Flick Drummond

Local authorities are best placed to understand and plan for the care needs of their populations. Under the Care Act 2014 they are required to shape their local markets, and ensure that people have a range of high-quality, sustainable and person-centred care and support options available to them, so that they can access the services that best meet their needs. We have made £4.6 billion available to local authorities so they can address pressures on local services.

The Care Act 2014 also provides for the Care Quality Commission (CQC) to monitor the financial health of the largest and most difficult-to-replace adult social care providers. This allows the CQC to warn local authorities if a provider is likely to fail for financial reasons and gives local authorities time to stand up their contingency plans.

Throughout the COVID-19 pandemic the CQC has adapted its way of working in order to continue to deliver its core regulatory role of keeping people safe during challenging circumstances. This has included developing a range of tools to identify providers that needed extra support and undertaking additional Infection Prevention and Control inspections in care homes.

We recognise that the adult social care sector is facing significant pressures in light of the pandemic and we are working closely across Government and with care providers to better understand the impact of cost increases across the sector. We have already made £4.6 billion of support available to local authorities so they can address pressures on local services caused by the pandemic, including in adult social care. In addition, we have made £1.1 billion available to social care, the majority for care homes, to support them with additional infection prevention and control costs related to Covid-19, and a further £149 million to help with additional costs of testing

As part of the 2020 Spending Review, the Chancellor of the Exchequer announced that the Government will provide councils with access to an additional £1 billion for social care next year and we also expect to provide them with estimated funding of around £3 billion to help manage the impact of COVID-19 across their services, including in adult social care and to compensate for income losses.

The financial allowances including the personal expense allowance and minimum income guarantee rates are reviewed annually.

Future funding for social care will be set out at the next spending review.

Taxation policy is a matter for the Chancellor of the Exchequer; the United Kingdom Government believes alcohol duties should be proportional to alcohol content. A consultation on the introduction of a new band to target, high strength ‘white’ ciders is underway and ends on 12 June.

No estimate has currently been made of the effect of a possible new duty band on health.

Data on costs is not available in the format requested. However the health costs associated with alcohol misuse are estimated to cost the National Health Service in England around £3.5 billion each year and the latest estimate of the cost to the NHS in England of overweight or obesity related ill-health is £5.1 billion each year.

Data is not available by cause of condition to provide an expenditure estimate requested for viral hepatitis.

In developing the new Carers Strategy we have been consulting widely and working closely with carers to understand the many issues that may impact on them, including the role of breaks for carers. The Strategy will look at the support we provide to carers themselves; to their families and will reach beyond the health and care system to help support carers in employment, education and in the development of ‘carer friendly communities’.

Developing new work based routes into nursing is a priority for the Department.

That is why we have developed the new Nursing Associate role and Nursing Degree Apprenticeship which will open up routes into the registered nursing profession for thousands of people from all backgrounds and allow employers to grow their own workforce.

The first 1,000 Nursing Associates were recruited to commence their training in January and the second wave of a further 1,000 Nursing Associates are due to commence training next month.

The National Institute for Health and Care Excellence guidance on conditions such as Chronic Obstructive Pulmonary Disease and asthma emphasise the importance of avoiding emergency admissions for patients with lung diseases. The introduction of an Enhanced Service for general practitioners in 2015-16, continuing in 2016-17, is designed to help reduce avoidable unplanned admissions by improving services for vulnerable patients and those with complex health needs, who are at high risk of admission.

The table below, taken from the General Ophthalmic Services Activity Statistics for England, published by NHS Digital, shows the number of National Health Service sight tests provided to people aged 60 and over in England, between 2013/14 and 2015/16.

It is not possible to estimate what proportion of people eligible for free NHS sight tests used their entitlement during the reported years.

Notes:

1. Patients may qualify for an NHS sight test on more than one criterion. However, they would only be recorded against one criterion on the form. Patients are more likely to be recorded according to their clinical need rather than their age. For example, a patient aged over 60, with glaucoma is likely to be recorded in the glaucoma category only. The count by eligibility is therefore approximate.
2. The figures do not represent the number of patients, as a person may have more than one NHS sight test within the same period.

To support local areas in addressing long waits, NHS England, supported by the Department and the Association of Directors of Adult Social Services, initiated a series of visits to clinical commissioning groups and local authorities. These visits aimed to develop a better idea of the challenges in securing timely autism diagnosis across all ages, looking at the variability in diagnosis times and sharing good practice to help areas to improve their service. NHS England submitted a report on the visits to the 16 June meeting of the Cross Government Autism Programme Board, which includes representatives of autism third sector organisations and people who have autism. NHS England will have further discussions with relevant organisations over the summer about actions in their report, including on the Clinical Commissioning Group Improvement and Assessment Framework, before reporting back to the Autism Programme Board.

In parallel, as recommended by the independent Mental Health Taskforce, the Department is undertaking a five year plan for the development of mental health data to be published by the end of the year. The plan will set out future requirements and timings for developing data to inform pathways of care, which will include requirements for autism in the Health and Social Care Information Centre Mental Health Services Data Set. Data on referrals or appointments for an autism diagnostic assessment are not currently captured in published mental health data.

Support and information about breastfeeding is currently available to health professionals and parents through: the NHS Choices website under the Start4Life banner; the National Breastfeeding Helpline; UNICEF UK Baby Friendly Initiative; and local peer support programmes.

Parents-to-be and new mums and dads can also sign up to the Start4life Information Service for Parents. Subscribers receive regular free emails, videos and SMS messages offering high quality advice and information, based on the stage of pregnancy and the age of the child, including breastfeeding support. The service also signposts parents to other quality assured information about parenting, relationship support and benefits advice.

Breastfeeding delivers significant health benefits both for the mother and her baby and is more cost effective for mothers than other methods of infant feeding. A mother’s milk provides a perfect balance of nutrients and vitamins, so exclusive breastfeeding is all a baby needs for around the first six months. This is why the Department in line with the National Institute of Health and Care Excellence guidelines encourages exclusive breastfeeding for the first six months of life.

There has been no assessment made on the effect of changes to funding levels on the provision of breastfeeding services. However, the Department is working with Public Health England and other stakeholders to develop a method and sources of information to monitor the impact of its policy on infant feeding.

Public Health England has not made an assessment of the impact of trends in folic acid supplement use in recent years. We continue to encourage women to take a folic acid supplement from before they are pregnant to the 12^th week of pregnancy, and include this in all appropriate public health messaging.

Results from the National Diet and Nutrition Survey (NDNS), published in March 2015, show that the mean serum folate level in women of child bearing age (16-49 years) was 20nmol/l. Approximately 16.5% of women in this age group fell below the published World Health Organization threshold for biochemical folate deficiency however, as a result of methodological difficulties the threshold needs to be adjusted to be comparable with the laboratory method used to measure folate in NDNS. The adjusted threshold will be higher than the published threshold and so the percentage of women with serum folate levels below the adjusted threshold is expected to be higher than the published value. A note setting out these points was published on 17 February 2016, alongside the NDNS report.

Recommendations on testing for hepatitis C are evidence-based, including whether it is appropriate to align with guidance on testing for other conditions. It should be noted that the National Institute for Health and Care Excellence has already published guidance on testing for hepatitis B and C. Screening programmes are considered and recommended by the United Kingdom National Screening Committee.

On 19 June, the Secretary of State set out the first stages of a New Deal for General Practice, including:

‒ an estimated 5,000 more doctors working in general practice by 2020;

‒ investing £1 billion over four years in infrastructure and £150 million through the Prime Minister’s Challenge Fund; and

‒ reducing bureaucracy to release capacity.