Asked by: Lord Scriven (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what the total cost to the NHS was in each of the past five years for treating complications resulting from non-therapeutic male circumcision performed outside of NHS settings; what the total expenditure for procedures under OPCS-4 code S47.4 (reconstruction of prepuce) and S47.5 (other operations on prepuce) is where the primary diagnosis was not a congenital medical condition; and what assessment they have made of the cost offset required to treat emergency admissions for ICD-10 code T81.0 (haemorrhage and haematoma) when linked to a history of recent non-therapeutic surgical intervention.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The Department does not hold the data in this format.
Asked by: Lord Scriven (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government why they instructed a reduction of integrated care board staff by April 2026 without making additional up-front funding provision for redundancy payments.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
Following the Prime Minister’s announcement of the abolition of NHS England, we have been clear on the need for a smaller centre, as well as scaling back integrated care board running costs and National Health Service provider corporate costs, in order to reduce waste and bureaucracy.
We have recently announced the Spending Review settlement which provides an additional £29 billion of annual day-to-day spending in real terms by 2028/29 compared to 2023/24. We are now carefully reviewing how the settlement is prioritised, including making provision for redundancy costs. In due course, the NHS will be asked to incorporate this into the multi-year planning round which has now been launched with the publication of the Medium-Term Planning Framework on 24 October 2025.
Asked by: Lord Scriven (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the Written Answer by Baroness Merron on 1 December 2025 (HL12313), where the results of the NHS Learning Disability Improvement Standard exercise are published; how people with learning disabilities and their families are involved in the exercise; and how the results are made accessible to people with learning disabilities and their families so they are able to compare performance amongst NHS Trusts.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The NHS Learning Disability Improvement Standards support National Health Service trusts to assess the quality of care provided for people with a learning disability and were designed with lived experience at the centre of the process. The standards and easy read information are available on the NHS England website.
To understand how well organisations are meeting the standards, the NHS Benchmarking Network undertakes an annual data collection exercise, with further information avaiable at the NHS Benchmarking Network website. All annual summary reports are published on the Learning Disability Improvement Standards Hub website. Each trust that participates in the exercise also receives their own bespoke report and are encouraged to share learning at the local level in suitable formats for the populations they serve.
Ahead of each annual benchmarking exercise, people with a learning disability and user-led organisations are engaged to design and revise the metrics which are asked of NHS organisations. This process recognises that people with lived experience are best placed to ask questions concerning the quality of services they expect and has recently been facilitated by Learning Disability England. Input is also sought from clinicians, managers, and senior leadership, ensuring greater transparency and accountability.
Asked by: Lord Scriven (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the Written Answer by Baroness Merron on 23 December (HL11565), of the executive senior managers at NHS England who have left since 1 March 2025 and received payments in lieu of notice or annual leave, (1) how many have since been re-employed in any capacity—including as consultants or interim staff—by the NHS or an NHS body, arm’s-length body, or government department, (2) how many of these individuals have been required to repay all or part of their exit payments under current clawback provisions, and (3) what is the total value of the funds successfully recovered to date.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
Of the 17 executive senior managers at NHS England who have left since 1 March 2025 and received a payment either in lieu of notice or in lieu of annual leave, six have since been re-employed in the National Health Service, an NHS body, an arm’s length body (ALB), or a Government department. We do not hold information related to consultancy.
One of these six individuals received a redundancy payment which is in the scope of the clawback provisions. Recovery has commenced for a partial recovery proportionate to their gap in NHS employment.
For the other five people securing re-employment in the NHS, an NHS body, an ALB, or a Government department, their payments in lieu related to annual leave or notice, and therefore were not within the scope of clawback arrangements.
Whilst recovery action has actively commenced for the individual in the scope of the claw back provisions, no funds have been recovered to date.
Asked by: Lord Scriven (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government whether they considered the findings of NHS England’s economic analysis which shows the community pharmacy sector is under-funded by over £2 billion per annum when deciding to clawback a further £16.8 million per quarter from community pharmacies through adjustments to drug tariff pricelists.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
Funding for pharmaceutical services is through the Community Pharmacy Contractual Framework (CPCF) settlement. For 2025/26, this was increased to £3.073 billion, of which £900 million is the amount pharmacy contractors are allowed to retain as medicine margin, the difference between the reimbursement price and the purchase price paid by the pharmacy contractor.
The Department, along with Community Pharmacy England, the representative body of community pharmacies, assesses the medicines margin retained by community pharmacies in totality, through a ‘quarterly margin survey’. If too much medicine margin is being delivered, then downwards adjustments, or clawbacks, are made to bring this in line with the allowed medicine margin as agreed under the CPCF settlement.
The economic analysis is considered as part of the wider decision on the CPCF settlement, which was agreed with Community Pharmacy England, the representative body of community pharmacies. The medicine margin adjustment made each quarter, including the downward adjustment of £16.8 million per quarter made in January 2026, is operating within the agreed 2025/26 CPCF settlement.
Asked by: Lord Scriven (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the Written Answer by Baroness Merron on 1 December 2025 (HL12313), what Core20Plus5 indicators they have developed and embedded to monitor access, experiences and outcomes for people with learning disabilities; and how this information will be reported upon nationally.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
NHS England has put in place indicators designed to monitor access, experience, and outcomes for Core20PLUS populations, including people with a learning disability who are expected to be identified as a priority group. The Core20PLUS5 indicator for learning disability is the ‘Percentage of patients aged 14+ on GP learning disability registers who received an annual health check'. This is reported nationally as part of the NHS Oversight Framework.
There are clear expectations of local systems to improve outcomes for people with a learning disability and governance through existing frameworks. NHS England has published a Statement on Information on Health Inequalities, avaiable on the NHS.UK website in an online only format, which sets out the data that integrated care boards (ICB) are expected to collect. This includes measures relating to percentage of learning disability annual health checks and adult mental health inpatient rates for people with a learning disability and autistic people. Within annual reports, ICBs should explain how information has been used to guide action.
In addition, each ICB is required to have an executive lead on learning disability and autism and to consider and demonstrate how they will reduce the health inequalities faced by people with a learning disability and autistic people in their local populations within the five year strategic plans mandated as part of the Medium-Term Planning Framework, which is avaiable on the NHS.UK website in an online only format.
Asked by: Lord Scriven (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what assessment they have made of the proposal to require prior approval introduced by the Black Country Integrated Care Board for ADHD and autism assessments; and what steps they are taking to ensure that such schemes do not infringe upon the statutory right to choose established in the NHS Constitution, particularly where referrals to independent providers are being paused or restricted.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
It is the responsibility of integrated care boards (ICBs) in England to make appropriate provision to meet the health and care needs of their local population, including providing access to attention deficit hyperactivity disorder (ADHD) and autism assessments, in line with relevant National Institute for Health and Care Excellence guidelines.
NHS England issued advice to systems on ADHD service delivery and prioritisation on 7 October 2025. This advice includes guidance on managing service provisions, reviewing waiting lists and providing patient support. The advice can be found on NHS England’s website.
The Medium-Term Planning Framework, published 24 October, was explicit that ICBs and providers are expected to optimise existing resources to reduce long waits for ADHD and autism assessments and improve the quality of assessments by implementing existing and new guidance, as published.
The NHS Black Country ICB has a prior-approval process to make sure referrals meet clinical criteria and that providers meet required quality and governance standards. This applies to all Right to Choose providers offering ADHD and autism assessments. This does not affect patient choice, as people will still be able to choose their preferred provider when their general practitioner makes a referral.
Patients already have the legal right to choose the provider and team who will provide their elective care in certain cases. These rights extend to any provider in England who holds a contract with an ICB, or NHS England, for the service/s the patient requires, as per the NHS Choice Framework. This includes independent sector providers. ADHD services are already in scope of this legislation.
Asked by: Lord Scriven (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what assessment they have made of the impact of activity management plans on the financial viability of independent providers of ADHD and autism services; and whether they plan to review the national system of spending controls to prevent Integrated Care Boards from pausing referrals to providers who have reached their contracted capacity but have the clinical capacity to treat more patients.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
It is the responsibility of integrated care boards (ICBs) in England to make appropriate provision to meet the health and care needs of their local population, including providing access to attention deficit hyperactivity disorder (ADHD) assessment and treatment, in line with relevant National Institute for Health and Care Excellence guidelines.
Patients already have the legal right to choose the provider and team who will provide their elective care in certain cases. These rights extend to any provider in England who holds a contract with an ICB, or NHS England, for the service/s the patient requires, as per the NHS Choice Framework. This includes independent sector providers. ADHD services are already in scope of this legislation.
The Medium-Term Planning Framework, published 24 October, was explicit that ICBs and providers are expected to optimise existing resources to reduce long waits for ADHD assessments and improve the quality of assessments by implementing existing and new guidance, as published.
The NHS Standard Contract, used for the commissioning of all non-primary National Health Service healthcare services in England, includes provision for an indicative activity plan to be agreed between providers and commissioners for each contract year.
This plan provides both parties with a useful tool to plan for the expected demand, capacity, and expenditure for any service. An indicative activity plan is not binding on either party, but if activity carried out is higher or lower than the plan, then either party can work through an activity management process and agree a binding activity management plan to bring activity back in line with the indicative activity plan.
Asked by: Lord Scriven (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what guidance they have provided to Integrated Care Boards regarding the definition of exceptional clinical grounds for neurodiversity assessments and weight management treatments; and how they intend to ensure that the prioritisation of maximum health gain does not lead to the exclusion of patients with moderate symptoms who may deteriorate without early intervention.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
Integrated care boards (ICBs) are legally required to fund and make available medicines recommended by the National Institute for Health and Care Excellence (NICE), including obesity medicines. These are available in specialist weight management services and recently one of these medicines, tirzepatide, under the name Mounjaro, has started to become available in primary care. NHS England has been supporting ICBs with a phased rollout for tirzepatide, prioritising those with the highest clinical need first to manage National Health Service resources and allow time to establish new obesity care pathways. NHS England worked with experts, patient and public representatives, and relevant organisations to develop the prioritisation approach.
Neurodiversity does not exclude patients from clinical assessment, and decisions about treatment are clinically led. NHS England’s interim commissioning guidance to ICBs on tirzepatide states that people with severe mental health conditions, a learning disability, or who are autistic, are at higher risk of cardiometabolic disease and will potentially benefit from weight management support and/or treatment through weight loss therapies. It states that these patients should be actively supported to access treatment, unless there is a clinical reason not to do so.
Where a patient is assessed as likely to benefit from treatment but does not fall within the scope of primary care management, they may be referred by their clinician to specialist services and secondary care to receive more individualised, multidisciplinary support. As part of a holistic assessment, clinicians consider the risk of deterioration and the benefits of earlier intervention when determining the most appropriate care pathway.
Asked by: Lord Scriven (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what is the total number of senior managers at NHS England who have left since 1 March and received a payment in lieu of notice, and what is the total amount of these payments; and how many senior managers received a payment in lieu of annual leave, and what is the total amount of those payments.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
Five executive senior managers at NHS England have left since 1 March 2025 and received a payment in lieu of notice. These payments total £553,252.15. 12 executive senior managers at NHS England have left since 1 March 2025 and received a payment in lieu of annual leave. These payments total £124,015.62.