Julia Buckley

The Child Maintenance Service (CMS) always encourages paying parents to pay their maintenance on time, to avoid accrual of arrears. Where a paying parent fails to pay on time or in full, the CMS aims to take immediate action to recover the debt and re-establish compliance. The CMS will initially negotiate a payment that is feasible for the parent to pay. If this is unsuccessful and the paying parent is employed, the CMS will use a Deductions from Earnings Order (DEO) to take payment directly from their wages. The CMS has a range of strong enforcement powers that can be used against those who consistently refuse to meet their obligations to provide financial support to their children. These powers include the ability to deduct directly from the paying parent’s bank accounts, forcing the sale of property and disqualifications from holding or obtaining driving licenses and passports. We are committed to making the most effective use of these strong enforcement powers and have made a number of improvements to our enforcement process to make it quicker and more efficient.

The Child Maintenance Service (CMS) aims to provide a high-quality service to all its customers. The CMS treats parents equally as individuals based on their roles within the scheme and makes no reference to gender. The Department has a specific duty to assess the impact of proposed policies and services and any changes to them on equality to ensure the Department meets its Public Sector Equality Duty obligations.

A principle of child maintenance is to increase levels of cooperation between separated parents and encourage parents to meet their responsibilities to provide their children with financial support. Where a family-based child maintenance arrangement is not suitable the Child Maintenance Service offers a statutory scheme for those parents who need it.

The Government is dedicated to ensuring parents meet their obligations to children and the Child Maintenance Service will do everything within its powers to make sure parents comply. Where parents fail to pay their child maintenance, the Service will not hesitate to use its enforcement which includes liability orders. The Service is committed to using these powers fairly and in the best interests of children and separated families.

The Department plans to bring forward changes to allow Child Maintenance Service (CMS) to make an administrative liability order against a person who has failed to pay child maintenance and is in arrears. The administrative liability order will replace the current requirement for the CMS to apply to the court for a liability order, which can take up to 22 weeks. We expect the new liability order process to take around six to eight weeks, meaning CMS can use its strong enforcement powers more quickly for those who seek to avoid their financial obligations to their children.

We will bring forward the legislation as soon as possible.

The Department publishes quarterly statistics for the Child Maintenance Service and the latest statistics are available up to March 2024. The next release to June 2024 is scheduled for Tuesday 24th September 2024 at 09:30am.

The statistics for liability orders are shown in Table 7.1 of the National tables. The relevant data taken from that table, covering the period requested, is shown in the following table:

Liability Orders in process and money collected in Great Britain, and Liability Orders applied for and granted in England and Wales, July 2023 to March 2024

Source: Child Maintenance Service Administrative and Clerical Data

Notes:

1. This table includes actions taken to collect both maintenance arranged by the Child Maintenance Service, and Child Support Agency arrears that have been transitioned to Child Maintenance Service systems. This may include actions taken against parents for whom no ongoing maintenance has been arranged under the Child Maintenance Service.

2. Figures are rounded to the nearest 100 or £100,000.

3. "In Process" counts give the number of Paying Parents for which the relevant enforcement action was ongoing at the end of the quarter. "Ongoing" includes the period in which the action was being formally considered, in addition to the period during which the action was actively being progressed.

4. A Paying Parent can be taken to court over unpaid child maintenance. Courts can grant a Liability Order, which is a legal recognition that a debt is owed. This enables recovery of the debt through further Civil Enforcement Actions, e.g. referral to an enforcement agency.

5. Some Liability Order figures are restricted to England and Wales and exclude Scotland, this is indicated in the row title where relevant.

The National Institute for Health and Care Excellence (NICE) guidance, Chronic kidney disease: Assessment and management [NG203], updated in November 2021, sets out best practice for clinicians in the diagnosis and management of chronic kidney disease (CKD). The guidance covers the care and treatment of patients at risk of CKD. It includes recommendations on the monitoring of patients at risk of CKD and aims to prevent or delay the progression of the disease. The guidance is available at the following link:

https://www.nice.org.uk/guidance/ng203

NHS England, through the Renal Services Transformation Programme and regional renal networks, is implementing initiatives to provide better, integrated care, reduce health inequalities, and focus on the prevention and timely intervention for kidney disease. Regional renal clinical networks have already prioritised CKD diagnosis and the prevention of disease progression within their core function. This includes assessing the concordance with NICE guidance around the use of drugs to mitigate the consequences of CKD. Regional renal clinical networks also prioritise CKD diagnosis and prevention within their transformation ambitions, facilitating earlier treatment. This includes considerations to develop a unified approach to testing populations at risk of developing CKD, and includes raising awareness of diagnostic tools like urine albumin creatinine tests, enabling CKD diagnosis at stages 1 and 2. NHS England aims to improve awareness and access to these important urine and blood tests across primary and secondary care. In addition, the transformation programme launched a renal toolkit earlier last year, for use by systems, that outlines principles to support better management of patients identified with CKD throughout their patient journey.

No assessment has been made of the adequacy of the implementation of NHS England’s Renal Services Transformation Programme by local National Health Service integrated care systems.

NHS England is working to detect people at risk of kidney disease through the NHS Health Check Programme. The programme, which is available for everyone between the ages of 40 and 74 years old who is not already on a chronic disease register, assesses people’s health and risk of developing certain health problems. Using this information, patients are supported to make behavioural changes and access treatment which helps to prevent and detect kidney disease earlier.

The NHS Long Term Plan has committed to a number of key ambitions to improve care and outcomes for individuals with cardiovascular disease (CVD), including enhanced diagnostic support in the community, better personalised planning, and increasing access to cardiac rehabilitation. These ambitions will support the delivery of the aim to help prevent 150,000 heart attacks, strokes, and dementia cases by 2029. Specific priorities include the management of CVD risk factors, such as hypertension, or high blood pressure, atrial fibrillation, or an abnormal, fast irregular heartbeat, and high cholesterol, ensuring early and rapid access to diagnostic tests and treatment. NHS England is working to identify opportunities for improved integration of CVD management across clinical specialities.

The UK National Screening Committee (UK NSC) reviewed chronic kidney disease (CKD) and glomerulonephritis in 2011, concluding that a population-wide screening programme would not be recommended. Although the UK NSC has not since looked at the evidence for a targeted programme, it can be alerted to any new published peer-reviewed evidence which may suggest the case for a new screening programme. Further information is available at the following link:

https://www.gov.uk/government/publications/uk-nsc-annual-call-submitting-a-screening-proposal/uk-nsc-annual-call-how-to-submit-a-proposal

The National Health Service provides access to tests and therapies to diagnose, code, and treat patients with early-stage CKD. NHS England, through the Renal Services Transformation Programme and regional renal networks, is implementing initiatives to provide better, integrated care, reduce health inequalities, and focus on prevention and timely intervention for kidney disease within both primary and secondary care. Regional renal clinical networks prioritise CKD diagnosis and prevention within their transformation ambitions, facilitating earlier treatment. This includes considerations to develop a unified approach to testing populations at risk of developing CKD, and includes raising awareness of diagnostic tools like urine albumin creatinine tests, enabling CKD diagnosis at stages 1 and 2. NHS England aims to improve awareness and access to these important urine and blood tests across primary and secondary care. In addition, the transformation programme launched a renal toolkit last year for use by systems, that outlines principles to support better management of patients identified with CKD throughout their patient journey.

The National Institute for Health and Care Excellence (NICE) guidance, Chronic kidney disease: Assessment and management [NG203], updated in November 2021, sets out best practice for clinicians in the diagnosis and management of CKD. The guidance covers the care and treatment of patients at risk of CKD. It includes recommendations on the monitoring of patients at risk of CKD and aims to prevent or delay the progression of the disease. The guidance is available at the following link:

https://www.nice.org.uk/guidance/ng203

The management of CKD has evolved over the last two decades. Increasingly, there are drug interventions to slow the progression of kidney disease, mitigate the risk of cardiovascular events associated with CKD, and reduce the additional risk of acute kidney injury. NICE guidance continues to be updated as evidence accumulates, and NHS England, through the Renal Clinical Reference Group, supports that process through advice and horizon scanning, as therapeutic interventions are introduced. The renal clinical networks have all established work examining the management of CKD, including diagnosis and intervention.

The Government recognises that long-term sickness continues to be the most common reason for economic inactivity among the working age population.  As part of the Get Britain Working plan, more disabled people and those with health conditions will be supported to enter and stay in work, by devolving more power to local areas so they can shape a joined-up work, health, and skills offer that suits the needs of the people they serve.

There are no current plans to make an assessment with Cabinet colleagues of the potential impact of trends in the number of people with kidney disease on the economy.

The Government is committed to building a fairer Britain by tackling the structural inequalities that contribute to poor health, particularly for disadvantaged groups. We are dedicated to ensuring that people live well for longer and spend less time in ill health, regardless of where they are born or their financial circumstances.

Our Health Mission in England will focus on addressing the social determinants of health, with the goal of halving the gap in healthy life expectancy between the richest and poorest regions. We will work across Government to address the root causes of health inequalities, including barriers of access to health and care services. We will prioritise prevention, shift more care into the community, and intervene earlier in life to raise the healthiest generation of children in our history.

The 10-Year Health Plan will ensure a better health service for everyone, regardless of condition or service area. On 21 October 2024, we launched a national conversation on the future of the National Health Service, inviting views from across the country on how to deliver a health service fit for the future. Patients, staff, and organisations, including those with experience of, or expertise in, kidney disease, can make themselves heard by logging onto the online portal, which is available at the following link:

http://change.nhs.uk

No formal assessment has been made of the potential impact of healthcare inequalities in kidney disease on NHS waiting lists.

We recognise that patients have been let down for too long whilst they wait for the care they need, including for kidney disease. Currently, the overall waiting list stands at 7.64 million patient pathways, with over six million people waiting. The Government is committed to putting patients first. This means making sure that patients are seen on time and ensuring that people have the best possible experience during their care.

Today, fewer than 60% of patients are being seen within 18 weeks. We will ensure 92% of patients return to waiting no longer than 18 weeks from Referral to Treatment within our first term, a standard which has not been met consistently since September 2015.

Tackling waiting lists is a key part of our Health Mission. We will start by delivering an extra 40,000 operations, scans, and appointments each week, as the first step in our commitment to ensuring patients are treated within 18 weeks. We will also address the challenges in diagnostic waiting times, providing the number of computed tomography, magnetic resonance imaging, and other tests that are needed to reduce elective waits.

NHS England has established the Renal Services Transformation Programme (RSTP), which aims to reduce unwarranted variation in the quality and accessibility of renal care, to improve outcomes and services for those with kidney disease. NHS England, through the RSTP and regional renal clinical networks, is implementing initiatives to provide better, integrated care, to reduce health inequalities, and to focus on prevention and timely intervention for kidney disease.

Working in collaboration with the NHS RightCare Programme and the renal community, the RSTP has developed a renal toolkit to provide integrated care boards, regional renal clinical networks, and providers with tools, case studies, and principles to support the transformation of services at a local level. The toolkit outlines principles to support better management of patients identified with chronic kidney disease (CKD) throughout their patient journey. The RSTP is working closely with NHS England’s regional renal clinical networks to review this toolkit, to work with local partners to develop transformation programmes that will focus on the early identification and management of kidney disease, and which will seek to reduce the number of patients progressing through the various stages of CKD and reduce the number of patients requiring dialysis. By supporting prevention and early intervention, the need for late-stage treatments will be reduced.

The Government is committed to building a fairer Britain by tackling the structural inequalities that contribute to poor health, particularly for disadvantaged groups. We are dedicated to ensuring that people live well for longer and spend less time in ill health, regardless of where they are born or their financial circumstances.

Our Health Mission in England will focus on addressing the social determinants of health, with the goal of halving the gap in healthy life expectancy between the richest and poorest regions. We will work across Government to address the root causes of health inequalities, including barriers of access to health and care services. We will prioritise prevention, shift more care into the community, and intervene earlier in life to raise the healthiest generation of children in our history.

The 10-Year Health Plan will ensure a better health service for everyone, regardless of condition or service area. On 21 October 2024, we launched a national conversation on the future of the National Health Service, inviting views from across the country on how to deliver a health service fit for the future. Patients, staff, and organisations, including those with experience of, or expertise in, kidney disease, can make themselves heard by logging onto the online portal, which is available at the following link:

http://change.nhs.uk

No formal assessment has been made of the potential impact of healthcare inequalities in kidney disease on NHS waiting lists.

We recognise that patients have been let down for too long whilst they wait for the care they need, including for kidney disease. Currently, the overall waiting list stands at 7.64 million patient pathways, with over six million people waiting. The Government is committed to putting patients first. This means making sure that patients are seen on time and ensuring that people have the best possible experience during their care.

Today, fewer than 60% of patients are being seen within 18 weeks. We will ensure 92% of patients return to waiting no longer than 18 weeks from Referral to Treatment within our first term, a standard which has not been met consistently since September 2015.

Tackling waiting lists is a key part of our Health Mission. We will start by delivering an extra 40,000 operations, scans, and appointments each week, as the first step in our commitment to ensuring patients are treated within 18 weeks. We will also address the challenges in diagnostic waiting times, providing the number of computed tomography, magnetic resonance imaging, and other tests that are needed to reduce elective waits.

NHS England has established the Renal Services Transformation Programme (RSTP), which aims to reduce unwarranted variation in the quality and accessibility of renal care, to improve outcomes and services for those with kidney disease. NHS England, through the RSTP and regional renal clinical networks, is implementing initiatives to provide better, integrated care, to reduce health inequalities, and to focus on prevention and timely intervention for kidney disease.

Working in collaboration with the NHS RightCare Programme and the renal community, the RSTP has developed a renal toolkit to provide integrated care boards, regional renal clinical networks, and providers with tools, case studies, and principles to support the transformation of services at a local level. The toolkit outlines principles to support better management of patients identified with chronic kidney disease (CKD) throughout their patient journey. The RSTP is working closely with NHS England’s regional renal clinical networks to review this toolkit, to work with local partners to develop transformation programmes that will focus on the early identification and management of kidney disease, and which will seek to reduce the number of patients progressing through the various stages of CKD and reduce the number of patients requiring dialysis. By supporting prevention and early intervention, the need for late-stage treatments will be reduced.

The Government is committed to building a fairer Britain by tackling the structural inequalities that contribute to poor health, particularly for disadvantaged groups. We are dedicated to ensuring that people live well for longer and spend less time in ill health, regardless of where they are born or their financial circumstances.

Our Health Mission in England will focus on addressing the social determinants of health, with the goal of halving the gap in healthy life expectancy between the richest and poorest regions. We will work across Government to address the root causes of health inequalities, including barriers of access to health and care services. We will prioritise prevention, shift more care into the community, and intervene earlier in life to raise the healthiest generation of children in our history.

The 10-Year Health Plan will ensure a better health service for everyone, regardless of condition or service area. On 21 October 2024, we launched a national conversation on the future of the National Health Service, inviting views from across the country on how to deliver a health service fit for the future. Patients, staff, and organisations, including those with experience of, or expertise in, kidney disease, can make themselves heard by logging onto the online portal, which is available at the following link:

http://change.nhs.uk

No formal assessment has been made of the potential impact of healthcare inequalities in kidney disease on NHS waiting lists.

We recognise that patients have been let down for too long whilst they wait for the care they need, including for kidney disease. Currently, the overall waiting list stands at 7.64 million patient pathways, with over six million people waiting. The Government is committed to putting patients first. This means making sure that patients are seen on time and ensuring that people have the best possible experience during their care.

Today, fewer than 60% of patients are being seen within 18 weeks. We will ensure 92% of patients return to waiting no longer than 18 weeks from Referral to Treatment within our first term, a standard which has not been met consistently since September 2015.

Tackling waiting lists is a key part of our Health Mission. We will start by delivering an extra 40,000 operations, scans, and appointments each week, as the first step in our commitment to ensuring patients are treated within 18 weeks. We will also address the challenges in diagnostic waiting times, providing the number of computed tomography, magnetic resonance imaging, and other tests that are needed to reduce elective waits.

NHS England has established the Renal Services Transformation Programme (RSTP), which aims to reduce unwarranted variation in the quality and accessibility of renal care, to improve outcomes and services for those with kidney disease. NHS England, through the RSTP and regional renal clinical networks, is implementing initiatives to provide better, integrated care, to reduce health inequalities, and to focus on prevention and timely intervention for kidney disease.

Working in collaboration with the NHS RightCare Programme and the renal community, the RSTP has developed a renal toolkit to provide integrated care boards, regional renal clinical networks, and providers with tools, case studies, and principles to support the transformation of services at a local level. The toolkit outlines principles to support better management of patients identified with chronic kidney disease (CKD) throughout their patient journey. The RSTP is working closely with NHS England’s regional renal clinical networks to review this toolkit, to work with local partners to develop transformation programmes that will focus on the early identification and management of kidney disease, and which will seek to reduce the number of patients progressing through the various stages of CKD and reduce the number of patients requiring dialysis. By supporting prevention and early intervention, the need for late-stage treatments will be reduced.

The Government recognises the importance of raising awareness of air pollution and the associated health impacts. The Department of Health and Social Care is supporting the Department for Environment, Food and Rural Affairs on their comprehensive Clean Air Strategy, which will include consideration of interventions to reduce emissions so that everyone’s exposure to air pollution is reduced. In addition, the Department for Environment, Food and Rural Affairs is undertaking a review of how we communicate air quality information to ensure members of the public, and vulnerable groups in particular, have what they need to protect themselves. The Government will also continue to raise awareness about the impact of domestic solid fuel burning.

We have no current plans to assess the impact of removing this exemption. The Smoke and Carbon Monoxide Alarm (England) Regulations 2015, later amended by the Carbon Monoxide Regulations 2022, are for rented residential premises in England. The regulations exclude a range of settings, including care homes.

The Government is determined to shift more healthcare out of hospitals and into the community, to ensure that patients and their families receive personalised care in the most appropriate setting, and palliative and end of life care, including hospices, will have a big role to play in that shift.

Palliative care services are included in the list of services an integrated care board (ICB) must commission. This promotes a more consistent national approach and supports commissioners in prioritising palliative and end of life care. To support ICBs in this duty, NHS England has published statutory guidance and service specifications.

Whilst the majority of palliative and end of life care is provided by National Health Service staff and services, we recognise the vital part that voluntary sector organisations, including hospices, also play in providing support to people at end of life and their loved ones.

Most hospices are charitable, independent organisations which receive some statutory funding for providing NHS services. The amount of funding charitable hospices receive varies by ICB area, and will, in part, be dependent on the breadth of a range of palliative and end of life care provision within their ICB footprint.

I recently met with NHS England, and discussions have begun on how to reduce inequalities and variation in access to, and quality of, palliative and end of life care.  We will consider next steps on palliative and end of life care, including funding, in the coming months.

No assessment has been made by the Government. The Professional Standards Authority for Health and Social Care (PSA) oversees the work of the statutory bodies that regulate health professionals in the United Kingdom, including the Health and Care Professions Council (HCPC).

On 30 August 2024, the PSA published its 2023/24 performance review of the HCPC. The HCPC met 16 out of 18 of the PSA’s Standards of Good Regulation. The HCPC met all four of the PSA’s standards on registration including Standard 11, that the regulator’s process for registration, including appeals, operates proportionately, fairly, and efficiently, with decisions clearly explained.

No assessment has been made by the Government. The Professional Standards Authority for Health and Social Care (PSA) oversees the work of the statutory bodies that regulate health professionals in the United Kingdom, including the Health and Care Professions Council (HCPC).

On 30 August 2024, the PSA published its 2023/24 performance review of the HCPC. The HCPC met 16 out of 18 of the PSA’s Standards of Good Regulation. The HCPC met all four of the PSA’s standards on registration including Standard 11, that the regulator’s process for registration, including appeals, operates proportionately, fairly, and efficiently, with decisions clearly explained.

Under the GP Contracts, premises liabilities are the responsibility of the contractor. Overall contractual payments reflect this arrangement, with the National Health Service also reimbursing direct premises costs including rent, business rates, water, and clinical waste.

There are 8,842 practice premises across England, of these, 51% are leased premises. The NHS is not a formal party to the leases on these properties. If NHS England were to consider a formal underwriting of the leases, legal advice notes, that would constitute a commitment, which would require capitalisation under the International Financial Accounting Standard IFRS16, and limited NHS capital budgets would have to be diverted to offset this commitment, in addition to the payment of rents against the properties.

This would provide, in effect, a double payment of costs against the asset and would commit substantial capital funds to the exercise, limiting the ability of integrated care systems to invest in the primary care estate, address secondary and community care, mental health services, and critical and usual infrastructure maintenance requirements, significantly adversely affecting the overall investment plans for communities. As a result, NHS England considers that a formal underwriting of leases would not provide best use of public funds.

No specific assessment has been made. Shared care records are in place in all integrated care boards, allowing information from general practice and acute settings to be shared for direct care.

The Frontline Digitisation programme is working to improve the digital maturity of all providers so that they have adequate enabling hardware, robust connectivity, electronic patient record systems, and other core capabilities in place.

The Data Information and Smart Data Bill announced in the King's Speech will include the statutory power to require IT suppliers to adhere to information standards. This will help ensure there is a ‘common language’ for health and care software systems to talk to each other, across all health and care settings.

We want a society where every person receives high-quality, compassionate care, including at end of life. We understand that, financially, times are difficult for many voluntary and charitable organisations, including hospices, due to the increased cost of living. We want a society where these costs are manageable for both voluntary organisations, like hospices, and the people whom they serve.

The Government is going to shift the focus of healthcare out of the hospital and into the community, and we recognise that hospices will play a vital role. We will consider next steps, including funding, on palliative and end of life care more widely in the coming months.

We want a society where every person receives high-quality, compassionate care, including at the end of their life. I know that hospices provide fantastic services to many people.

The government is going to shift the focus of healthcare out of the hospital and into the community.

We recognise the value of the voluntary sector, including hospices, and we will continue to work closely with the sector to understand the pressures they are under.