Jeremy Hunt

The recent Birthrate Plus assessment identified a national differential in England of 844 full-time equivalent (FTE) or 3.5% of midwives between employed FTE staff in post and the total number of funded posts and 1,088 FTE or 4.4% of midwives between the total number of funded posts and the number of posts recommended using the Birthrate Plus midwifery workforce planning tool.

The Department has not made an assessment of the extent of shortages in obstetricians in the National Health Service in England.

The recent Birthrate Plus assessment identified a national differential in England of 844 full-time equivalent (FTE) or 3.5% of midwives between employed FTE staff in post and the total number of funded posts and 1,088 FTE or 4.4% of midwives between the total number of funded posts and the number of posts recommended using the Birthrate Plus midwifery workforce planning tool.

The Department has not made an assessment of the extent of shortages in obstetricians in the National Health Service in England.

The Government response to the Committee’s report set out that we would consider an assessment of midwifery and obstetric workforce levels to inform considerations of future funding. In early 2022, the Royal College of Obstetricians and Gynaecologists will provide information on the number of obstetricians at all grades required in maternity units. By June 2022, a complex workforce tool will be developed which can be used by maternity units to calculate the number of obstetricians required. This information will inform considerations of the Committee’s recommendation.

Responsibility for monitoring the implementation of the Healthcare Safety Investigation Branch’s (HSIB) national patient safety recommendations rest with the recipient organisations. The National Patient Safety Committee, coordinated by NHS England and NHS Improvement, has established a pilot to examine how the implementation of all the HSIB’s national recommendations could be monitored, the potential resources required and information that may aid future evaluation. The National Patient Safety Committee’s draft report on the pilot is currently undergoing review and is expected to be finalised this year.

Responsibility for monitoring the implementation of the maternity safety recommendations made by the HSIB rests with individual National Health Service trusts. The HSIB works closely with trusts on addressing emerging themes from the investigations and has quarterly review meetings where trusts provide feedback on the actions being taken to implement the recommendations. The HSIB will raise any immediate concerns to the Department and NHS England and NHS Improvement via governance and assurance meetings.

Responsibility for monitoring the implementation of the Healthcare Safety Investigation Branch’s (HSIB) national patient safety recommendations rest with the recipient organisations. The National Patient Safety Committee, coordinated by NHS England and NHS Improvement, has established a pilot to examine how the implementation of all the HSIB’s national recommendations could be monitored, the potential resources required and information that may aid future evaluation. The National Patient Safety Committee’s draft report on the pilot is currently undergoing review and is expected to be finalised this year.

Responsibility for monitoring the implementation of the maternity safety recommendations made by the HSIB rests with individual National Health Service trusts. The HSIB works closely with trusts on addressing emerging themes from the investigations and has quarterly review meetings where trusts provide feedback on the actions being taken to implement the recommendations. The HSIB will raise any immediate concerns to the Department and NHS England and NHS Improvement via governance and assurance meetings.

Responsibility for monitoring the implementation of the Healthcare Safety Investigation Branch’s (HSIB) national patient safety recommendations rest with the recipient organisations. The National Patient Safety Committee, coordinated by NHS England and NHS Improvement, has established a pilot to examine how the implementation of all the HSIB’s national recommendations could be monitored, the potential resources required and information that may aid future evaluation. The National Patient Safety Committee’s draft report on the pilot is currently undergoing review and is expected to be finalised this year.

Responsibility for monitoring the implementation of the maternity safety recommendations made by the HSIB rests with individual National Health Service trusts. The HSIB works closely with trusts on addressing emerging themes from the investigations and has quarterly review meetings where trusts provide feedback on the actions being taken to implement the recommendations. The HSIB will raise any immediate concerns to the Department and NHS England and NHS Improvement via governance and assurance meetings.

The Care Act 2014 secured important rights for carers, including an assessment of, and support for, their specific needs where eligible. Local authorities have been able to access the £1.49 billion Infection Control Fund which has been used to help day services reopen safely or be reconfigured to work in a COVID-19 secure way. We have also committed at least £6.9 billion in 2021-2022 to the Better Care Fund, which includes funding that can be used for respite services. In addition, we have worked with the Social Care Institute for Excellence to publish guidance for day care managers, commissioners, and providers, to help them make decisions on the safe operation of day services.

We will continue to work with local authorities, in collaboration with Association of Directors of Adult Social Services and the Ministry of Housing, Communities and Local Government, to ensure, where possible, the safe resumption of these services.

The United Kingdom National Screening Committee (UK NSC) received a proposal to look at fetal presentation as a new screening topic as part of its annual call for topics in 2019. The proposal suggested that all pregnant women could be screened at around 36 weeks gestation using a handheld ultrasound device at routine antenatal appointments to check the positioning of the baby.

The UK NSC’s evaluation group assessed the proposal as being of relevance within the Committee’s remit and agreed that an evidence map should be commissioned to scope the volume and type of evidence available. This was noted by the UK NSC at its February 2020 meeting. The outcome of this evidence map will be presented at the upcoming UK NSC meeting on the 5 March 2021 to consider and recommend next steps.

We do not collect this information centrally.

We do not collect this information centrally.

The following table shows the percentage of National Health Service provider trust staff, who responded to the NHS Staff Survey, who reported experiencing at least one incident of harassment, bullying or abuse in the previous 12 months. Prior to 2015 the format of questions posed in the survey changed and as such a longer timeseries is not possible.

Source: Weighted NHS Staff Survey Results for NHS trusts in England- February 2020 NHS England

The annual NHS Staff survey asks NHS staff in England about their experiences of working for their respective NHS organisations. For the 2019 survey, over 1.1 million NHS employees in England were invited to participate in the survey between September and December 2019 and there was a 48% response rate.

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

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

The information requested is not available.

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.

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.

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%.

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.