Jeremy Hunt

As of 6 January 2021, the NHS COVID-19 app has been downloaded 21,258,726 times. It is estimated that 62% of those with a compatible smartphone aged 16 years old and over in England and Wales have downloaded the app and 56% of smartphone users overall aged 16 years old and over.

Information obtained by the Care Quality Commission from mental health inpatient providers indicates that providers who responded reported 96 locked inpatient mental health rehabilitation wards in England in 2019.

The mental health rehabilitation workstream of the Getting It Right First Time programme has considered locked mental health rehabilitation facilities to help improve care for people in those facilities. The workstream’s report is expected to be published in early 2021.

The Government is clear that restrictive interventions and restraint should only ever be used as a last resort, when all attempts to de-escalate a situation have been employed. We are working to finalise the draft statutory guidance for the Mental Health Units (Use of Force) Act 2018 and accompanying public consultation and will set out a timetable for publishing the guidance and commencing the Act at the earliest opportunity.

The Government is clear that, where needed, inpatient care should be high quality, therapeutic and for the shortest time possible. The use of seclusion and any kind of restraint should only be used as a last resort and in line with strict protocols.

We are improving practice and minimising all types of force used on patients in accordance with the aims of the Mental Health Units (Use of Force) Act 2018. We are working to finalise the draft statutory guidance for this Act and accompanying public consultation.

Work is also ongoing with the Care Quality Commission, NHS Digital and NHS England and NHS Improvement to prepare for the implementation and commencement of the Act’s requirements. We will set out a timetable for publishing the statutory guidance and commencing the Act at the earliest opportunity.

Health and social care staff working in locked mental health rehabilitation facilities must have the skills and knowledge to make a positive difference to the lives of people with learning disabilities and autistic people. This is a priority for the Government and we are developing plans to introduce the Oliver McGowan mandatory training in learning disability and autism to make sure that this happens.

We are working with Health Education England and Skills for Care to develop and test a standardised training package, backed by £1.4 million investment. Work is already underway to develop the training and testing will take place in a variety of health and social care settings to help shape how it will be rolled out and delivered in future.

The latest information available on the number of inpatients in England with a learning disability or autistic people by ward type is set out in the following table.

Source: Assuring Transformation Data, NHS Digital.

The data excludes revisions made by providers after the data was initially collated and the data between years is therefore not directly comparable.

The information relating to the proportion of other people in locked mental health rehabilitation facilities in England is not available in the format requested and could only be obtained at disproportionate cost.

This information requested could only be obtained at disproportionate cost.

The NHS Long Term Plan sets out that all health systems in England will deliver new and integrated models of primary and community mental health care for adults and older adults with severe mental illnesses backed by almost £1 billion of new investment per year by 2023/24. These new models will include transformed and improved care for people with community mental health rehabilitation needs, building services in local communities both to prevent people from going into hospital unnecessarily and to support timely discharge for those people who are in need of inpatient care. All health systems in England are expected to be delivering these new models from 2021/22.

The mental health rehabilitation workstream of the Getting It Right First Time programme has considered discharge from acute mental health inpatient care. The workstream’s report is expected to be published in early 2021.

In 2019, the Secretary of State for Health and Social Care committed to conducting independent case reviews for people with a learning disability or autistic people who were identified as being in long term segregation. The reviews of people identified as being in long term segregation in November 2019 have now been completed and recommendations were made in each case to improve individual circumstances and support moving individuals to less restrictive settings.

The Care Quality Commission report into the state of care in mental health services from 2014-2017 highlighted concerns about the high number of people in out of area locked rehabilitation wards. Following this, the mental health rehabilitation workstream of the Getting It Right First Time programme has considered locked mental health rehabilitation facilities alongside its consideration of out of area placements. The workstream’s report is expected to be published in early 2021.

NHS England and NHS Improvement expect this report to recommend that all trusts and clinical commissioning groups should develop robust systems to bring patients treated out of area back to their local area. It also expects the report to recommend that clear monitoring arrangements are in place where out-of-area placements are considered necessary.

The Department is working intensively with the Ministry of Justice, other Government departments and NHS Resolution and will publish a consultation on next steps in 2021.

£9.4 million has been provided to support maternity safety pilots through the 2020 Spending Review. The pilots will provide cutting-edge training and expert guidance, to improve practice and avoid harm to babies. This will include:

- Fresh learning from recent investigations and academic research to be used to improve clinical practice during childbirth;

- Pilots to provide cutting-edge training and expert guidance, to improve practice and avoid harm to babies; and

- Funding to also cover the costs of the final year of the Ockenden Review into maternity safety at Shrewsbury and Telford Hospitals NHS Trust.

The funding is in addition to existing funding to improve maternity safety by strengthening clinical leadership, implementing best clinical practice and fostering cultures of continuous learning for improvement through reviews and investigations.

£9.4 million has been provided to support maternity safety pilots through the 2020 Spending Review. The pilots will provide cutting-edge training and expert guidance, to improve practice and avoid harm to babies. This will include:

- Fresh learning from recent investigations and academic research to be used to improve clinical practice during childbirth;

- Pilots to provide cutting-edge training and expert guidance, to improve practice and avoid harm to babies; and

- Funding to also cover the costs of the final year of the Ockenden Review into maternity safety at Shrewsbury and Telford Hospitals NHS Trust.

The funding is in addition to existing funding to improve maternity safety by strengthening clinical leadership, implementing best clinical practice and fostering cultures of continuous learning for improvement through reviews and investigations.

The funding for technology transformation that was secured in the Spending Review will support local provider organisations to generate a step change in their digital maturity as well as to ensure that there is the right national infrastructure to support them.

We are now planning activity for 2021-22 and we will provide guidance to the system before the start of the next financial year.

Green social prescribing is funded by HM Treasury’s Shared Outcomes Fund and therefore does not form part of the Spending Review 2020. This fund recently awarded £4.27 million to deliver a joint project with the Department of Health and Social Care, the Department for the Environment, Food and Rural Affairs, Natural England, NHS England, Public Health England and the Ministry for Housing, Communities and Local Government to test green social prescribing in multiple pilot locations, run national experimental work to understand its scalability, and deliver a robust project evaluation.

The Government is committed to supporting the National Health Service and social care workforce. The NHS People Plan, published in July, is focused on the wellbeing of the NHS workforce and on strengthening resilience during COVID-19. We have invested in mental health support with £15 million recently going into the roll out of mental health hubs that will provide proactive outreach to overcome barriers to seeking help for frontline staff.

In September we published a winter plan for adult social care setting out the wellbeing support available to support the adult social care workforce through the winter. We have worked alongside the NHS and other organisations to develop a package of emotional, psychological and practical resources for the workforce and wherever possible the same offer is in place for all social care staff as is for their colleagues in the NHS. We have funded extensions of the Samaritans staff support line and the Hospice UK bereavement and trauma line to all social care staff as well as bespoke support for Registered Managers. We will continue to work with local authorities to improve access to occupational health provision and other wellbeing support for care workers, in line with our commitments in the winter plan.

We are taking action to increase recruitment into adult social care in both the short and long term. We have launched an online recruitment tool, Join Social Care, to simplify and fast track the recruitment process, and are offering free and rapid induction training via Skills for Care for new and existing staff and volunteers. In the last year we have run a National Recruitment Campaign across broadcast, digital and social media highlighting the vital work care workers do.

The Department for Health and Social Care is also working with the Department for Work and Pensions to promote adult social care careers to jobseekers, including those who may have lost their jobs during the pandemic from other sectors, such as tourism, hospitality and retail. We are continuing to work with the sector and other government departments to understand how we can further support recruitment and retention, and we continue to work to raise the profile of adult social care careers.

The Carers Action Plan, announced in 2018, set out a cross-Government programme of work to support carers. We continue to implement and build on the commitments made at that time, including committing in our manifesto to extend the entitlement to leave for unpaid carers to one week.

We have also sought to support carers throughout the COVID-19 pandemic. We have provided funding to a range of charities including funding to extend the Carers UK’s helpline opening hours so unpaid carers are able to access trusted information and advice. This funding has been extended to March 2021. A further £500,000 was provided to the Carers Trust to provide support to unpaid carers experiencing loneliness during the pandemic

In addition, to help carers and those they care for, we have worked with the Social Care Institute for Excellence, to publish guidance to help providers make decisions on restarting day services. We have also enabled local authorities to use some of the money provided to them through the Infection Control Fund to help services reopen safely or be reconfigured to work in a COVID-19 secure way.

The Adult Social Care Winter Plan outlined the latest National Health Service clinical support offer, which includes support for care homes and social care through primary care and community services and the rollout of the Enhanced Health in Care Homes model; and professional leadership and expert advice on infection prevention and control where needed.

The Plan extended the Infection Control Fund until March 2021. This means we have now ringfenced over £1.1 billion for the care sector to take key steps to improve infection prevention and control.

The Department’s Ministerial Correspondence and Public Enquiries (MCPE) unit has a baseline establishment of 51 staff. This is inclusive of correspondence, Freedom of Information (FOI), Subject Access Requests and the call centre.

In 2019 the Department received 29,800 correspondence cases and 1,068 FOI requests. This year, to 23 November 2020, we have received 69,555 correspondence cases and 2,326 FOI requests. This significant increase in volume has been driven by interest in the COVID-19 pandemic.

In response to this the Department has temporarily increased resources in the MCPE unit and there are now 111 members of staff.

The Government is committed to the sustainable improvement of adult social care, including care for the elderly and will bring forward proposals later this year on plans for reform.

We published a White Paper on 11 February 2021 which sets out proposals to introduce, through the Health and Care Bill, a new duty for the Care Quality Commission (CQC) to review and assess local authorities’ delivery of their adult social care duties and publish their assessment. This is alongside powers for the Secretary of State to intervene and provide support where, following review by the CQC, it is considered that a local authority is failing to meet their duties.

These changes will support improved quality of care and access, with improved oversight and transparency providing insight into how good commissioning works, allowing for best practice to be shared and helping to address inefficiencies and poor practice.

Promoting integrated care is a priority for the Government. We have already made progress in facilitating integrated health and care services through the development of Integrated Care Systems (ICSs). NHS England have set out their goal that all sustainability and transformation partnerships (STPs) will become ICSs by April 2021. So far, 18 out of 42 STPs have developed into ICSs.

The Better Care Fund (BCF) is the national policy driving forward the integration of health and social care in England. The BCF requires National Health Service clinical commissioners and local authorities to make joint plans and pool budgets for the purposes of integrated care, providing a context in which the they can work together, as partners, towards shared objectives.

We continue to expand access to talking and psychological therapies through the Improving Access to Psychological Therapies (IAPT) programme. Data from 2019/20 shows that there were 1.69 million referrals to IAPT in England and 1.17 million people started a course of treatment within this year.

In addition, we continue to meet our waiting time targets for IAPT. Latest figures for August 2020 indicate that 89.1% of people completing treatment waited less than 6 weeks against a target of 75% and 97.8% waited less than 18 weeks, against a target of 87.5%.

Work to reduce health inequalities around maternal mortality rates is being led by Professor Jacqueline Dunkley-Bent OBE, Chief Midwifery Officer. This includes understanding why mortality rates are higher, considering evidence about what will reduce mortality rates and taking action.

The NHS Long Term Plan outlines plans to reduce health inequalities and address unwarranted variation in maternity care. Targeted and enhanced continuity of carer can significantly improve outcomes for women. The Long Term Plan sets out that 75% of women from ethnic minority backgrounds and women from the most socially deprived areas will receive continuity of carer by 2024.

The NHS Long Term Plan commits the National Health Service to expanding access to evidence-based psychological therapies within specialist perinatal mental health services so that they also include parent-infant, couple, co-parenting and family interventions.

Fathers and partners of women accessing specialist perinatal mental health services and maternity outreach clinics will be offered evidence-based assessments for their mental health and signposting to support as required. This will help the five to 10% of fathers who experience mental health difficulties during the perinatal period and increase access to evidence-based psychological support and therapy, including digital options, in maternity settings.

The Government’s Green Paper on children and young people’s mental health aims to improve the provision of mental health support through its key proposals, including creating new Mental Health Support Teams in and near schools and colleges.

These teams will support mental health leads in schools and colleges to put in place effective whole school/college approach to promote and support good mental health. They will work alongside the support that already exists, such as counselling, educational psychologists, school nurses, pastoral care, educational welfare officers, local authority provision and National Health Service mental health services.

Acute core services are not rated at trust or provider level, but at location level only. Ratings from inspections of the locations operated by the provider are combined into the overall ratings for the trust under the headings of safe, effective, caring, responsive and well-led.

National Health Service locations providing a core service of ‘maternity and gynaecology’ are rated are shown in the following table:

The Maternity and Neonatal Safety Improvement Programme covers all maternity and neonatal services across England. The programme has been working with trusts to support frontline staff to create the conditions for continuous improvement, a safety culture and a national maternal and neonatal learning system to reduce unwarranted variation in outcomes and care experiences, and provide a high quality healthcare experience for all women, babies and families across maternity and neonatal care settings in England.

The Government also funded Sands, the Stillbirth and Neonatal Death charity to work with other baby loss charities and Royal Colleges to produce and support the roll-out of a National Bereavement Care Pathway to reduce the variation in the quality of bereavement care provided by the National Health Service.

National Health Service providers are responsible for delivering safe services and ensuring that staff receive the training they need to provide the highest standard of care.

Health Education England (HEE) allocated £420,000 to directly support maternity safety training in 2019/20. No funds were directly allocated to be spent on maternity safety training in 2018/19 or 2020/21 by the HEE maternity programme.

The numbers of neonatal brain injuries and neonatal deaths in England in years from 2010 is shown in the following table:

Notes:

¹Source: Imperial College, London, 2017 and 2019. The 2017 report is available at https://www.gov.uk/government/publications/safer-maternity-care-progress-and-next-steps

²Source: Office for National Statistics: Child mortality (death cohort) tables in England and Wales, available at https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/childmortalitystatisticschildhoodinfantandperinatalchildhoodinfantandperinatalmortalityinenglandandwales

³The original report presents a range for the years 2010 (3,160 to 3,619) and 2011 (3,434 to 3,630) as the available data did not cover all births in England. The table presents the midpoints of these ranges.

The Government is clear in its commitment to improve the quality and safety of care and treatment across England.

NHS England and NHS Improvement published the NHS’s first ever Patient Safety Strategy in July 2019. The Strategy sets out a vision to continue to improve patient safety, building on the foundation of a patient safety culture and patient safety system.

A series of programmes are planned and underway to help create a safety culture in the National Health Service and to continuously improve the safety of patients in the NHS. For example, patients are being supported to contribute to their own safety by having patients or their advocates on all safety-related clinical governance committees in NHS organisations.

We have made good progress on, and remain committed to, carrying out the Green Paper’s core proposals, including piloting a four-week waiting time to access specialist National Health Service children and young people’s mental health services.

In 2018 we announced the first 25 trailblazer sites delivering 59 mental health support teams in and near schools and colleges. Twelve of the trailblazer sites are also testing four-week waiting times specialist NHS services, and they will deliver a recommendation for the phased introduction of an access and waiting time standard for children and young people’s mental health.

The continued rises in clinical negligence costs are eating into resources available for front-line care; this is unsustainable. This is despite our substantial safety programmes.

In 2017 the Department of Health and Social Care and the Ministry of Justice commissioned the independent Civil Justice Council (CJC) to draw up a new claims handling process for clinical negligence claims of up to £25,000, together with proposals for fixed recoverable costs for these cases.

The CJC published its report with recommendations on a new claims handling process for Clinical negligence claims up to £25,000 in October 2019. We are analysing the report closely and will consult on next steps shortly.

We remain committed to improving perinatal mental health services for new mothers and their partners - not only during the current pandemic. From April 2019, new and expectant mothers have been able to access specialist perinatal mental health community services in every part of the country.

The NHS Long Term Plan includes a commitment for a further 24,000 women to be able to access specialist perinatal mental health care by 2023/24, building on the additional 30,000 women who will access these services each year by 2020/21 under pre-existing plans. Specialist care will also be available from preconception to 24 months after birth, which will provide an extra year of support.

We do not have data on how much funding was spent specifically on self-harm prevention in 2018, 2019, and 2020.

National Health Service mental health services have remained open for business throughout the pandemic. Our community, talking therapies and children and young people’s services have deployed innovative digital tool to connect with people and provide ongoing support. For those with severe needs or in crisis, all NHS mental health providers have established 24 hours a day, seven days a week mental health crisis lines.

The Department does not hold data in the format requested.

The Office for National Statistics publishes mortality data for deaths involving COVID-19 for healthcare workers and social care workers in England and Wales. The last iteration of this release showed that in England there were 305 deaths involving COVID-19 among healthcare workers and 307 deaths involving COVID-19 among social care workers.

These were registered between 9 March and 12 October 2020 in England, of those aged 20-64 years, using the last known occupation. The definition of healthcare workers used will include not only those employed in the National Health Service but wider healthcare sector workers.

Under the NHS Long Term Plan, we have set out our plans to invest £57 million to support local suicide prevention plans and establish suicide bereavement support services in all areas of England by 2023/24.

We have committed that all local systems will have suicide bereavement support services providing timely and appropriate support to families and staff by 2023/24 and have provided funding to 40% of local systems in 2020/21 for them to establish and deliver such services. This is in line with the planning and delivery expectations set out in the Mental Health Implementation Plan 2019/20-2023/24.

NHS Digital collects information in the mental health services dataset on people of all ages in contact with secondary mental health services in England who have a recorded diagnosis of a mental disorder, or who have been referred for talking and psychological therapies for conditions such as depression or anxiety.

However, NHS Digital has advised that recording levels of such diagnoses in the dataset are currently too low for any meaningful interpretation.

This information is not collected centrally.

This information is not collected centrally.

NHS Digital publishes Hospital and Community Health Services (HCHS) workforce statistics. These include staff working in hospital trusts and clinical commissioning groups but not staff working in primary care, local authorities or other providers.

The following table shows the number of mental health and learning disability nurses, full time equivalent (FTE) employed in the National Health Service as at September each year along with the latest figure as of July 2020.

Source: NHS HCHS monthly workforce statistics, NHS Digital - July 2020

Notes:

Mental health and learning disability service provision is also commissioned by the NHS from private sector providers. The figures do not reflect staffing in the private sector.

Further information, including on different methodologies for counting the mental health workforce, is published by NHS Digital at the following link:

https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics/december-2018

NHS Resolution handles clinical negligence claims on behalf of National Health Service organisations and independent sector providers of NHS care in England.

NHS Resolution has provided the following information:

The following table shows the total value of payments made by NHS Resolution in respect of medication errors in financial years 2005/06 to 2019/20 on behalf of NHS organisations in England.

The Office for National Statistics publish mortality data for deaths involving COVID-19 for healthcare workers and social care workers in England and Wales. The last iteration of this release showed that in England there were 305 deaths among healthcare workers and 307 deaths among social care workers registered between 9 March and 12 October 2020 in England, of those aged 20-64 years, using last known occupation. The definition of healthcare workers used will include not only those employed in the National Health Service but wider healthcare sector workers.

The data is not available in the format requested.

The average number of prescriptions dispensed daily in the community in England since April 2017 is shown in the following table.

Information for hospitals is not available in the format requested.

National Health Service prescribing and dispensing data for financial years 2017/18, 2018/19 and 2019/20 has been obtained from aggregated monthly Prescription Cost Analysis data that is published on the NHS Business Services Authority website at the following link:

https://www.nhsbsa.nhs.uk/prescription-data/dispensing-data/prescription-cost-analysis-pca-data

NHS Digital publishes Hospital and Community Health Services workforce statistics. These include staff working in hospital trusts and clinical commissioning groups, but not staff working in primary care, general practitioner surgeries, local authorities or other providers.

The attached table shows the number of adult nurses as at each month between 2010 and 2018. This data contains data on adult nurses and does not include mental health nurses or learning disability nurses.

In 2012, any estimates of the number of nurses needed would have been made by strategic health authorities who were abolished as part of the Health and Social Care Act 2012 reforms. Workforce planning moved from being responsibility of strategic health authorities to Health Education England (HEE) and no formal estimates by HEE were made in 2012.

Over 25,000 former doctors and nurses have come forward to assist the National Health Service during the COVID-19 outbreak. We are working with the regulators, NHS England and NHS Improvement and local employers to explore opportunities for those professionals who wish to permanently join the workforce.

NHS Resolution manages clinical negligence and other claims against the National Health Service in England.

NHS Resolution spent £952 million on clinical negligence claims relating to NHS maternity services in 2018/19. This represented around 40% of total clinical negligence spend relating to NHS services in 2018/19.

Doctors who work in a maternity setting are part of the specialty of obstetrics and gynaecology. The National Health Service spent £586 million on salaries for this speciality in 2018/19. It is not possible to separate the time doctors spent in working in obstetrics and in gynaecology.

The NHS spent a total of £126 million in 2018/19 on salaries for nurses who work in a maternity setting. The total cost of salaries to the NHS in 2018/19 for midwives totalled £1.038 billion.

These figures include total earnings paid to staff, Employer National Insurance Contributions and Employer Pension Contributions.

The combined total number of individual hospital trusts placed in Special Measures for Quality reasons and/or Special Measures for Financial reasons between September 2012 and July 2018, not double-counting any trusts placed in both types of Special Measures during the specified period, was 39. This figure does not include two ambulance service trusts placed in Special Measures for Quality reasons during the specified period.

Social Work England (SWE) took over the regulation of social workers in England on 2 December 2019 from the Health and Care Professions Council (HCPC). The figures for 2020 are between the period of 1 January – 18 March 2020.

The number of social workers in England who voluntarily left the register of social workers in England since 2017 is shown in the following table:

The number of social workers in England who were struck off the register of social workers in England in since 2017 is shown in the following table:

Social Work England (SWE) took over the regulation of social workers in England on 2 December 2019 from the Health and Care Professions Council (HCPC). The figures for 2020 are between the period of 1 January – 18 March 2020.

The number of social workers in England who voluntarily left the register of social workers in England since 2017 is shown in the following table:

The number of social workers in England who were struck off the register of social workers in England in since 2017 is shown in the following table:

This information is not held centrally. However, the 2011 Census indicates that about 10% of the population in England were providing informal care, equivalent to approximately 5.4 million people in 2011¹.

The Department for Work and Pensions’ Family Resources Survey suggests that just below 40% of carers provide care to a parent, and around 20% care for a spouse, partner or cohabitee within the same household².

Notes:

¹ Official Labour Market Statistics, 2016/2017

² DWP, 2019. Family Resources Survey 2017/18

The National Health Service has a stockpile of personal protective equipment (PPE) including facemasks, respirators, protective eyewear, aprons and gloves. These are being ordered and delivered at speed daily so it is not possible to give a specific number as this is changing rapidly. The Department is confident that there is sufficient immediate stock. The central stockpiles held for European Union Exit and pandemic influenza have also been released for use. The Department is working with the NHS and others in the supply chain to ensure these are delivered to the frontline as soon as possible.

The Department is working with wholesalers to ensure a longer-term supply of all aspects of PPE.

The latest cumulative number of cases, as published by the Chinese Health Commission at 24:00 on 11 March 2020 is 80,793 cases in mainland China and 67,781 cases in Hubei province. This data is published here at the following link:

http://www.nhc.gov.cn/xcs/yqtb/202003/37c1536b6655473f8c2120ebdc475731.shtml

The Chinese Health Commission does not publish prevalence rates.

Public Health England stopped modelling China on 12 February 2020. This corresponded with multiple changes to how China counted cases. No figures are held.

The National Health Service with Public Health England (PHE) is undertaking a significant expansion of coronavirus testing, with enhanced labs helping the health service carry out 10,000 tests daily.

PHE has developed a highly sensitive test to detect the virus, one of the first countries in the world to do so, which has been rapidly rolled out to their regional labs across the country.

Approximately 1,500 tests are being processed every day at PHE labs with the great majority of tests being turned around within 24 hours. PHE has processed over 25,000 tests as of 10 March and has not exceeded capacity during this time.

As more people come forward to be tested, the NHS is now scaling up tests by 500%, with NHS England asking expert NHS laboratory services across the country to bring new capacity online, and other labs to begin checks, enabling 8,000 more samples to be analysed every day of the week.

As announced on 27 March, the Government is working with industry, philanthropy and universities to significantly scale up testing.

The Government relies on modelling work undertaken by several academic groups, who report to the Scientific Advisory Group for Emergencies (SAGE) through its various subgroups. SAGE will continue to publish the evidence that it considers.

From modelling and current data on the outbreak, it is likely that the number of confirmed United Kingdom cases will rise, but it is not possible to estimate how many individuals will be infected currently. This will be dependent on the implementation of and adherence to public health measures, and the success of those measures in suppressing transmission of the virus and the numbers of cases of infection.

National Health Service organisations make decisions locally on the provision of toilets to patients, visitors and staff. Data on them is not collected centrally.

Information is not held centrally on the stock levels of products and supplies at individual National Health Service bodies.

NHS England commissions a total of 15 adult respiratory extra corporeal membrane oxygenation (ECMO) beds per annum from five providers in England (with a further provider in Scotland), as well as paediatric respiratory ECMO beds from five providers in England (again with further provider in Scotland). Whilst there is no set number of beds per provider because the number of paediatric cases is very small, there are typically no more than three patients requiring respiratory ECMO at any one time. In periods of high demand, adult and paediatric capacity can be increased in line with agreed standard operating procedure.

Highly specialised beds will only be needed by a minority of affected patients. In relation to the Chief Medical Officer’s recent announcement on COVID-19, hospitals have been advised on what next steps they need to take to respond to any outbreak and hardworking staff are working round the clock to test and treat patients with coronavirus and as you'd expect, work is under way to explore all practical options to increase capacity.

NHS England commissions a total of 15 adult respiratory extra corporeal membrane oxygenation (ECMO) beds per annum from five providers in England (with a further provider in Scotland), as well as paediatric respiratory ECMO beds from five providers in England (again with further provider in Scotland). Whilst there is no set number of beds per provider because the number of paediatric cases is very small, there are typically no more than three patients requiring respiratory ECMO at any one time. In periods of high demand, adult and paediatric capacity can be increased in line with agreed standard operating procedure.

Highly specialised beds will only be needed by a minority of affected patients. In relation to the Chief Medical Officer’s recent announcement on COVID-19, hospitals have been advised on what next steps they need to take to respond to any outbreak and hardworking staff are working round the clock to test and treat patients with coronavirus and as you'd expect, work is under way to explore all practical options to increase capacity.

The Department does not hold the information requested.

The National Maternity Review report, ‘Better Births - Improving outcomes of maternity services in England, A Five Year Forward View for maternity care’ reviewed maternity services across the country including in rural and isolated areas.

In the 2016/17 clinical commissioning group allocations, NHS England made a change to the allocation funding formulae for remoteness. In part, this funding recognises that services in remote areas, including maternity services, have unavoidably higher costs because the level of activity is too low for services to operate. Further, we know that the challenges faced by services in remote areas are broader than funding which is why we committed in the NHS Long Term Plan to develop new operating models for rural hospitals, as well as to reduce geographical and specialty imbalances in medical posts. As part of this, NHS England and NHS Improvement is working with 35 smaller acute hospitals and local systems leaders to identify and accelerate the spread of new delivery models through peer learning and in partnership with national stakeholders, including the Care Quality Commission and Royal Colleges.

The Department is committed to ensuring that citizens using the National Health Service are able to access high quality, effective healthcare services that are responsive to patients’ needs. Digital tools, such as the NHS App, are able to support people to access their medical records.

The percentage of the general practitioner (GP) registered population that have registered and are able to access their medical record online is as follows:

Prior to 2015, no patients were registered to access their medical record online.

The NHS App launched following a period of testing from September 2018 to January 2019, and now has over 250,000 registered users.

The proportion of the GP-registered population who have registered to access and have accessed their medical records via the NHS App is as follows:

We do not have data on the number of users who have solely accessed their records online. However we do capture the total number of monthly transactions for both online and app access. In the month of December 2019 patients accessed their medical records 1 million times.

The Department is committed to ensuring that citizens using the National Health Service are able to access high quality, effective healthcare services that are responsive to patients’ needs. Digital tools, such as the NHS App, are able to support people to access their medical records.

The percentage of the general practitioner (GP) registered population that have registered and are able to access their medical record online is as follows:

Prior to 2015, no patients were registered to access their medical record online.

The NHS App launched following a period of testing from September 2018 to January 2019, and now has over 250,000 registered users.

The proportion of the GP-registered population who have registered to access and have accessed their medical records via the NHS App is as follows:

We do not have data on the number of users who have solely accessed their records online. However we do capture the total number of monthly transactions for both online and app access. In the month of December 2019 patients accessed their medical records 1 million times.

Medical examiners have been introduced on a non-statutory basis from April 2019 to scrutinise all non-coronial deaths and ensure the right deaths are referred to coroners. This includes neonatal death.

Since April 2018, the Healthcare Safety Investigation Branch has been investigating all term intrapartum stillbirths (at least 37+0 completed weeks of gestation), neonatal deaths of all term babies born following labour when the baby died within the first week of life (0-6 days) of any cause and maternal deaths.

MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the United Kingdom) conduct surveillance of all late fetal losses, stillbirths, neonatal and maternal deaths and produce Confidential Enquires to provide valuable learning and inform service improvement.

The Department is committed to ensure that services across the health and care system are of the highest quality through ongoing system regulation and oversight.

The Care Quality Commission is the independent regulator of quality for health and adult social care in England, it uses its powers to provides assurance and encourages improvement.

The new regional architecture has quality embedded into the role and responsibility of Clinical Quality Directors and other regional leads as well as through clinical networks and Local Maternity Systems.

The National Quality Board is reviewing the national model of quality surveillance, specifically the role of Quality Surveillance Groups in monitoring and managing quality issues within local health and care systems.

The Healthcare Safety Investigation Branch was established in 2017 to investigate to improve patient safety and create a learning culture across the National Health Service.

The Health Service Safety Investigations Bill was introduced in the previous Parliament. This legislation will establish a fully independent arms-length patient safety investigation body, create a statutory ‘safe space’ in this body and provide the new body with powers to discharge its investigative function effectively. These include the power to ask individuals, to attend to answer questions or to provide information, documents equipment or other information as required.

The Department will bring forward these proposals when Parliamentary time allows.

NHS Improvement, in 2016, published national compulsory guidance on the duties, and the current legislation relating to coroner inquests that National Health Service trusts, foundation trusts, and individual clinicians must follow with regards to coronial processes.

Healthcare professional regulators, the Nursing and Midwifery Council and the General Medical Council’s guidance requires nurses, midwives and doctors to cooperate with all investigations, formal inquires and inquests.

As independent bodies, the regulators of healthcare professionals are responsible for operational matters concerning the discharge of their statutory duties. Accordingly, it would not be appropriate for Ministers to become involved with individual fitness to practise cases.

The Morecambe Bay Investigation recommended that healthcare professionals who had provided care that fell short of the expected standards should be held to account. As a result, the General Medical Council and Nursing and Midwifery Council (NMC) investigated the conduct of the registrants involved. These investigations have been completed.

In May 2018, at the request of both the Department and the NMC, the Professional Standards Authority published a ‘Lessons Learned Review’ into the handling of concerns relating to the handling of the Morecambe Bay fitness to practise cases.

Since the publication of the Morecambe Bay Investigation, the Department and the National Health Service have put in place a number of measures that are designed to ensure that organisational change is well managed.

These include arrangements to support local integration of services and strengthened regional support and oversight. The NHS has also developed a Long Term Plan to provide clear strategic direction to organisations making local changes.

NHS England and NHS Improvement are responsible for ensuring that organisational changes such as the merger of provider organisations are in the interests of patients and taxpayers and manage any risks effectively.

National Health Service trusts are asked to submit details of the commissioning and conclusion of relevant external reviews or investigations undertaken in the previous 12 months and describe key outcomes to the Care Quality Commission (CQC) as part of the Routine Provider Information Return.

NHS England and NHS Improvement have agreed to establish an advisory function for independent reviews which they sponsor, commission or oversee. This will advise on the establishment and best practice management of these types of reviews.

The CQC does not have a system for disseminating learning to other trusts. However, Local Maternity Systems (LMSs) and Clinical Networks have a role in sharing learning from reviews and investigations. A recent review of LMSs suggests this is working well with systems for shared learning embedding.

The National Quality Board (NQB) provides coordinated leadership for quality on behalf of the Department, Public Health England, NHS England, the Care Quality Commission, NHS Improvement, NHS Digital and the National Institute for Health and Care Excellence.

The NQB works to promote quality nationally; support local quality improvement with providers, commissioners and those who use services; and identify new challenges and opportunities to improve quality.

Quality Surveillance Groups bring together different parts of the health and care system, to share intelligence about risks to quality and identify those risks to quality at as early a stage as possible.

The Department’s Impact Assessment process seeks to identify risks and uncertainties associated with proposed policy changes, following best practice guidance for impact assessments and quality assurance set out by HM Treasury in the Green Book and Aqua Book.

Impact assessment procedures have been strengthened by introducing an internal Senior Review Committee who review and quality assure all impact assessments.

Risk and resource implications are a focus throughout the process and are explicitly set out when the Department publishes impact assessments.

NHS England and NHS Improvement have agreed to establish an advisory function for independent reviews which they sponsor, commission or oversee. This will advise on the establishment and best practice management of these types of reviews.

The Care Quality Commission (CQC) has a Memorandum of Understanding (MoU) in place with the Parliamentary and Heath Service Ombudsman (PHSO). The MoU sets out the framework for the working relationship between the two organisations.

In addition, the CQC and the PHSO are working on a more direct means of sharing final PHSO investigation reports and are drafting an outline information sharing agreement for this purpose which will be published in due course.

Since summer 2018, as part of the Care Quality Commission’s annual Routine Provider Information Return, National Health Service trusts are asked to submit details of the commissioning and conclusion of relevant external reviews or investigations undertaken in the previous 12 months and describe key outcomes. Trusts are prompted to include actions taken resulting from coroner or ombudsman investigations and learning from external reviews of other providers.

NHS England and NHS Improvement have agreed to establish an advisory function for independent reviews which they sponsor, commission or oversee. This will advise on the establishment and best practice management of these types of reviews.

In July 2019, NHS Improvement published a new NHS Patient Safety Strategy. The strategy commits the National Health Service to developing a new Patient Safety Incident Response Framework (PSIRF), which will replace the Serious Incident Framework (published in March 2015) and support clinicians to identify insights at the point of care.

In April 2018, the Healthcare Safety Investigations Branch (HSIB) began rolling out its new maternity investigation approach, which investigates cases of unexplained severe brain injury, term intrapartum stillbirths and early neonatal deaths (all cases notifiable to the Royal College of Obstetricians and Gynaecologists under the 'Each Baby Counts' programme) and maternal deaths in England. Since 1 April 2019 HSIB has completed its roll out of investigations to all 130 trusts with maternity services in England.

The Health Education England (HEE) working group undertook a comprehensive review of education and training issues for staff working in smaller units and rural areas and published its report in 2016.

The 2019 Maternity Workforce Strategy which superseded the work of the HEE group, recommended that HEE undertake a further review to consider both the benefits and risks of rural settings.

In August 2019 HEE established a Programme Board to oversee the review, agreement and delivery of the equitable distribution of post-foundation medical training posts in England.

The Government introduced a statutory duty of candour on organisations in response to the Mid Staffordshire NHS Foundation Trust Public Inquiry, and this is regulated as part of the Care Quality Commission inspection regime. Providers must ensure that they have processes in place to ensure staff are supported to deliver the duty of candour and have a system in place to identify and deal with possible breaches by registered staff. There are currently no plans to make further changes to these regulations.

The General Medical Council and the Nursing and Midwifery Council produce professional duty of candour guidance that registered doctors, nurses and midwives must follow.

Tom Kark QC in his Review into the Fit and Proper Persons Test suggested that compliance with the duty of candour should be included in the core competencies of directors to sit on the board of any health providing organisation. NHS England and NHS Improvement are currently considering how best to bring forward this proposal as part of the NHS People Plan.

The National Maternity Review report, ‘Better Births - Improving outcomes of maternity services in England, A Five Year Forward View for maternity care’ reviewed maternity services across the country including in rural and isolated areas. It found that in a number of rural areas, small obstetric units see a low number of births and face challenges in employing sufficient numbers of staff.

As part of the New Care Models programme, NHS England alongside the other arm’s length bodies, has established 50 vanguards to explore how new models of care can address the quality, care and efficiency challenges faced by the National Health Service; this includes services that are rural, geographically isolated or difficult to recruit to. Examples of best practice and shared learning from these Vanguard sites are continually made available to the wider NHS, through reports, publications, press and media.

In March 2015, the Secretary of State for Health asked Sir Bruce Keogh to review the professional codes of doctors and nurses, and to ensure that the right incentives are in place to prevent health care professionals from covering up mistakes. On 16 July 2015, Sir Bruce confirmed that the professional codes of conduct for doctors and nurses are both fit for purpose.

All professional regulators are overseen by the Professional Standards Authority for health and social care (PSA). The PSA annually reviews each professional regulator’s performance against the following four core functions: guidance and standards; education and training; registration; and fitness to practice.

The Faculty of Medical Leadership and Management is developing the third edition of the Leadership and management standards for medical professionals to be released in 2020.

The interim People Plan published in June 2019 gave a commitment to undertake a system wide engagement on a new ‘NHS Leadership Compact’ that will establish the cultural values and leadership behaviours we expect from National Health Service leaders, together with the support and development that leaders should expect in return. NHS England and NHS Improvement are working with the Care Quality Commission (CQC) to reflect the principles of the leadership compact in an updated version of the CQC’s Well-Led Framework, which will be consulted on and launched by spring 2021.

The NHS Leadership Academy’s Healthcare Leadership Model sets out the behaviours that are required of all NHS leaders in order to deliver effective, high quality care. Additionally, in November 2019, NHS England and NHS Improvement published a competency framework for Chairs and will publish further competency frameworks for executive and non-executive role on NHS boards, in line with the commitment set out in the interim People Plan.

The Faculty of Medical Leadership and Management is developing the third edition of the Leadership and management standards for medical professionals to be released in 2020.

The interim People Plan published in June 2019 gave a commitment to undertake a system wide engagement on a new ‘NHS Leadership Compact’ that will establish the cultural values and leadership behaviours we expect from National Health Service leaders, together with the support and development that leaders should expect in return. NHS England and NHS Improvement are working with the Care Quality Commission (CQC) to reflect the principles of the leadership compact in an updated version of the CQC’s Well-Led Framework, which will be consulted on and launched by spring 2021.

The NHS Leadership Academy’s Healthcare Leadership Model sets out the behaviours that are required of all NHS leaders in order to deliver effective, high quality care. Additionally, in November 2019, NHS England and NHS Improvement published a competency framework for Chairs and will publish further competency frameworks for executive and non-executive role on NHS boards, in line with the commitment set out in the interim People Plan.

Both the Parliamentary and Health Service Ombudsman’s and Dr Bill Kirkup’s reports following Morecambe Bay were critical of the Local Supervising Authority system provided for in legislation for midwives.

The Nursing and Midwifery (Amendment) Order 2017 separated the function of midwifery supervision, which is the responsibility of the employer, from regulatory activity, which is the responsibility of the Nursing and Midwifery Council. This brought the regulation of midwives into line with the arrangements for other regulated professions and means that supervisors are no longer involved in regulatory investigations and sanctions.

Subsequently, a new non-statutory model of supervision for midwives has been developed and rolled out in each of the four countries of the United Kingdom with NHS England leading this work in England. The new model focuses on the professional and developmental aspects of the role.

We are currently developing a national strategy which aims to drive improvements in how feedback and concerns from patients are dealt with by the National Health Service so that the NHS listens, learns and acts.

The Government has established an independent National Guardian to help drive positive cultural change across the National Health Service so that speaking up becomes business as usual. The National Guardian oversees a network of over 500 Local Guardians covering every trust. We have also enhanced the legal protections available for whistle blowers to prohibit discrimination against job applicants.

Medical examiners will scrutinise all non-coronial deaths and ensure the right deaths are referred to coroners. This includes neonatal deaths. We remain committed to establishing a statutory system in the National Health Service, that will scrutinise all deaths which do not involve a coroner, as soon as Parliamentary time allows. This will build upon the non-statutory system already being implemented.

There is currently no provision for the medical examiner to become involved in the certification for stillborn babies. This is because the functions of medical examiners, as set out in the Coroners and Justice Act 2009, are limited to scrutinising causes of death. Stillborn babies are not legally classified as having died because Common law does not see this as a death, as they were not born alive. Officials have been analysing responses to the consultation that sets out proposals for giving coroners new powers to investigate term stillbirths. The Government plans to publish a response in the spring or early summer.

The Government has introduced measures to improve the systematic recording of perinatal deaths.

The Perinatal Mortality Review Tool was launched in 2018 to support National Health Service trusts to undertake systematic, multidisciplinary, high quality reviews of the circumstances and care leading up to and surrounding each stillbirth and neonatal death. Reports from the tool enable organisations providing and commissioning care to identify emerging themes across a number of deaths to support learning and changes in the delivery and commissioning of care to improve future care and prevent the future deaths which are avoidable.

In May 2019, MBRRACE-UK introduced a new real-time data monitoring tool, incorporated into the MBRRACE-UK web-based system. The tool allows registered users of the MBRRACE-UK surveillance system to monitor, filter and summarise the perinatal deaths reported for their organisation, using live surveillance data from the MBRRACE-UK system.

The data requested is attached.

The data requested is attached.

The data requested is attached.

The data requested is attached.

In 2018/19, trusts spent around £2.40 billion on agency staff – £200 million more than the £2.2 billion target, and about the same as the previous year. Since April 2017, agency costs have consistently been below 5% of overall pay costs and have now fallen to 4.4%. The continued reduction in the proportion of agency staff costs to total pay bill is a significant achievement in view of the record levels of demand and the extreme pressure on the acute sector.

The information requested is shown in the following table.

We do not hold staff group data for 2014/15 and 2015/16.

This information is not available in the format requested.

NHS England and NHS Improvement have published seven day services self-assessment results for NHS Trusts, this data relating to each of the priority clinical standards for seven day services both for weekends, weekdays and overall as at July 2019 (latest data) is available at the following link:

https://www.england.nhs.uk/publication/7-day-hospital-services-self-assessment-results/

This information is not available in the format requested.

NHS England and NHS Improvement have published seven day services self-assessment results for NHS Trusts, this data relating to each of the priority clinical standards for seven day services both for weekends, weekdays and overall as at July 2019 (latest data) is available at the following link:

https://www.england.nhs.uk/publication/7-day-hospital-services-self-assessment-results/

This information is not available in the format requested.

NHS England and NHS Improvement have published seven day services self-assessment results for NHS Trusts, this data relating to each of the priority clinical standards for seven day services both for weekends, weekdays and overall as at July 2019 (latest data) is available at the following link:

https://www.england.nhs.uk/publication/7-day-hospital-services-self-assessment-results/

This information is not available in the format requested.

NHS England and NHS Improvement have published seven day services self-assessment results for NHS Trusts, this data relating to each of the priority clinical standards for seven day services both for weekends, weekdays and overall as at July 2019 (latest data) is available at the following link:

https://www.england.nhs.uk/publication/7-day-hospital-services-self-assessment-results/

This information is not available in the format requested.

NHS England and NHS Improvement have published seven day services self-assessment results for NHS Trusts, this data relating to each of the priority clinical standards for seven day services both for weekends, weekdays and overall as at July 2019 (latest data) is available at the following link:

https://www.england.nhs.uk/publication/7-day-hospital-services-self-assessment-results/

There are acute operational waiting time standards relating to cancer treatment, accident and emergency (A&E) and elective care which the National Health Service reports against on a monthly basis. These are outlined in the following table:

In addition to the acute operational standards mentioned, there are also mental health waiting times targets which are published on either a monthly or a quarterly basis:

The United Kingdom’s five-year national action plan for antimicrobial resistance includes a strengthened focus on infection prevention and control and sets an ambition to halve levels of healthcare associated Gram-negative blood stream infections by 2023-2024. The draft NHS Standard Contract for 2020/21 includes a proposal for annual targets for trust and clinical commissioning group-level reductions in E. coli, Methicillin-Sensitive Staphylococcus aureus, Klebsiella and Pseudomonas bloodstream infections. The draft contract is out for consultation until 31 January 2020.

The NHS Standard Contract will continue to include targets for both methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (CDI). The zero-tolerance approach for MRSA bacteraemia will continue, and all acute providers submit monthly data on all positive MRSA bacteraemia specimens. CDI thresholds are published annually by NHS England and NHS Improvement and all acute providers must report positive CDI specimens.

National targets for vaccine preventable disease/immunisation are 95% national coverage for key vaccines, and 50% coverage for the childhood flu vaccine. The UK has also committed to meeting the World Health Organization elimination targets for hepatitis C, hepatitis B and Tuberculosis (TB) ahead of 2030, and is committed to eradicating HIV transmission in England by 2030 (Public Health England’s infectious disease strategy).

We are determined to reduce the number of cases where babies are harmed, often permanently, by medical error. Our National Maternity Safety Ambition, launched in November 2015 and updated in November 2017, is to halve the rates of maternal and neonatal deaths, stillbirths, and brain injuries that occur during or soon after birth by 2025. Details can be found at the following link:

https://www.gov.uk/government/publications/safer-maternity-care-progress-and-next-steps

NHS Resolution handles clinical negligence claims on behalf of National Health Service organisations and independent sector providers of NHS care in England. NHS Resolution is also responsible for handling the clinical liabilities of former NHS bodies, where the defendant is the Secretary of State.

In the financial year 2018/19 the number of legal cases settled worth more than £1 million in relation to babies disabled for life by medical error were:

- Department of Health and Social Care legacy schemes – five; and

- Clinical Negligence Scheme for Trusts covering the NHS - 105.

It should be noted that this covers the period for the financial year 2018/19, rather than for the last 12 months, as the numbers for cases since April 2019 have not yet been audited.