Anne Marie Morris

COVID-19 vaccines authorised for use are commensurate across the United Kingdom and are recognised by NHS England and NHS Improvement. Data sharing agreements are in place to ensure health records of individuals vaccinated outside of their home nation can access their proof of vaccination via the relevant health authority.

The Government addressed the annual allowance taper issue in March 2020 by increasing thresholds by £90,000, removing all staff with earnings below £200,000 from scope. This restores the incentive to continue working or take on additional work for the majority of previously affected staff, with an estimated 96% of general practitioners and 98% of consultants now out of scope of the taper based on their National Health Service earnings

NHS England and NHS Improvement are implementing a programme to help employers to engage with senior staff to improve understanding of pension tax and to address concerns. NHS Employers has published guidance on the approaches employers can take locally to support staff who wish to continue working up to and beyond retirement age.

The Department of Health and Social Care has indicated that it will not be possible to answer this question within the usual time period. An answer is being prepared and will be provided as soon as it is available.

The false positive rate of the polymerase chain reaction (PCR) test is very low at 0.005%. This does not change in the 90 days following infection as false positives are caused by external factors such as contamination during sampling and laboratory processing.

Public Health England has not made a formal assessment of the impact of the accuracy of PCR tests on people travelling and being required to quarantine on return. The day two PCR test aims to identify COVID-19 infection that has been incubating during the duration of the travel. In order to test positive at or before day two, it is likely that individuals were infected in advance of their journey. PCR therefore provides an accurate way of identifying and containing travel-associated COVID-19 cases to prevent onward transmission.

As cases continue rising it is vital that people are aware of their personal risk so that they can make informed decisions on their behaviour to protect those around them. The NHS COVID-19 app is doing exactly what it was designed to do - informing close contacts of someone who has tested positive for COVID-19 that they are at risk and advising them to isolate. Our communications campaigns and messaging across government reflects the latest scientific advice about the importance of self-isolation. The NHS COVID-19 app continues to be an important tool in response to the pandemic.

Currently, the Joint Committee on Vaccination and Immunisation (JCVI) recommends an interval of eight weeks between doses of all the available COVID-19 vaccines. On 14 May, we amended the interval of second doses for the most vulnerable cohorts who were offered a vaccine in phase one of the programme, from 12 weeks to eight weeks. The eight week dose interval was applied to all eligible cohorts from 6 July.

Current evidence shows that a longer dose interval produces a better immune response. As such, the JCVI has advised against reducing the dose interval further in order to maximise the effectiveness of the vaccination programme. The JCVI regularly reviews its advice taking into account new data and evidence on the effectiveness of the programme and epidemiological situation.

NHS Planning Guidance 2021/2022 outlines the cancer recovery priorities for 2021-22 and local systems, drawing on advice and analysis from their Cancer Alliance, will ensure that there is sufficient treatment capacity in place to meet cancer needs. Patients will benefit from approximately £1 billion allocated to tackle the elective backlog, including those awaiting treatment for cancer.

Data from the Virus Watch study suggests a modestly reduced antibody response after one dose among individuals with immunosuppression, including those on immunosuppressive therapy. However, as this is not a direct measure of protection it is too soon to determine the impact on clinical disease or whether this remains after a complete course of vaccination.

As part of the COVID-19 Immunity National Core Study, UK Research and Innovation is providing £1.8 million towards the OCTAVE study. This study will examine the effectiveness of COVID-19 vaccines in clinically at-risk groups including patients with certain immunosuppressed conditions.

We are currently reviewing the proposed timetable for publication and we will provide more information in due course.

There is no universally agreed description of ultra-processed foods based on either their ingredients and/or additives or by how much processing has been involved in their production. However, a diet high in processed foods is often high in calories, salt, saturated fat and sugar.

‘Tackling obesity: empowering adults and children to live healthier lives’, sets out our intention to end the advertising of high fat, salt and sugar products being shown on TV before 9pm and we have consulted on a total high fat, salt and sugar products advertising restriction online. We have also confirmed we will restrict the promotions of high fat, salt and sugar food and drinks in retailers.

We are planning to diversify the supply of lateral flow devices (LFDs) and have begun to deploy other products in some settings, including the Orient Gene device. We will expand this over the coming months.

In December last year, the Medicines and Healthcare products Regulatory Agency (MHRA) provided the Department with an Exceptional Use Authorisation (EUA) which permits NHS Test and Trace to deploy the repurposed Innova COVID-19 as a self-test device throughout the United Kingdom as a test to detect infection in asymptomatic individuals. At this time an EUA was necessary due to a limited pool of suppliers offering a device which had passed the Government’s relevant validation tests and no suppliers had a CE mark for a COVID-19 self-test LFD. We will continue to work closely with the MHRA to ensure all available tests are safe and effective.

The Government welcomes the World Health Organization’s guideline on health workforce attraction, recruitment and retention in rural areas and is committed to ensuring there is a sufficient workforce supply across all geographies of England.

Five new medical schools have opened in hard-to-recruit areas, including rural and coastal locations in Sunderland, Lancashire, Chelmsford, Lincoln and Canterbury. To further attract trainees to remote geographies, foundation priority programmes were introduced in 2019 allowing applicants to rank their preference for selected priority programmes and be offered places prior to national allocation. The NHS People Plan has a key focus on retention. National Health Service organisations locally should shape their workforce plans to meet local workforce challenges focusing on both recruitment and retention to increase overall supply.

NHS Digital piloted phase four of the Electronic Prescription Service (EPS) at general practitioner practices and dispensers across England, from November 2018 and the national deployment, which includes dispensing doctor practices, began in November 2019. The Department and NHS England and NHS Improvement are currently looking at what potential further support can be provided to dispensing practices to implement EPS dispensing functionality.

Capitation payments to practices include a formula weighting for rurality. We also recognise there are issues with recruitment and retention in some rural locations. The Targeted Enhanced Recruitment Scheme offers a £20,000 salary supplement to attract general practitioner trainees to work in areas of the country in which training places have been unfilled for a number of years.

Additionally, NHS England and NHS Improvement have allowed commissioners to waive the Primary Care Network (PCN) minimum population where a PCN serves a community with a low population density across a large rural and remote area.

The Department is in regular discussions with NHS England and NHS Improvement over the provision of services. On 27 March 2020, directions were issued on behalf of the Secretary of State for Health and Social Care to enable Regulation 61 of the National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013. It has been regularly reviewed and extended during the pandemic. Currently the directions are in place until 30 June 2021.

Regulation 61 allows NHS England and NHS Improvement to commission a dispensing doctor to provide pharmaceutical services to patients to whom the dispensing doctor is not otherwise entitled to provide pharmaceutical services during an emergency. Exercise of this function is an operational decision for regional offices, taking into account local circumstances.

We have issued new guidance on care home visiting and will keep arrangements under review.

If a resident or their family believe a care home is not following visiting guidance appropriately then concerns should be raised with the home in the first instance. If this does not resolve the situation, they can also raise concerns with the Care Quality Commission who will investigate.

All medicines appraised by the National Institute for Health and Care Excellence (NICE) address important areas of health. NICE works closely with the Medicines and Healthcare products Regulatory Agency to ensure that licensing procedures and health technology assessments are streamlined and aims wherever possible to publish its recommendations on all new medicines very close to licensing.

During the COVID-19 pandemic, NICE adapted its priorities to support the health and care system at a time of unprecedented pressure. This involved pausing the publication of topics that were not COVID-19 related or regarded as therapeutically critical.

The legislative measures in the Health and Care Bill White Paper are a critical first step in wider reform in the adult social care sector. However, our commitment to the reform of social care extends beyond this legislation and we will bring forward further proposals in 2021.

There were no defined criteria or financial commitments.

The Government is currently working on a number of statutory instruments under the powers in the Medicines and Medical Devices Act 2021. Regulations made using the majority of powers under the Act are subject to public consultation. More details on the upcoming consultations will be made available in due course.

The target date to begin the evaluative rollout of non-invasive prenatal testing (NIPT) is 1 June 2021. This will include women who are identified, by existing tests, as having a higher chance of having a baby with Down’s syndrome, Edwards’ syndrome or Patau’s syndrome and is expected to be complete in around three years. Once this has begun, the United Kingdom National Screening Committee (UK NSC) will be updated on monitoring at future meetings.

This is to ensure NIPT screening is clinically safe, cost effective and provides an acceptable service to those women who accept the offer of screening using NIPT. The evaluation data will be reviewed throughout to identify any issues that may arise. Once areas of uncertainty have been addressed the UK NSC will then review this to consider formally recommending NIPT as a permanent part of the pathway.

NHS England and NHS Improvement are currently collating referral to treatment data from April 2021, which will be published on 10 June. This data will be published in weekly time bands from 52 weeks to more than 104 weeks.

The Government is committed to bringing physician associates (PAs) and anaesthesia associates (AAs) into statutory regulation.

We are currently consulting on proposals to modernise each of the healthcare professional regulators’ legal frameworks and on the proposed approach to introducing statutory regulation for PAs and AAs. A separate consultation on the draft legislation that will bring this framework into force will be carried out later this year.

The reforms will update the General Medical Council’s (GMC) current legislation and will enable it to bring PAs and AAs into regulation under its new, modernised framework. We are working with the GMC to ensure that regulation of PAs and AAs begins as early as possible in the second half of 2022.

We are working closely with the World Health Organization, the Food and Agriculture Organization, the World Organisation for Animal Health and the United Nations Environment Programme to build the proposal for developing the Hub and are discussing potential support with G7 partners.

Non-invasive prenatal testing (NIPT) will be available to women as an additional option as part of the NHS Fetal Anomaly Screening Programme. NIPT will be offered if the woman has been identified by existing tests as having a higher chance of having a baby with Down’s syndrome, Edwards’ syndrome or Patau’s syndrome.

The target date to commence the offer of NIPT is 1 June 2021. NIPT will be nationally introduced as an ‘evaluative roll out’. This means the programme will be able to monitor how the introduction of NIPT is working at each stage and make any required changes to the pathway and screening processes quickly and effectively.

We have already announced that £79 million of this additional funding will go to supporting children and young people with their mental health and wellbeing. Details of how the remaining funds will be allocated will be announced shortly.

The Government is committed to the improvement of the adult social care system and will bring forward proposals later this year.

We have no plans to do so as this information is not collected centrally. It is for clinical commissioning groups to allocate funding to meet the mental health needs of their local populations.

There are no plans to do so. A national access and waiting times standard for children and young people’s mental health services in England has not yet been defined.

A response to the Medicines and Healthcare products Regulatory Agency’s review of the safety of immunoglobulins from fractionated United Kingdom plasma will be published by the spring.

From 8^th March care homes will be supported to allow residents more meaningful visits. We will enable care homes to identify a single named repeat visitor for residents, and facilitate indoor visits with lateral flow testing and PPE.

We have acted to protect those most at risk in care homes and ensure visits can go ahead safely in some form. Visits to care homes can continue to take place with arrangements such as substantial screens, visiting pods or behind windows. Close-contact indoor visits are not currently allowed. Visits in exceptional circumstances including end of life should always be supported and enabled.

We will be looking to ensure that a wider range of visiting arrangements are made available when it is safe to do so and publish updated guidance as this period of national lockdown ends.

The recommendations on what personal protective equipment (PPE) is required in which settings, including the use of FFP3 masks, is set out in ‘COVID-19: infection prevention and control (IPC)’, which was last updated on 21 January 2021. These recommendations are agreed by an expert group of clinicians and scientists from across the United Kingdom and are consistent with World Health Organization guidance.

Due to the identification of new COVID-19 variants, the UK Infection Prevention Control Cell conducted a comprehensive review and assessed the available evidence in order to inform any necessary changes to the guidance for health workers in England including recommended levels of PPE. Based on the evidence, they concluded that current guidance and PPE recommendations remain appropriate. Emerging evidence and data on variant strains will be continually monitored and reviewed, and the guidance amended accordingly if needed.

We have security in place in and outside accommodation to support people staying there.

In response to clinical advice and following a successful pilot, free personal protective equipment (PPE) for COVID-19 needs is now being provided to unpaid carers who do not live with the person they care for. In line with the Government’s commitment to provide free PPE for COVID-19 needs to the adult social care sector, this offer for unpaid carers is currently available until the end of June 2021 and can be accessed through local authorities and local resilience forums.
As of May 2020, the Government included unpaid carers in its list of essential workers and those prioritised for COVID-19 testing in England. If they have symptoms of COVID-19, unpaid carers can book a test directly online and access testing themselves or for members of their household who are experiencing symptoms.

Car parking regulations are enforced at National Health Services sites where they are distributing the COVID-19 vaccine and elsewhere to ensure parking remains safe and available for all users. Suspending such enforcement would have a detrimental effect on car parking users and their access to such facilities. However, NHS organisations will consider the appropriateness of taking action, for example issuing Parking Charge Notices, with regard to the local circumstances.

The Department currently has no plans to review the units of dental activity targets for the final quarter of the 2020/21 financial year, as set by NHS England and NHS Improvement.

NHS England and NHS Improvement have set a 45% dental activity target for the final financial quarter of the 2020/21 financial year. This target is based upon clinical advice and modelling from the office of the Chief Dental Officer and has taken into consideration robust adherence to infection prevention and control guidance and social distancing requirements. This target also takes into consideration the levels of dental activity that have been achieved to date.

National Health Service commissioners have the discretion to make exceptions, for instance in cases where a dental practice has been impacted by staff being required to self-isolate or the reinstatement of shielding during the national lockdown.

The Eatwell Guide applies to most people regardless of their weight, energy or calorie requirements. People with a Body Mass Index of 30 or above would be classified as living with obesity and should be supported to achieve a healthier weight through sustainable changes to their eating habits and physical activity levels. To achieve weight loss, the average person should reduce their daily calorie intake by 600 kilocalories. Whilst aiming to lose weight, the Eatwell Guide can help people choose a variety of different foods from each of the groups to help them get the wide range of nutrients they need to stay healthy.

Whilst there are no official recommendations on the consumption of white meat, the Government recommends that people who currently eat more than 90 grams (cooked weight) of red and processed meat a day, cut down to no more than an average of 70 grams a day. This is based on advice from the Scientific Advisory Committee on Nutrition (SACN).

The SACN reviewed the evidence on red and processed meat intake as part of their report ‘Iron and Health’ in 2010. The report concluded that red and processed meat is probably associated with increased bowel cancer risk. The SACN recommended that people with relatively high intakes of red and processed meat should consider reducing their intakes. ‘Iron and Health’ is available at the following link:

https://www.gov.uk/government/publications/sacn-iron-and-health-report

The former healthcare professionals who came forward to help the National Health Service in the first wave of the COVID-19 outbreak have wide ranging skills and experience and have been employed across health and social care - for example within NHS 111, secondary care, mental health and community services. More recently, efforts have focused on matching these former healthcare professionals to the covid vaccination programme.

Data on the numbers of those on the temporary registers who are employed is not collected centrally. Thousands of these former healthcare professionals remain in touch with NHS England and NHS Improvement’s regional ‘Bring Back Staff’ teams and are available for deployment to a range of clinical settings and programmes, including Nightingale hospitals.

NHS England confirmed on the 11 January that the Nightingale hospital in London is now open and will be proving step-down care, freeing up beds in existing hospitals for those who need them.

The data is not held in the format requested.

The Government has ensured that the regulations do allow charitable lunches over the festive period to continue this year.

In all three tiers there is an exception to gathering restrictions where the gathering is a permitted organised gathering which includes gatherings operated or organised by a charity. An attendee can participate in the gathering alone or as a member of a qualifying group.

There are also exceptions to the business closure requirements in each of the three tiers to enable premises to be used for the provision of voluntary services, including the provision of food banks, or to provide support for the homeless or vulnerable people.

The Joint Committee on Vaccination and Immunisation (JCVI) has considered the available evidence and published the prioritisation list for COVID-19 vaccination, which is largely prioritised by age due to the strong association of older age and mortality from COVID-19. Those considered clinically extremely vulnerable have also been prioritised for vaccination and those in clinical risk groups aged 16 years old and over.

Persons with severe mental illness are included as a risk group prioritised for COVID-19 vaccination and are described as individuals with schizophrenia or bipolar disorder, or any mental illness that causes severe functional impairment.

The NHS England Highly Specialised Services report for services delivered in 2019 is currently in its final stages of sign-off and is expected to be published at the beginning of 2021. Publication of the report has been delayed due to other documents having to be prioritised for publication during the COVID-19 period.

The report for 2020 is in the process of being prepared and is expected to be published by the end of the financial year.

The Government plans to publish a new United Kingdom Rare Diseases Framework by the end of 2020 which will replace the UK Strategy for Rare Diseases.

All four United Kingdom nations have signed up to the development of a new UK Rare Diseases Framework, set for publication at the end of 2020. The Rare Diseases Framework will be followed by nation-specific action plans that will detail the steps each government will take to meet the shared priorities of the Framework. The devolved administrations have agreed to publish nation specific action plans within two years of the Framework publication.

We welcome the Care Quality Commission’s report which gives us an invaluable insight into the ways that mental health inpatient services have responded to the pandemic.

We have announced measures which address some of the concerns raised in the report. This includes a £50 million winter discharge support package which will boost capacity and support good quality discharge from mental health inpatient settings to help reduce pressures on inpatient beds and keep patients safe over the winter.

It is important that any restrictions on hospital visiting are proportionate and only kept in place when absolutely necessary and in line with the Government’s and NHS policies during the pandemic. We are aware that advocacy services have had to innovate during the pandemic in order to continue to offer patients the advice and support that they need.

Rules on data exclusivity and Supplementary Protection Certificates fulfil two separate functions within the United Kingdom’s intellectual property regime for medicines. These arrangements therefore necessarily have differing start dates. As such, the Government has not made a direct assessment of the potential effect of different starting dates for regulatory data protection and Supplementary Protection Certificates.

‘We are the NHS: People Plan for 2020/2021 – action for us all’ sets out a plan to expand capacity and skills in the workforce. This includes additional training support for shortage specialties and measures to improve wellbeing and retention.

NHS Digital statistics, as at July 2020, showed that there were almost 37% more full time equivalent rheumatology consultants and almost 14% more rheumatology trainees in National Health Service trusts and clinical commissioning groups since 2010.

To further increase the supply of doctors we have increased the number of medical school places by 1,500 over the last three years, and this year we have seen more medical students in training than at any other time in NHS history. Health Education England is also investing in an extra 250 foundation year two posts in 2020/21, to enable the doctors filling them to grow the pipeline into psychiatry, cancer, general practice and other priority areas.

Information on the total number of National Health Service beds is not available in the format requested.

NHS England and NHS Improvement collect sickness absence data on staff contracted by the NHS. The figures report the number of COVID-19 related absences of staff, either through sickness or self-isolation.

The latest available figures show 82,021 total absences of staff either through sickness or self-isolation on 4 November 2020. Of these 31,129 were reported as COVID-19 related.

Each Nightingale hospital plays a different role for their region and any decision to stand-up the hospitals will be based on expert clinical advice and in response to local pressures.

In late October 2020, the Manchester Nightingale reopened to support step-down care for non-COVID-19 patients, helping to maintain routine care in the region’s hospitals. The other Nightingale hospitals remain on standby, ready to quickly step up and support local National Health Service hospitals if needed. Additionally, while on standby, the Nightingale hospitals in Exeter and Harrogate have provided valuable additional diagnostics capacity.

The status of each Nightingale hospital is under constant review and they remain valuable assets that will continue to be used, when required, to support local NHS services over the busy winter period.

On 23 November, we brought forward our Wellbeing and Mental Health Support Plan for COVID-19 which includes a commitment, backed by £50 million, to boost capacity and support good quality discharge for mental health service users from inpatient settings. Guidance on effective approaches to rapid discharge will be made available in due course.

Our policy is informed by expert advice to ensure it is based on the latest international and domestic evidence. We have worked closely with a range of social care stakeholders in developing our policy on visiting care homes during the pandemic.

We will continue to monitor the evidence, and ensure best practice is reviewed and can be applied as we amend our care home visiting guidance to reflect the national situation, and account for the risk of transmission of COVID-19 to vulnerable residents and social care staff.

Plans are currently being developed to allow specific family and friends to visit care homes supported by testing. We have begun rollout of visitor testing, and aim to have nationwide visitor testing by Christmas.

Building on the commitments of the Adult Social Care Winter Plan, we are working with the Care Quality Commission (CQC) and the NHS to ensure everyone discharged from hospital to a care home has an up-to-date COVID-19 test result and anyone testing positive is discharged to a designated setting that that meets a set of agreed standards to provide safe care for COVID-19 positive residents.

No care home provider will be required to admit a new or returning resident if they do not feel they can provide the appropriate care or isolation. The individual’s local authority should secure alternative appropriate accommodation and care for the required isolation period if needed.

Insurance is a private contract between care providers and insurance companies which the Government is not directly involved in.

However, we recognise that COVID-19 is imposing significant pressures on the care sector. We are working closely across Government, with care providers, and insurance representatives, to understand the breadth and severity of insurance issues – including any changes to the cost of insurance – and whether there is any action the Government should take. The Government has already made an additional £4.6 billion available to local authorities to help address pressures on local services, such as insurance costs, caused by the pandemic.

The Government does not publish data in the format requested.

Until the review reports its findings in early 2021, we will continue to work across the health and care system to address the issue. Guidance from clinical bodies such as the British Medical Association, the Resuscitation Council UK and Royal College of Nursing reflects the policy that Do not attempt cardiopulmonary resuscitation (DNACPR) orders should only ever be made on an individual basis and should be led by the clinical team. The adult social care winter plan published on 18 September 2020 reiterates this. The pandemic does not permit any health or care professional to deviate from that approach. All health professionals nationally are expected to follow the clear statements on the use of individual DNACPR orders.

The Scientific Advisory Group for Emergencies (SAGE) has provided expert strategic scientific advice to the Government throughout the COVID-19 response.

SAGE’s advice has highlighted that alcohol consumption may increase risk of non-compliance with social distancing and that gatherings in hospitality are higher risk of transmission. SAGE continues to release minutes from its meetings and the supporting scientific papers on GOV.UK, as has been the case since the start of the pandemic.

Public Health England’s Weekly Coronavirus Disease 2019 (COVID-19) surveillance report highlighted that from 21-27 September, 13% of those testing positive for COVID-19 reported eating out in the time before symptom onset, when there is a high risk of asymptomatic transmission.

When making decisions on any COVID-19 restrictions the Government assess a wide range of data. At the core is an assessment of the rate of transmission, infection and death rate however, a wide range of other impacts are also assessed including the physical and mental health of the population. We understand how difficult the first national lockdown was for people and want to avoid the need for one by taking a localised approach as seen through the local alert levels.

The Government is also absolutely committed to only having restrictions in place for as long as is necessary to protect public health, acknowledging the impact that they have on people’s lives.

The evidence considered by the Scientific Advisory Group for Emergencies and used to support the Government’s response to COVID-19 is available at the following link:

https://www.gov.uk/government/collections/scientific-evidence-supporting-the-government-response-to-coronavirus-covid-19

NHS England and NHS Improvement work with the National Institute for Health and Care Excellence (NICE) to ensure access to personalised cancer treatments that target specific gene mutations.

NHS England and NHS Improvement are involved in the NICE Topic Selection process to identify treatments which may proceed through the NICE technology appraisal process and include a genomic test as part of the patient pathway. Following NICE recommendation of a treatment that targets specific gene mutations, NHS England and NHS Improvement develop and follow a detailed implementation plan to ensure that genomic testing is available within the appropriate time scale.

NHS England and NHS Improvement have confirmed that there has never been an instruction or directive issued by the National Health Service to put in place blanket ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR) decisions for any group of people in hospitals or care homes.

The Department remains clear that the blanket application of DNACPRs is unacceptable and that standards and quality of care should be maintained even in pressurised circumstances. The Adult Social Care Winter Plan published on 18 September 2020 reiterates this.

The Department has asked the Care Quality Commission (CQC) to review how DNACPR decisions were used during the COVID-19 pandemic, building on concerns that the CQC reported earlier in the year. Interim findings are expected to be reported later this year with a final report in early 2021.

The data is not held in the format requested.

The Department’s Medicine Supply Team has established robust procedures to deal with medicine supply issues and they regularly communicate information on these with the National Health Service via networks in primary and secondary care. Where appropriate, the communications include guidance on the management of patients who may be affected by the supply issue.

Pharmacists are expected to use their professional judgement and expertise about the prescribed medicine and how quickly a patient needs it as to what they do to ensure the patient has timely access to the medicine.

In their letter of 31 July, NHS England and NHS Improvement provided guidance that included a clear expectation that digital services would be developed in an inclusive manner. This inclusive approach needs to take account of the needs of those for whom digital services may not be accessible or present accessibility issues, including for deaf and other disabled people.

Work is being developed with NHSX to specifically assess the needs of digitally excluded groups and how digital services can be adjusted to provide the widest possible access, while acknowledging that a mixed approach is necessary and non-digital channels must also remain available.

The letter is available at the following link:

https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/07/Phase-3-letter-July-31-2020.pdf

Policy makers in the Department are guided in their work by the Civil Service Professional Development Framework for policy professionals which was published in 2019 and can be found at the following link:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/851078/Policy_Profession_Standards_AUG19.pdf

The Framework sets out the requirement for policy professionals to take into account genuine user needs when developing their policy, understand the impact for end users and use a range of tools and techniques to gather evidence and test policy solutions. The Department also has a policy improvement team which provides specific guidance and support on all aspects of the Framework to policy makers including how to engage and consult with a wide range of stakeholders including service users.

The Government’s current priority for adult social care is for everyone who relies on care to get the care they need throughout the COVID-19 pandemic.

We know we need a long-term solution for social care and are looking at a range of proposals as part of our commitment to bringing forward a strategy that puts the sector on a sustainable footing for the future.

During the early stages of the COVID-19 pandemic all non-essential elective surgery was postponed, including minimally invasive procedures. The use of minimally invasive techniques was mooted as a potential solution to operating in a COVID-19 environment and, where clinically appropriate, this technique was used once non-urgent procedures resumed. As COVID-19 infection control measures have been developed, the need for minimally invasive techniques has receded and the use of these has now returned to normal levels.

The Government publishes an annual review on the Health Service Products (Provision and Disclosure of Information) Regulations 2018, which assesses the regulations against their objectives. The latest review can be found at the following link:

https://www.gov.uk/government/publications/health-service-products-and-medicines-regulations-2018-annual-review

The collection of data under the regulations ensures reimbursement prices set using market data includes data from all suppliers and therefore the reimbursement price more fairly reflects the average market selling price. A number of factors effect both the selling and the reimbursement price.

The Government published a Consultation last year which asked stakeholders to give their feedback to proposals that included improving the system for reimbursement of special medicinal products. The Government will consider the report on Special Medicinal Products by the All-Party Parliamentary Group on Access to Medicines and Medical Devices as work post the consultation is taken forward. The Consultation is available at the following link:

https://www.gov.uk/government/consultations/community-pharmacy-drug-reimbursement-reform

Concerns about potential drug pricing abuses are a matter for the Competition and Markets Authority (CMA). The CMA has several ongoing investigations into excessive prices of generic medicines. Where it has concerns about the price of a generic medicine, the Department asks the CMA to investigate that price.

Concerns about potential drug pricing abuses are a matter for the Competition and Markets Authority (CMA). The CMA has several ongoing investigations into excessive prices of generic medicines. Where it has concern about the price of a generic medicine, the Department asks the CMA to investigate that price.

Early data suggests that a significant proportion of exposure to the virus is seen in the hospitality sector, which is even more pronounced in younger age groups.

10pm closure seeks to strike the balance of allowing people to continue to socialise while reducing social contact and minimising negative impact on the economy. This relies on us ensuring that businesses remain COVID-secure.

We have put in place an unprecedented package of support to support impacted businesses, including over £11 billion already been paid out through the Small Business Grants Fund and Retail, Hospitality and Leisure Business Grants Fund to over 897,000 businesses across the country, with a further £617 million available to councils to use at their discretion to support small businesses which are not eligible for the main grant scheme.

The National Institute for Health and Care Excellence has published two technology appraisals on medicines for rare diseases where they have received a negative recommendation as a result of a lack of data:

- cenegermin for treating neurotrophic keratitis [TA532]; and

- darvadstrocel for treating perianal fistula in Crohn’s disease [TA556].

The National Institute for Health and Care Excellence has made recommendations on two medicines for rare diseases through a managed access agreement that were not eligible for the evaluation through the highly specialised technologies process.

These are:

- Belimumab (Benlysta) for treating active autoantibody-positive systemic lupus erythematosus [TA397] published 22 June 2016; and

- Nusinersen (Spinraza) for treating spinal muscular atrophy [TA588] published on 24 July 2019.

Supporting children and young people's mental health including those living in rural areas, is one of the Government’s top priorities.

We are committed to transforming mental health services as part of the NHS Long Term Plan, funded by an additional £2.3 billion a year in real terms by 2023/24. We have provided £9.2 million of additional funding for mental health charities to support adults and children struggling with their mental wellbeing during this time.

Clinical commissioning groups (CCGs) are best placed to decide on how our investment in mental health services should be used to meet the needs of their populations living in rural areas. CCGs are required to continue to increase investment in mental health services in line with the mental health investment standard. In 2018/19, all CCGs met the standard.

Allowing pharmacists to take local action to amend prescriptions without a Serious Shortage Protocol being in place could potentially risk exacerbating shortages by depleting supplies of any alternative medicine provided. The Government is not currently formally pursuing such a proposal in England.

The forthcoming vaccine strategy, as announced in the Green Paper ‘Advancing our health: prevention in the 2020s’, will consider all vaccination programmes over the life-course.

Due to re-prioritisation necessary as part of the health and care system’s response to the COVID-19 pandemic, publication has been delayed, but is expected in due course.

The new Government ‘Vaccines Taskforce’ is working with the BioIndustry Association Taskforce to review existing domestic capability to manufacture vaccines, in response to COVID-19. The Taskforce is also reviewing options for increasing this capacity, including how to support the acceleration and expand the capacity of the Vaccines Manufacturing and Innovation Centre, so that it becomes operational earlier than planned and is able to manufacture population level doses.

For COVID-19, the type of vaccine manufacturing capacity needed will be determined by the nature of the vaccine that is developed and the technology used to produce the vaccines. This work is proceeding at pace, with the support of industry and academic partners, to ensure that we are identifying suitable capacity across different vaccine types, while those vaccines are still under development.

Formularies are developed locally between trusts and clinical commissioning groups as part of their local responsibilities.

The National Institute for Health and Care Excellence (NICE) have developed good practice guidance on developing and updating local formularies. The guidance supports developing formularies that reflect local needs, reduce variation in prescribing, and allow rapid adoption of new medicines and treatments. It also recommends that local formularies be published. The guidance is available at the following link:

https://www.nice.org.uk/Guidance/MPG1

Formularies are developed locally between National Health Service trusts and clinical commissioning groups and are not set nationally. Therefore we do not hold a list or have the information for each sustainability and transformation partnership.

Local areas publish terms of reference for formulary groups online, this will include membership for their local formulary group. Good practice guidance also recommends that formularies are published online.

The Department is highly invested in increasing innovation within the National Health Service, and over the last five years, national bodies including NHS England, NHS Improvement, NHS Digital and the Department have managed a series of high-profile central funding programmes designed to support the digitisation of primary and secondary healthcare services. NHSX has been formed to accelerate the adoption of digital innovation across the NHS and social care.

In December 2019, we announced the Digital Aspirant Fund to support NHS providers. This fund will provide support to organisations with low levels of digitisation in order to help them reach a national standard.

We are working towards a health service that supports innovators to develop safe and effective innovations that meet user needs, promotes the testing and iteration of these innovations so they can be used with confidence, and ensures the best innovations are used so that everyone can benefit.

There is an official statistical rural urban classification, based on the 2011 Census, which determines settlements with populations of 10,000 or more as urban. Further details of the rural urban classification can be found at the following link:

www.gov.uk/government/collections/rural-urban-classification

The rural urban classification is intended to support statistical analysis. Other definitions of rural could be more appropriate in some policy or analytical contexts.

The Cancer Drugs Fund will be extended to create a new Innovative Medicines Fund so that doctors can use the most advanced, life-saving treatments for conditions such as autoimmune disease or cancer, or for children with other rare diseases.

Detailed proposals for the new Innovative Medicines Fund are in development and will be consulted on in due course.

The Cancer Drugs Fund will be extended to create a new Innovative Medicines Fund so that doctors can use the most advanced, life-saving treatments for conditions such as autoimmune disease or cancer, or for children with other rare diseases.

Detailed proposals for the new Innovative Medicines Fund are in development and will be consulted on in due course.

The Cancer Drugs Fund will be extended to create a new Innovative Medicines Fund so that doctors can use the most advanced, life-saving treatments for conditions such as autoimmune disease or cancer, or for children with other rare diseases.

Detailed proposals for the new Innovative Medicines Fund are in development and will be consulted on in due course.

The Department is aware that there is currently limited availability of the pneumococcal polysaccharide vaccine (PPV23), due to manufacturing capacity constraints. Further deliveries of the vaccines are due at the end of February 2020.

Public Health England has issued comprehensive guidance to the National Health Service that provides information to clinicians on the management of potentially affected patients during this time of limited availability. General practices have been advised to prioritise PPV23 vaccinations based on clinical risk and to plan vaccinations to ensure demand is more consistent across the year.

On the 6 November 2019, PPV23 was added to the list of medicines that cannot be parallel exported, further protecting United Kingdom supplies and vaccine availability.

The vaccine differs from the pneumococcal conjugate vaccine (PCV13) vaccine used for the routine childhood programme. There is no supply issue affecting the PCV13 vaccine used in infants and toddlers—but this vaccine is not suitable for protection of older people.

On 7 February 2019 the Government published its response to the consultation on the Regulation of Medical Associate Professions in the United Kingdom, confirming its decision to introduce statutory regulation for physician associates (PAs) and anaesthesia associates (AAs), formerly known as physicians’ assistants (anaesthesia).

On 18 July 2019, the Government announced that it would be asking the General Medical Council (GMC) to take forward the regulation of these roles.

The Government is now working with the GMC and stakeholders to develop legislation to bring PAs and AAs into regulation. Funding has been agreed with the GMC to carry out development work.

We intend to consult on draft legislation later this year.

On 7 February 2019 the Government published its response to the consultation on the Regulation of Medical Associate Professions in the United Kingdom, confirming its decision to introduce statutory regulation for physician associates (PAs) and anaesthesia associates (AAs), formerly known as physicians’ assistants (anaesthesia).

On 18 July 2019, the Government announced that it would be asking the General Medical Council (GMC) to take forward the regulation of these roles.

The Government is now working with the GMC and stakeholders to develop legislation to bring PAs and AAs into regulation. Funding has been agreed with the GMC to carry out development work.

We intend to consult on draft legislation later this year.

The Government is committed to considering the extension of prescribing responsibilities for this group once physician associates are brought into regulation.

Treasury ministers and officials engage with stakeholders on a variety of issues. However, the decision to close a branch is a commercial issue for banks and building societies and the Government does not intervene in these decisions or make direct assessments of the impact of closures.

However, the Government also firmly believes that the impact of branch closures should be understood, considered and mitigated where possible so that all customers and businesses continue to have access to banking services. That is why the Government continues to be supportive of the Access to Banking Standard which commits firms to ensure customers are well informed about branch closures, the bank’s reasons for closure and options for continued access to banking services. Alternative options for access include the Post Office, which allows 95% of business and 99% of personal banking customers to carry out their everyday banking at 11,500 Post Office branches across the UK.

In September 2020, the Financial Conduct Authority also published guidance setting out its expectation of firms when they are deciding to reduce their physical branches or the number of free-to-use ATMs. Firms are expected to carefully consider the impact of a planned closure on their personal and small business customers’ everyday banking and cash access needs, and other relevant branch services and consider possible alternative access arrangements. This will ensure the implementation of closure decisions is undertaken in a way that treats customers fairly.

The Government also recognises that cash is important to the daily lives of millions of individuals and businesses across the UK. I have announced that the Government will consult this summer on further legislative proposals for protecting access to cash for the long term.

The National Institute for Health and Care Excellence (NICE)’s review into its methods and processes for assessing new medicines is currently live. The review has sought input from a wide range of stakeholders, and officials from across Government – including those in HM Treasury – have been engaged as appropriate. NICE is an independent body, and I look forward to seeing the outcome of the Review in due course.

The National Institute for Health and Care Excellence (NICE)’s review into its methods and processes for assessing new medicines is currently live. The review has sought input from a wide range of stakeholders, and officials from across Government – including those in HM Treasury – have been engaged as appropriate. NICE is an independent body, and I look forward to seeing the outcome of the Review in due course.

The Government announced at Budget on 3 March that the Self-Employment Income Support Scheme (SEISS) will continue until September, with a fourth and a final fifth grant. This provides certainty to business as the economy reopens and means the SEISS continues to be one of the most generous schemes for the self-employed in the world.

The Chancellor also announced that the fourth and fifth SEISS grants would be based on 2019-20 Self-Assessment tax returns and individuals must have submitted their 2019-20 tax return by 2 March 2021. This date balances access for the vast majority of eligible self-employed individuals, with the duty to protect the taxpayer against fraud as the details of the SEISS grants became public.

HM Revenue & Customs waived the late filing penalty for Self-Assessment tax returns filed online by 28 February to provide relief to all self-assessment taxpayers and agents at a time of unprecedented pressure. The statutory filing deadline of 31 January did not change.

Further information about the fourth grant is available in recently published guidance: https://www.gov.uk/guidance/claim-a-grant-through-the-coronavirus-covid-19-self-employment-income-support-scheme.

The Government is committed to regulating only where there is a clear case for doing so, in order to avoid putting additional costs on lenders that would ultimately lead to higher costs for business customers. Business lending is unregulated and is not generally within the scope of the Financial Conduct Authority's (FCA's) conduct rules.

However, the Government has provided unprecedented support to businesses through the emergency Covid-19 loan schemes which have been open since March 2020: over 1.6 million businesses have accessed over £75 billion of finance through the schemes to date.

Whilst it is important that businesses are responsible for repaying any facility they take out, to help businesses repay their loans the Government has taken steps to give them time to get back on their feet. This includes “Pay as You Grow” (PAYG) options for the Bounce Back Loan Scheme (BBLS), giving businesses the option to: repay their BBLS facility over ten years, move temporarily to interest-only payments for periods of up to six months (an option which they can use up to three times), or to pause their repayments entirely for up to six months.

The Government has also amended the Coronavirus Business Interruption Loan Scheme (CBILS) rules to allow lenders to extend loan terms from six to a maximum of ten years at their discretion and where they judge that the borrower is in difficulty and this will help them repay their loan, helping to reduce their monthly repayments.

Businesses which need support should discuss options with their lenders, who are best placed to offer tailored engagement based on individual business’ circumstances.

The Government recognises the extreme disruption the necessary actions to combat Covid-19 are having on sectors like events.

During this difficult time the Treasury is working intensively with employers, delivery partners, industry groups, and other government departments to understand the long-term effects of Covid-19 across all key areas of the economy.

We have already announced considerable and unprecedented support for businesses and individuals.

Businesses forced to close can claim grants of up to £3,000 per month (worth over £1 billion per month) through the Local Restrictions Support Grant (Closed). Any business in England forced to close due to national or local restrictions can claim grants, via their local authority, of up to £3,000 per month, per business premises, depending on rateable value.

In addition, on 5th January, the Government announced an extra £4.6 billion to protect jobs and support affected businesses as restrictions get tougher. Businesses forced to close can claim a one-off grant of up to £9,000. This is in addition to the monthly closed grant amounts above. Local authorities (in England) will also be given an additional £500 million discretionary funding to support their local businesses. This builds on the £1.1 billion discretionary funding (worth £20 per head of population) which local authorities in England have already received to support their local economies and help businesses impacted

The Coronavirus Job Retention Scheme (CJRS) has been extended until the end of April. This provides a substantial grant for employers to cover 80% of the wages of their employees.

Eligible events and businesses may have also benefit from business rates relief, a moratorium on commercial tenant evictions and the £1.57 billion Culture Recovery Fund supporting thousands of cultural organisations including theatres, music venues, comedy clubs and festivals.

Looking forward, we will continue to monitor the impact of government support on public services, businesses, individuals and sectors, including the events sector, as we respond to this pandemic. The Budget in March will be an opportunity to take stock of our wider support and set out the next stage of our economic response to the pandemic. But we must recognise that it will not be possible to preserve every job or business indefinitely, nor stand in the way of the economy adapting and people finding new jobs or starting new businesses.

The Government recognises that our new relationship with the EU requires businesses to adapt to new rules whilst at the same time responding to the unprecedented coronavirus pandemic.

We have already invested funds to help businesses adapt to changes, which includes:

• £84 million made available by HMRC in grants for intermediaries and traders supporting recruitment, employee training and IT projects
• scaling of our Growth Hub network in England to provide more support to SMEs locally
• an economic package of support for businesses impacted by Covid-19 to provide certainty over the Winter months, including further support measures announced on 5 January.

Moreover, the Government is taking a flexible and pragmatic approach to allow businesses to prepare. For example, recognising the impact of Coronavirus, we decided to introduce our border controls in three stages up until 1 July 2021, giving businesses extra time to adjust to the new procedures.

Going forward, we are continuing to engage intensively with business in sectors that are most affected by our changing relationship with the EU to help them adjust and to continue to successfully compete on the global stage.

The Government will continue to look at how to adjust support in a way that ensures people can get back to work, protecting both the UK economy and the livelihoods of people across the country. The Government will consider all reliefs in the round, against the broader fiscal and economic impacts of COVID-19, as part of the Business Rates Review.

The Prudential Regulation Authority (PRA) is responsible for setting the UK’s deposit protection limit. The current limit of £85,000 has been in place since 2017 and protects more than 97% of eligible depositors’ accounts.

There are currently no plans for the coverage level to change. However, from the end of the transition period the PRA will be required to review the limit at least once every five years and may adjust the limit following such a review, subject to HM Treasury approval.

Those not eligible for the Self-Employment Income Support Scheme (SEISS), such as sole employees of limited companies, may still be eligible for other elements of the unprecedented financial support provided by the Government. The Government has temporarily increased the Universal Credit standard allowance for 2020-21 by £20 per week and relaxed the Minimum Income Floor, so that where self-employed claimants' earnings have significantly fallen, their Universal Credit award will have increased to reflect their lower earnings. They may also have access to Bounce Back loans, tax deferrals, rental support, mortgage holidays, and other business support grants, with a new extended deadline of 30 November.

In addition to this, up to half a million businesses which deferred their VAT bills will also be given more breathing space through the New Payment Scheme. This gives them the option to spread their payments over the financial year 2021-2022. In addition, all 11 million UK self-assessment taxpayers will be able to benefit from the recently enhanced Time to Pay ‘self-service’ facility to form a 12-month, interest-free payment arrangement for up to £30,000 of self-assessment debt.

Small businesses which are not eligible for business grants should still be able to benefit from other elements of the Government’s unprecedented package of support for business, including:

• An option to defer VAT payments by up to twelve months;
• The Bounce Back Loan scheme, which will ensure that small and micro businesses can quickly access loans of up to £50,000 which are 100% guaranteed by the Government;
• The Coronavirus Business Interruption Loan Scheme, now extended to cover all businesses including those which would be able to access commercial credit;
• The Coronavirus Job Retention Scheme, to support businesses with their wage bill;
• The Self-Employment Income Support Scheme, to provide support to the self-employed.

During the pandemic, we have worked closely with local authorities and the sector to offer vulnerable people safe accommodation and support. That work is ongoing and in September, we had successfully supported over 29,000 people, with 10,000 in emergency accommodation and nearly 19,000 provided with settled accommodation or move on support.

On 13 October, we announced additional winter support, to give local areas the tools they need to support vulnerable rough sleepers this winter. This includes a new £10 million Cold Weather Fund for local areas and £2 million in funding for the faith, communities and voluntary sector to bring forward self-contained and COVID secure accommodation this winter.

We have worked extensively with Public Health England (PHE) to provide Operating Principles for the sector to help them open shelters as safely as possible where necessary, when self-contained accommodation cannot be made available and when local partners agree that it is the right thing to do.

This Government is providing support to local leadership with a High Streets Task Force that will give high streets and town centres the expert advice they need to adapt and thrive.

Through the Task Force local authorities in England will receive free expert advice to help them evolve their town centres and respond to the impact of COVID-19.

These high streets experts have been recruited from the Design Council, Landscape Institute, Institute of Place Management and Royal Town Planning Institute. They will work with places, bringing insight into town centre change and how to work with communities to build capacity for that change.

The High Streets Task Force will publish the full list of experts on the register in due course

In a place of worship, where food or drink are essential to the act of worship, they can be served and consumed. If it is necessary to handle food or drink as a part of a faith practice, those giving and receiving these items should wash their hands thoroughly before and after consumption, or wear gloves

If a place of worship provides hospitality spaces, such as cafes, these are permitted to open but should be limited to table-service, social distancing should be observed, and with minimal staff and customer contact in line with the hospitality guidance.

The Government has delivered one of the most generous and comprehensive packages of support globally, with a total fiscal response of close to £200 billion. Many of the measures introduced, including loan schemes, tax deferrals, Self-Employment Income Support Scheme and the Coronavirus Job Retention Scheme remain open and have been designed to be accessible to businesses in most sectors and across the UK

Eligible market stalls with a rateable value could also benefit from flat rate payments of £10,000 under the grant scheme for the retail, hospitality, and leisure sectors. Moreover, in recognition that some market traders were excluded from this grant fund because of the way they interact with the business rates system, the Government encouraged local authorities to include these businesses as a priority group for the Discretionary Grant Fund

In terms of rent assistance, the Government encourages tenants to continue to pay their rent in full where they are in a position to do so, although we recognise that others may not be in this position. We welcome the fact that many local authorities and other operators have been able to be flexible in their approach and negotiate suitable arrangements including rent concessions for a significant number of market traders in support of the industry, recognising the financial strain the pandemic has placed on their finances.

The Ministry for Housing, Communities and Local Government is working with councils through this period to ensure they can support their communities best and that national guidance has been translated into a range of languages throughout the pandemic by individual departments and agencies. Guidance issued by local authorities would be locally produced and be targeted to the area they serve. Local authorities know their communities best and as independent organisations, will have the ability to decide how best to communicate with, and serve their communities.

The Government is committed to undertaking a review of the relative needs and resources of English local authorities. We are working closely with local government representatives and others to examine all elements of the review. We aim to share emerging results with the sector shortly, followed by a full consultation in the Spring. Our aim is to implement the review in 2021-22.

The Government is committed to undertaking a review of the relative needs and resources of English local authorities. We are working closely with local government representatives and others to examine all elements of the review. We aim to share emerging results with the sector shortly, followed by a full consultation in the Spring. Our aim is to implement the review in 2021-22.