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 the integrated care board (ICB) reorganisation process on ICB staff satisfaction.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
No formal assessment has been made, although the Department recognises that the current process of transition to new integrated care board (ICB) structures and roles directly impacts staff. As the Secretary of State for Health and Social Care acknowledged in his speech at the NHS Providers conference on 12 November, there has been uncertainty for staff for too long but funding arrangements for voluntary redundancy arrangements have now been confirmed and that will help to provide certainty for people. NHS England is working to support ICBs as part of the change process.
The Government is committed to the modernisation of the National Health Service as set out in the 10-Year Health Plan, including refocusing the role of ICBs to strategic commissioning. This will help to support the delivery of the three shifts, from hospital to community, from analogue to digital, and from sickness to prevention, that are needed to build a health service fit for the future.
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 plan to introduce a modern service framework for learning disability services to improve patient outcomes and reduce inequalities, and if so, by when.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The Government is committed to driving service improvements and reducing health inequalities for people with a learning disability. There are currently no plans to introduce a specific modern service framework for learning disability services.
A wide range of work is underway to improve the care of people with a learning disability. The NHS Learning Disability Improvement Standard supports National Health Service trusts by setting guidance on safe, personalised, and high-quality care provision. The standards are designed to support organisations in assessing the quality of their services and to promote uniformity across the NHS in the care and treatment provided to people with a learning disability.
People with a learning disability are identified as a priority cohort in the national Core20PLUS5 programme, which seeks to drive local action on health inequalities. NHS England has developed and embedded indicators to monitor access, experience, and outcomes for Core20PLUS populations.
Integrated care boards (ICBs) are required to have an Executive Lead for learning disability and autism, ensuring there is senior oversight and accountability for tackling health inequalities. Every ICB has a requirement to consider and demonstrate how they will reduce the health inequalities faced by people with a learning disability and autistic people within their local populations within the five year strategic plans required as part of the Medium-Term Planning Framework issued by NHS England in October 2025.
The NHS Act 2006 requires ICBs to have regard to the need to reduce health inequalities and NHS England produces a Statement of Information on Health Inequalities setting out advice for ICBs on how they can achieve this duty. Published in November 2025, this year the statement includes specific reference to people with a learning disability and autistic people.
Asked by: Lord Scriven (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government whether the remits of the National Director of Patient Experience, the National Quality Board, and the forthcoming Quality Strategy specifically include the quality of care for people with learning disabilities.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The remits of the National Director of Patient Experience, the National Quality Board, and the forthcoming Quality Strategy will encompass all patient groups, including those with learning disabilities. The remit of the National Director of Patient Experience will include listening to the experiences of people with learning disabilities and understanding their priorities for improvement.
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 letter from the chief executive of the Queen's Institute of Community Nursing to the Secretary of State for Health and Social Care that raised concerns about the safety, quality and oversight of services.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
Community nurses will be a vital part of our ambitions to shift more care from hospital to the community.
Understanding current community nursing capacity and planning and monitoring future community nursing capacity as well as addressing variation across England is central to achieving our 10-Year Health Plan. As part of this, the Government is committed to publishing a 10 Year Workforce Plan to set out action to create a workforce ready to deliver the transformed service set out in the 10-Year Health Plan.
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 10 November (HL11512), how many separate formal meetings involving a minister and either a senior manager or the clinical lead at NHS England with specific responsibility for the learning from lives and deaths (LeDeR) programme there have been with the LeDeR programme and its findings as the principal or only item on the agenda since July 2024; and on which specific dates those focused meetings took place.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
As set out in the Written Answer on 10 November, there are regular conversations between the relevant minister, Department officials, and senior clinical and managerial leads at NHS England in relation to improving overall health outcomes for people with a learning disability and autistic people.
Several meetings have taken place since July 2024 and the publication of the recent annual Learning from Lives and deaths, people with a learning disability and autistic people report was discussed. The Parliamentary Under Secretary of State for Health Innovation and Safety, who recently assumed responsibility for this, has met senior managers and discussed key findings from the report and the wider work underway to tackle health inequalities and improve access to, and the quality of, services for people with a learning disability.
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 will introduce an NHS activity-based payment scheme for mental health and community services; and if so, what measures they will introduce to ensure stable and fair payment for those services through that scheme.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
Neither the Department or NHS England have any plans to introduce an activity-based payment scheme for all community and mental health services. However, it may be appropriate to introduce activity-based payment for some community and mental health services in the future.
NHS England is developing standard currencies for community and mental health services that can be used as the basis for future payment models. The development of community and mental health tariffs will be dependent on the availability of good quality costing and activity data.
Asked by: Lord Scriven (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what formal mechanism is in place to monitor and audit how local authorities and integrated care boards use resources designated for people with a learning disability, particularly where delegated agreements under section 75 of the National Health Service Act 2006 or equivalent arrangements are in effect, to ensure that funding intended for statutory duties is not being used to offset general budgetary deficits.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
Integrated care boards (ICBs), as set out in NHS England statutory guidance published 9 May 2023, are expected to assign an executive lead role for learning disability and autism to a suitable board member. The named lead is expected to support the board in planning to meet the needs of its local people with a learning disability and its local autistic people and to have effective oversight of, and support improvements in, the quality of care for people in a mental health, learning disability and autism.
There are clear expectations of ICBs in relation to care and support provision for people with a learning disability and autistic people, and they are held accountable through existing governance processes. The Medium-Term Planning Framework, published 24 October, sets out priorities for ICBs and providers on learning disability and autism, including reducing health inequalities and reliance on mental health inpatient care. ICBs report their spend on Learning Disability and Autism Services as part of routine financial reporting, monitored by NHS England. The Model ICB Blueprint sets out the direction of travel for the role and functions of ICBs in relation to commissioning services for the needs of their local population. There is a range of best practice guidance available and published to support ICBs to commission services for people with a learning disability.
Asked by: Lord Scriven (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what specific policy and funding steps they will take to mandate the full implementation of the learning disabilities mortality review programme recommendations.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
Learning from lives and deaths reviews (LeDeR) play a vital role in identifying learning from the notified deaths of people with a learning disability and autistic people, and the recommendations made in individual reviews, as well as the annual report, are key drivers for national and local service improvement. LeDeR reviews incorporate more than just the last episode of care before a person’s death, as they also include the key health and social care experiences the person had. The Government remains committed to reviewing every death notified to LeDeR and sharing the learning from these reviews widely to inform change.
There are no plans to mandate aspects of the LeDeR programme. Integrated care boards (ICBs) are held accountable for the care of people with a learning disability through existing governance processes, such as the NHS Operating Framework and annual assessment of ICB delivery. ICBs are expected to have an Executive Lead on LeDeR and NHS England’s national LeDeR policy sets out the clear expectation that ICBs prioritise LeDeR in their delivery plans and produce an annual report on their findings and actions taken.
Asked by: Lord Scriven (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what specific policy changes they will make to ensure that integrated care boards and healthcare providers are held accountable for systemic failures in providing equitable care for people with learning disabilities.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
The Government is committed to improving care for people with a learning disability and has recognised within our new 10-Year Health Plan the unacceptable inequalities and poor life expectancy this group of people faces.
Integrated care boards (ICBs) are held accountable for the care of people with a learning disability through existing governance processes, such as the NHS Operating Framework and annual assessment of ICB delivery. ICBs are expected to have an Executive Lead for learning disability and autism to support the board in planning to meet the needs of its local population of people with a learning disability and autistic people and to have effective oversight of, and support improvements in, the quality of care.
Findings from learning from lives and deaths reviews (LeDeR) are a crucial tool for identifying systemic failures in the care of people with a learning disability and autistic people, as well as driving local service improvements. This is why ICBs are expected to have an Executive Lead on LeDeR and NHS England’s national LeDeR policy sets out the clear expectation that ICBs prioritise LeDeR reviews in their delivery plans and ensure that actions are implemented to improve services and reduce premature mortality.
In the recently published Medium-Term Planning Framework, published 24 October 2025, the Government reaffirmed its commitment to reducing the health inequalities faced by people with a learning disability and autistic people, setting up ambitious targets for ICBs and health care providers. This includes reducing admission rates to mental health hospitals for people with a learning disability and autistic people, and optimising existing resources to reduce long waits for autism and attention deficit hyperactivity disorder assessments.
Asked by: Lord Scriven (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government how many formal meetings there have been between a minister and either (1) the senior manager, or (2) the clinical lead at NHS England, with responsibility for the learning from lives and deaths programme since July 2024, and on which dates those meetings took place.
Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)
There have been regular conversations between the relevant minister, Department officials, and senior clinical and managerial leads at NHS England in relation to improving overall health outcomes for people with a learning disability and autistic people. Insights from the programme of learning from the lives and deaths of people with a learning disability and autistic people plays an important role in shaping these broader conversations about tackling health inequalities and improving identification, access to, and the quality of services.