Lord Kamall

In response to the range of pressures facing local authorities, the Government will make available up to £3.7 billion of additional funding for social care authorities in 2025/26.

In England, the Department of Health and Social Care is responsible for nutrition legislation including food supplements, fortified foods, nutrition and health claims, foods for specific groups, and nutrition labelling.

The Government has been working closely across all four nations to implement the policy to fortify non-wholemeal flour with folic acid to reduce the risk of neural tube defects in babies. In England, this change has been implemented via amendments to The Bread and Flour Regulations 1998 alongside other changes and will come into force in December 2026.

This is a complex policy, which has required careful consideration of the evidence, advice from scientific committees and involved much scientific debate. It has been taken forward as a measure across the United Kingdom and has involved two consultations and coordination across the four nations and across successive governments in each nation.

The Department for Environment, Food and Rural Affairs published responses to the second public consultation in January 2024. The Government has prioritised swift action to protect unborn babies and moved rapidly to reach agreement with the other nations and lay the legislation in England on 14 November 2024.

The length of time needed to develop policies varies depending on the complexity of the policy and other factors.

We have taken necessary decisions to fix the foundations in the public finances at the Autumn Budget, and this enabled the Spending Review settlement of a £22.6 billion increase in resource spending for the Department from 2023/24 outturn to 2025/26. The employer National Insurance rise will be implemented in April 2025, and the Department will set out further details on the allocation of funding for next year at the earliest opportunity.

We have taken necessary decisions to fix the foundations in the public finances at the Autumn Budget, and this enabled the Spending Review settlement of a £22.6 billion increase in resource spending for the Department from 2023/24 outturn to 2025/26. The employer National Insurance rise will be implemented in April 2025, and the Department will set out further details on the allocation of funding for next year at the earliest opportunity.

There are no current plans to produce or publish a follow-up report to the independent review by Professor Sir Mike Richards, Diagnostics: Recovery and Renewal. The Department will publish a ten-year plan for the National Health Service in spring 2025.

NHS England’s Diabetes Programme uses a range of communication channels, including mainstream and social media, to share information about the latest technologies that are available for people with Type 1 diabetes. NHS England works closely with its partners, including Breakthrough T1D, Diabetes UK and the Association of British Clinical Diabetologists Technology Network to amplify key messages.

A new decision support tool has been designed to support people to understand what diabetes treatment technologies are available on the National Health Service, supporting discussions between someone living with type 1 diabetes and their healthcare professional about the technology they are eligible for and supports shared decision-making about the person’s care in managing type 1 diabetes.

Furthermore, nationally commissioned self-management resources have been put in place, including DigiBete, designed for children and young people aged between zero and 25 years old with type 1 diabetes in ten languages and MyType1 Diabetes, which is available to all adults living with type 1 diabetes.

As part of NHS England’s focus on improving equity of access to diabetes technology, diabetes care is one of the five clinical areas of focus for integrated care boards to achieve system change and improve care within the Core20Plus5 for children and young people . Core20PLUS5 is a national NHS England approach to support the reduction of health inequalities at both national and system level. The approach defines a target population cohort and identifies five focus clinical areas requiring accelerated improvement. The aim of this work is to increase access to real-time continuous glucose monitors and insulin pumps for people in the most deprived 20% of the national population and people from ethnic minority backgrounds.

The Secretary of State for Health and Social Care has been clear that the Government will not tolerate National Health Service managers who silence whistleblowers. The Government recognises the importance of strong and accountable leadership in supporting whistleblowers and fostering a positive, compassionate culture within the NHS. That is why we have committed to introducing professional standards for and regulating NHS managers. We are currently considering the most appropriate and effective means of delivering this.

The Employment Rights Act 1996, as amended by the Public Interest Disclosure Act 1998, gives legal protection to those who speak up in the public interest. The legislation is intended to build openness and trust in workplaces by ensuring that workers who hold their employers to account are treated fairly. In 2018, enhanced legal protections were introduced that made it unlawful for NHS employers to discriminate against job applicants on the grounds that they have made a protected disclosure in the past. This complements the longstanding legal provisions within the Public Interest Disclosure Act 1998.

There is a network of more than 1,200 local Freedom to Speak Up Guardians throughout healthcare in England, whose role is to help and support staff who want to speak up about their concerns. NHS England has also published a national Freedom to Speak Up policy, which provides the minimum standard for local Freedom to Speak Up policies across the NHS, which NHS organisations are required to adopt. Workers who wish to speak up can also receive advice and support from Speak Up Direct.

We are determined that alongside the 10-Year Health Plan, there will be a long-term plan for adult social care to build consensus on the reform needed to create a National Care Service. We have now launched the Change NHS website, where everyone can submit their ideas and experiences to help us build a health service fit for the future and inform the 10-Year Health Plan. We will listen to and co-design the plan with the public and health and care staff.

This Government, since taking office, has not held any such conversations.

The SURMOUNT-REAL clinical trial of tirzepatide, announced on 15 October 2024, is being developed between Health Innovation Manchester, The University of Manchester, and Eli Lilly and Company, with further details about the study to be published by these organisations at a later date, following on from relevant approvals.

The study will evaluate the real-world effectiveness of tirzepatide in weight loss, diabetes prevention, and the prevention of obesity-related complications for people living with obesity. Additionally, data will be collected on healthcare resource utilisation, health-related quality of life, and changes in participants’ employment status, including sick days from work.

The evidence generated will seek to increase the global evidence base on the long-term impacts of weight loss medicines more broadly, and the placement of the trial is a clear vote of confidence in the United Kingdom from a global healthcare stakeholder, working with our brilliant and regionally diverse life sciences sector to improve understanding of a priority healthcare field.

This announcement was made as part of a collaboration agreement between Eli Lilly and Company and Government unveiled at the International Investment Summit, as part of an intended £279 million package of investment from Eli Lilly and Company into the UK's innovation and research ecosystem.

We are proposing a single or unified health record as a vision for the future, to develop in consultation with the public and healthcare professionals. Ensuring that patients’ confidential information remains protected and is seen only by those who need to see it will be a priority. Public engagement next month will help us understand what safeguards patients would want to see.

NHS England is developing the NHS Federated Data Platform (FDP) Solution Exchange, a catalogue of products for trusts and integrated care boards to improve efficiency and patient care. This is in an early phase of release and will develop over the coming months to include opportunities for suppliers of innovative solutions.

For developers the solution exchange provides a safe and secure space to create and test new ideas to strict NHS FDP standards, using synthetic data. New innovations will be reviewed and tested for suitability before being made available in the NHS FDP Solution Exchange Product Catalogue.

During Autumn and Winter 2024-25, the programme will host a series of sessions to describe the opportunities this will provide for National Health Service organisations developing their own products and those jointly or independently developed by third party suppliers. This will include how products are prioritised and assessed for inclusion in the Solution Exchange.

Pregnant women with folate deficiency are at greater risk of neural tube defects (NTDs). Currently government advice recommends that women who could become pregnant take a daily supplement of folic acid before conception and up until the 12th week of pregnancy. However, we know that around 50% of pregnancies in the UK are unplanned. Government is therefore looking at this UK-wide measure to mandate the fortification of flour with folic acid to reduce the number of NTDs in pregnancies as a priority.

The Scientific Advisory Committee on Nutrition (SACN) and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) have considered the proposed level of fortification in depth.

The proposed policy is to fortify non-wholemeal wheat flour at 250 micrograms per 100 grams. Fortification above this level would allow for greater reductions in NTD risk but would increase the risk of people exceeding the recommended upper level of folic acid intake.

An upper limit of 1 milligram per day was set in the UK by the UK Expert Group on Vitamins and Minerals in 2003, which was later reviewed and agreed by COT in 2018. In 2006 and 2009, SACN concluded that it was also necessary to minimise exposure to high intakes of folic acid because there was still uncertainties regarding folic acid and cancer risk at high intakes.

The UK Government and devolved governments addressed concerns on the interaction of folic acid with treatments and medications for different conditions, such as cancer and epilepsy, in the consultation on the policy proposal in 2021. In addition, information on the presence of folic acid will be included on the ingredients list on product labels to inform consumers. In 2023, COT published a risk assessment of the potential risks of allergic reaction (hypersensitivity) to folic acid if flour is fortified with folic acid at 250 micrograms per 100 grams.

There is agreement from both SACN and COT that the proposed levels of fortification are appropriate and provide a balanced approach to fortification.

The level of folic acid fortification will be kept under review as part of the monitoring and evaluation of the policy, which would assess both positive and postulated negative impacts.

NHS England has published on its website an overarching National Health Service Federated Data Platform (FDP) data protection impact assessment (DPIA), an overarching NHS FDP information governance framework, and overarching NHS FDP privacy notice and privacy notices, for each national FDP product.

NHS England plans to publish an overarching NHS Privacy Enhancing Technology DPIA, and a DPIA for each national FDP product on the NHS England website in autumn 2024. These will be placed in the library of the House.

The Department does not hold the information on what percentage of general practice (GP) surgeries and primary care centres currently offer an online booking option for GP appointments.

The government is carefully considering the valuable work done by the Hughes Report and will respond in due course.

While this was an IT outage, not a cyber security incident, the National Health Service has robust cyber security measures in place, and is increasing cyber resilience across health and social care.

Health and care organisations are required to have business continuity plans in place, which we will continue to strengthen, to minimise disruption in the event of an IT outage or cyber incident. As outlined in The King’s Speech, the Government’s new Cyber Security and Resilience Bill will strengthen our defences and ensure that essential digital services are protected by expanding the remit of the existing regulation, putting regulators on a stronger footing, and increasing reporting requirements, to build a better picture in Government of cyber threats.

As of April 2024, 97% of general practices in England have cloud-based telephony systems in place. The Government has pledged to deliver a modern appointment booking system to end the 8:00am scramble, and ensure that there is an online booking option for all that wish to use it.

The Government is considering the recommendations of The Hughes Report, and to prevent future harm, the Medicines and Healthcare products Regulatory Agency, NHS England, and others have taken action to strengthen oversight of valproate prescribing and mesh procedures. For example, nine specialist mesh centres are in operation across England, ensuring that women with complications of mesh inserted for urinary incontinence and vaginal prolapse get the right support in every region, and we have maintained the national pause on the use of pelvic mesh, which has been in place since July 2018.