do arise.

Where issues do arise, the Department will use a host of tools which might include working with the MHRA to expedite regulatory procedures, working with manufacturers to manage remaining supplies and expedite the delivery of further stock and commissioning clinical advice on alternative options from specialist clinicians.

Furthermore, the team routinely works with specialist importer companies to obtain unlicensed products from abroad to help to manage supply issues affecting the National Health Service.

Occasionally the team will work with wholesalers and suppliers to put demand management processes in place to ensure the equitable distribution of stock throughout the country as this ensures the NHS can continue to access the medicines it requires.

The majority of medicines are dispensed in England every day without issue, with over two million prescription items dispensed each day. However, the production of medicines is complex and highly regulated, and materials and processes must meet rigorous safety and quality standards. Supply problems can affect a wide range of drugs and can arise for various reasons, such as manufacturing issues, problems with the raw ingredients and batch failures.

The Department has well established processes to manage and mitigate supply problems that may arise at any one time and works closely with the Medicines and Healthcare Regulatory Authority (MHRA), the pharmaceutical industry, NHS England and NHS Improvement and others operating in the supply chain, to help prevent shortages and to ensure that the risks to patients are minimised when they do arise.

Where issues do arise, the Department will use a host of tools which might include working with the MHRA to expedite regulatory procedures, working with manufacturers to manage remaining supplies and expedite the delivery of further stock and commissioning clinical advice on alternative options from specialist clinicians.

Furthermore, the team routinely works with specialist importer companies to obtain unlicensed products from abroad to help to manage supply issues affecting the National Health Service.

Occasionally the team will work with wholesalers and suppliers to put demand management processes in place to ensure the equitable distribution of stock throughout the country as this ensures the NHS can continue to access the medicines it requires.

Guidance is provided to the National Health Service on the management of buildings of special architectural or historical interest in Health Building Note 00-08 Part B: Supplementary information for Part A - Strategic framework for the efficient management of healthcare estates and facilities. A copy of the guidance is attached.

There is no requirement under existing guidance Health Building Notes, the National Planning Policy Framework or at local level for any organisation, including the NHS, to request for an asset to be listed. There is only an obligation once something is listed by Heritage England (on behalf of the Secretary of State) or local listed status.

The Government’s policy for conserving and enhancing the historic environment including historic buildings is set out in the National Planning Policy framework. Trusts are responsible for implementing this guidance locally. Guidance is reviewed periodically to ensure it remains fit for purpose and at this time there are no current plans to amend or update this guidance.

NHS Property Services report that it does not own any part of the estate of Kingston Hospital.

The Regent Wing required major capital investment to make it fit for purpose and would not provide appropriate modern healthcare facilities. The Trust has therefore saved substantial costs by disposing of the asset but has also been able to utilise the proceeds for other capital projects across the estate.

Before disposing of the asset, the Trust undertook a full heritage survey of the Regent Wing as part of its pre-application process with the local authority – no comments were made by the local community or local authority. The building was not found to be of significant worth nationally.

In addition, it undertakes regular community engagement sessions led by the Trust’s Chief Executive Officer, which has included the Regent Wing disposal. The purchaser of the site is planning to utilise it to develop residential accommodation.

NHS Property Services report that it does not own any part of the estate of Kingston Hospital.

The Regent Wing required major capital investment to make it fit for purpose and would not provide appropriate modern healthcare facilities. The Trust has therefore saved substantial costs by disposing of the asset but has also been able to utilise the proceeds for other capital projects across the estate.

Before disposing of the asset, the Trust undertook a full heritage survey of the Regent Wing as part of its pre-application process with the local authority – no comments were made by the local community or local authority. The building was not found to be of significant worth nationally.

In addition, it undertakes regular community engagement sessions led by the Trust’s Chief Executive Officer, which has included the Regent Wing disposal. The purchaser of the site is planning to utilise it to develop residential accommodation.

Guidance is provided to the National Health Service on the management of buildings of special architectural or historical interest in Health Building Note 00-08 Part B: Supplementary information for Part A - Strategic framework for the efficient management of healthcare estates and facilities. A copy of the guidance is attached.

There is no requirement under existing guidance Health Building Notes, the National Planning Policy Framework or at local level for any organisation, including the NHS, to request for an asset to be listed. There is only an obligation once something is listed by Heritage England (on behalf of the Secretary of State) or local listed status.

The Government’s policy for conserving and enhancing the historic environment including historic buildings is set out in the National Planning Policy framework. Trusts are responsible for implementing this guidance locally. Guidance is reviewed periodically to ensure it remains fit for purpose and at this time there are no current plans to amend or update this guidance.

NHS Property Services report that it does not own any part of the estate of Kingston Hospital.

The Regent Wing required major capital investment to make it fit for purpose and would not provide appropriate modern healthcare facilities. The Trust has therefore saved substantial costs by disposing of the asset but has also been able to utilise the proceeds for other capital projects across the estate.

Before disposing of the asset, the Trust undertook a full heritage survey of the Regent Wing as part of its pre-application process with the local authority – no comments were made by the local community or local authority. The building was not found to be of significant worth nationally.

In addition, it undertakes regular community engagement sessions led by the Trust’s Chief Executive Officer, which has included the Regent Wing disposal. The purchaser of the site is planning to utilise it to develop residential accommodation.

We have made no such assessment.

NHS England and NHS Improvement are committed to learning from a wide range of models of care from across the world to help improve patient care.

NHS England and NHS Improvement officials met once with representatives of Buurtzorg UK in 2019 and have previously visited the Netherlands to gain first-hand experience of this model of care. Whilst there are no current plans to encourage the introduction of the model in its pure form to the National Health Service, underpinning elements of the model for example, supported self-management and person-centred care, are strongly encouraged.

Given the Buurtzorg model continues to be trialled in a few areas in England, no national assessments have been undertaken.

NHS Resolution handles clinical negligence claims on behalf of National Health Service organisations and independent sector providers of NHS care in England.

NHS Resolution is unable to provide the data requested as they do not capture the specific reason for litigation broken down into the categories referred to.

In view of the nature of litigation, disputes can arise concerning breach of duty, causation and quantum, or a mixture of all of them. The NHS Resolution five-year strategy, published in 2017, references its aim to prevent claims entering litigation unnecessarily. In certain circumstances litigation is unavoidable, for example where a child is involved and the court is required to approve a damages award or if the statutory limitation period has expired for the commencement of legal proceedings.

NHS Resolution manages clinical negligence and other claims against the National Health Service in England, and shares learning from claims to help improve safety for patients and staff. NHS Resolution has a responsibility to settle justified claims fairly and promptly and defend unjustified claims to secure NHS resources. Each case must be considered on its own merits and it is important that a proper investigation is undertaken. NHS Resolution aims to get to the right answer as quickly as possible in every case and to help resolve claims sooner, and without the need for court proceedings. To support this NHS Resolution launched a new mediation service in December 2016.

NHS Resolution strategy specifically references its aim to prevent claims entering litigation unnecessarily. In certain circumstances litigation is unavoidable, for example where a child is involved and the court is required to approve a damages award or if the statutory limitation period has expired for the commencement of legal proceedings. NHS Resolution challenges important issues of principle in the courts, including the appeals courts where necessary. Decisions to go to trial are not taken lightly but sometimes it is necessary so that public funds are not spent on compensating cases which do not have merit. In 2018/19, of 106 cases taken to trial with court judgements handed down, NHS Resolution successfully defended 69%. Testing claims at trial often has wider implications for other similar cases, potentially deterring further claims without merit. In 2018/19 over 70% of claims were settled without formal court proceedings being taken. It is not possible to estimate conclusively how many litigated clinical negligence claims will result in damages being paid.

NHS Resolution is an arm’s length body of the Department and is accountable to the Department. Its performance is subject to regular review through the Department’s sponsorship arrangements. The Department’s assessment is that NHS Resolution is a well-run and efficient organisation and that it has had some success, within the current legal framework, in containing the cost of NHS litigation. The National Audit Office, in its report Managing the costs of clinical negligence in trusts published in September 2017, corroborated with this assessment. A copy of the report is attached.

NHS Resolution regularly agrees large-scale contracts for legal services, using its position as a bulk purchaser to obtain the best expertise at value for money for the health service. The contracts include a combination of fixed and capped fees as well as competitive hourly rates for its panel firms, which are also required to support NHS Resolution’s work to learn from claims to improve safety.

NHS Resolution manages clinical negligence and other claims against the National Health Service in England, and shares learning from claims to help improve safety for patients and staff. NHS Resolution has a responsibility to settle justified claims fairly and promptly and defend unjustified claims to secure NHS resources. Each case must be considered on its own merits and it is important that a proper investigation is undertaken. NHS Resolution aims to get to the right answer as quickly as possible in every case and to help resolve claims sooner, and without the need for court proceedings. To support this NHS Resolution launched a new mediation service in December 2016.

NHS Resolution strategy specifically references its aim to prevent claims entering litigation unnecessarily. In certain circumstances litigation is unavoidable, for example where a child is involved and the court is required to approve a damages award or if the statutory limitation period has expired for the commencement of legal proceedings. NHS Resolution challenges important issues of principle in the courts, including the appeals courts where necessary. Decisions to go to trial are not taken lightly but sometimes it is necessary so that public funds are not spent on compensating cases which do not have merit. In 2018/19, of 106 cases taken to trial with court judgements handed down, NHS Resolution successfully defended 69%. Testing claims at trial often has wider implications for other similar cases, potentially deterring further claims without merit. In 2018/19 over 70% of claims were settled without formal court proceedings being taken. It is not possible to estimate conclusively how many litigated clinical negligence claims will result in damages being paid.

NHS Resolution is an arm’s length body of the Department and is accountable to the Department. Its performance is subject to regular review through the Department’s sponsorship arrangements. The Department’s assessment is that NHS Resolution is a well-run and efficient organisation and that it has had some success, within the current legal framework, in containing the cost of NHS litigation. The National Audit Office, in its report Managing the costs of clinical negligence in trusts published in September 2017, corroborated with this assessment. A copy of the report is attached.

NHS Resolution regularly agrees large-scale contracts for legal services, using its position as a bulk purchaser to obtain the best expertise at value for money for the health service. The contracts include a combination of fixed and capped fees as well as competitive hourly rates for its panel firms, which are also required to support NHS Resolution’s work to learn from claims to improve safety.

NHS Resolution manages clinical negligence and other claims against the National Health Service in England, and shares learning from claims to help improve safety for patients and staff. NHS Resolution has a responsibility to settle justified claims fairly and promptly and defend unjustified claims to secure NHS resources. Each case must be considered on its own merits and it is important that a proper investigation is undertaken. NHS Resolution aims to get to the right answer as quickly as possible in every case and to help resolve claims sooner, and without the need for court proceedings. To support this NHS Resolution launched a new mediation service in December 2016.

NHS Resolution strategy specifically references its aim to prevent claims entering litigation unnecessarily. In certain circumstances litigation is unavoidable, for example where a child is involved and the court is required to approve a damages award or if the statutory limitation period has expired for the commencement of legal proceedings. NHS Resolution challenges important issues of principle in the courts, including the appeals courts where necessary. Decisions to go to trial are not taken lightly but sometimes it is necessary so that public funds are not spent on compensating cases which do not have merit. In 2018/19, of 106 cases taken to trial with court judgements handed down, NHS Resolution successfully defended 69%. Testing claims at trial often has wider implications for other similar cases, potentially deterring further claims without merit. In 2018/19 over 70% of claims were settled without formal court proceedings being taken. It is not possible to estimate conclusively how many litigated clinical negligence claims will result in damages being paid.

NHS Resolution is an arm’s length body of the Department and is accountable to the Department. Its performance is subject to regular review through the Department’s sponsorship arrangements. The Department’s assessment is that NHS Resolution is a well-run and efficient organisation and that it has had some success, within the current legal framework, in containing the cost of NHS litigation. The National Audit Office, in its report Managing the costs of clinical negligence in trusts published in September 2017, corroborated with this assessment. A copy of the report is attached.

NHS Resolution regularly agrees large-scale contracts for legal services, using its position as a bulk purchaser to obtain the best expertise at value for money for the health service. The contracts include a combination of fixed and capped fees as well as competitive hourly rates for its panel firms, which are also required to support NHS Resolution’s work to learn from claims to improve safety.

Cancer is a priority for this Government and survival rates are at a record high. The National Health Service is finding and treating more cancers in line with the ambitions set out in the Long Term Plan. Demand continues to rise and more people are also being diagnosed than ever before. The increasing demand has created a challenge in achieving the standard that 85% of patients commence treatment within 62 days following an urgent referral.

NHS England and NHS Improvement are working with providers, local systems and Cancer Alliances to improve performance. This includes £200 million investment in diagnostic equipment, the implementation of optimal timed diagnosis pathways and new Rapid Diagnostic Centres and actions to increase staff in key cancer and diagnostic professions.

Further to this, at the Government’s request, NHS England and NHS Improvement are working with clinical leaders across the system to review our performance standards and will update on this in due course.

NHS Resolution manages clinical negligence and other claims against the National Health Service in England, and shares learning from claims to help improve safety for patients and staff. NHS Resolution has a responsibility to settle justified claims fairly and promptly and defend unjustified claims to secure NHS resources. Each case must be considered on its own merits and it is important that a proper investigation is undertaken. NHS Resolution aims to get to the right answer as quickly as possible in every case and to help resolve claims sooner, and without the need for court proceedings. To support this NHS Resolution launched a new mediation service in December 2016.

NHS Resolution strategy specifically references its aim to prevent claims entering litigation unnecessarily. In certain circumstances litigation is unavoidable, for example where a child is involved and the court is required to approve a damages award or if the statutory limitation period has expired for the commencement of legal proceedings. NHS Resolution challenges important issues of principle in the courts, including the appeals courts where necessary. Decisions to go to trial are not taken lightly but sometimes it is necessary so that public funds are not spent on compensating cases which do not have merit. In 2018/19, of 106 cases taken to trial with court judgements handed down, NHS Resolution successfully defended 69%. Testing claims at trial often has wider implications for other similar cases, potentially deterring further claims without merit. In 2018/19 over 70% of claims were settled without formal court proceedings being taken. It is not possible to estimate conclusively how many litigated clinical negligence claims will result in damages being paid.

NHS Resolution is an arm’s length body of the Department and is accountable to the Department. Its performance is subject to regular review through the Department’s sponsorship arrangements. The Department’s assessment is that NHS Resolution is a well-run and efficient organisation and that it has had some success, within the current legal framework, in containing the cost of NHS litigation. The National Audit Office, in its report Managing the costs of clinical negligence in trusts published in September 2017, corroborated with this assessment. A copy of the report is attached.

NHS Resolution regularly agrees large-scale contracts for legal services, using its position as a bulk purchaser to obtain the best expertise at value for money for the health service. The contracts include a combination of fixed and capped fees as well as competitive hourly rates for its panel firms, which are also required to support NHS Resolution’s work to learn from claims to improve safety.

This agreement is not exclusive. There are over 2,000 other organisations that are accessing and using information from the National Health Service website in a similar way.

We want to continue working with Amazon and other companies in order to ensure that citizens have access to the best source of verified health information, and therefore this contract is intended to be open-ended. We will continue to review our relationships with Amazon and other organisations that are using information taken from the NHS website to ensure that they continue to provide the best possible service.

National Health Service website content is available for all organisations if they have agreed with NHS terms of use. This agreement is not exclusive and open to any vendor who complies with the terms of the license agreement. NHS Digital assesses and evaluates companies’ compliance with the terms of use. It does not compare this system with alternatives on the market.

Increased access for patients to information on the National Health Service website will help people become better informed, receiving NHS accredited information on the symptoms of different healthcare issues. This will enable people to take better control of their own healthcare needs, thereby potentially helping with prevention and early diagnosis.

Demand on the National Health Service hospitals continues to grow, with an increase in attendances to accident and emergency of over 6% in December 2019 compared to December 2018. Despite this increase in demand, the NHS continues to provide high quality care, and is seeing more people than ever before, in a timely manner.

The NHS Long Term Plan sets out our plans for transformation and improvement across the NHS. In the shorter term, the NHS Accountability Framework for 2019-20 outlines how NHS England and NHS Improvement will continue ongoing service development so that performance is maintained and improved, including with the commencement of the redesign of outpatient services.

Further to this, at the Government’s request, NHS England and NHS Improvement is also working with clinical leaders across the system to review our performance standards and will update on this in due course.

Demand on the National Health Service hospitals continues to grow, with an increase in attendances to accident and emergency of over 6% in December 2019 compared to December 2018. Despite this increase in demand, the NHS continues to provide high quality care, and is seeing more people than ever before, in a timely manner.

The NHS Long Term Plan sets out our plans for transformation and improvement across the NHS. In the shorter term, the NHS Accountability Framework for 2019-20 outlines how NHS England and NHS Improvement will continue ongoing service development so that performance is maintained and improved, including with the commencement of the redesign of outpatient services.

Further to this, at the Government’s request, NHS England and NHS Improvement is also working with clinical leaders across the system to review our performance standards and will update on this in due course.

The agreement between the Department and Amazon is clear that none of the data generated will be shared with third parties; that it will not be used for selling products or making product recommendations to Amazon users; nor is it building any form of health profiles on Amazon customers.

NHS Digital are working closely with Amazon to assess the effectiveness of the service. The algorithm used by Amazon is still learning and will be updated continuously to learn how people are asking questions about health conditions.

All information is treated with high confidentiality and Amazon use multi-factor authentication to restrict access, service encryption, and audits of our control environment to protect it. No Amazon employee has direct access to information that can identify the person or account, and Amazon have the appropriate measures in place to ensure General Data Protection Regulation compliance.

Patients already use Alexa and other devices to search for health information on a range of health issues. This agreement ensures that the information they receive from Alexa is medically verified by the National Health Service instead of from a range of other sources, such as non-United Kingdom websites.

This agreement is not exclusive. There are over 2,000 other organisations that are accessing and using information from the NHS website in a similar way.

There is already an app, called the NHS App, which provides the same information as the National Health Service website on a range of conditions, their symptoms and their treatments.

More modes to access medically verified NHS information will give United Kingdom citizens a better understanding of different medical conditions. The agreement with Amazon is convenient for those who rely on voice-activated technology, in particular blind and visually impaired people.

This is a mutually beneficial collaboration that will enable greater numbers of people to access information accredited by the NHS, helping to put people in control of their own healthcare. The information being provided to users of Alexa devices asking questions is already freely available through the NHS website. This is an alternative mechanism for delivering that information. Patients already use Alexa and other devices to search for information on a range of health issues. This agreement ensures that the information they receive from Alexa is medically verified by the NHS instead of from a range of other sources, such as non-UK websites.

The service provided by Amazon connects people to medical information that is already freely available through the National Health Service website. Patients already use Alexa and other devices to search for information on a range of health issues. This agreement ensures that the information they receive from Alexa is medically verified by the NHS instead of from a range of other sources, such as non-United Kingdom websites.

The agreement signed between the Department and Amazon is designed to enable greater numbers of people to access information accredited by the NHS, helping to put people in control of their own healthcare. This agreement is not exclusive. There are over 2,000 other organisations that are accessing and using information from the NHS website in a similar way.

There is no cost to the taxpayer, nor have we received any income as a result of the agreement to share this freely available information from the NHS website with Amazon. This new service through Alexa will enable a greater number of people to access it and help them to manage their own healthcare.

No patient data is being shared with Amazon as part of this agreement. The collaboration with Amazon simply connects people to information that is already freely available through the National Health Service website. Use of Amazon Alexa is an alternative mechanism for accessing that information. Patients already use Alexa and other devices to search for information on a range of health issues. This agreement ensures that the information they receive from Alexa is medically verified by the NHS instead of from a range of other sources, such as non-United Kingdom websites.

This agreement is not exclusive. There are over 2,000 other organisations that are accessing and using information from the NHS website in a similar way.

The agreement signed between the Department and Amazon is clear that none of the data generated through voice search using Alexa will be shared with third parties; that it will not be used for selling products or making product recommendations to Amazon users; nor is it building any form of health profiles on Amazon customers.

All information is treated with high confidentiality and Amazon use multi-factor authentication to restrict access, service encryption, and audits of our control environment to protect it. The information that Amazon collects is only used to train its speech recognition software and natural language understanding systems, so Alexa can better understand the requests of users and ensure the service works well for everyone. No Amazon employee has direct access to information that can identify the person or account, and Amazon have the appropriate measures in place to ensure General Data Protection Regulation compliance.

The agreement with Amazon is non-exclusive and we want to work with other organisations to arrange for the content to be provided on other home devices. There are currently over 2,000 other organisations using content from the National Health Service website.

This is a mutually beneficial collaboration that will enable greater numbers of people to access health information accredited by the NHS, helping to put people in control of their own healthcare. The information being provided to users of Alexa devices asking questions is already freely available through the NHS website. This is an alternative mechanism for delivering that information. Patients already use Alexa and other devices to search for information on a range of health issues. This agreement ensures that the information they receive from Alexa is medically verified by the NHS instead of from a range of other sources, such as non-United Kingdom websites.

NHS Digital and NHSX have built an interface (known technically as an API, or Application Programming Interface) to content on the NHS website so that other organisations can use it to make NHS information available through their own sites. It is freely available.

The service available through Alexa enables a greater number of people to access certified NHS information from a trusted source, instead of potentially misleading information from a range of worldwide websites where the information may not have been clinically assessed.

The agreement between the Department and Amazon is about using content from the National Health Service website to provide reliable and informative answers to basic health questions asked to Amazon’s virtual assistant voice service, Alexa. This content is already freely available on the NHS website. Patients already use Alexa and other devices to search for information on a range of health issues. This agreement ensures that the information they receive from Alexa is medically verified by the NHS instead of from a range of other sources, such as non-United Kingdom websites.

This agreement is not exclusive. There are over 2,000 other organisations that are accessing and using information from the NHS website in a similar way.

A limited number of clauses have been redacted due to being exempt under Section 43(2) of the Freedom Of Information Agreement, which exempts information where the release would, or would be likely to, prejudice the commercial interests of any entity, including the public authority holding the information.

In this case, we consider that the release of the redacted clauses would be likely to prejudice the commercial interests of Amazon on the basis that it would make public the non-standard terms that Amazon has been willing to enter into in respect of this agreement. Disclosure of the redacted clauses has potential to prejudice existing agreements between Amazon and other parties, which could result in other parties challenging Amazon over the terms and conditions of their agreements.

In addition, certain personal information has been redacted in the agreement. This information is exempt from disclosure under Section 40(2) of Freedom Of Information Agreement as disclosure of this personal information would breach the data protection principles. In particular, we consider that the disclosure of this personal information would be unfair and breach the first data principle.

In developing and taking forward leasehold reforms, the Government is taking into consideration all relevant sectors of the UK housing market, including new retirement homes.

Unfair leasehold practices have no place in a modern housing market. The Government is taking forward a comprehensive programme to reform leasehold. This includes reducing ground rents on future leases to a zero and banning new leasehold houses.

The Government’s response to the technical consultation Implementing reforms to the leasehold system in England, published on 27 June 2019, set out that in future, purchasers of retirement homes must be offered the choice between paying ground rents on their new home or purchasing the property with zero ground rents (but with a higher sales price). In addition, ground rents cannot be used where event (exit) fees apply.

The law is clear that service charges must be reasonable and, where costs relate to work or services, the work or services must be of a reasonable standard. Leaseholders may make an application to the First-tier Tribunal to make a determination on the reasonableness of their service charges.

In October 2018 my Department established an independent Regulation of Property Agents working group, chaired by Lord Best, to raise standards across the property sector, which also considered how fees such as service charges should be presented to consumers, and whether they should be capped or banned. The working group reported in July 2019 and we are considering their recommendations.

Home buyers are under no obligation to use the solicitor recommended by their developer and the Government makes this point clearly in its How to Buy a Home guide (attached). https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/829864/6.5492_-_MHCLG_-_How_to_Buy_Guide_WEB.PDF

There can be beneficial reasons for a property buyer to use a solicitor proposed by the house builder, such as greater familiarity with the processes of the house builder leading to fewer delays in the conveyancing process. The Solicitors Regulation Authority, however, is clear in setting standards of conduct and behaviour and provides a framework for ethical and competent practice.

If a homebuyer has a complaint against a conveyancer or solicitor, an estate agent, property developer, landlord or freeholder or management agent, they do have a right of redress. Trading Standards have published guidance for leaseholders seeking redress, which is available (attached) here: https://en.powys.gov.uk/article/7263/Guidance-for-consumers-seeking-redress-for-leasehold-matters.

Home buyers are under no obligation to use the solicitor recommended by their developer and the Government makes this point clearly in its How to Buy a Home guide (attached). https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/829864/6.5492_-_MHCLG_-_How_to_Buy_Guide_WEB.PDF

There can be beneficial reasons for a property buyer to use a solicitor proposed by the house builder, such as greater familiarity with the processes of the house builder leading to fewer delays in the conveyancing process. The Solicitors Regulation Authority, however, is clear in setting standards of conduct and behaviour and provides a framework for ethical and competent practice.

If a homebuyer has a complaint against a conveyancer or solicitor, an estate agent, property developer, landlord or freeholder or management agent, they do have a right of redress. Trading Standards have published guidance for leaseholders seeking redress, which is available (attached) here: https://en.powys.gov.uk/article/7263/Guidance-for-consumers-seeking-redress-for-leasehold-matters.