Lord Luce

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​The information requested falls within the responsibility of the UK Statistics Authority. I have asked the Authority to reply.

Letter from John Pullinger CB, National Statistician, to Lord Luce, dated 26 February 2018

As National Statistician and Chief Executive of the UK Statistics Authority, I am replying to your Parliamentary Questions asking (i) how many deaths in England over the past five years were caused by or linked to prescription opioids (HL5647); and (ii) how many deaths in England over the past five years were caused by or linked to the use of over the counter opioids (HL5648).

The Office for National Statistics produces an annual report on deaths relating to drug poisoning.1 Drug poisoning deaths involve a broad spectrum of substances, including legal and illegal drugs, prescription type drugs and over-the-counter medications. Tables 6a to 6d published alongside the bulletin show the different drugs involved in each death, for England and Wales.

Table 1 below provides the number of deaths registered in England in the five years 2012 to 2016 where the underlying cause of death was drug-related and involved opiates. It cannot be inferred from the available data whether the substances were prescribed to the deceased, prescribed to another person, or obtained by other means.

Yours sincerely

John Pullinger

1 https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2016registrations

2 Cause of death was defined using the International Classification of Diseases, Tenth Revision (ICD-10). Deaths were selected where the underlying cause was drug poisoning and the specified substance was mentioned on the death certificate. The ICD codes used to select deaths related to drug poisoning are shown in Box 1 above.

3 Figures are for deaths registered, rather than deaths occurring in each calendar year. Due to the length of time it takes to complete a coroner’s inquest, it can take months or even years for a drug-related death to be registered. More details can be found in the 'deaths related to drug poisoning' statistical bulletin: www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/previousReleases

4 Any Opiate' figures include unspecified opiates, but exclude paracetamol compounds.

​The information requested falls within the responsibility of the UK Statistics Authority. I have asked the Authority to reply.

Letter from John Pullinger CB, National Statistician, to Lord Luce, dated 26 February 2018

As National Statistician and Chief Executive of the UK Statistics Authority, I am replying to your Parliamentary Questions asking (i) how many deaths in England over the past five years were caused by or linked to prescription opioids (HL5647); and (ii) how many deaths in England over the past five years were caused by or linked to the use of over the counter opioids (HL5648).

The Office for National Statistics produces an annual report on deaths relating to drug poisoning.1 Drug poisoning deaths involve a broad spectrum of substances, including legal and illegal drugs, prescription type drugs and over-the-counter medications. Tables 6a to 6d published alongside the bulletin show the different drugs involved in each death, for England and Wales.

Table 1 below provides the number of deaths registered in England in the five years 2012 to 2016 where the underlying cause of death was drug-related and involved opiates. It cannot be inferred from the available data whether the substances were prescribed to the deceased, prescribed to another person, or obtained by other means.

Yours sincerely

John Pullinger

1 https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2016registrations

2 Cause of death was defined using the International Classification of Diseases, Tenth Revision (ICD-10). Deaths were selected where the underlying cause was drug poisoning and the specified substance was mentioned on the death certificate. The ICD codes used to select deaths related to drug poisoning are shown in Box 1 above.

3 Figures are for deaths registered, rather than deaths occurring in each calendar year. Due to the length of time it takes to complete a coroner’s inquest, it can take months or even years for a drug-related death to be registered. More details can be found in the 'deaths related to drug poisoning' statistical bulletin: www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/previousReleases

4 Any Opiate' figures include unspecified opiates, but exclude paracetamol compounds.

I refer the noble peer to the answer I gave on 13 October 2014, Official Report, Column WA13.

The Secretary of State for Digital, Culture, Media and Sport has written to the Department's Arms Length Bodies to increase and encourage participation in the Commonwealth Summit celebrations. Departmental officials are continuing to work with the Commonwealth Summit Unit to put together a national package.

Local authorities have a statutory duty to provide a comprehensive and efficient library service that takes account of local needs within available resources. Statistics for the number of public libraries published by the Chartered Institute of Public Finance and Accountancy do not include figures for Northern Ireland, so it is not possible to provide the number of public libraries in the UK. However, in the rest of the country, the total number of public library service points open ten hours or more per week at 31 March 2015 was 3,917, compared with 4,356 in 2010. Based on desk research undertaken by the Department, we estimate that from January 2010 to January 2016 only approximately 110 static public libraries in England closed. Government has the power to ensure public libraries comply with the law, and where individual authorities have failed to meet this duty we will - and have - intervened.

This Government is helping libraries innovate, to ensure they serve the needs of local communities - particularly through the expansion of their digital offer. In the latest spending round we secured extra funding for our Libraries Task Force, set up in 2014, to promote the role of digital and share best practice between councils, and we have funded the rollout of free Wi-Fi in 99% of public libraries in England. E-book loans have rocketed more than four-fold from nearly 445,000 in 2011/12 to over 2.3 million in 2014/15.

The history curriculum gives teachers and schools the freedom and flexibility to use specific examples from history to teach pupils about the history of Britain and the wider world.

There are opportunities within the themes and eras of the history curriculum for teachers and schools to teach about the history of the Commonwealth at Key Stages 1-3. Schools can teach about the Commonwealth at Key Stage 1, when teaching about events beyond or within living memory that are significant nationally or globally, and at Key Stage 2, within a study of an aspect or theme in British history that extends pupils’ chronological knowledge beyond 1066. There are also opportunities at Key Stage 3, within the ‘ideas, political power, industry and empire: Britain, 1745-1901’ and ‘challenges for Britain, Europe and the wider world 1901 to the present day’ themes. ‘Indian independence and end of Empire’ is one of the example topics in this latter theme. The Commonwealth also falls within the scope of the subject content set out for GCSE history.

The government shared a Commonwealth Education Pack for teachers in 2018, in support of the UK’s hosting of the Commonwealth Heads of Government Meeting that year. The pack is available here: https://www.gov.uk/government/news/department-for-education-launches-commonwealth-education-pack, and has been attached.

As the Noble Lord, Lord Luce, notes, the government’s consultation on proposals to incentivise wider provision and uptake of accelerated degrees in higher education was published in December 2017. This consultation closed in February 2018.

The Department for Education received a range of detailed and comprehensive responses from providers, organisations and individuals across the higher education sector. We are currently considering these responses and will respond to the consultation in due course.

As part of the Department for Education’s outreach to schools ahead of the Commonwealth Heads of Government Meeting (CHOGM), we have prepared an education pack for 11-14 year-old school pupils. We plan to contact the Lord Lieutenants when the pack is ready to be sent to schools, with a view to asking them to support the promotion of the pack.

Schools are also free to teach their pupils about the Commonwealth as part of their school curriculum. The national curriculum for citizenship education, introduced in September 2014, sets out that pupils are taught about local, regional and international governance and the United Kingdom’s relations with the rest of Europe, the Commonwealth, the United Nations and the wider world.

There are also a number of opportunities in the history programmes of study for pupils to be taught about the Commonwealth; for example, pupils are taught about British history from 1745 to 1901, including the development of empire; and they are taught about the end of Empire and Britain’s place in the world since 1945.

It has not yet been decided who will represent Her Majesty’s Government at the Conference of Commonwealth Education Ministers. However, we hope to confirm attendance shortly, subject to parliamentary business. The purpose of the Conference is to strengthen cooperation across the Commonwealth for the benefit of young people of all ages. A key objective of this year’s conference is to address and define mechanisms through which education systems across the Commonwealth can enable sustainable development, and address major global challenges, such as climate change. This is a topic, which is of importance to young people across all member states.

The National Curriculum for history at Key Stage 2 states that pupils in maintained schools should study an aspect or theme in British history beyond 1066. This could be used by schools to teach about the Commonwealth. At Key Stage 3, pupils should study ideas, political power, industry and empire: Britain, 1745-1901. This could include the development of the British Empire.

Pupils at Key Stage 3 should also study the challenges for Britain, Europe and the wider world from 1901 to the present day, which could include the end of Empire and Britain’s place in the world since 1945.

In Key Stage 4 citizenship education, pupils in maintained schools must be taught about the different electoral systems used in and beyond the UK, the actions that citizens can take in democratic and electoral processes to influence decisions, and the UK’s relations with the Commonwealth, the UN and the wider world.

Schools have the autonomy to decide how to teach, and many use modern technology as part of their teaching. We are looking at the role of government in supporting schools to have access to quality content and materials.

In April last year, the UK hosted one of the most successful Commonwealth Heads of Government Meetings (CHOGM) ever. All 53 members of the Commonwealth adopted the Commonwealth Blue Charter, agreed to establish action groups on ocean issues led by Commonwealth member countries and mandated the Secretariat to take forward a Commonwealth Blue Charter plan of action. Since CHOGM, nine action groups have now been proposed of which the UK Government has joined three so far: the coral reef protection, ocean acidification, and ocean and climate change action groups. The UK Government is in the process of joining the action groups on Mangroves and Marine Protected Areas.

The UK and Vanuatu also spearhead the groundbreaking Commonwealth Clean Oceans Alliance (CCOA), the action group to tackle the scourge of plastic pollution in the ocean. The CCOA has gained unparalleled support since its launch in April, increasing its membership from seven to 24 countries across the Caribbean, Africa, Asia and the Pacific regions. In recognition of our global leadership on tackling the problem of plastic in the ocean, the Prime Minister has announced up to £66.4 million of UK aid to assist Commonwealth countries. This includes a technical assistance facility that will support developing countries in achieving their commitments under the CCOA, which was increased from £5 million to £10 million by the Prime Minister in August last year.

The first phase of the £6 million Commonwealth Litter Programme (CLiP) work in the Pacific region has been completed. Minister Coffey and Pacific country leaders attended a regional conference last month to showcase the marine litter action plans produced by the CLiP with Vanuatu and the Solomon Islands. Furthermore, over 35 Government funded Commonwealth Blue Charter Fellowships are underway which continue to support emerging Commonwealth scholars to explore solutions to the marine plastics challenge. We have made tremendous progress in safeguarding our ocean since CHOGM 2018 and we expect even more successful action ahead of the next CHOGM meeting in Rwanda in 2020.

The UK is committed to the Sustainable Development Goals, and tackling climate change and managing the natural environment is a core part of the Government’s international work. For example:

• The UK has increased its contribution to the Global Environment Facility to £250 million in the latest replenishment round (2018-2022).
• The Prime Minister will lead on galvanising international efforts on climate resilience at the UN Secretary General’s Summit in September this year.
• As part of a £61.4 million package of UK support announced by the Prime Minister at CHOGM, together with further announcements made during the Prime Minister’s visit to Africa, the Government has committed support to priority countries to increase recycling and tackle poor waste management. This includes: £3 million to trial approaches to the management of plastic waste in cities in three developing Commonwealth countries (Bangladesh, Ghana and Uganda) and up to £10 million of technical assistance to developing countries that have signed up to the CCOA.

At the International Wildlife Trade Conference hosted in London in October last year, the Government reaffirmed its commitment to tackling the international wildlife trade and we are now investing over £36 million between 2014 and 2021 to counter the trade, including £900,000 of new funding to develop a British military counter-poaching taskforce in Africa.

At last year’s Katowice Climate Change Conference, the UK demonstrated its climate leadership through our instrumental role in the creation of a rulebook to bring the Paris Agreement to life. This common set of rules and metrics is essential for driving genuine climate action globally and for future agreements.

Since April last year the Green Climate Fund has approved the funding of $1.05 billion in funding proposals, and successfully launched its first replenishment for the second resource mobilisation phase. A further $122.5 million has been approved for readiness funding to be deployed this year. Polices related to results management, prohibited practices, the restructuring and cancellation of funding proposals and the appointment of the World Bank as Trustee were also approved. The Fund also selected its next Executive Director, who will serve a four year term from April.

As announced by the Foreign Secretary at CHOGM, the UK and New Zealand co-hosted a meeting at Wilton Park on 16-18 December to discuss climate change and resilience in the Pacific. The Forum was an opportunity to listen to Pacific concerns, needs and priorities in relation to climate change, and provided a space for representatives from across governments and the academic and private sectors to discuss innovative solutions to these challenges.

Article 3 of the Withdrawal Agreement published on 26 November clearly states that Gibraltar is covered to the extent that Union Law applied to it before. Article 184, which records the UK and the EU’s commitment to negotiate in good faith and conclude agreements envisaged by the Political Declaration on their future relationship within a certain time frame, imposes no obligations regarding the territorial scope of future agreements. This is the EU and the UK’s shared interpretation. The government has also been clear that the UK will negotiate future agreements on behalf of all territories for whose external relations it is responsible.

As the Prime Minister has set out, we are seeking a strictly time-limited implementation period as part of our withdrawal negotiations, to provide certainty and stability for both people and businesses - in the UK and in the EU - to adjust to the new arrangements in a smooth and orderly way. The Prime Minister said clearly in the House on 18 December that we are not going to exclude Gibraltar from our negotiations for either the implementation period or the future agreement. It is the UK’s consistent position that our negotiations extend to include UK Overseas Territories, including Gibraltar, in those areas where their association with the EU is affected.

The Minister for Africa visited Kasai Central, in the DRC, in November 2017 to see for himself the impact of the conflict. UK bilateral aid is already supporting 25,800 children with food assistance in the Kasais. Over the next 5 years the UK will be providing a range of humanitarian support. As part of this, we will support a further 840,000 people nationally with food assistance, including people in the Kasais.

According to the UN, 21 million people - more than 80% of the population - are in need of humanitarian assistance in Yemen. Of those, over 6 million people are facing severe food shortages, with households struggling to meet their daily needs. In particular, 1.8 million children are most at risk and require access to life-saving nutrition services. In Hodeidah city alone, UNICEF have warned that 96,000 severely malnourished children are at risk of dying.

The UK is one of the largest donors to the crisis in Yemen and has announced £55 million to respond to the humanitarian crisis in Yemen, focused on the most urgent life-saving needs. UK aid will provide emergency shelter, healthcare, water, food and nutrition assistance for at least half a million Yemenis, as well as supporting UN work to co-ordinate the international humanitarian response.

The United Kingdom continues to closely monitor events in Zimbabwe, including the recent changes within the ruling party. We remain committed to supporting the aspirations of the Zimbabwean people for a more democratic, stable and prosperous future.

In 2013/14 we provided £106 million in aid to Zimbabwe. This aid focused on helping the country’s poorest people, including providing healthcare, water, sanitation, and access to markets needed for people to earn enough money to meet their basic needs.

No UK aid goes directly through GoZ systems. UK aid is instead channelled through multilateral institutions such as United Nations Agencies, most notably the United Nations Children’s Fund (UNICEF), as well as international Non-Governmental Organisations and the private sector.

The most up to date figures of DFID spend can be found in DFID’s Annual Report.

There are no plans to introduce legislation in relation to Fit for Work.

The Green Paper consultation set out our ambition to transform employment prospects for disabled people and people with long-term health conditions, and sought views on a range of issues including how to improve occupational health provision, drawing lessons from the Fit for Work service. We have been carefully considering the responses we received, to inform our approach to better supporting individuals to stay in and return to work. We will set out our plans for taking forward our ambitions in the Autumn.

We would like to take this opportunity to thank Lord Luce and the Chronic Pain Policy Coalition for their response to the Green Paper consultation which has given us valuable insight.

The consultation on the Work, Health and Disability Green Paper closed on 17^th February 2017. During the consultation period we engaged with a wide range of stakeholders, and received a large number of responses from people and organisations across society. We are currently evaluating all that we have heard before deciding what our next steps should be. In moving forward we are committed to continuing to engage with stakeholders, to build upon the discussion and debate that has been started by the Green Paper.

From 9 March 2015, roll-out of the assessment service commenced. By the end of Summer 2015 all GPs in England and Wales will be able to refer to the service.

Fit for Work Scotland assessment service went live on 30 January 2015. Roll-out to all remaining NHS Boards in Scotland was completed on 29 June 2015.

Evaluation of the pilots was published in June 2015 in the report, ‘Evaluation of the 2010–13 Fit for Work Service pilots’.

Fit for Work, previously known as the Health and Work Service, is comprised of two elements:

i) Free, expert and impartial work-related health advice via a website and telephone line

ii) Referral to an occupational health professional for employees who are, or are expected to, undergo a period of sickness absence from work lasting four weeks or more. The Fit for Work occupational health professional will identify obstacles preventing the employee from returning to work and produce a Return to Work Plan tailored to the employee’s needs.

The advice element of Fit for Work went live in England and Wales in December 2014.

From January 2015 some GPs in the Sheffield area had the opportunity to try the assessment service. This will be expanded across the country over a period of months from spring, building on this experience and learning.

Fit for Work Scotland is being delivered by the Scottish Government; the advice element went live in December 2014 and the referral element went live, initially in three NHS Board areas, in January 2015. As with England and Wales, this will be expanded across Scotland from the spring.

Physiotherapy services are commissioned locally by clinical commissioning groups. This includes agreeing and monitoring the waiting time to access services rather than this being set nationally.

A count of first outpatient attendances and the average (mean and median) waiting time in days, where the treatment specialty is physiotherapy, is shown in the following table. Data is for the 2018-19 financial year.

Source: Hospital Episode Statistics (NHS Digital)

Physiotherapy services are commissioned locally by clinical commissioning groups. This includes agreeing and monitoring the waiting time to access services rather than this being set nationally.

A count of first outpatient attendances and the average (mean and median) waiting time in days, where the treatment specialty is physiotherapy, is shown in the following table. Data is for the 2018-19 financial year.

Source: Hospital Episode Statistics (NHS Digital)

NHS Digital publishes Hospital and Community Health Services workforce statistics for England. These include staff working in hospital trusts and clinical commissioning groups (CCGs), but not staff working in primary care, local authorities or other providers.

As at September 2019, the latest available data, there were 19,977 full time equivalent physiotherapists employed in National Health Service trusts and CCGs.

Following publication of the interim People Plan on 3 June 2019, a full NHS People Plan is in development. This will set out the workforce implications for all staff groups, including physiotherapists, in delivering the NHS Long Term Plan priorities.

NHS Digital publishes data biannually on staff in some independent sector healthcare organisations in England, mainly data from large organisations. The latest available data as at March 2019, shows that there are 2,270 full time equivalent (FTE) physiotherapists in 56 independent sector organisations which provided data. The data presented for the independent healthcare provider workforce does not represent the entire workforce employed across the whole of this sector and does not only show the staff providing National Health Service-commissioned services. These statistics relate to the workforce directly employed in a range of independent healthcare provider organisations in England and may include staff on maternity leave and career breaks.

Independent healthcare provider workforce: qualified staff working within the care setting 'physiotherapy' as at 31 March 2019, experimental statistics.