Beccy Cooper

There is no additional national funding for those not prioritised by their local systems to access the capital fund of £102m for GP upgrades allocated in the 2024 Autumn Budget.

This capital fund is in addition to annual capital allocations to Integrated Care Boards (ICBs). Since 2022/23, the Department includes a substantial proportion of primary care business as usual estates and GP IT capital in ICB capital funding envelopes. This allows ICBs to take a more cohesive approach to capital investment decisions across all organisations within that system. In addition, ICBs are responsible for commissioning - planning, securing, and monitoring – GP services within their health systems through delegated responsibility from NHS England.

The Government is committed to delivering a National Health Service that is fit for the future, which means we require world class NHS infrastructure across the entire NHS estate. Beyond hospitals, we know we need the right infrastructure in the right place to deliver on our commitments of creating a true Neighbourhood Health Service and ensuring that patients receive the care they deserve.

At the Autumn Budget, we established a dedicated capital fund of £102 million to deliver approximately 200 upgrades to general practice surgeries across England, supporting improved use of existing buildings and space, boosting productivity, and enabling delivery of more appointments. This funding represents a first step in delivering the additional capital the primary care sector needs. It responds directly to issues highlighted by Lord Darzi’s independent review of the NHS and is the first dedicated national capital fund for primary care since 2020.

The Department and NHS England are working with integrated care boards to prioritise high-impact projects where investment can unlock significant productivity gains and additional usable space from existing buildings. Capital budgets for 2026/27 onwards will be considered through Phase 2 of the Spending Review process, concluding in Spring 2025.

The Scientific Advisory Committee on Nutrition (SACN) discussed the topic of plant-based diets at its horizon scan meetings in 2022 and 2024. The SACN concluded it is an important topic and will continue to grow in interest, particularly from a sustainability viewpoint. The SACN agreed to keep the topic on its watching brief. Meeting papers are available on the SACN’s website, at the following link:

https://www.gov.uk/government/groups/scientific-advisory-committee-on-nutrition#sacn-meetings

Government advice on a healthy, balanced diet is encapsulated in the United Kingdom’s national food model, the Eatwell Guide. The Eatwell Guide depicts a diet that is based on fruit, vegetables, and higher fibre starchy carbohydrates. It divides the foods and drinks we consume into five main groups and illustrates that both animal products and plant-based products can be part of a healthy balanced diet. Further information on the Eatwell Guide is available at the following link:

https://www.gov.uk/government/publications/the-eatwell-guide

These Eatwell Guide nutrition principles underpin the Government Buying Standards for Food and Catering Services (GBSF). Hospitals, the Government, and their agencies are required to apply the GBSF, with other public sector settings also encouraged to follow. Further information on the GBSF is available at the following link:

https://www.gov.uk/government/publications/sustainable-procurement-the-gbs-for-food-and-catering-services

Adherence to the Eatwell Guide has been shown to significantly improve both health and environmental outcomes, as per the 2020 Scheelbeek et al. study, with appreciably lower environmental impact than the current UK diet, as noted in 2016 by the Carbon Trust. Further information on the Scheelbeek et al. study and the Carbon Trust’s analysis is available, respectively, at the following two links:

https://bmjopen.bmj.com/content/10/8/e037554

https://www.carbontrust.com/our-work-and-impact/guides-reports-and-tools/the-eatwell-guide-a-more-sustainable-diet

Given that most people in the UK do not currently follow a diet in line with Government’s dietary recommendations, moving the population to dietary intakes in line with the Eatwell Guide remains the priority.

The Government recognises the valuable contribution that plant-based foods and drinks can make to people’s diets, alongside the contribution that fish and animal-based foods and drinks can make. Health care professionals in primary care settings are expected to provide a wide range of advice and support to patients that is based around their clinical needs. This advice should be based on robust clinical evidence and should allow patients freedom of choice over the way their care is planned and delivered, which includes individual dietary requirements and preferences where appropriate.

The Government has committed to increasing the number of general practitioners (GPs), and this includes doing more to address GP retention and the reasons why GPs leave the profession. The 10-Year Health Plan, which will be published in spring 2025, will set out a long-term vision to train and retain the staff the National Health Service needs to be fit for the future. The plan will be shaped by responses from the public, NHS staff, and experts to the biggest national conversation about the future of the NHS since its birth, launched by the Department and NHS England in October.

The Government recognises the importance of improving health for the 20 million people in the United Kingdom who live with a musculoskeletal condition. This forms a key part of the Government’s mission to build a National Health Service fit for the future.

Financial allocations will be confirmed through NHS Planning Guidance. In the meantime, we are working with NHS England and other stakeholders to explore options to increase access to, and improve support for, those living with arthritis and musculoskeletal conditions.

We will publish a 10-Year Health Plan for the NHS in the spring which will focus on increasing productivity and ensuring that every pound of taxpayer money is spent wisely, by reforming how healthcare is delivered.

My Rt Hon. Friend, the Secretary of State for Health and Social Care has announced the intention for there to be a single patient record, including primary care and hospital data, so professionals have the data they need when treating patients and are able to make better informed decisions and deliver more preventative health and care.

We are in the early stages of engaging with the public and stakeholders to understand their views about the use of health and care data. We will use the findings to form the basis of any future plans regarding a single patient record.

Services for those with musculoskeletal (MSK) conditions, including arthritis, are commissioned locally by integrated care boards (ICBs). The Department expects MSK services and fragility fracture to be fully incorporated into integrated care system planning and decision-making.

At a national level, NHS England is working to improve the diagnosis, treatment, and care of patients with MSK conditions, such as arthritis, and increase support for patients with arthritis through its Getting It Right First Time rheumatology programme. In January 2023, NHS England also published an improvement framework to reduce community MSK waits while delivering the best outcomes and experience. This supports integrated care systems to improve timely access to commissioned MSK triage and therapy services.

To support health and care professionals in the early diagnosis and management of rheumatoid arthritis and osteoarthritis, and in the provision of services for people living with arthritis, the National Institute for Health and Care Excellence has published expert guidance for rheumatoid arthritis and osteoarthritis, with further information on the two available, respectively, at the following two links:

https://www.nice.org.uk/guidance/ng100

https://www.nice.org.uk/guidance/ng226

The Department funds research into MSK conditions, including arthritis, through the National Institute for Health and Care Research (NIHR). Through the NIHR, the Department spent approximately £26.3 million on MSK research in 2023/24 and £79.2 million since 2019/20. Six NIHR Biomedical Research Centres have MSK conditions as a research theme. In particular, the Leeds Biomedical Research Centre aims to improve treatment for osteoarthritis. The NIHR, in collaboration with Versus Arthritis, also funds a dedicated UK Musculoskeletal Translational Research Collaboration, aligning investment in MSK translational research, and creating a United Kingdom-wide ambition and focus to drive cutting edge research and improve outcomes for patients.

The Department, in collaboration with NHS England, will outline details of the funding allocation for surgical hubs at the earliest opportunity. This will include the number of hubs to be established, and their specialty focus. Each hub will be developed based on the needs of patients and the current waiting list pressures in the areas that they cover.

No formal assessment has been made on the impact of surgical hubs on waiting times for trauma and orthopaedic treatment.

Surgical hubs enable trusts to increase resilience for elective procedures and minimise cancellations during periods of high pressure. This can reduce uncertainty for patients around last-minute cancellations, maximise the use of available capacity, and helps to reduce waiting times. In the Budget, we committed additional funding to set up new surgical hubs to help with our commitment to get the waiting lists down.

It is important that National Health Service staff are able to work in a supportive and compassionate environment that prioritises their health and wellbeing. NHS England has a wide-ranging package of mental health and wellbeing support for all staff, including nurses, which includes access to counselling services, a self-check wellbeing tool, free access to a range of wellbeing apps, and a health and wellbeing guardian role to provide board level scrutiny within NHS organisations. NHS England is also leading work with partner organisations to strengthen occupational health and wellbeing services for NHS staff.

We are committed to training the staff we need to ensure that patients are cared for by the right professional, when and where they need it. The Long Term Workforce Plan, which included assessments of nursing demand and supply, will be reviewed following the recommendations of 10-Year Health Plan.

On 5 November 2024, the Government introduced the Tobacco and Vapes Bill, which stands to be the most significant public health intervention in a generation. It will create the first smoke-free generation, as children turning 15 years old this year or younger can never legally be sold tobacco, whilst those who currently legally smoke are able to continue doing so. The bill sits alongside wider support across the health service to assist smokers in quitting for good.

We remain committed to helping existing smokers to quit with effective support, which is three times as effective as making an unassisted quit attempt. The National Institute for Health and Care Excellence recommends nicotine replacement therapy for young people aged 12 years old and over, and if prescribed, that behavioural support is also provided. Local authority funding has been boosted with an additional £70 million in 2024/25 to build capacity and demand for local stop smoking support.

Selling tobacco to someone underage, whether in person or online, is a serious criminal offence which carries a fine of up to £2,500 on conviction in a magistrates’ court. It is the responsibility of all retailers including those online to ensure their customers are over the age of sale. The Tobacco and Vapes Bill, introduced to Parliament on 5 November 2024, is the biggest public health intervention in a generation, and takes significant action to strengthen enforcement to ensure that current and new sales regulations are successfully implemented.

The Bill introduces a new £200 fixed penalty notice in England and Wales, which will enable Trading Standards Officers to act ‘on the spot’ to clamp down on rogue retailers selling tobacco, vapes or nicotine products to people underage, whether in-person or online. The Bill also provides powers in England, Wales, and Northern Ireland to introduce a licensing scheme for the retail sale of these products. Once the scheme is introduced, it will be a criminal offence to sell these products, either in person or online, without a licence. Licensing offences will carry significant financial penalties, and those who commit sales offences could face licence revocation, enabling Trading Standards to further clamp down on rogue retailers. The details of the licensing scheme including licence conditions will be subject to consultation ahead of introduction.

Alongside the Bill, the Government is exploring how we can further tackle online underage sales. The Department for Science, Innovation and Technology is creating a framework of standards and governance, namely the UK digital identity and attributes trust framework, underpinned by legislation, to enable the widespread use of trusted digital identity services. This framework provides a potential opportunity for companies providing age verification services to be certified, to prove they are delivering age assurance solutions that meet Government standards.

The Healthy Start scheme is kept under review. There have been no discussions with my Rt Hon. Friend, Secretary of State for Work and Pensions on introducing auto-enrolment for Healthy Start.

The Healthy Start scheme was introduced in 2006 to encourage a healthy diet for pregnant women, babies, and young children under four years old, from very low-income households. It can be used to buy, or put towards the cost of, fruit, vegetables, pulses, milk, and infant formula. Healthy Start beneficiaries have access to free Healthy Start Vitamins for pregnant women and children aged under four years old. Healthy Start now supports over 355,000 beneficiaries. This figure is higher than the previous paper voucher scheme.

The NHS Business Services Authority operates the Healthy Start scheme on behalf of the Department. All applicants to the Healthy Start scheme, where they meet the eligibility criteria, must accept the terms and conditions of the prepaid card at the point of application. As the prepaid card is a financial product and cannot be issued without the applicant accepting these terms, the NHS Business Services Authority is not able to automatically provide eligible families with a prepaid card. However, we remain open to all viable routes to improve uptake.

Children currently consume twice the recommended level of sugar. There is strong evidence that high sugar intakes increase the risk of tooth decay and weight gain. Being overweight increases the risk of heart disease, stroke, type 2 diabetes, and some cancers.

We face a childhood obesity crisis, and the Government is committed to tackling this and raising the healthiest generation of children. The Government has already taken action to ensure the implementation of restrictions on the advertising of high sugar food and drink, which will incentivise industry to reformulate and reduce sugar levels in their products.

The Soft Drinks Industry Levy has nearly halved the level of sugar in drinks in scope, and the voluntary sugar reduction programme has also reduced sugar in many products.

Working together as a mission led Government, and through our shift to prevention, we are reviewing the balance of mandatory and voluntary measures that will be required to deliver further reductions in sugar levels in everyday food and drink products.

In the United Kingdom, most people’s diet is not in line with the Government’s dietary recommendations as encapsulated in the Eatwell Guide. Most people consume too many calories, too much salt, sugar, and saturated fat, and not enough fibre, fruit, and vegetables. This increases the risk of gaining weight and suffering from type 2 diabetes, heart attacks, stroke, and some cancers at an earlier age.

Whilst the Government has not made a specific assessment of the impact of improving access to healthy food for people who cannot work due to long term illness, published modelling data suggests that if population intakes were in line with the Eatwell Guide it would improve life expectancy by approximately eight years for the average 40 year old.

The Eatwell Guide shows the proportions in which different types of foods and drinks should be consumed to achieve a healthy, balanced diet. It is communicated through the NHS.UK website and Government social marketing campaigns such as Better Health, Healthier Families, and Start for Life.

Poor diet and obesity are major drivers of physical and mental ill health. No assessment has been made to date to specifically assess the impact of improving access to healthy food on National Health Service waiting lists, however shifting the focus from treatment to prevention is one of the three shifts for the Government’s mission for an NHS fit for the future, and is a cornerstone of supporting people to live healthier lives.

NHS England has no plans to update the guidance. The Department undertook a national consultation in 2017 on the prescribing of gluten-free (GF) foods in primary care. The rationale for this was the increased availability of these products in supermarkets and other food outlets at a time when the annual cost to the National Health Service of prescribing such items was £15.7 million. The first of these proposed changes to prescribing arrangements resulted in the Government’s decision to restrict NHS prescribing of such foods to only bread and mixes.

NHS England’s guidance, Prescribing Gluten-Free Foods in Primary Care, was developed to communicate to local commissioners, now integrated care boards (ICBs), the changes in legislation. Wording is included in the guidance which states that commissioners may further restrict the prescribing of GF foods by selecting bread or mixes only, or may choose to end the prescribing of GF foods altogether if they feel this is appropriate for their population, whilst taking account of their legal duties to advance equality and provided they have regard to reducing health inequalities. In NHS England’s guidance, there are no limits on the amount of bread or mixes that can be prescribed. This guidance is available at the following link:

https://www.england.nhs.uk/wp-content/uploads/2018/11/prescribing-gluten-free-foods-primary-care-guidance-for-ccgs.pdf

Decisions about the commissioning and funding of local health services are the responsibility of local ICBs. NHS England’s guidance should be taken into account when ICBs formulate local policies, and prescribers are expected to reflect local policies in their prescribing practice. The guidance does not remove the clinical discretion of prescribers in accordance with their professional duties.

No assessment has been made of the potential impact of outdoor physical advertising for less healthy food and drink products on levels of child obesity. However, the Government welcomes recent action at a local level to ban junk food marketing across public transport networks and public spaces that are controlled locally.

Supporting people to stay healthier for longer is at the heart of the Government’s Health Mission. This includes taking bold action to tackle the childhood obesity crisis and create the healthiest generation of children ever.

The Government has committed to implementing the advertising restrictions set out in the Communications Act 2003 on less healthy food and drink products without further delay. The regulations introduce a 9:00pm watershed for the advertisement of less healthy food or drink products on television, and a total restriction of paid-for advertising of these products online, which will come into force United Kingdom-wide on 1 October 2025.

Evidence shows that these restrictions will have a direct impact on childhood obesity by reducing children’s exposure to advertising of less healthy products. We estimate that these restrictions will remove up to 7.2 billion calories from children’s diets per year in the UK, and reduce the number of children living with obesity by 20,000.

My Rt. Hon. Friend, the Secretary of State for Health and Social Care, chairs a cross-government Health Mission Board to oversee and drive delivery of the health mission to ‘build a health and social care system fit for the future'.

We are committed to creating the healthiest generation of children ever. To achieve this, we must ensure that families have the support they need to give their babies and children the best start and the building blocks for a healthy life.

The child health workforce, including health visitors and school nurses, is central to how we support families to give their child the best start in life. Their contact with parents, carers and children of all ages provides vital advice and support and helps ensure that health, development, and safeguarding needs are identified early.

We are committed to training the staff we need to ensure patients, their carers and their families are cared for by the right professional, when and where they need it. We will want to assure ourselves, and the National Health Service, that the current plan will deliver the reform needed. We will need to do this in light of the 10 Year Plan.

There are 10 community diagnostic centres (CDC) currently providing ultrasound liver elastography, otherwise known as a fibroscan. NHS England has plans to understand the diagnostic pathways for liver disease and how CDCs can further support this.

The pathway for assessing liver disease should start with blood tests taken in primary care, with FIB-4 liver tests available at National Health Service trusts.

Annual reviews, including reviews of medication, play a key role in the ongoing management of people with respiratory diseases, such as asthma and chronic obstructive pulmonary disorder (COPD). They are recommended by the National Institute for Health and Care Excellence (NICE), playing a core part in its guidance for the diagnosis and management of asthma and COPD. Further information on the NICE’s guidance for the diagnosis and management asthma and COPD is available respectively at the following two links:

https://www.nice.org.uk/guidance/ng80

https://www.nice.org.uk/guidance/ng115

The majority of patients with COPD and asthma are managed by general practitioners and members of the primary care team, with onward referrals to secondary care where required, and so the provision of annual reviews is incentivised in primary care through the Quality and Outcomes Framework. There are specific indicators for annual reviews for both COPD and asthma within this framework, specifically sections COPD010 and AST007. The Quality and outcomes framework guidance for 2024/25 is available at the following link:

https://www.england.nhs.uk/publication/quality-and-outcomes-framework-guidance-for-2024-25/

The NICE is currently reviewing its guideline for the diagnosis, monitoring, and management of chronic asthma, and an updated version is due to be published in November 2024. Based on the draft that has been published for consultation, we anticipate annual reviews will remain a recommended core component of the ongoing management of people with asthma.

There are currently no plans for a review into the adequacy of adult liver services across the National Health Service. The commissioning of services for liver disease is generally the responsibility of integrated care systems (ICS). ICS are responsible for decisions on commissioning health services and reviewing those services to ensure they best meet the needs of their local population.

NHS England has a Hepatobiliary and Pancreas Clinical Reference Group (CRG) which provides clinical advice to NHS England in support of the commissioning of specialised services. By working in partnership with key stakeholders, the CRG helps drive improvements in the quality, equity, experience, efficiency, and outcomes of specialised services. The CRG is currently reviewing its service specification in relation to liver and pancreatic care, which is scheduled for completion before the end of the current financial year.