Lord Warner

The department remains committed to introducing statutory local authority registers for children not in school, as well as a duty for local authorities to provide support to home-educating families. The department will legislate for these at the next suitable opportunity, to help local authorities undertake their existing duties to ensure all children receive a suitable education and are safe, regardless of where they are educated. However, local authorities’ existing powers and duties, if used in the way set out in our guidance, are enough for a local authority to determine whether provision is suitable.

Elective home education needs to be suitable, although there is no requirement to follow the national curriculum, nor are parents required to enter children for public examinations. However, if the home education does consist of one or more of these, that would constitute strong evidence that education was ‘suitable’ in terms of section 7 of the Education Act 1996.

Out-of-school settings, such as supplementary religious schools, are not regulated under education or childcare law and are therefore not required to register with the department or Ofsted. However, the department remains committed to ensuring that children are safeguarded across all education settings and are working closely with key safeguarding partners, sector representatives, and parent groups to develop proposals for how we might further enhance safeguarding in this sector. The department will look to consult on such proposals later this year. We will be publishing updated safeguarding guidance for providers and parents, as well as a new e-learning package aimed at strengthening providers’ understanding of the arrangements they should have in place to keep children safe.

Any education setting which makes full-time provision to five or more pupils of compulsory school age (or one or more such pupils who is looked after or has an education, health and care plan), is not maintained by a local authority and is not a non-maintained special school is required to register with the department as an independent school. It is a criminal offence to conduct an educational setting which meets the definition of an independent school if this is not registered with my right hon. Friend, the Secretary of State for Education.

The government has been working proactively since 2016 to identify, investigate and, where appropriate, prosecute those operating unregistered independent schools. Between 1 January 2016 and 31 August 2022, Ofsted issued warning notices to 132 settings that may be operating as unregistered schools (this includes all settings including those with a secular or faith ethos). Of those settings, 81 changed their operation to comply with legislation, 21 closed and 16 registered. There have been six successful prosecutions against those operating unregistered schools and there are several ongoing investigations.

If safeguarding concerns are raised about a specific setting, we expect local authorities to intervene, as they are legally responsible for safeguarding and promoting the welfare of children in their areas, regardless of the educational setting they attend.

All independent fostering agencies (IFAs) are registered with Ofsted under the Care Standards Act 2000 and must meet the legal requirements set out in the Fostering Services (England) Regulations 2011. IFAs are inspected by Ofsted under the Social Care Common Inspection Framework (SCCIF) on a three-year inspection cycle.

Under the National Minimum Standards IFAs have a duty to ensure the welfare of the children in care and a duty to work effectively in partnership with other agencies concerned with child protection, such as the responsible authority, schools, hospitals and general practitioners.

Serious incidents must be reported by IFAs to Ofsted, including any serious complaints about an approved foster parent. Local authorities must notify the Child Safeguarding Practice Review panel, and by extension the department and Ofsted, within five working days of becoming aware of a serious incident. These incidents are where abuse or neglect is known or suspected.

If a foster carer’s approval to foster is terminated, a copy of the notice must be sent to the responsible authority for any child placed by another local authority, and to the relevant local authority if the foster carer lives outside the area of the fostering service.

The department intends to reopen the consultation on 'Regulating independent educational institutions' when stakeholders ability to respond is less likely to be significantly affected by the COVID-19 outbreak. Responses received to date will be combined with responses received after the consultation reopens and fully reviewed after the consultation finally closes.

It is not yet appropriate to set a date for reopening the consultation as the situation in relation to the COVID-19 outbreak continues to change.

Ofsted continues to investigate potential illegal schools including consideration of new intelligence. Where appropriate, Ofsted have liaised with local authorities and other statutory bodies to consider whether there is appropriate action that should be taken, for example, to close settings where people are gathering illegally during the COVID-19 outbreak.

The department intends to reopen the consultation on 'Regulating independent educational institutions' when stakeholders ability to respond is less likely to be significantly affected by the COVID-19 outbreak. Responses received to date will be combined with responses received after the consultation reopens and fully reviewed after the consultation finally closes.

It is not yet appropriate to set a date for reopening the consultation as the situation in relation to the COVID-19 outbreak continues to change.

Ofsted continues to investigate potential illegal schools including consideration of new intelligence. Where appropriate, Ofsted have liaised with local authorities and other statutory bodies to consider whether there is appropriate action that should be taken, for example, to close settings where people are gathering illegally during the COVID-19 outbreak.

We are consulting on proposals to update the statutory scheme for branded medicines pricing, which is broadly commercially equivalent to the Voluntary Scheme for Branded Medicines Pricing and Access. The consultation includes a proposal for a “lifecycle adjustment” mechanism that would provide a flat, lower payment for older products in more competitive markets. This proposal is intended to be pro-competition as older products with little to no competition in the market currently could access this lower payment if competition develops.

The Voluntary Scheme for Branded Medicines Pricing and Access (VPAS) payment percentages have been at or below those projected when the scheme was agreed. Recent increases to payment percentages reflect the scheme working as intended to adjust for increased sales of branded medicines to the National Health Service, which is the result of the positive access and uptake environment within the NHS.

The VPAS agreement was described as a “pro-innovation deal” by the Association of the British Pharmaceutical Industry who negotiated and signed the deal on behalf of the whole pharmaceutical industry in the United Kingdom.

There are several factors which influence company investment decisions in any country or region. Available evidence suggests that supply side factors, such as availability of expert scientific labour and favourable tax conditions, are of greatest significance in the decision on future investment. However, we understand that price regulation schemes such as VPAS may be a consideration in the decision to locate some investments, which is why we are committed to agreeing a successor voluntary scheme to VPAS that supports a strong UK life sciences sector.

The estimated value of foreign direct investment in the UK life sciences sector can be found in the ‘Life sciences competitiveness indicators’ publication, which is available on GOV.UK in an online-only format. The estimated value of foreign direct investment in 2022 was just over £1 billion, nearly £1.9 billion in 2021 and £927 million in 2020.

The following table shows the number of presentations between 2019 and 2023 to date where members of the 2019 Voluntary Scheme for Branded Medicines Pricing and Access had applied for a price increase. In addition, for 2023, price increase applications have been received for a further five presentations that are currently undergoing assessment by the Department.

We are unable to provide the information requested on the proportion of successful applications, as such information is commercially sensitive.

All healthcare providers carrying out regulated activity should follow clinical best practice and must be registered with their professional body and any other regulators, as appropriate, for that service. If a private organisation fails to meet the standards expected of it, then regulators including the Care Quality Commission have powers to inspect these services to determine whether patient safety is at risk or if best practice is not being followed.

All healthcare providers, whether they are providing an NHS funded or privately funded service, should follow clinical best practice and be registered with their professional body and any other regulators, as appropriate for that service. The Department will work with relevant regulatory bodies to ensure that any organisation and people prescribing puberty blockers are doing so in line with the regulatory framework and appropriate professional standards which any health care provider must legally meet.

The Department recognises the important role that biosimilars and generics play in ensuring affordability, patient access, and supply resilience. We have not seen convincing evidence that the voluntary scheme for branded medicines pricing and access has had an impact on medicines supply including biosimilars, given available mitigations such as provisions in the scheme for companies to apply for price increases should supply of products be otherwise uneconomical.

The information requested is not held centrally. It would not be appropriate for us to comment on a representation of the off-patent sector as this is closely connected with an ongoing legal case.

An assessment on interoperability has been made across several areas through the Digital Maturity Assessment, providing greater understanding of individual organisational-level capability and enabling focus on national efforts to support levelling up those organisations at a lower level of maturity.

Every child born in England is issued a National Health Service number at birth which stays with them throughout their life. The NHS number acts as a unique patient identifier and is used to share information within electronic healthcare records. This contributes to improved health outcomes for children by ensuring that health professionals identify patients correctly and have access to information to inform the delivery of appropriate care.

No specific assessment has been made. Every child is assigned a National Health Service number at birth or the first time they have contact with NHS services. The NHS number acts as a unique patient identifier and is used to share information within electronic healthcare records. This contributes to improved health outcomes for children by ensuring that health professionals identify patients correctly and have access to information to inform the delivery of appropriate care.

No specific assessment has been made. Every child is assigned an National Health Service number at birth or the first time they have contact with NHS services. The NHS number acts as is a unique patient identifier and is used to share information within electronic healthcare records. This contributes to improved health outcomes for children, including looked after children and those with complex needs, disabilities and long-term conditions, by ensuring that health professionals identify patients correctly and have access to information to inform the delivery of appropriate care.

Through the Health and Care Act 2022, the Government has committed to report on Government’s policy on information sharing in relation to the safeguarding of children, including looked after children and those at risk, by summer 2023. The report will include an explanation of whether it is the Government’s policy that a consistent child identifier should be used across agencies.

We are running a national recruitment campaign until 31 March 2023 to encourage more people to consider a rewarding role in care. In February 2022, we made care workers eligible for the Health and Care Visa and added them to the Shortage Occupation list.

We are making available £15 million in 2023/24 to help local areas establish support arrangements for international recruitment and improve workforce capacity in adult social care. In addition, the £500 million adult social care discharge fund announced last September can be used by local authorities for the recruitment and retention of the social care workforce.

All businesses irrespective of their size or business sector are responsible for paying the correct National Living Wage and National Minimum Wage to their staff.

If any care worker is concerned that they are being underpaid, we strongly urge them to call the the Advisory, Conciliation and Arbitration Service (Acas) helpline for free, impartial and confidential advice about their rights and entitlements. Acas officers will pass on cases to HM Revenue & Customs for further consideration where appropriate.

The Department has no plans to align the pay progression of adult social care workers to National Health Service pay scales.

Local authorities are responsible for setting budgets for adult social care. They are best placed to assess local resources and need. The funding we have made available gives them the flexibility to do so in their local budgets.

The Department is committed to the roll out of social prescribing and associated activities, including arts, music and gardening across the National Health Service in England. Social Prescribing Link Workers (SPLWs) work with people to understand ‘what matters to them’ then to connect them to agencies for practical, emotional and social support and to community groups and activities. Where individuals consent, SPLWs capture wellbeing outcomes before and after engagement with the social prescribing service as routine practice, using standardised outcomes measures such as Office for National Statistics Four. There is growing evidence on the role that activities, whether they be creative, activity- or nature-based, improve people’s health and wellbeing. The role of SPLW is also being evaluated by the National Institute for Health and Care Research to determine how access, engagement and outcomes vary by delivery model, geography and population characteristics over time.

The National Institute for Health and Care Excellence (NICE) Guidance has been released for guided Digital Cognitive Behavioural Therapy tools for children and young people with symptoms of low mood and anxiety. The technologies in these categories are being evaluated by NICE as part of their Early Value Assessment, which covers both clinical and cost effectiveness.

For NHS Talking Therapies for anxiety and depression services, a key characteristic is the routing collection of clinical outcome measures and monitoring activity. NHS England’s Digitally Enabled Therapies (DETs) Assessment Criteria enables DETs to be reviewed for suitability for use in NHS Talking Therapies Services.

The Government published its final impact assessment of updates to the statutory scheme on 2 March 2023. A copy of the impact assessment is attached.

The Department carefully considers all evidence in the public domain on matters relating to the growth and competitiveness of the United Kingdom’s life science sector, including the recent report by the Association of the British Pharmaceutical Industry. This occurs in combination with broad engagement with individual companies, the National Health Service and with charities and patient representatives and will continue moving forward as part of the delivery of the Government’s Life Science Vision.

The Department carefully considers all evidence in the public domain on matters relating to the growth and competitiveness of the United Kingdom’s life science sector, including the recent report by the Association of the British Pharmaceutical Industry. This occurs in combination with broad engagement with individual companies, the National Health Service and with charities and patient representatives and will continue moving forward as part of the delivery of the Government’s Life Science Vision.

We have no plans to undertake such a comparison. Differences in the structure of medicine pricing policies and systems make direct comparisons of payment percentages or rebates with other countries difficult and potentially misleading.

The Government is open to ideas about how a successor to the voluntary scheme for branded medicines pricing and access should operate from 2024 onwards. We will be considering a range of factors and will work with industry to consider learning from approaches in the United Kingdom and internationally, to agree a mutually beneficial successor that supports better patient outcomes; ensures the sustainability of National Health Service spend on branded medicines; and enables a strong UK life sciences industry.

The Delivery plan for recovering urgent and emergency care services was published on 30 January 2023 and sets out plans for increasing National Health Service capacity. A copy of the plan is attached.

The plan includes over 800 new ambulances, of which 100 are specialist mental health ambulances, in 2023/24, with the majority of these on the road by next winter. There will be an additional 5,000 staffed beds in 2023/24 as part of the permanent bed base for next winter.

NHS England has asked systems as part of the 2023/24 planning round to develop and implement integrated urgent and emergency care workforce plans based on capacity and demand assessments in line with local population need. As such, these estimates are still under consideration.

To support the overall health workforce, the Department has commissioned NHS England to develop a long-term plan for the National Health Service workforce for the next 15 years.

The Government has committed to publishing the high-level workforce plan this year, including independently verified projections for the number of doctors, nurses and other professionals that will be needed in five, 10 and 15 years’ time.

The £50 million capital funding announced on 9 January 2023 is a reallocation within the Department’s 2022/23 budget where some underspends have emerged in-year. The funding can be used to provide expanded spaces that can handle larger volumes of patients, for example to expand hospital discharge lounges and ambulance hubs. NHS England has worked with local areas and trusts to identify where the investments are deliverable in this financial year, have the best impact, and fit with their existing estate. The funding will be provided to the individual trusts through issuing public dividend capital.

The £200 million discharge funding announced on 9 January 2023 will provide short-term National Health Service step-down care packages to help ease the pressure on hospital beds. It will be for the local NHS trust to determine the most clinically appropriate settings for community-based care. The funding is held centrally by NHS England and allocated to integrated care boards (ICBs) and has been taken from the Department’s existing 2022/23 budget. ICBs lead on the procurement and purchasing of this additional capacity, working closely with local authorities, in line with local need.

The commissioning of care and support services is a matter for local authorities. The Department does not have oversight of contract hand backs, with local authorities being used to manage entry and exit of care providers in the market and having appropriate plans in place to minimise any disruption to services.

The Care Quality Commission notes that from financial years 2017/18 to 2022/23, there was a net overall increase of 79,081 beds. 4,151 care homes were registered in this period, with 3,126 care homes unregistered, leading to a net increase of 1,025 care homes. 8,764 home care providers were registered in the same period, with 3,640 home care providers unregistered, meaning a net increase of 5,124 home care providers.

The Department does not hold adult social care assessment data centrally.

An impact assessment was published in December 2022 as part of the consultation on the impact of changes to the Statutory Scheme for Branded Medicines. The Department has received materials from pharmaceutical industry Trade Associations and from individual companies about a wide range of issues relevant to both the voluntary and statutory schemes for branded medicines pricing. We will be considering this evidence over the coming weeks and will publish our response alongside the final impact assessment.

The latest data published by the NHS Business Services Authority on prescribing costs in hospitals and the community for 2021/22 shows spending on medicines increased from £15.74 billion in 2019/20 to £17.78 billion in 2021/22, which is also an increase in real terms.

No assessment has been made.

The Government is open to ideas about how a successor to Voluntary Scheme for Branded Medicines Pricing and Access should operate from 2024 onwards and will work with industry and apply learning from approaches in the United Kingdom and internationally to agree a mutually beneficial successor that that supports better patient outcomes; ensures the sustainability of National Health Service spend on branded medicines; and enables a strong UK life sciences industry.

Whilst we have made no specific assessment, the Government’s Life Sciences Vision sets out our ambition to stimulate the United Kingdom’s life sciences sector. The vision commits the Government to supporting the National Health Service to test, purchase and spread innovative technologies more effectively, so that cutting-edge science and innovations can be embedded widely across the NHS as early as possible, and rapidly adopted in the rest of the world. We are working with industry and system partners to make the NHS the country’s highest driver of innovation.

As part of our preparations to negotiate with the pharmaceutical industry a mutually beneficial successor scheme to the current Voluntary Scheme for Branded Medicines Pricing and Access (VPAS), the Government is considering all relevant issues such as the use of a cap on allowed sales.

In the December 2022 consultation on the impact of changes to the Statutory Scheme for Branded Medicines, which included an associated Impact Assessment, we consulted on the scheme’s methodology which is based around ensuring we continue to control growth at a rate of 1.1% and maintain broad commercial equivalence with VPAS. The Department has received materials from the pharmaceutical industry, Trade Associations and from individual companies about a wide range of issues relevant to both the Voluntary and Statutory Schemes for branded medicines pricing. We will be considering this evidence over the coming weeks, and will publish our response alongside the final Impact Assessment.

With regard to increasing medicine spend, the Secretary of State met with industry Trade Associations in 2022 and was clear that, whilst we cannot agree any change to the current scheme, the Government is open to ideas about how a successor to VPAS should operate from 2024 onwards and that we will work with industry to agree a successor scheme that supports better patient outcomes, ensures the sustainability of National Health Service spend on branded medicines, and enables a strong United Kingdom life sciences industry.

As part of our preparations to negotiate with the pharmaceutical industry a mutually beneficial successor scheme to the current Voluntary Scheme for Branded Medicines Pricing and Access (VPAS), the Government is considering all relevant issues such as the use of a cap on allowed sales.

In the December 2022 consultation on the impact of changes to the Statutory Scheme for Branded Medicines, which included an associated Impact Assessment, we consulted on the scheme’s methodology which is based around ensuring we continue to control growth at a rate of 1.1% and maintain broad commercial equivalence with VPAS. The Department has received materials from the pharmaceutical industry, Trade Associations and from individual companies about a wide range of issues relevant to both the Voluntary and Statutory Schemes for branded medicines pricing. We will be considering this evidence over the coming weeks, and will publish our response alongside the final Impact Assessment.

With regard to increasing medicine spend, the Secretary of State met with industry Trade Associations in 2022 and was clear that, whilst we cannot agree any change to the current scheme, the Government is open to ideas about how a successor to VPAS should operate from 2024 onwards and that we will work with industry to agree a successor scheme that supports better patient outcomes, ensures the sustainability of National Health Service spend on branded medicines, and enables a strong United Kingdom life sciences industry.

An impact assessment was published in December 2022 as part of the consultation on the impact of changes to the statutory scheme for branded medicines. The Department has received materials from pharmaceutical industry Trade Associations and from individual companies about a wide range of issues relevant to both the voluntary and statutory schemes for branded medicines pricing. We will be considering this evidence over the coming weeks and will publish our response alongside the final impact assessment.

The impact assessment published in December 2022 on the impact of proposed changes to payment percentages in the statutory scheme for branded medicines pricing considered matters relevant to the risk to the supply of medicines of any changes.

We have little evidence to suggest that, given the available mitigations, changes to volume-based payment rates will lead to supply issues.

We work closely with suppliers, NHS England, Medicines and Healthcare products Regulatory Agency, the devolved Governments and other stakeholders to ensure patients continue to have access to the treatments they need.

The Department has received materials from pharmaceutical industry Trade Associations and from individual companies about the impact of payment percentages under the voluntary and statutory schemes.

These include responses to the assessment made by the Department in the draft impact assessment that accompanies our recent consultation on increased rates in the statutory scheme. We will be considering this evidence over the coming weeks and will publish our response alongside the final impact assessment.

The Department has received materials from pharmaceutical industry Trade Associations and from individual companies about the impact of changes to the voluntary and statutory schemes for branded medicines prices.

These include responses to the assessments made by the Department in the draft impact assessment that accompanies our recent consultation on increased rates in the statutory scheme. We will be considering this evidence over the coming weeks and will publish our response alongside the final impact assessment.

No assessment has been made.

The Government is open to ideas about how a successor to the voluntary scheme for branded medicines pricing and access (VPAS) should operate from 2024 onwards. The Government will work with industry and apply learning from approaches in the United Kingdom and internationally to agree a mutually beneficial successor that supports better patient outcomes; ensures the sustainability of National Health Service spend on branded medicines; and enables a strong UK life sciences industry.

Within VPAS there are strong incentives to launch new products in the UK in the form of the new active substance exemptions, which allow innovative medicines containing new active substances to set their list price freely and exempts such medicines from payments for three years.

A table showing surgical hubs and community diagnostic centres (CDCs) established in 2022, with the services provided, the National Health Service region, the relevant integrated care system and NHS trust, the name of the hub and the date of opening, is attached due to the size of the data. Information on the selection criteria for each CDC and surgical hub is not held centrally.

Local systems undertake an evaluation of the most appropriate locations for CDCs, including consideration of accessibility, affordability and addressing inequality and deprivation. Business cases are scrutinised by a national approvals panel with clinical and diagnostic experts to assess feasibility prior to approval. CDC locations are also subject to Ministerial approval. Surgical hub locations have been selected by a clinically-led process to ensure that sites are connected to the appropriate services to deliver high quality outcomes for patients and to consider health inequalities. The independent sector were not invited to participate in the selection of CDCs or surgical hubs.

NHS England has engaged with patient forums and undertaken a public awareness campaign on the expansion of services. The Department and NHS England are working with general practitioners (GPs), cancer charities and patient representatives to expand direct GP access to diagnostic scans for those with concerning symptoms which do not align with the two-week cancer referral target to see a specialist.

A table showing surgical hubs and community diagnostic centres (CDCs) established in 2022, with the services provided, the National Health Service region, the relevant integrated care system and NHS trust, the name of the hub and the date of opening, is attached due to the size of the data. Information on the selection criteria for each CDC and surgical hub is not held centrally.

Local systems undertake an evaluation of the most appropriate locations for CDCs, including consideration of accessibility, affordability and addressing inequality and deprivation. Business cases are scrutinised by a national approvals panel with clinical and diagnostic experts to assess feasibility prior to approval. CDC locations are also subject to Ministerial approval. Surgical hub locations have been selected by a clinically-led process to ensure that sites are connected to the appropriate services to deliver high quality outcomes for patients and to consider health inequalities. The independent sector were not invited to participate in the selection of CDCs or surgical hubs.

NHS England has engaged with patient forums and undertaken a public awareness campaign on the expansion of services. The Department and NHS England are working with general practitioners (GPs), cancer charities and patient representatives to expand direct GP access to diagnostic scans for those with concerning symptoms which do not align with the two-week cancer referral target to see a specialist.

A table showing surgical hubs and community diagnostic centres (CDCs) established in 2022, with the services provided, the National Health Service region, the relevant integrated care system and NHS trust, the name of the hub and the date of opening, is attached due to the size of the data. Information on the selection criteria for each CDC and surgical hub is not held centrally.

Local systems undertake an evaluation of the most appropriate locations for CDCs, including consideration of accessibility, affordability and addressing inequality and deprivation. Business cases are scrutinised by a national approvals panel with clinical and diagnostic experts to assess feasibility prior to approval. CDC locations are also subject to Ministerial approval. Surgical hub locations have been selected by a clinically-led process to ensure that sites are connected to the appropriate services to deliver high quality outcomes for patients and to consider health inequalities. The independent sector were not invited to participate in the selection of CDCs or surgical hubs.

NHS England has engaged with patient forums and undertaken a public awareness campaign on the expansion of services. The Department and NHS England are working with general practitioners (GPs), cancer charities and patient representatives to expand direct GP access to diagnostic scans for those with concerning symptoms which do not align with the two-week cancer referral target to see a specialist.

A table showing surgical hubs and community diagnostic centres (CDCs) established in 2022, with the services provided, the National Health Service region, the relevant integrated care system and NHS trust, the name of the hub and the date of opening, is attached due to the size of the data. Information on the selection criteria for each CDC and surgical hub is not held centrally.

Local systems undertake an evaluation of the most appropriate locations for CDCs, including consideration of accessibility, affordability and addressing inequality and deprivation. Business cases are scrutinised by a national approvals panel with clinical and diagnostic experts to assess feasibility prior to approval. CDC locations are also subject to Ministerial approval. Surgical hub locations have been selected by a clinically-led process to ensure that sites are connected to the appropriate services to deliver high quality outcomes for patients and to consider health inequalities. The independent sector were not invited to participate in the selection of CDCs or surgical hubs.

NHS England has engaged with patient forums and undertaken a public awareness campaign on the expansion of services. The Department and NHS England are working with general practitioners (GPs), cancer charities and patient representatives to expand direct GP access to diagnostic scans for those with concerning symptoms which do not align with the two-week cancer referral target to see a specialist.

NHS England collects and publishes ‘National Cost Collection for the NHS’ annually in an online only format. This data is collected by Healthcare Resource Groups (HRGs), which are standard groupings of clinically similar treatments using similar levels of healthcare resources.

This data will show HRGs for hip, knee, cataract procedures and outpatient computerised tomography (CT) or magnetic resonance imaging (MRI) when the relevant clinical coding has been documented in the patient’s record. A cost for the activity will then be assigned by the relevant National Health Service trust. However, where a CT or MRI has been undertaken during an inpatient episode or attendance in accident and emergency, this will be included in the composite cost of the HRG and will not be separately identifiable.

While information on x-rays and pathology testing is collected, this is for direct access for general practitioners (GPs). The report of an x-ray or result of a pathology test is returned to the GP rather than a hospital clinician or consultant. Where this procedure is undertaken at the request of a hospital clinician or consultant, it is not reported separately.

Additionally, data on costs is also made available to NHS providers through Patient Level Information Costing System (PLICS) dashboards, the Model Hospital and Getting It Right First Time programmes, which support health providers to improve patient treatment and productivity. The PLICS dashboards allow trusts to examine data to understand the difference between costs incurred in comparison to other similar organisations. NHS England uses this information and other performance data to hold NHS organisations to account.

This information is not held centrally. Pharmacists, registered nurses, physiotherapists, occupational therapists, radiographers and paramedics are subject to statutory regulation and must be registered with the relevant healthcare regulatory body to practise in the United Kingdom. Pharmacists are regulated by the General Pharmaceutical Council, registered nurses are regulated by the Nursing and Midwifery Council and physiotherapists, occupational therapists, radiographers and paramedics are regulated by the Health and Care Professions Council.

Pharmacists, registered nurses, physiotherapists, therapeutic radiographers and paramedics are legally entitled to be independent prescribers. Diagnostic radiographers are legally entitled to be supplementary prescribers. Individuals must have completed an approved post-registration training course and have an annotation placed against their name in the professional register to state that they have completed this course before this entitlement can be utilised. Occupational therapists are currently able to supply and/or administer medicines under a Patient-Specific Direction or Patient Group Direction within local clinical governance arrangements.

The Department is responsible for providing the legal framework for allowing registered health professionals to train as independent prescribers. Healthcare providers are responsible for utilising the legal framework to increase local capacity according to clinical need and the desired service configuration. The medicines which may be prescribed is dependent on the individual’s clinical competence and scope of practice. Where any controlled drugs are to be prescribed, there must be specific provision in the Misuse of Drugs Regulations 2001.

As of June 2022, there were 1,261 full time equivalent (FTE) physician associates (PAs) employed in National Health Service hospital trusts and commissioning bodies. This is an increase of 18% from the previous year. In September 2002, there were also 1,362 FTE PAs employed in general practice and Primary Care Networks, an increase of 51% from the previous year.

There are approximately 1,800 students on a PA programme. Health Education England offers a £5,000 preceptorship allowance paid to employers to support the supervision and educational needs for newly qualified PAs working in primary care.

The information requested is not held centrally.

The information requested on the nationality of students on medical courses in England or the United Kingdom is not held centrally. However, the Office for Students (OFS) reports the intake of medical students at UK medical schools by ‘home fees’ and ‘other fees’ status. ‘Home’ fee status refers to students eligible to pay the ‘home’ level of tuition fees, where individuals must be resident and ‘settled’ in the UK on ‘the first day of the first academic year’ of their course. With some exceptions, they must also have been ‘ordinarily resident’ in the UK for the three years prior to that date. The following table shows the number of starters in English medical schools by ‘home’ fees status in each year since 2015/16.

Source: OFS medical and dental intakes

The information requested on the number of British nationals or the number of ‘home fees’ students who subsequently join the Foundation Programme of training in UK hospitals is not held centrally.

The following table shows the number of Hospital and Community Health Service doctors which have joined and left active service in the National Health Service hospital trusts and commissioning bodies in June of each year since 2014.

Source: NHS Digital workforce statistics

This includes those staff moving to or joining from settings such as primary care and general practice. This movement is commonplace with the rotations of placements undertaken by doctors in training grades. It will also include staff who choose to take breaks from active service such as career breaks and maternity or paternity leave.

While data on agency staff by headcount is collected, this information has not been centrally validated.

The following table shows expenditure on agency staff in the healthcare science, medical and dental and nursing, midwifery and health visiting staff groups in each year from 2017/18 to 2020/21. This data was not collected prior to 2017 and information for 2021/22 has not been centrally validated.

Note: Information based on provider financial return.

The National Health Service Commissioning Board and Clinical Commissioning Groups Responsibilities and Standing Rules Regulations 2012 state that integrated care boards and NHS England, in exercising its commissioning functions, have a duty to ensure that the awareness and availability of choice is publicised to referrers and patients. NHS England has regulatory oversight and operational implementation of patient choice and provides advice and guidance to the public, patients, referrers, commissioners and providers on the choices available in England and how patient choice can be facilitated.

The independent Pay Review Body process is the established mechanism for determining pay increases in the public sector, including for National Health Service staff, outside of negotiating pay and contract reform deals. Terms and conditions for NHS staff are agreed nationally through collective agreements with trade unions. The Department is represented on the NHS Staff Council for Agenda for Change staff and at the Joint Negotiating Committees for medical staff.

Flexibility exists within the national terms and conditions for employers to use local recruitment and retention premia. We understand that these flexibilities are seldom used by employers locally due the administrative process, complying with legislation on equal pay and the risk of exacerbating recruitment, retention and pay issues with neighbouring trusts and within the local labour market.

The National Health Service asks those patients offered earlier treatment at an alternative provider whether they are able to travel and discusses any issues associated with that offer. This may include covering costs associated with travel and overnight accommodation, if clinically appropriate.

The Government uses the Office for National Statistics’ measure of Quality-Adjusted Total Factor Productivity growth, which reviews how the level of quality adjusted outputs produced per input has changed compared to the previous year. Quality-adjusted output is measured through cost-weighted activity, where more intensive treatments are attributed more weight than lower intensive treatments. This is then quality adjusted where increased life expectancy, shorter waiting times, improved survival rates and patient reported outcomes all increase output. Inputs include both labour and non-labour inputs, where labour inputs are weighted by expected skill level.

The following table shows whether English healthcare productivity increased in each year since 2009/10.

The productivity measure usually reports 21 months following the end of the financial year. We expect data for 2020/21 to be published in January 2023.

This information is not held in the format requested. However, NHS Digital has collected data on the proportion of patients offered a choice of provider for elective referrals from those who responded to the Manage Your Referral (MYR) NHS e-Referral Service (e-RS) Survey. The MYR e-RS Survey enables patients who have used e-RS for elective referrals for directly bookable services to record their experience of being offered a choice of elective care provider. These results are available to integrated care boards and NHS England to review, assure and improve in order to meet its responsibilities related to patient choice.

The following table shows the responses received to the question “When you agreed to be referred to a specialist, did you talk about the different hospitals or services you could go to?” in each year since 2018.

The following table shows the responses received to the question “Did you feel that you were able to make choices that met your needs?” in each year since 2018.

The Pay Review Body process is the established mechanism for determining pay increases in the public sector, outside of negotiating multi-year pay and contract reform deals.

A table showing annual increases to basic pay for National Health Service consultants, salaried general practitioners (GPs) and GP partners, nurses and health visitors and NHS Chief Executives in each year from 2009/10 to 2022/23 compared with the average Retail Price Index inflation is attached, due to the size of the data.

Information on pay increases for porters is not held in the format requested.

The Department’s capital allocated by HM Treasury for the National Health Service is shown in the following table.

NHS England’s spend in 2019/20 was £255 million and £331 million in 2020/21.

The information on acute hospitals, primary care, community health and mental health services is not held in the format requested. However, the following table shows spend in NHS acute, mental health and community health trusts in 2019/20 and 2020/21.

The financial data for 2021/22 is currently being audited and will be published in the Department’s forthcoming Annual Report and Accounts.

The information on elective surgery capacity is not held in the format requested. However, the following table shows capital expenditure on new imaging equipment and urgent emergency care which supported elective surgery capacity in National Health Service providers in England in 2019/20 and 2020/21.

Notes:

1. The expenditure shown for new imaging equipment consists of all funding granted by the diagnostic screening programme. However, it does not include investment in imaging equipment NHS trusts made using operational capital or COVID-19 funds.
2. The expenditure for urgent emergency care which supported elective surgery capacity was classified as accident and emergency upgrades and urgent emergency care programmes.

Financial information for 2021/22 is currently being audited and will be published in the Department’s Annual Report and Accounts.

The Manage Your Referral (MYR) NHS e-Referral Service (e-RS) survey enables patients who have used e-RS for elective referrals for directly bookable services to record their experience of a choice of elective care provider.

The survey includes a question which measures whether patients are aware of the choices available for the location of a first outpatient appointment. The MYR e-RS survey is currently active and data is continuously collected and reviewed. The specific questions relating to patients’ choices and awareness levels are currently being reviewed to ensure we understand their experiences.

We are exploring the option of such alerts within the National Health Service e-Referral Service (e-RS) system to identify where there are capacity pressures within individual services. These have been utilised previously at the point of referral to allow referring clinicians to view capacity within providers. The re-introduction of this option requires further work to ensure there are no unintended consequences and regional oversight with local system commissioners to ensure provision for patient referrals is always available.

NHS England has enforcement powers in relation to patient choice provisions and engages directly with integrated care boards to support compliance with statutory duties. NHS England also advises patients, providers and commissioners on the relevant regulations. Providers may raise concerns relating to patient choice provisions directly with NHS England.

The majority of commissioning between independent sector providers and the National Health Service takes place locally. While central contracts were regularly used by NHS England during the pandemic, in 2022/23 there have been no central contracts between NHS England and independent care providers to increase diagnostic or elective surgery capacity.

In February 2022, NHS England published the Delivery plan for tackling the COVID-19 backlog of elective care, which sets out how the National Health Service will recover and expand elective services over the next three years. It advises that effective use of the independent sector should be encouraged to increase capacity and reduce waiting times. A copy of the plan is attached.

In January 2022, NHS England published the 2022/23 priorities and operational planning guidance, which states that independent sector should be considered to manage winter pressures and increase capacity, including through virtual wards. A copy of the guidance is attached.

The following table shows the annual headcount of staff joining and leaving in each ambulance trusts in England between July 2021 and July 2022.

Source: NHS Digital workforce statistics July 2022; Turnover from organisation by benchmarking tool

Notes:

1. Staff commencing or returning from maternity leave are not counted as joiners or leavers in this information. This differs from NHS Digital’s other published turnover statistics.
2. Junior doctors have been excluded due to rotation between organisations as part of training.
3. Recorded staff may leave one National Health Service trust to join another. This data does not show staff leaving the health system entirely.

This information is not held in the format requested. The following table shows the mean Category 1 response time in hours, minutes and seconds for each ambulance trust in England in September 2022. However, this is not comparable to September 2010 and September 2016 as the current standards for ambulance response times were introduced in 2017/18. The following table also shows the last monthly period in which each ambulance trust in England responded to Category 1 calls within an average of seven minutes.

Source: NHS Quality Indicators

The mean Category 1 (C1) response time standard of seven minutes was last met by the London Ambulance Service (LAS) in April and May 2022. Between September 2019 and February 2020, the response time standard was achieved in each month except December 2019. The standard was achieved in each month between May 2020 and August 2021 and January to February 2022. The 90^th percentile response time standard of 15 minutes for C1 incidents has been met by the LAS in every month in the last three years except in March 2020.

The mean response time standard of 18 minutes for Category 2 (C2) incidents was last met by the LAS in February to April 2021 and between May and November 2020. The C2 90^th percentile response time standard of 40 minutes was last met by the LAS in February to April 2021. It was met in each month between May and November 2020, September to October 2019 and January 2020.

The Category 3 90^th percentile response time standard of 120 minutes was last met by the LAS in February and March 2021 and between April and November 2020. The Category 4 90^th percentile response time standard of 180 minutes was last met by the LAS in February 2021 and in each month between April and November 2020 except September and also in October 2019 and January 2020.

This information is not held in the format requested. The following table shows the mean Category 1 response time in hours, minutes and seconds for each ambulance trust in England in September 2022. However, this is not comparable to September 2010 and September 2016 as the current standards for ambulance response times were introduced in 2017/18. The following table also shows the last monthly period in which each ambulance trust in England responded to Category 1 calls within an average of seven minutes.

Source: NHS Quality Indicators

The mean Category 1 (C1) response time standard of seven minutes was last met by the London Ambulance Service (LAS) in April and May 2022. Between September 2019 and February 2020, the response time standard was achieved in each month except December 2019. The standard was achieved in each month between May 2020 and August 2021 and January to February 2022. The 90^th percentile response time standard of 15 minutes for C1 incidents has been met by the LAS in every month in the last three years except in March 2020.

The mean response time standard of 18 minutes for Category 2 (C2) incidents was last met by the LAS in February to April 2021 and between May and November 2020. The C2 90^th percentile response time standard of 40 minutes was last met by the LAS in February to April 2021. It was met in each month between May and November 2020, September to October 2019 and January 2020.

The Category 3 90^th percentile response time standard of 120 minutes was last met by the LAS in February and March 2021 and between April and November 2020. The Category 4 90^th percentile response time standard of 180 minutes was last met by the LAS in February 2021 and in each month between April and November 2020 except September and also in October 2019 and January 2020.

This information is not held in the format requested. The following table shows the mean Category 1 response time in hours, minutes and seconds for each ambulance trust in England in September 2022. However, this is not comparable to September 2010 and September 2016 as the current standards for ambulance response times were introduced in 2017/18. The following table also shows the last monthly period in which each ambulance trust in England responded to Category 1 calls within an average of seven minutes.

Source: NHS Quality Indicators

The mean Category 1 (C1) response time standard of seven minutes was last met by the London Ambulance Service (LAS) in April and May 2022. Between September 2019 and February 2020, the response time standard was achieved in each month except December 2019. The standard was achieved in each month between May 2020 and August 2021 and January to February 2022. The 90^th percentile response time standard of 15 minutes for C1 incidents has been met by the LAS in every month in the last three years except in March 2020.

The mean response time standard of 18 minutes for Category 2 (C2) incidents was last met by the LAS in February to April 2021 and between May and November 2020. The C2 90^th percentile response time standard of 40 minutes was last met by the LAS in February to April 2021. It was met in each month between May and November 2020, September to October 2019 and January 2020.

The Category 3 90^th percentile response time standard of 120 minutes was last met by the LAS in February and March 2021 and between April and November 2020. The Category 4 90^th percentile response time standard of 180 minutes was last met by the LAS in February 2021 and in each month between April and November 2020 except September and also in October 2019 and January 2020.

The following table shows the income received by National Health Service ambulance trusts for healthcare services provided in cash figures and real terms in each year from 2017/18 to 2022/23. The information for 2022/23 is the planned income for the year.

Note:

The real terms figures are calculated using the Gross Domestic Product deflators published by HM Treasury on 30 September 2022. Figures are in 2021/22 prices.

This information is not collected in the format requested. However, in June 2022, the vacancy rate for all staff employed in National Health Service ambulance trusts in England was 6.1% and in June 2018, the equivalent vacancy rate was 6.5%.

The Department is currently working with NHS England to develop the My Planned Care online platform to provide advice and support to patients awaiting surgery and to prepare for hospital consultations, treatment or surgery. This includes information on waiting times at their hospital to allow patients to make the appropriate choices for their care.

The Manage Your Referral (MYR) NHS e-Referral Service (e-RS) Survey enables patients who have used e-RS for elective referrals for directly bookable services to record their experience of being offered a choice of elective care provider.

The MYR e-RS Survey includes a question on whether patients are aware of the choices available to them when attending a first outpatient appointment. In 2021/22, 50% of 7,000 patients surveyed reported that they were aware of the choice of hospitals or clinics for an appointment. The Survey’s results are available to integrated care boards and NHS England to review in order to meet its responsibilities relating to patient choice.

Use of the e-RS for referrals from general practitioners for consultant-led first outpatient appointments is mandated in the latest NHS and GP Standard Contracts.

The Manage Your Referral (MYR) NHS e-Referral Service (e-RS) Survey enables patients who have used e-RS for elective referrals for directly bookable services to record their experience of being offered a choice of elective care provider.

The MYR e-RS Survey includes a question on whether patients are aware of the choices available to them when attending a first outpatient appointment. In 2021/22, 50% of 7,000 patients surveyed reported that they were aware of the choice of hospitals or clinics for an appointment. The Survey’s results are available to integrated care boards and NHS England to review in order to meet its responsibilities relating to patient choice.

Use of the e-RS for referrals from general practitioners for consultant-led first outpatient appointments is mandated in the latest NHS and GP Standard Contracts.

We do not publish data in the format requested.

For the week commencing 18 January 2021 the number of tests conducted in pillar 1 was 592,698 against a capacity of 1,352,685, which is a utilisation rate of 43.82%. In pillar 2, the number of tests conducted was 3,233,418 against a capacity of 4,321,944, which is a utilisation rate of 74.81%.

Since the start of the pandemic, we increased the capacity of National Health Service and Public Health England laboratories, as well as setting up an entirely new nationwide network of new Lighthouse laboratories and partner laboratories to process samples. Lighthouse laboratories and partner laboratories have continued to maximise capacity. This includes recruiting staff, mobilising additional equipment and optimising workflows. All Lighthouse laboratories are now working on a 24 hours a day, seven days a week basis.

HM Treasury approved £22 billion of spending this year for the NHS Test and Trace programme. This covers testing to meet demand over the winter. We are providing an additional £7 billion for NHS Test and Trace to support increased testing, including community testing and ongoing improvements to contact tracing. Eighty per cent of this will be directly spent on laboratories, tests and testing kits.

Pillar 2 uses Lighthouse laboratories and has partnership arrangements with public, private and academic sector laboratories. The United Kingdom’s daily COVID-19 testing capacity passed the 500,000 on 31 October. Testing capacity in the UK across all pillars between 29 October and 4 November was at 4,367,049 tests, an increase of 21% compared to the previous week.

The Government does not publish data in the format requested. The Government publishes information, from 20 March onwards, on daily tests processed and daily testing capacity at GOV.UK. We provide data on daily testing capacity by swab tests, using polymerase chain reaction assay, within pillars 1, 2, and 4 to show if someone has COVID-19; and antibody testing of a blood sample within pillar 3 and pillar 4 to show if people have antibodies from having had COVID-19.

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

Funding announced alongside the COVID-19 Hospital Discharge Service Requirements was not conditional on care homes accepting discharged patients. Discharges from hospital are decided by local clinicians and only happen when doctors determine it is in an individual patient’s best interests.

This is an unprecedented global pandemic and at every stage we have been guided by the latest scientific advice. We keep our policies under continuous review, based on the emerging international and domestic evidence.

The Government launched the NHS and Social Care Coronavirus Life Assurance scheme on 20 May 2020. The scheme is non-contributory and pays a £60,000 lump sum where staff who had been recently working where personal care is provided to individuals who have contracted COVID-19 die as a result of the virus.

As of 13 July 2020, the scheme administrator has received 29 claims for social care as a whole in England, of which 25 claims are from the families of staff who had been providing adult social care in a care home. This is out of a total of 57 claims to the scheme. Of these 25, eight have been agreed for payment subject to receiving probate, nine require further information and eight are in the process of consideration.

The Department worked closely with stakeholders in the adult social care sector to ensure the details of the scheme were made as widely available as possible. This included cascading the information to employers through provider representatives, and also through the Care Quality Commission.

Public Health England, the Care Quality Commission (CQC) and the Department have all published guidance relevant to care homes.

Due to the fast-moving situation with the pandemic, all guidance has been published online in order to reach target audiences quickly. The CQC has also released their guidance through a regular weekly bulletin.

A table listing the guidance with dates of issue, and showing those documents shared with Parliamentarians, is attached due to the size of the data.

During this unprecedented global outbreak, we have kept our social care guidance under constant review and have been working tirelessly with the sector to reduce transmission and save lives. The Government is fully committed to ensuring care homes feel confident in their personal protective equipment (PPE) supply. We are now confident in the stocks and sources of supply of PPE to meet the needs of health and social care over the next seven and 90 days.

More widely, in the long term, we have set out a comprehensive action plan to support the adult social care sector throughout the COVID-19 outbreak. This has included £3.2 billion of funding for councils and providing millions of items of PPE.

Data for median waiting times for MRI, CT and Non-obstetric Ultrasound tests is provided in the following tables. It should be noted that all data is provisional and subject to review.

Data provided is between the months of May 2020 – May 2019 this is the most recent data available as collection and reporting has a two-month delay.

MRI

Public safety remains the Government’s top priority and the Chancellor of the Exchequer has been clear from the outset that the National Health Service will get whatever funding it needs to respond to the COVID-19 pandemic.

£31.9 billion of support for healthcare was set out in the summer economic update. This includes over £15 billion for personal protective equipment (PPE), and £10 billion for NHS Test and Trace. The Government has also confirmed a further package of £3 billion for the NHS as part of the COVID-19 recovery strategy, covering support for winter. The total level of funding that is needed may change further.

Details on a funding package for general practitioners (GPs) of nearly £200 million have been confirmed. This covers the legitimate additional costs of the response borne by GP practices due to the pandemic. NHS providers are currently able to claim for COVID-19 costs retrospectively under the temporary finance regime that has been put in place until the end of September. This is operating at trust/foundation trust level rather than for specific services such as community health services. Allocations totalling an additional £2.7 billion are then being made available to local systems for the rest of the year. Funding specific to Public Health England forms part of the NHS Test and Trace budget and the PPE budget the specific distribution to PHE is currently being agreed.

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

With the support of NHS England, we have been piloting COVID-19 swab testing in a small number of general practices around the United Kingdom. The aim was to improve access to testing by enabling general practitioners to test symptomatic patients who present to general practice settings, when deemed it clinically appropriate, for example for some patients who are vulnerable and may otherwise struggle to access a test through the main testing routes.

The available capacity and staffing of the Nightingale hospitals is decided locally by National Health Service trusts and varies over time based on demand. At present, the Nightingale hospitals are on standby but are ready to be stood up if needed. The continued future use of the Nightingale hospitals is currently under consideration.

The Government has stated that the NHS will get what it needs in terms of funding during the COVID-19 pandemic.

The number of patients admitted to each of the Nightingale Hospitals is not available in the format requested. Admission data for COVID-19 patients is published online by NHS England and NHS Improvement at trust level but not for individual hospitals.

The development of the Nightingale hospitals was a response to an unprecedented challenge as they provided extra capacity to manage surges in demand due to COVID-19.

To provide additional capacity for the National Health Service the Nightingale hospitals have been flexed to respond to changing demand and it was recently announced that Harrogate and Exeter Nightingale hospitals are to be used to increase diagnostic capacity in a COVID-19 free environment. Regions and host trusts will continue to consider future use and the Nightingales will be an important part of ensuring the NHS has the capacity required at this time and in the coming months.

The information requested is not collected centrally.

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

Data on outbreaks are published weekly on COVID-19: number of outbreaks in care homes – management information data set. The latest published analysis from 21 May provides data on outbreaks between 2 March until 17 May 2020 and shows that 5,876 care homes in England have reported an outbreak of suspected or confirmed COVID-19. The latest weekly update and summary report are attached.

Public Health England has shared a care home situation report which provides data on outbreaks with the Care Quality Commission on a daily basis since 1 April 2020.

On 19?March 2020, the Department and the National Health Service co-published COVID-19 Hospital Discharge Service Requirements,?setting out guidance on supporting the safe discharge of patients who no longer need acute care. A copy of this guidance is attached.

The guidance also sets out the steps that care providers should be taking and we provided £1.3 billion to support the process. We have provided advice to care homes throughout the pandemic in response to the latest conditions and emerging evidence.

The COVID-19 hospital discharge service requirements were expected to help free up 15,000 hospital beds across England.

On 2 June, NHS England published an analysis on discharges to care homes. This data was not previously available. The data showed that the proportion of people discharged to care homes, nursing homes and hospices between 15 March and 16 April was 2.8%.

A small number of people who have tested positive for COVID-19 may be discharged from the NHS within the 14-day period from the onset of COVID-19 symptoms and also require ongoing social care. If a care home provider does not feel they can provide the appropriate care for these individuals, the individual’s local authority should secure alternative appropriate accommodation and care for the remainder of the required isolation period.

Every Care Quality Commission (CQC) registered provider received at least 300 face masks in mid-March to meet a spike in demand for personal protective equipment (PPE). Providers can contact their Local Resilience Forum (LRF) if they are unsuccessful in obtaining PPE and can request an emergency PPE pack through the National Supply Disruption Response system if they cannot access PPE through their LRF. The CQC has disseminated guidance and information on PPE from central Government to the health and social care sectors and has engaged social care stakeholders to check understanding and provide clarity. The CQC’s Emergency Support Framework also considers issues arising out of a lack of PPE. Any enforcement action, which could impact on a provider’s registration, is balanced against wider pressures including obtaining PPE.

The Government has taken significant steps to provide financial support for public services during COVID-19, including making £3.2 billion available to local authorities so they can address pressures on local services caused by the pandemic, including in adult social care. To improve transparency, local authorities should also publish on their websites the support they are offering to providers of residential and domiciliary care services, as well as any other social care services they are supporting. We have asked for these to be published by 29 May 2020.

Furthermore, on 15 May we published details of an additional £600 million Infection Control Fund for Adult Social Care to support adult social care providers in England reduce the rate of transmission in and between care homes and to support workforce resilience. The Government will continue to monitor pressures in the National Health Service and local government and will keep future funding under review.

The Government has launched a life assurance scheme for frontline National Health Service and social care staff. The scheme is non-contributory and pays a £60,000 lump sum where staff who had been recently working where personal care is provided to individuals who have contracted COVID-19 die as a result of the virus.

Care home staff are eligible, providing that their work requires them to be present in frontline settings where COVID-19 is present, and that they are employed by an organisation registered by the Care Quality Commission (CQC) to provide social care services.

Furthermore, any social care staff working in non-CQC registered settings are also eligible, if their employer receives public funding.

Previously, Public Health England published guidance for supported living providers. This was withdrawn on 13 May and updated guidance for the sector is being developed.

Guidance on the provision of home care was published on 22 May and is available in an online only format at GOV.UK. This may also be relevant to supported living settings where domiciliary care is provided.

The Care Quality Commission advised that it is not possible to isolate death notifications where providers register for multiple service types. Therefore, they have analysed deaths reported by providers who are registered to provide supported living services only.

Between 10 April and 15 May 2020, there were 39 deaths notified - 18 of which have been COVID-19 related, whether suspected or confirmed. It is important to note that this may not offer a complete picture of all deaths in supported living settings.

The Government has published the scientific evidence supporting its action on social distancing. In the document, Potential effect of non-pharmaceutical interventions on a COVID-19 epidemic in the UK 26 February 2020, the Scientific Pandemic Influenza Group on Modelling assessed four different response options. It outlined that social distancing for 13 weeks could reduce the peak by up to 50-60%, showing that this measure would have the largest impact than the other proposed measures in containing the outbreak. A copy of Potential effect of non-pharmaceutical interventions on a COVID-19 epidemic in the UK 26 February 2020 is attached.

The Government continues to be led by the evidence in our response to COVID-19. Following the Scientific Advisory Group for Emergencies’ advice, we think there will be some benefit for people wearing face coverings for epidemiological reasons and for giving people confidence as we return to work.

We will set out plans soon on what role face coverings may have as we look towards easing any lockdown measures.

The Department meets with a number of trade associations, including the British Healthcare Trades Association, on a weekly basis. There have been regular discussions at these meetings on the challenges of responding to COVID-19. The Government issued a ‘call to arms’ for industry partners and other manufacturers to respond through a central hub for COVID-19 support. So far, we have received over 12,000 offers of support.

Under the NHS Funding Bill 2019-20, the Government commits to increase investment in the National Health Service in the years to 2023-24 (compared with 2018-19) by £33.9 billion in cash terms.

At the time the NHS settlement was confirmed in January 2019, real terms growth calculations used the GDP Deflator forecasts, as set out in the Economic and Fiscal Outlook in October 2018.

The NHS funding settlement was fixed in cash terms and it is these cash budgets that underpin the NHS Long Term Plan.

The National Health Service is funded through the NHS funding settlement for finance costs on loans drawn from the Department. Individual trusts are, therefore, expected to finance loan repayments from either their internal resources or surplus cash generated from operating activities. Those cash reserves are ultimately financed by the NHS funding settlement.

Loans are provided to trusts from the Department’s own cash limit set as part of HM Treasury Parliamentary Supply Estimates that are presented to and voted upon by Parliament. The NHS is expected to achieve financial balance within the figures set out in the NHS Funding Bill and that includes covering any deficits associated with loans that have been provided.

As explained in the NHS planning guidance dated January 2020, we are considering whether reforms to the cash regime might be appropriate and will provide further detail on this ahead of 2020-21. The following table shows loans issued to trusts in difficulty in the current financial year until 31 December 2019.

Part of National Health Service capital expenditure by NHS organisations is self-financed and used to address their operational capital requirements, including backlog maintenance rather than through funding that has been centrally allocated. The extent of spend on backlog is dependent on local operational planning which is currently underway.

Additionally, some backlog maintenance will be tackled through the larger transformational capital programmes by replacement of old run-down estate with new facilities. Since 2017, the Government has announced over 170 Sustainability and Transformation Plan capital schemes amounting to around £3.3 billion, including the 20 hospital upgrades announced in August 2019. In addition, as part of the Health Infrastructure Plan launched in September 2019, the Government announced £2.8 billion funding to back its commitment to build 40 new hospitals. However, while these programmes will often address significant backlog maintenance the related funding element is not separately identified.

The National Health Service is funded through the NHS funding settlement for finance costs on loans drawn from the Department. Individual trusts are, therefore, expected to finance loan repayments from either their internal resources or surplus cash generated from operating activities. Those cash reserves are ultimately financed by the NHS funding settlement.

Loans are provided to trusts from the Department’s own cash limit set as part of HM Treasury Parliamentary Supply Estimates that are presented to and voted upon by Parliament. The NHS is expected to achieve financial balance within the figures set out in the NHS Funding Bill and that includes covering any deficits associated with loans that have been provided.

As explained in the NHS planning guidance dated January 2020, we are considering whether reforms to the cash regime might be appropriate and will provide further detail on this ahead of 2020-21. The following table shows loans issued to trusts in difficulty in the current financial year until 31 December 2019.

We have agreed a number of headline metrics against which progress on delivering the NHS Long Term Plan will be measured. NHS England published these headline metrics along with initial proposals for the specific measures to underpin them in July 2019. The metrics and proposed measures include real spend on primary and community health services, as well as on mental health services, rolling out community services response times, and the number of adults and children accessing mental health services.

We are working with NHS England and NHS Improvement to finalise the underpinning measures. Both metrics and the measures will be embedded in the Government’s statutory mandate to NHS England from 2020-21, and performance against them will therefore be reflected in the Government’s annual assessment of NHS England’s performance which includes performance against the mandate. Both the mandate and the annual assessment will be laid in Parliament and published.

The majority of social care in England is delivered by private companies. It is a matter for those employers to determine the rate of pay for their staff, including social care workers. The National Minimum Wage is the legal minimum employers must pay their workers. In addition, local authorities, as commissioners of adult social care were given market shaping duties by the Care Act 2014 and must work with care providers to determine a fair rate of pay for fair work based on local market conditions.

The relative levels of pay in the National Health Service and social care are kept under frequent review.

The majority of social care in England is delivered by private companies. It is a matter for those employers to determine the rate of pay for their staff, including social care workers. The National Minimum Wage is the legal minimum employers must pay their workers. In addition, local authorities, as commissioners of adult social care were given market shaping duties by the Care Act 2014 and must work with care providers to determine a fair rate of pay for fair work based on local market conditions.

The relative levels of pay in the National Health Service and social care are kept under frequent review.

The Department has made no assessment of unmet and partially met need within adult social care. Therefore, it has made no assessment of cost of any unmet or partially met need for 2024-25.

This Government has enshrined in legislation, through the Care Act 2014, councils’ statutory responsibility to meet eligible needs. This eliminates the postcode lottery of eligibility across England.

We are pleased that 84% of adult social care providers are rated as good or outstanding by the Care Quality Commission (February 2020).

However, we know the social care sector is under pressure due to growing need for care. We are providing councils with a £1 billion grant for adults and children’s social care on top of maintaining £2.5 billion of existing social care grants for 2020/21.

Local authorities are best placed to understand and plan for the care needs of their populations, and to develop and build local market capacity. This funding will support local authorities to meet rising demand and continue to stabilise the social care system.

The Adult Social Care Activity and Finance Report for 2018/19 shows that, in that year, from the potential clients who applied for adult social care packages, 14,030 received a package that was 100% funded by the National Health Service. There are likely to be other packages that are funded in part by the NHS, but this information is not held centrally.

Information on the overall expenditure of the NHS on care home placements and the homes concerned is not held centrally.

The total expenditure through the Better Care Fund (BCF) from 2015-16 to 2018-19 in nominal and constant prices is set out in the following table. This includes National Health Service clinical commissioning group (CCG) contributions, the Disabled Facilities Grant, the improved BCF and additional voluntary NHS and local government contributions.

In 2019-20, the BCF will be a minimum of £6.422 billion in nominal prices. This excludes voluntary contributions, which were over £2 billion in 2018-19.

For 2020-21, the 2019 Spending Round announced that the NHS CCG minimum allocations would continue into 2020-21 with a real-terms increase of 3.4%, and that the improved Better Care Fund would be maintained at flat cash.

The Policy Research Unit on Quality and Outcomes of Person-Centred Care (QORU) was commissioned by the Department to carry out a system’s level evaluation of the Better Care Fund (BCF) covering its first year in 2015/16. A system-level evaluation of the Better Care Fund: Final Report was published in 2018, a copy of which is attached.

QORU found that areas which spent more BCF money per person had fewer delayed transfers of care than areas with low spending and concluded that the BCF reduced delays. The evaluation also found that local areas planned to spend a quarter of their BCF funding on maintaining social care services in 2015/16, underlining the contribution that the BCF makes to maintaining social care expenditure.

We continue to monitor and evaluate the BCF, to inform our approach to the Fund going forward. Last year, 93% of local areas agreed that joint working had improved as a result of the BCF.

The information is not available in the format requested.

The average daily costs of a bed in an acute hospital ward and in a care home setting are calculated differently and come from different sources, so are not directly comparable.

This information is not collected centrally.

We are providing councils with access to an additional £1.5 billion for adults and children’s social care in 2020/21. This includes an additional £1 billion of grant funding for adults and children’s social care, and a proposed 2% precept that will enables councils to access a further £500 million for adult social care. This £1.5 billion is on top of maintaining £2.5 billion of existing social care grants and will support local authorities to meet rising demand and continue to stabilise the social care system.

Putting social care on a sustainable footing, where everyone is treated with dignity and respect, is one of the biggest challenges we face as a society. The Government will bring forward a plan for social care this year.

Putting social care on a sustainable footing, where everyone is treated with dignity and respect, is one of the biggest challenges we face as a society. The Government will bring forward a plan for social care this year. There are complex questions to address, which is why we will seek to build cross-party consensus. We will consider all options available to ensure that every person is treated with dignity and offered the security they deserve, and that nobody needing care is forced to sell their home to pay for it.

The Government has no current plans to transfer responsibility for the funding provision of nursing home care to the National Health Service.

The NHS already provides NHS-funded nursing care. This is funding for care homes which supports the provision of nursing care by registered nurses to individuals who are assessed as eligible for funded nursing care.

The following table shows the number of nursing homes registered with the Care Quality Commission (CQC) along with the number of nursing home beds, between 2015 and 2019.

Source: CQC database as at 16 January 2020.

Notes:

¹The data is as at 16 January 2020.

All other data is as at 1 April 2019.

‘Nursing homes’ are defined as locations with the service type of 'care home service with nursing'.

The Care Act 2014 placed a duty on councils to offer a meaningful choice of services, so that people have a range of high quality, appropriate care options to choose from and that they get the services that best meet their needs. Decisions on how to allocate funding to comply with this duty are for councils.

We are also providing councils with an additional £1 billion of grant funding for adults and children’s social care, on top of maintaining £2.5 billion of existing social care grants next year. In addition, the Government has proposed a 2% precept that will enable councils to access a further £500 million for adult social care.