Liz Twist

High quality, accessible childcare is important in ensuring that every child has the best possible start in life. The overall quality of provision within the early years sector remains high and, as of 31 March 2021, 96% of providers on the Ofsted Early Years Register were judged good or outstanding, which is a substantial increase from 74% in 2012. Ofsted are responsible for monitoring the quality of provision.

We continue to monitor the sufficiency of childcare through regular attendance data collection and monitoring the open or closed status of providers. We also discuss sufficiency of provision in our regular conversations with local authorities. Local authorities are not currently reporting any significant sufficiency or supply issues and we have not seen any significant number of parents unable to secure a childcare place, either this term or since early years settings re-opened fully on 1 June 2020.

Ofsted data shows that as of March 2021 the number of childcare places available on the Early Years Register has remained broadly stable since August 2015.

On 2 June 2021, as part of the government’s announcement on providing an additional £1.4 billon for education recovery, we announced a £153 million investment for high-quality professional development for early years practitioners. This includes new programmes focusing on key areas such as speech and language development, and physical and emotional development for the youngest children, of which play is an important part. This is in addition to the £18 million announced in February 2021 and the £9 million announced in June 2020 to support early language development for children in light of the COVID-19 outbreak.

The package will build on our early years foundation stage reforms, which support more effective early years curriculum and assessment, and reducing unnecessary assessment paperwork, so that practitioners and teachers can spend more time engaging children in rich activities, including through play, to support their learning.

All children have had their education disrupted by the COVID-19 outbreak, but it is likely that disadvantaged and vulnerable groups will have been hardest hit.

Since 2011 we have spent more than £20 billion to provide Pupil Premium funding for school leaders to use, based on the needs of their disadvantaged pupils. Between 2011 and 2019, the attainment gaps between disadvantaged and non-disadvantaged pupils narrowed by 13% at age 11 and 9% at age 16.

On top of this funding, we increased core schools funding by £2.6 billion last year and are increasing core schools funding by £4.8 billion and £7.1 billion in 2021-22 and 2022-23 respectively, compared to 2019-20.

In addition, over the past year we have made three major interventions to support education recovery, totalling over £3 billion additional spend: £1 billion in June 2020, a further £700 million in February 2021 and our latest £1.4 billion package announced in June 2021.

Recovery programmes have been designed to allow early years, school and college leaders the flexibility to support those pupils most in need, including the most disadvantaged. The latest announcement expands our reforms in two areas where the evidence is clear our investment will have a significant impact for disadvantaged children, high quality tutoring and great teaching.

We are providing over £1.5 billion for tutoring programmes, including an expansion of the National Tutoring Programme (NTP), an ambitious scheme that supports schools to access targeted tutoring intervention for disadvantaged pupils who have missed out on learning due to school closures. We will also provide greater flexibility to schools to make it easier for them to take on local tutors or use existing staff to supplement those employed through the NTP. This new blended offer ensures that the NTP works for all disadvantaged children, giving schools the flexibility to choose what type of approach best suits their needs and those of individual pupils.

The £302 million Recovery Premium has been weighted so that schools with more disadvantaged pupils receive more funding and includes £22 million to scale up proven approaches to reduce the attainment gap.

We have also invested more than £400 million to provide internet access and over 1.3 million laptops and tablets for disadvantaged children and young people.

We are aware of a small number of children with complex needs, including those that require Aerosol Generating Procedures (AGPs), who have found it harder to return to schools. We are working with families, education settings, health services and local authorities to ensure that they are able to attend safely as soon as possible.

We published the Safe Working Guidance to help support schools in keeping everyone safe, including those children with complex medical needs who require AGPs and the staff carrying out the procedures. We are trying to give the best possible guidance to schools while recognising that every school setting is different. This guidance is available here: https://www.gov.uk/government/publications/safe-working-in-education-childcare-and-childrens-social-care/safe-working-in-education-childcare-and-childrens-social-care-settings-including-the-use-of-personal-protective-equipment-ppe.

The department has worked closely with Public Health England and stakeholders to publish guidance based on a ‘system of controls’ which, when implemented, creates an inherently safer system where the risk of transmission of the infection is substantially reduced. This includes guidance on the specific protective measures needed to undertake AGPs in education settings to manage risk effectively. The guidance can be found here: https://www.gov.uk/government/publications/safe-working-in-education-childcare-and-childrens-social-care/safe-working-in-education-childcare-and-childrens-social-care-settings-including-the-use-of-personal-protective-equipment-ppe.

The guidance on undertaking AGPs in education settings, including where use of a designated room is not possible, can be found here: https://www.gov.uk/government/publications/safe-working-in-education-childcare-and-childrens-social-care/safe-working-in-education-childcare-and-childrens-social-care-settings-including-the-use-of-personal-protective-equipment-ppe.

We have heard examples of good practice locally and are working with Public Health England and NHS England to establish whether any changes to the guidance or further information about practice principles are needed.

The Departments SEND and NHS England Adviser teams are working with local areas affected by this situation to determine whether further local measures can be put in place to secure pupils’ return to school. It is important that schools communicate clearly with parents on progress towards supporting children who need AGPs to return to school safely and provide remote education and support if they are unable to do so.

We do not hold data on the number of schools that do not have a separate room to undertake AGPs.

We are aware of a small number of children with complex needs, including those that require Aerosol Generating Procedures (AGPs), who have found it harder to return to schools. We are working with families, education settings, health services and local authorities to ensure that they are able to attend safely as soon as possible.

We published the Safe Working Guidance to help support schools in keeping everyone safe, including those children with complex medical needs who require AGPs and the staff carrying out the procedures. We are trying to give the best possible guidance to schools while recognising that every school setting is different. This guidance is available here: https://www.gov.uk/government/publications/safe-working-in-education-childcare-and-childrens-social-care/safe-working-in-education-childcare-and-childrens-social-care-settings-including-the-use-of-personal-protective-equipment-ppe.

The department has worked closely with Public Health England and stakeholders to publish guidance based on a ‘system of controls’ which, when implemented, creates an inherently safer system where the risk of transmission of the infection is substantially reduced. This includes guidance on the specific protective measures needed to undertake AGPs in education settings to manage risk effectively. The guidance can be found here: https://www.gov.uk/government/publications/safe-working-in-education-childcare-and-childrens-social-care/safe-working-in-education-childcare-and-childrens-social-care-settings-including-the-use-of-personal-protective-equipment-ppe.

The guidance on undertaking AGPs in education settings, including where use of a designated room is not possible, can be found here: https://www.gov.uk/government/publications/safe-working-in-education-childcare-and-childrens-social-care/safe-working-in-education-childcare-and-childrens-social-care-settings-including-the-use-of-personal-protective-equipment-ppe.

We have heard examples of good practice locally and are working with Public Health England and NHS England to establish whether any changes to the guidance or further information about practice principles are needed.

The Departments SEND and NHS England Adviser teams are working with local areas affected by this situation to determine whether further local measures can be put in place to secure pupils’ return to school. It is important that schools communicate clearly with parents on progress towards supporting children who need AGPs to return to school safely and provide remote education and support if they are unable to do so.

We do not hold data on the number of schools that do not have a separate room to undertake AGPs.

We are aware of a small number of children with complex needs, including those that require Aerosol Generating Procedures (AGPs), who have found it harder to return to schools. We are working with families, education settings, health services and local authorities to ensure that they are able to attend safely as soon as possible.

We published the Safe Working Guidance to help support schools in keeping everyone safe, including those children with complex medical needs who require AGPs and the staff carrying out the procedures. We are trying to give the best possible guidance to schools while recognising that every school setting is different. This guidance is available here: https://www.gov.uk/government/publications/safe-working-in-education-childcare-and-childrens-social-care/safe-working-in-education-childcare-and-childrens-social-care-settings-including-the-use-of-personal-protective-equipment-ppe.

The department has worked closely with Public Health England and stakeholders to publish guidance based on a ‘system of controls’ which, when implemented, creates an inherently safer system where the risk of transmission of the infection is substantially reduced. This includes guidance on the specific protective measures needed to undertake AGPs in education settings to manage risk effectively. The guidance can be found here: https://www.gov.uk/government/publications/safe-working-in-education-childcare-and-childrens-social-care/safe-working-in-education-childcare-and-childrens-social-care-settings-including-the-use-of-personal-protective-equipment-ppe.

The guidance on undertaking AGPs in education settings, including where use of a designated room is not possible, can be found here: https://www.gov.uk/government/publications/safe-working-in-education-childcare-and-childrens-social-care/safe-working-in-education-childcare-and-childrens-social-care-settings-including-the-use-of-personal-protective-equipment-ppe.

We have heard examples of good practice locally and are working with Public Health England and NHS England to establish whether any changes to the guidance or further information about practice principles are needed.

The Departments SEND and NHS England Adviser teams are working with local areas affected by this situation to determine whether further local measures can be put in place to secure pupils’ return to school. It is important that schools communicate clearly with parents on progress towards supporting children who need AGPs to return to school safely and provide remote education and support if they are unable to do so.

We do not hold data on the number of schools that do not have a separate room to undertake AGPs.

Supporting and promoting children and young people’s mental health and wellbeing is a priority for this government. We continue to work closely with schools, colleges, the higher education sector, and local areas to provide support, guidance, and encourage good practice.

The Department for Health and Social Care (DHSC) has overall policy responsibility for children and young people’s mental health. The Department for Education works closely with DHSC to take significant steps to support the mental health and wellbeing support for young people across all education settings.

Mental Health Support Teams (MHSTs) are an important part of our long term plan to promote and support children and young people’s mental health in state-funded schools and colleges, and we remain committed to rolling them out to at least a fifth to a quarter of the country by the end of the academic year 2022/23.

There are 59 MHSTs already established in 25 areas across the country. An additional 123 MHSTs are being set up in a further 57 areas this year, and a further 104 teams have been commissioned to begin training in academic year 2020/21. Once established, MHST support schools and colleges to promote good mental health, identify and manage a wide range of issues relating to mental health and wellbeing, and deliver interventions for mild and moderate needs. This may include thoughts of self-harm and providing support with alternative coping strategies.

The NHS Long Term Plan commits to ensure that, by the academic year 2023/24, at least an additional 345,000 children and young people aged 0 to 25 will be able to access support from NHS-funded children and young people’s mental health services (formerly CAMHS) and school–based or college-based mental health support teams. Funding for CYMPHS has grown faster than overall NHS and adult mental health spending.

Every NHS mental health trust in England has provided 24/7 crisis helplines for those in all age groups who need urgent help in a mental health crisis, and will continue to do so over the coming months. We provided funding and support to the people and organisations who play a vital role in young people’s mental health, with over £10 million of funding to support mental health charities, including Young Minds and Place2Be which specifically support the mental health of children and young people. We have invested £8 million in local authorities to fund mental health and wellbeing experts to provide advice and resources for education staff to support and promote children and young people’s mental health.

We recognise that many university students are facing additional mental health challenges due to the disruption and uncertainty caused by the COVID-19 outbreak, and it is important students can still access the mental health support they need.

My right hon. Friend, the Minister of State for Universities, wrote to Vice Chancellors in October outlining that student welfare should remain a priority, and has convened a working group of representatives from the higher education and health sectors to specifically address the current and pressing issues that students are facing during the COVID-19 outbreak.

Higher education providers are expected to continue to support their students. This has included moving services online or making services accessible from a distance and we encourage students to stay in touch with their provider’s student support and welfare teams as these services are likely to continue to be an important source of support. Many providers have bolstered their existing mental health services, and adapted delivery to means other than face to face. Staff at universities and colleges responded quickly to the need to transform mental health and wellbeing services, showing resourcefulness and there are many examples of good practice.

The Office for Students funded Student Space platform bridges gaps in support for students arising from this unprecedented situation and is designed to work alongside existing services. Students struggling with their mental health at this time can also access support via the NHS at: https://www.nhs.uk/apps-library/category/mental-health/.

Online resources from Public Health England can be found at: https://www.gov.uk/government/publications/covid-19-guidance-for-the-public-on-mental-health-and-wellbeing, along with support from mental health charity, Mind, available here: https://www.mind.org.uk/information-support/tips-for-everyday-living/student-life/about-student-mental-health/.

Protecting all students', domestic and international, mental health and wellbeing continues to be a priority for this government. The disruption and uncertainty resulting from the COVID-19 outbreak has impacted all age groups, but particularly young people who are making transitions during this time.

Higher education providers are best placed to identify and address the needs of their particular student body as well as how to develop the services needed. Many providers have boosted their existing welfare and counselling services to ensure support services can be accessed, which is particularly important for those students having to self-isolate or who are affected by local restrictions.

Student Space, funded with £3 million from the Office for Students (OfS), provides dedicated support services (phone and text) for students and a collaborative online platform to help students access vital mental health and wellbeing resources. The platform bridges gaps in support for students arising from the outbreak and is designed to work alongside existing services.

The government has recently provided over £9 million to leading mental health charities to help them expand and reach those most in need. In addition, NHS mental health trusts are ensuring 24/7 access to crisis telephone lines to support people of all ages.

We have asked providers to prioritise the mental health and wellbeing of students during this period and have enabled them to use funding, worth up to £23 million per month from April to July this year and £256 million for the academic year 2020/21 starting from August, to go towards student hardship funds and mental health support.

My right hon. Friend, the Secretary of State for Education, has regularly discussed the reopening of higher education (HE) providers with his Cabinet colleagues, including with my right hon. Friend, the Secretary of State for Health and Social Care. The arrangements for the end of the autumn term were discussed on Monday 28 September.

As the Secretary of State for Education announced to the House on Tuesday 29 September, the department is working with universities to make sure that all students are supported to return home safely and spend Christmas with their loved ones, if they choose to do so. Where students choose to stay in their university accommodation over Christmas, universities should continue making sure that they are safe and well looked after. The department will work with universities to publish guidance on students returning home safely at Christmas, shortly.

The safety and wellbeing of staff and students in HE is always our priority, and the government is doing all it can to minimise the risks to those working and studying at HE providers in this unprecedented situation, while mitigating the impact on education.

I refer the hon. Members to the answer I gave on 23 June 2020 to Question 54195.

The Department is committed to supporting schools to deliver high-quality teaching of relationships education, relationships and sex education, and health education.

Many schools are already teaching aspects of these subjects as part of their sex and relationships education provision or their personal, social, health and economic education programme. Schools have flexibility to determine how to deliver the new content, in the context of a broad and balanced curriculum.

To support schools in their preparations, the Department is investing in a central package to help all schools to increase the confidence and quality of their teaching practice. We are currently developing a new online service featuring innovative training materials, case studies and support to access resources. This will be available from April 2020 with additional content added through the summer term, covering all of the teaching requirements in the statutory guidance. We will also publish an implementation guide which will be provided to all schools as part of this service, and face-to-face training will be available for schools that need additional support.

The Department is currently working with lead teachers, non-specialist teachers, schools and subject experts to develop this central programme of support to help ensure it meets the needs of schools and teachers. It will complement the wide range of training opportunities that are being provided by local authorities and sector organisations.

The Department wants to support all children and young people to be happy, healthy and safe. Through the new subjects of relationships, sex and health education, we want to equip them for adult life and to make a positive contribution to society.

These subjects will help in ensuring all young people, at age appropriate points, know the signs of unhealthy or abusive relationships, and that violence in relationships and domestic abuse is unlawful and never acceptable. Throughout these subjects there is a focus on ensuring pupils know how to get further support.

The guidance can be accessed via the following link:
https://www.gov.uk/government/consultations/relationships-and-sex-education-and-health-education.

Eight water companies have established data sharing agreements with the Department for Work and Pensions (DWP). The water sector and DWP are working together to roll out agreements with the remaining companies.

Initial feedback from water companies who have secured data sharing agreements has been positive. The data shares have enabled water companies to identify financially vulnerable customers who may benefit from specially discounted and capped water tariffs, and where appropriate, to proactively add eligible customers to these tariffs.

Defra has established a Development Group, consisting of representatives from the Consumer Council for Water (CCW), Ofwat, water companies and charities to explore the review’s recommendations of a single social tariff scheme.

The Consumer Council for Water's (CCW) Affordability Review suggested that Defra should make the Landlord and Tenant Address Portal compulsory in England to raise the visibility of residents who may need help.

Since the publication of CCW's report, Defra has had initial discussions with CCW and Landlord Tap Ltd on this recommendation and look forward to further engagement. Data sharing agreements enabled under the Digital Economy Act 2017 and the pilots that have evolved out of the CCW's report, should also help identify vulnerable tenants. We will work with CCW and industry on how water companies can better identify and support their customers.

Water Direct is not intended as a budgeting tool or an alternative method of paying bills for those receiving benefit.

All water companies offer WaterSure and social tariffs to help reduce bills for households who struggle to pay their bills in full. Water companies also offer a range of financial support measures to assist households to better manage their budgets including payment holidays, bill matching, benefit entitlement checks and money/debt advice referral arrangements.

(a) Ofwat, the independent economic regulator, is responsible for ensuring that water companies charge fair prices and deliver quality services, through a process called the Price Review.

(b) All water companies offer reduced bills for eligible customers via the WaterSure scheme and social tariffs. Water companies also offer a range of other financial support measures such as payment holidays, bill matching and advice on debt management and water efficiency. Last October, Defra commissioned the Consumer Council for Water (CCW) to review the effectiveness of existing support schemes in water to ensure they are fit for purpose now and in the future. Defra is working with CCW and industry to explore CCW’s recommendations (see Independent Affordability Review | CCW (ccwater.org.uk)) further.

(c) As part of Ofwat's 2019 Price Review process, water companies have set out their investment needs and associated costs up to 2024/2025. The Government has set its future expectations for Ofwat in a new strategic policy statement ( The government's strategic priorities for Ofwat: draft for consultation (defra.gov.uk)) which sets out the significant Government ambitions on the environment and climate change, and how the water industry should contribute to that work.

The Government is consulting on a draft strategic policy statement for Ofwat. This will set priorities for the economic regulator in the following areas:

• Protecting and enhancing the environment – including supporting delivery of the 25 Year Environment Plan, net zero, nature-based solutions and catchment approaches by water companies,
• Delivering a more resilient water sector; and
• Serving and protecting customers, including those who are vulnerable.

The consultation for the strategic policy statement can be accessed via the link here:

https://www.gov.uk/government/consultations/water-industry-governments-strategic-policy-statement-for-ofwat

The Government is consulting on a draft strategic policy statement for Ofwat. This will set priorities for the economic regulator in the following areas:

• Protecting and enhancing the environment – including supporting delivery of the 25 Year Environment Plan, net zero, nature-based solutions and catchment approaches by water companies,
• Delivering a more resilient water sector; and
• Serving and protecting customers, including those who are vulnerable.

The consultation for the strategic policy statement can be accessed via the link here:

https://www.gov.uk/government/consultations/water-industry-governments-strategic-policy-statement-for-ofwat

The Government is consulting on a draft strategic policy statement for Ofwat. This will set priorities for the economic regulator in the following areas:

• Protecting and enhancing the environment – including supporting delivery of the 25 Year Environment Plan, net zero, nature-based solutions and catchment approaches by water companies,
• Delivering a more resilient water sector; and
• Serving and protecting customers, including those who are vulnerable.

The consultation for the strategic policy statement can be accessed via the link here:

https://www.gov.uk/government/consultations/water-industry-governments-strategic-policy-statement-for-ofwat

The health and documentary requirements for pet travel to the EU are set out under the EU Pet Travel Regulations. Under the Northern Ireland Protocol, EU rules also apply to the non-commercial movements of pets into Northern Ireland from Great Britain. There are no derogations for assistance dogs under the legal framework of the EU Pet Travel Regulations.

We will continue to press the European Commission in relation to securing Part 1 listed status, recognising that achieving this would alleviate some of the new requirements for pet owners and assistance dog users travelling to the EU and to Northern Ireland. We are clear that we meet all the animal health requirements for this, and we have one of the most rigorous pet checking regimes in Europe to protect our biosecurity.

The Government is engaging with the Northern Ireland Department of Agriculture, Environment and Rural Affairs (DAERA) to explore means to streamline pet travel between Great Britain and Northern Ireland recognising the high standards of animal health that we share. The Chancellor of the Duchy of Lancaster has also written to the European Vice-President seeking to ensure that an agreement can be made to address the barriers imposed on pet travel between Great Britain, Northern Ireland and Ireland.

In the meantime, the Department of Agriculture, Environment and Rural Affairs (DAERA) in Northern Ireland has recently published guidance on a pragmatic enforcement approach to pets entering from Great Britain. Northern Ireland-based pets and assistance dogs returning to Northern Ireland from Great Britain can continue to use a Northern Ireland-issued EU Pet Passport to re-enter Northern Ireland and will not need an animal health certificate. Pets and assistance dogs entering from Great Britain will not be subject to routine checks until July 2021. Current guidance on pet travel to Northern Ireland is available on DAERA's NIDirect website.

We are proactively engaging with the assistance dog community and relevant stakeholders on the impacts on dog movements from Great Britain to the EU and to Northern Ireland. We will continue to work closely with assistance dog organisations to share the latest advice and guidance (in accessible formats) with their members on pet travel requirements

We are reviewing our policies for these vessels operating in UK waters. Any action taken will align with the UK/EU Trade and Cooperation Agreement and must be evidence-based.

The Government is committed to securing the long-term future of the hen harrier as a breeding bird in England. The Hen Harrier Action Plan sets out what will be done to increase hen harrier populations in England and includes measures to stop illegal persecution. The long-term plan was published in January 2016 and we believe that it remains the best way to safeguard the hen harrier in England. A copy of the plan is available at:

www.gov.uk/government/uploads/system/uploads/attachment_data/file/491818/hen-harrier-action-plan-england-2016.pdf.

Natural England has recorded the best year for hen harrier breeding in England since Natural England’s hen harrier recovery project was established in 2002. Illegal persecution of raptors such as the hen harrier is one of the UK's wildlife crime priorities. There are strong penalties in place for offences committed against birds of prey and other wildlife. Those convicted of committing an offence can face an unlimited fine and/or a six-month custodial sentence.

The Government recognises the conservation and economic benefits that shooting sports bring to rural communities.

All wild birds are protected under the Wildlife and Countryside Act 1981. There are strong penalties in place for offences committed against birds of prey and other wildlife; significant sanctions are available to judges to hand down to those convicted of wildlife crimes. Most wildlife crimes carry up to an unlimited fine and/or a six-month custodial sentence.

To address concerns about illegal killing of birds of prey, senior government and enforcement officers have identified raptor persecution as a national wildlife crime priority. Since 2016 Defra has contributed approximately £165,000 annually to the National Wildlife Crime Unit that monitors and gathers intelligence on wildlife crime, including raptor persecution, and aids police forces in their investigations when required.

We are committed to securing the long-term future of the hen harrier as a breeding bird in England. The Hen Harrier Action Plan sets out what will be done to increase hen harrier populations in England and includes measures to stop illegal persecution. The long-term plan was published in January 2016 and we believe that it remains the best way to safeguard the hen harrier in England. A copy of the plan is available at: www.gov.uk/government/uploads/system/uploads/attachment_data/file/491818/henharrier-action-plan-england-2016.pdf

Whilst the Government has no current plans to carry out a review of the management of grouse moors, we recognise that it is vital that wildlife and habitats are respected and protected, and that the law is observed. We will continue to work to ensure a sustainable, mutually beneficial relationship between shooting and conservation.

Public transport plays a key role in supporting several Government policy areas including decarbonisation, levelling up and growth.

I was delighted to visit Gateshead recently to launch the Get Around for £2 bus fare cap. We are also pushing ahead with the National Bus Strategy and the Integrated Rail Plan.

Following the confirmation of our budgets in the 2022 Autumn Statement, we are working through how we continue to deliver our priorities whilst managing the impact of inflation.

The Government recognises the challenges faced by the light rail sector caused by higher energy costs. Light rail systems are eligible under the Government’s Energy Bill Relief Scheme which provides a discount on wholesale electricity prices. This scheme is in place from 1 October 2022 to 31 March 2023 and is reducing financial pressures across the light rail sector by millions of pounds this winter.

The Government has announced the new Energy Bill Discount Scheme, which will provide a level of support with energy costs for a further 12 months for non-domestic customers from 1 April 2023 to March 2024.

The Department continues to engage with Nexus and all local transport authorities that have light rail systems to fully understand the ongoing impacts of higher energy prices.

The Government recognises the challenges faced by the light rail sector caused by higher energy costs. Light rail systems are eligible under the Government’s Energy Bill Relief Scheme which provides a discount on wholesale electricity prices. This scheme is in place from 1 October 2022 to 31 March 2023 and is reducing financial pressures across the light rail sector by millions of pounds this winter.

The Government has announced the new Energy Bill Discount Scheme, which will provide a level of support with energy costs for a further 12 months for non-domestic customers from 1 April 2023 to March 2024.

The Department continues to engage with Nexus and all local transport authorities that have light rail systems to fully understand the ongoing impacts of higher energy prices.

Platform edge tactiles are part of the scope for more than 100 accessible routes due to be installed under our Access for All programme by 2024. In addition, whenever the industry installs, replaces or renews platform infrastructure they are required to install tactiles.

I have asked Network Rail to work up a costed plan for a wider roll out of tactiles for stations where tactiles are not being delivered under another programme.

Platform edge tactiles are part of the scope for more than 100 accessible routes due to be installed under our Access for All programme by 2024. In addition, whenever the industry installs, replaces or renews platform infrastructure they are required to install tactiles.

I have asked Network Rail to work up a costed plan for a wider roll out of tactiles for stations where tactiles are not being delivered under another programme.

The Department has been clear that airlines and travel agents should not deny consumers their legal right to a refund, if it is requested and this should be done in a timely manner. The Civil Aviation Authority (CAA) undertook a review of the refund policies of all UK airlines, as well as a number of international airlines that operate flights to and from the UK. The CAA has utilised this review to influence airlines to change their processes and practices in order to improve performance in providing refunds. The CAA’s actions have led to an improved quality of service and performance from most airlines. The CAA continues to work with carriers to drive down waiting times, but balancing the support businesses need during this unprecedented situation.

The COVID-19 pandemic has highlighted a number of challenges. The department is keen to work with the regulator, industry and consumer groups to learn lessons from pandemic, to make changes that are practicable and deliverable.

The Department has been working closely with bus operators to understand the issues they face in providing services whilst ensuring social distancing for both passengers and staff. We are also working urgently to provide further support to the bus sector to enable operators, working with local transport authorities, to ramp up service provision for people returning to work. An announcement will be made shortly on the further support that will be provided.

A further £29 million was announced by the Transport Secretary on 23 May to increase tram and light rail services across the country so that people who need to travel, including critical workers in the NHS, can do so safely. The Tyne and Wear Passenger Transport Executive (NEXUS) is estimated to receive £7.6 million of that funding for the Tyne and Wear Metro.

A further £29 million was announced by the Transport Secretary on 23 May to increase tram and light rail services across the country so that people who need to travel, including critical workers in the NHS, can do so safely. The Tyne and Wear Passenger Transport Executive (NEXUS) is estimated to receive £7.6 million of that funding for the Tyne and Wear Metro.

The Government recognises the important economic contribution of disabled people in the labour market and is committed to seeing 1 million more disabled people in work. DWP delivers a range of programmes to support disabled people, including those with severe asthma, to stay in or move into work.

These include the Work and Health Programme, Intensive Personalised Employment Support, Access to Work, Disability Confident and initiatives in partnership with the health system, including Employment Advice in NHS Improving Access to Psychological Therapy services and Individual Placement and Support.

Analysis published by the Office for National Statistics (ONS) shows that disabled employees are generally under-represented in higher skilled and typically higher paying occupation groups, while they are over-represented in lower-skilled and lower paying occupations when compared to non-disabled employees. Disabled workers are also less likely to move into and be in work, as well as more likely to move out of work.

Baroness Ruby McGregor-Smith is currently leading a commission looking at how DWP, wider Government and employers can best support people to progress out of low pay, especially for those groups more likely to be in persistent low pay, such as disabled workers.

The Government is committed to ensuring that everybody, including people with asthma, has equal access to employment opportunities and offers a range of support to help disabled people to stay in or move into work.

In 2019, the Government consulted on ways to support and encourage employers to minimise the risk of ill-health related job loss among their employees in Health is Everyone's Business: proposals to reduce ill-health related job loss. Our response is due shortly.

The Government will also publish a National Strategy for Disabled People which will focus on issues that disabled people say affect them the most in all aspects of life, including employment.

The Government is committed to ensuring that people with disabilities and health conditions are able to stay in work and offers a range of support. Access to Work (ATW) is a demand-led, discretionary grant scheme administered by Jobcentre Plus (JCP). The scheme facilitates recruitment and retention of disabled people for employers by contributing towards covering the costs of employment –related support above the level of reasonable adjustment. The scheme can fund up to £60,700 worth of flexible, personalised support per person per year.

In 2019, the Government consulted on ways to support and encourage employers to minimise the risk of ill-health related job loss among their employees in Health is Everyone's Business. Our response is due shortly.

The available information on the number of households with children with Universal Credit in payment, by parliamentary constituency, is published and can be found at:

https://stat-xplore.dwp.gov.uk/

Guidance on how to extract the information required can be found at:

https://stat-xplore.dwp.gov.uk/webapi/online-help/Getting-Started.html

The Government is committed to ensuring that older people are able to live with the dignity and respect they deserve, and the State Pension is the foundation of state support for older people.

In April 2020, both the basic and new State Pensions (excluding protected payments) increased by 3.9%, in line with average earnings. The full yearly basic State Pension is worth over £1,900 more in 2020/21 than it was in 2010.

A range of mental health support is available. We have delivered mental health training to all work coaches to support claimants with mental health conditions. The Department has developed an enhanced mental health training programme, which has been delivered to all work coaches and managers. Work Coaches will tailor the support to the needs of the individual and work closely with local organisations that provide additional specialist support.

NHS mental health services have remained open for business throughout the covid-19 pandemic, and have used digital tools to connect with people and provide ongoing support. For those with severe needs or in crisis, NHS England has instructed all NHS mental health trusts to establish 24/7 mental health crisis lines and every mental health provider has at least one line. The Government is also working with the NHS and a wide range of stakeholders to assess potential need in all areas over the coming weeks and months and to plan accordingly.

There are currently no plans to include a proposal to provide alert cards to patients with rare diseases in the England Rare Diseases Action Plan in the next five years.

In the Second Progress Report from the Rare Disease Policy Board (2018), NHS England proposed to give every patient with a rare disease an ‘alert card’, which would include information about the patient’s rare disease. This proposal to develop ‘alert cards’ was not progressed at the time due to capacity constraints.

This proposal has not featured in the subsequent England Rare Diseases Action Plans (2022 and 2023), and NHS England is now focussing on delivering against the actions identified in these new plans. Progress is being made on existing actions to improve coordination of care and awareness of rare diseases amongst all health care professionals, including those who work in emergency settings.

The Major Conditions Strategy will set out a vision for how systems can be better organised around patients, rather than in silos around single diseases. Support and management for people with multiple conditions will increasingly require the management of complexity and moving from a single condition approach. The National Health Service will need to adapt to manage the complexity of multiple conditions with the consequent need to co-ordinate clinical support across primary, community and secondary care.

No assessment has been made of the potential impact of the withdrawal of Bluebird Bio from the United Kingdom and European markets on access to gene therapy treatment for people with beta thalassemia and cerebral adrenoleukodystrophy. NHS England continues to make cost-effective treatments available to patients in England as determined by NICE’s technology appraisal and highly specialised technologies programmes.

Companies may decide to stop manufacturing a medicine for several reasons including commercial decisions, manufacturing capacity restraint and production problems. Companies are free to review their portfolios as they think necessary, and the Department has no powers to insist that a company continues to keep a product on the market.

There is a team within the Department that deals specifically with medicine supply problems. It has well-established procedures to deal with medicine shortages and discontinuations, whatever the cause, and works closely with the Medicines and Healthcare products Regulatory Agency, the pharmaceutical industry, NHS England, and others operating in the supply chain to help prevent shortages and to ensure that the risks to patients are minimised when shortages do arise. The team will also communicate management advice to the National Health Service advising clinicians on how to manage medicine supply issues.

A table showing how many inspections of (a) adult social care providers, (b) primary medical services, (c) hospitals and (d) mental health services were carried out by the Care Quality Commission in (i) London (ii) East of England network (iii) the South East and (iv) the South West, in each of the last 24 months, is attached.

A table showing how many inspections of (a) adult social care providers, (b) primary medical services, (c) hospitals and (d) mental health services were carried out by the Care Quality Commission in (i) London (ii) East of England network (iii) the South East and (iv) the South West, in each of the last 24 months, is attached.

I refer the hon. Member to the written statement HCWS861 that I gave to the House on 19 June 2023 regarding Sight Testing in Special Schools. The Department will continue to support NHS England with implementation, including considering whether any regulatory changes may be necessary. The written statement is available at the following link:

https://questions-statements.parliament.uk/written-statements/detail/2023-06-19/hcws861

A total of £57 million was allocated through the NHS Long Term Plan to enable every area of the country to receive funding for suicide prevention and bereavement services by 2023/24. Approximately two thirds of this £57 million, £38 million, has been spent on suicide prevention and the remainder on suicide bereavement services.

The ‘NHS Mental Health Implementation Plan 2019/20 – 2023/24’ provides a detailed breakdown of this investment and the activity that it is due to fund. This is available at the following link: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/07/nhs-mental-health-implementation-plan-2019-20-2023-24.pdf.

The NHS Mental Health Dashboard sets out year by year spending plans for local and national NHS commissioning organisations, which is available at the following link: https://www.england.nhs.uk/mental-health/taskforce/imp/mh-dashboard/

We continue to provide funding to local authority stop smoking services via the Public Health Grant. The local authority in Gateshead commission a highly effective Stop Smoking Service which is available to all smokers locally.

We are analysing all the responses to the Down Syndrome Act guidance call for evidence which ran from July to November 2022. The responses to the call for evidence will inform the development of the guidance, required by the Act, which will be consulted on at the earliest opportunity.

The Act places a duty on the Secretary of State for Health and Social Care to publish guidance for relevant authorities, including health, social care, education and housing, on the steps it would be appropriate to take to meet the needs of people with Down syndrome. Guidance will cover these areas and others highlighted as important by the call for evidence. We will continue to work closely with stakeholders and a working group will be set up in due course to support development of the guidance.

We are undertaking analysis of the consultation responses received from the Down Syndrome Act guidance call for evidence and will issue a report in due course. This report will include a detailed breakdown of respondents and information about what capacity individuals or organisations were responding in, and the area they work in, for example healthcare, social care, or local Government.

We are undertaking analysis of the consultation responses received from the Down Syndrome Act guidance call for evidence and will issue a report in due course. This report will include a detailed breakdown of respondents and information about what capacity individuals or organisations were responding in, and the area they work in, for example healthcare, social care, or local Government.

Minimising the time taken to deliver a genomic test is a key priority for NHS England. NHS England has implemented a monthly data collection and monitoring system across all seven Genomic Laboratory Hubs (GLHs) to better identify variation, implement service improvements and to ensure agreed national turnaround times are met in every region for all patients.

The COVID-19 pandemic has had an ongoing impact on the genomic testing pathway. NHS England are providing the GLHs with additional funding to support recovery and reduce backlogs caused by the COVID-19 pandemic.

GLHs are also undertaking clinical risk assessments on all cases waiting for results so that any can be prioritised for early reporting as needed.

Clinicians are also able to classify cases as ‘urgent’ when a patient has a deteriorating or unstable condition that requires a quicker diagnosis.

Minimising the time taken to deliver a genomic test is a key priority for NHS England. NHS England has implemented a monthly data collection and monitoring system across all seven Genomic Laboratory Hubs (GLHs) to better identify variation, implement service improvements and to ensure agreed national turnaround times are met in every region for all patients.

The COVID-19 pandemic has had an ongoing impact on the genomic testing pathway. NHS England are providing the GLHs with additional funding to support recovery and reduce backlogs caused by the COVID-19 pandemic.

GLHs are also undertaking clinical risk assessments on all cases waiting for results so that any can be prioritised for early reporting as needed.

Clinicians are also able to classify cases as ‘urgent’ when a patient has a deteriorating or unstable condition that requires a quicker diagnosis.

Several of the actions in the 2022 and 2023 England Rare Diseases Action Plans focus on genomic approaches to provide faster diagnosis for people with undiagnosed rare conditions, including genetic conditions. However, for some people living with extremely rare diseases, the complex and rare nature of their conditions may mean that they never receive a diagnosis. We are committed to ensuring that these people and their families also receive the support and care they need.

In the England Rare Diseases Action Plan 2022 NHS England committed to ‘pilot new approaches for patients with undiagnosed conditions’ (action 5). To address this commitment, during 2022, NHS England developed a proposal for a syndrome without a name (SWAN) Pilot Programme for people whose conditions remain undiagnosed. It will progress through the NHS England finance and governance processes and there will be a clearer plan for delivery in the next few months. If the SWAN Pilot Programme expands such that there is a need for a service specification, the normal processes would be followed in terms of engaging with stakeholders, including consulting with patients and the public on the delivery of the Programme.

Several of the actions in the 2022 and 2023 England Rare Diseases Action Plans focus on genomic approaches to provide faster diagnosis for people with undiagnosed rare conditions, including genetic conditions. However, for some people living with extremely rare diseases, the complex and rare nature of their conditions may mean that they never receive a diagnosis. We are committed to ensuring that these people and their families also receive the support and care they need.

In the England Rare Diseases Action Plan 2022 NHS England committed to ‘pilot new approaches for patients with undiagnosed conditions’ (action 5). To address this commitment, during 2022, NHS England developed a proposal for a syndrome without a name (SWAN) Pilot Programme for people whose conditions remain undiagnosed. It will progress through the NHS England finance and governance processes and there will be a clearer plan for delivery in the next few months. If the SWAN Pilot Programme expands such that there is a need for a service specification, the normal processes would be followed in terms of engaging with stakeholders, including consulting with patients and the public on the delivery of the Programme.

Several of the actions in the 2022 and 2023 England Rare Diseases Action Plans focus on genomic approaches to provide faster diagnosis for people with undiagnosed rare conditions, including genetic conditions. However, for some people living with extremely rare diseases, the complex and rare nature of their conditions may mean that they never receive a diagnosis. We are committed to ensuring that these people and their families also receive the support and care they need.

In the England Rare Diseases Action Plan 2022 NHS England committed to ‘pilot new approaches for patients with undiagnosed conditions’ (action 5). To address this commitment, during 2022, NHS England developed a proposal for a syndrome without a name (SWAN) Pilot Programme for people whose conditions remain undiagnosed. It will progress through the NHS England finance and governance processes and there will be a clearer plan for delivery in the next few months. If the SWAN Pilot Programme expands such that there is a need for a service specification, the normal processes would be followed in terms of engaging with stakeholders, including consulting with patients and the public on the delivery of the Programme.

In the Second Progress Report from the Rare Disease Policy Board (2018), NHS England proposed to give every patient with a rare disease an ‘alert card’, which would include information about the patient’s rare disease.

This proposal to develop ‘alert cards’ was not progressed at the time due to capacity constraints. This proposal has not featured in the subsequent England Rare Diseases Action Plans (2022 and 2023), and NHS England is now focussing on delivering against the actions identified in these new plans. Under the coordination of care priority this has included developing a toolkit for virtual consultations to help people with complex, multi-system rare diseases access multiple specialists without needing to travel. The England 2023 Rare Diseases Action Plan includes actions to provide the evidence needed to operationalise better coordination of care in the National Health Service and to include the definition of coordination of care in service specifications for patients with rare diseases.

Under the Care Act 2014, local authorities are required to undertake a carer’s assessment for any unpaid carer who appears to have a need for support and to meet their eligible needs on request from the carer. We have not made any assessment of the potential impact of waiting times for National Health Service Parkinson's disease care in England on people who provide unpaid care to their partners who have Parkinson's.

No assessment has been made by the Department.

As the Chancellor announced in the Spring Budget, we will assign an extra £10 million over the next two years for a Suicide Prevention Voluntary, Community and Social Enterprise Grant Fund. Further information about the fund will be set out in due course.

NHS England firmly supports and encourages local integrated care boards to adopt National Institute for Health and Care Excellence guidance in relation to the management of Type 1 diabetes, which includes recommended use of insulin pump.

NHS England is using the Core20PLUS5 approach to support the reduction of healthcare inequalities at both national and system level. A clinical focus for Core20PLUS5 for children and young people includes diabetes.

The approach targets populations living in 20% of the most deprived areas as identified by the national Index of Multiple Deprivation and identifies five focussed clinical areas requiring accelerated improvement.

The Major Conditions Strategy will include both immediate and long-term action to tackle major conditions.

The Strategy’s focus is on tackling conditions that contribute most to morbidity and mortality across the population in England: cancers; cardiovascular disease, including stroke and diabetes; chronic respiratory diseases; dementia; mental ill health; and musculoskeletal conditions.

The Strategy will cover treatment and prevention for all six conditions and we will continue to work closely with stakeholders, citizens and the National Health Service in the coming weeks to identify actions that will have the most impact.

The Department of Health and Social Care will deliver the Major Conditions Strategy in consultation with NHS England and other Government Departments.

The Major Conditions Strategy will cover prevention to treatment for six broad conditions including mental ill health and we will continue to work closely with stakeholders, citizens and the National Health Service in coming weeks to identify actions that will have the most impact. No decisions have yet been made on which specific mental health conditions might be included in the strategy.

We received over 5,000 submissions to our mental health and wellbeing call for evidence, and we appreciate the engagement work many stakeholders carried out with children and young people, to inform their responses. We have analysed these responses and we will consider them as part of the process for developing the mental ill health content in the Major Conditions Strategy.

The Department and NHS England are working together on an ongoing basis to review progress of commitments in the NHS Long Term Plan. The Hewitt Review is currently looking at the scope and options for national targets and how to empower local leaders to improve outcomes for their populations and the Department looks forward to considering its conclusions. The Government is building on the commitments in the NHS Long Term Plan through the ‘Delivery plan for tackling the COVID-19 backlog of elective care’, the ‘Delivery plan for recovering urgent and emergency care services’, the upcoming general practice access recovery plan, as well as the long term workforce plan and the major conditions strategy which will be published in due course.

The Government remains committed to tackling gambling-related harms and prioritising gambling as a public health issue. The Department for Digital, Culture, Media and Sport (DCMS), the lead Government department responsible for gambling policy, is currently leading a review of the Gambling Act (2005). The Department of Health and Social Care continues to work with DCMS to strengthen the current public health approach, including encouraging actions to prevent harms from arising in the first place.

To address the relationship between gambling and suicide, we are focused on ensuring those experiencing harms are able to access the right treatment and support in a timely manner. NHS England remain on track to deliver against their Long Term Plan commitment to create 15 specialist gambling treatment clinics by 2023/24. As at time of writing, there are now eight of these clinics in operation across England.

On 24 January 2023, we announced that we will publish a new National Suicide Prevention Strategy later this year. As part of the development of the strategy, we will consider the changing pattern of risk of suicide associated with issues such as harmful gambling and the Department will engage with key stakeholders, across both the gambling and health sector, during this process.

The Government announced on 24 January 2023 that it will publish a Major Conditions Strategy. An interim report will be published in the summer. The strategy will set out a strong and coherent policy agenda that sets out a shift to integrated, whole-person care. Interventions set out in the strategy will aim to alleviate pressure on the health system, as well as support the Government’s objective to increase healthy life expectancy and reduce ill-health related labour market inactivity.

The strategy will tackle conditions that contribute most to morbidity and mortality across the population in England including, cancers, cardiovascular disease, including stroke and diabetes, chronic respiratory diseases, dementia, mental ill health and musculoskeletal conditions.

Health disparities exist across a wide variety of conditions from cancer to mental health, and contribute to stark and unacceptable variation in the number of years people live in good health. Therefore, the Major Conditions Strategy will apply a geographical lens to each condition to address regional disparities in health outcomes, supporting the levelling up mission to improve health and reduce disparities. As material for the Major Conditions Strategy will cover many of the same areas as the Health Disparities White Paper (HDWP), we will no longer be publishing the HDWP.

The Government published a draft Mental Health Bill on 23 June 2022. It is available at the following link:

https://www.gov.uk/government/publications/draft-mental-health-bill-2022

The draft Bill is focused on modernising the Mental Health Act 1983, which provides the legislative framework under which people may be detained and treated for a severe mental disorder. The draft Bill is currently subject to pre-legislative scrutiny by a joint Parliamentary Committee. Information on the Committee is available at the following link:

https://committees.parliament.uk/committee/605/joint-committee-on-the-draft-mental-health-bill/

Following pre-legislative scrutiny, the Government will bring forward a Mental Health Bill when Parliamentary time allows.

The ambition to improve healthy life expectancy by five years by 2035 and reduce the gap by 2030 remains Government policy. A significant proportion of ill-health is preventable. We are focusing on the major conditions which contribute to early mortality and reduce years of good health and factors such as smoking, poor diet and alcohol which disproportionately impact some communities.

The measures include the ambition for England to be smoke-free by 2030 and addressing obesity through working with the food industry to ensure it is easier to make healthier choices and to increase progress on the reformulation of foods. We will set out more information on plans to address health disparities in due course.

The information requested is not collected centrally.

There are currently two memory assessment services provided by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, with 682 patients currently waiting to attend a first appointment, of which 527 are yet to be offered an appointment date. The data requested for England is not held centrally.

There are currently two memory assessment services provided by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, with 682 patients currently waiting to attend a first appointment, of which 527 are yet to be offered an appointment date. The data requested for England is not held centrally.

NHS England has made guidance available for services related to specific care pathways to improve the data submitted to the Mental Health Services Dataset and issued guidance for the recording of outcomes data, access data and for the measurement of waiting times for non-urgent access to community children and young people’s mental health services. NHS England is providing additional support to assist local areas to overcome local data flow challenges and to make data products such as dashboards routinely available for services to review. Existing guidance is being improved to support local National Health Service commissioners supporting voluntary and community sector providers to submit data to the Mental Health Services Dataset and question and answer sessions have been delivered to respond to enquiries and examine barriers to submitting the data.

England’s adult and paediatric cystic fibrosis service specification sets out national standards for cystic fibrosis services, including the importance of multi-disciplinary teams involving clinical psychologists and social workers. There are regular discussions between regional commissioning teams and providers, which include reviewing compliance with service standards and service quality issues in the services commissioned.

Service specifications are contractual documents between commissioners and providers. However, it does not mandate the number of staff in a multi-disciplinary team, as that is determined by the local trust according to the size of the service and the needs of the patient population. There are no plans to review staffing levels in cystic fibrosis multi-disciplinary teams.

No specific assessment has been made. The Health and Care Professions Council (HCPC) is independent of Government and is responsible for setting its registration fees policy. Any changes to its fees are included in rules which must be laid before Parliament.

On 22 September 2022, the HCPC opened a consultation on a proposal to increase the fees it charges registrants and applicants, which is due to close on 15 December 2022. The HCPC published an online equality impact assessment alongside its consultation document.

No specific assessment has been made. The Health and Care Professions Council (HCPC) is independent of Government and is responsible for setting its registration fees policy. Any changes to its fees are included in rules which must be laid before Parliament.

On 22 September 2022, the HCPC opened a consultation on a proposal to increase the fees it charges registrants and applicants, which is due to close on 15 December 2022. The HCPC published an online equality impact assessment alongside its consultation document.

There have been no discussions between the Secretary of State for Health and Social Care, and representatives of the Professional Standards Authority (PSA) on the organisation’s funding model.

Section 25A of the NHS Reform and Health Care Professions Act 2002 sets out the process for setting the PSA’s fee. PSA funding is reviewed as part of an annual fees consultation process and the Privy Council is responsible for making the regulations requiring the healthcare regulatory bodies to pay fees to the PSA and for determining the amount they should pay.

Reforms to professional regulation is not expected to add costs to the health and care sector. The current model of regulation for healthcare professionals will be reformed to provide further protection for patients, support health services and allow the workforce meet future challenges.

Hospital Episode Statistics data is collected by financial year. In 2020/21, the mean average waiting time between a decision to admit and admission to hospital for free flap or autologous breast reconstruction was 319 days, with a median average of 301 days. Provisional data for 2021/22 shows a mean average waiting time of 388 days and a median average of 330 days.

This information is not held in the format requested as Hospital Episode Statistics data is collected by financial year. In 2020/21, the mean average waiting time for breast reconstruction between a decision to admit and admission to hospital was 209 days, with an average median waiting time of 140 days. Provisional data for 2021/22 shows that the mean average waiting time was 256 days, with a median average of 132 days.

While there are no current plans to do so, there are two existing indicators within the Investment and Impact Fund (IIF) aimed at improving the care of people with asthma. NHS England and NHS Improvement will continue to work with representatives of general practitioners (GPs) to refine the IIF. Within the Quality and Outcomes Framework (QOF), practices are incentivised to establish and maintain a register of patients with an asthma diagnosis. The QOF also incentivises GPs to develop a written, personalised asthma plan for each patient to identify the best courses of treatment.

This information is not collected in the format requested.

Asthma biologics were selected for tailored support by the Accelerated Access Collaborative’s (AAC) Rapid Uptake Products programme. This aimed to increase adoption in the National Health Service for the treatment of severe asthma in 2021/22. The AAC has now concluded its support following an additional 2,185 patients initiated on asthma biologics through the programme. The Academic Health Sciences Network continues to support NHS organisations to improve access to these medicines in 2022/23.

All asthma biologics are prescribed following a decision by a specialist severe asthma multi-disciplinary team under specialised commissioning arrangements. Severe asthma networks are configured to meet local needs and in some areas biologics may be prescribed in secondary care through these networks, with the appropriate governance in place.

Asthma biologics were selected for tailored support by the Accelerated Access Collaborative’s (AAC) Rapid Uptake Products programme. This aimed to increase adoption in the National Health Service for the treatment of severe asthma in 2021/22. The AAC has now concluded its support following an additional 2,185 patients initiated on asthma biologics through the programme. The Academic Health Sciences Network continues to support NHS organisations to improve access to these medicines in 2022/23.

All asthma biologics are prescribed following a decision by a specialist severe asthma multi-disciplinary team under specialised commissioning arrangements. Severe asthma networks are configured to meet local needs and in some areas biologics may be prescribed in secondary care through these networks, with the appropriate governance in place.

This information is not held in the format requested as data on the number of dentists treating National Health Service patients is collected at national, regional and clinical commissioning group level. Patients are registered with a dental practice for the duration of their treatment and do not routinely join dental waiting lists.

The Department is aware of supply issues affecting a limited number of hormone replacement therapy (HRT) products. However, most products including alternatives to those experiencing supply issues, remain available. We are working with all suppliers of HRT medicines to maintain overall supply to patients in the United Kingdom and share regular updates with the National Health Service and the Royal College of Obstetrics and Gynaecologists.

The National Institute for Health and Care Excellence’s (NICE) guideline on the diagnosis and management of menopause includes recommendations on the use of HRT and is currently being updated. It is for clinicians to take decisions on the prescribing of HRT if appropriate, in discussion with patients and taking account of NICE guidance.

The menopause will be a priority within the forthcoming Women’s Health Strategy. We are working with the National Health Service and the UK Menopause Taskforce on improving access to hormone replacement therapy. This includes reviewing implementation options for reducing the cost of NHS prescriptions. The Life Sciences Vision sets out the aim of establishing the United Kingdom as a centre for the development, trialling and adoption of innovative new medicines. This includes the role of the NHS as a testbed for innovative treatments, creating new commercial partnerships with industry and a culture of innovation.

No specific assessment has been made. The National Institute for Health and Care Excellence (NICE) has published a guideline on the diagnosis and management of menopause that includes recommendations on the use of hormone replacement therapies (HRT). NICE’s guideline is currently being updated. It is for clinicians in discussion with their patients and taking account of NICE guidance to take decisions on the prescribing of HRT. NICE aims to publish recommendations on the clinical and cost effectiveness of all new medicines approximately at the time of licensing. National Health Service commissioners are legally required to fund medicines positively appraised by NICE.

The National Institute for Health and Care Excellence (NICE) is an independent body and is responsible for maintaining its published guidelines and quality standards.

NICE quality standards draw on existing NICE guidelines or NICE-accredited guidance and describe high-priority areas for quality improvement in a defined care or service area. NICE’s guideline on the assessment and management of heavy menstrual bleeding recommends that women are advised to take pain relief before hysteroscopy and have the option of hysteroscopy under general or regional anaesthesia. This is in line with recommendations made by the Royal College of Obstetricians and Gynaecologists.

NICE currently has no plans to update or review its quality standard or guideline on heavy menstrual bleeding. NICE maintains close surveillance of new evidence that may affect its published guidance, and would consult on proposed changes if significant new evidence were to emerge.

The National Institute for Health and Care’s guidelines for heavy menstrual bleeding suggest that hysteroscopy should be used as a diagnostic tool only when ultrasound results are inconclusive, for example, to determine the exact location of a fibroid or the exact nature of the abnormality. The Royal College of Obstetricians and Gynaecologists’ guidelines outlines best practice in outpatient hysteroscopy and identifies that outpatient treatment has both clinical and economic benefits. The Royal College is updating its clinical guidelines which are expected to be published in 2023.

No specific assessment has been made. The National Health Service advises women to consult a clinician prior to the procedure to discuss any concerns and pain relief options, including a local or general anaesthetic. Women can also discuss the option of alternative treatment, such as a pelvic ultrasound. If a woman experiences pain during the hysteroscopy, she should alert the clinician who can halt the procedure at any time. The Royal College of Obstetricians and Gynaecologists’ guideline also stresses the minimisation of pain during hysteroscopies.

NHS England and NHS Improvement’s National Speciality Adviser for Gynaecology met with representatives of the Campaign Against Painful Hysteroscopy, the Royal College of Obstetricians and Gynaecologists, and The Royal College of Anaesthetists. Officials have been advised that all attendees agreed that hysteroscopy is an effective way of assessing and treating abnormalities in the cavity of the uterus and it is essential women feel able and safe to have the procedure.

The Royal College of Obstetricians and Gynaecologists are consulting on a good practice paper ‘Pain relief and informed decision-making for outpatient hysteroscopy and procedures’. This paper makes clear that all doctors or nurses carrying out hysteroscopies must make sure women are listened to before, during and after their procedure.

On 23 December 2021, we published ‘Our Vision for the Women’s Health Strategy for England’ with the results of the call for evidence survey. The analysis of the call for evidence showed that women have often felt they were not listened to by healthcare professionals with regards to pain related to menstruation and other gynaecological conditions. The Department will be informed by the views of women as we develop the Strategy, which will be published in spring 2022.

On 22 December 2021, the Joint Committee on Vaccination and Immunisation (JCVI) provided advice on the primary vaccination of five to 11 year olds. The potential merits from vaccination were assessed according to the presence or absence of underlying health conditions that increase the risk of serious COVID-19. It advised that children aged five to 11 years in a clinical risk group, which includes complex respiratory and neurological conditions, or who were household contacts of someone who is immunosuppressed should be offered two 10 micrograms doses of the Pfizer-BioNTech COVID-19 vaccine (Comirnaty) with an interval of eight weeks between the first and second doses. The minimum interval between any vaccine dose and recent COVID-19 infection should be four weeks. Further advice regarding COVID-19 vaccination for other five to 11 year olds will be issued in due course following consideration of additional data.

On 22 December 2021, the Joint Committee on Vaccination and Immunisation (JCVI) provided advice on the primary vaccination of five to 11 year olds. The potential merits from vaccination were assessed according to the presence or absence of underlying health conditions that increase the risk of serious COVID-19. It advised that children aged five to 11 years in a clinical risk group, which includes complex respiratory and neurological conditions, or who were household contacts of someone who is immunosuppressed should be offered two 10 micrograms doses of the Pfizer-BioNTech COVID-19 vaccine (Comirnaty) with an interval of eight weeks between the first and second doses. The minimum interval between any vaccine dose and recent COVID-19 infection should be four weeks. Further advice regarding COVID-19 vaccination for other five to 11 year olds will be issued in due course following consideration of additional data.

The Department is assessing options for delivering a near Real Time Suspected Suicide Surveillance System as part of the national near Real Time Suicide Surveillance pilot (nRTSS). The next steps for establishing a national nRTSS system, including a timetable, will be considered once the findings from the current pilot project are available. The pilot project is due for completion at the end of March 2022. We have identified 16 areas in England where a system that aims to deliver near real time suspected suicide surveillance has been established. The Department is currently working with 37 of the local authorities covered by existing systems to develop and pilot a national system by the end of March 2022.

An effective national system has the potential to improve local bereavement support by reducing the time taken for suicide-related information to be made available to local service providers and commissioners. This could include proactive approaches to individuals and families who have been bereaved by suicide.

The ongoing funding requirement for a national near Real Time Suicide Surveillance system in England, and the potential contribution of coroners and the police will be assessed following the findings of the pilot. To date £360,000 of revenue funding has been spent or is committed to delivering the pilot by 31 March 2022. Capital funding of £140,000 is currently being distributed to the seven participating local areas, which are submitting bids against the remaining £700,000 of capital funding to meet further costs required to deliver the pilot this year.

The Department is assessing options for delivering a near Real Time Suspected Suicide Surveillance System as part of the national near Real Time Suicide Surveillance pilot (nRTSS). The next steps for establishing a national nRTSS system, including a timetable, will be considered once the findings from the current pilot project are available. The pilot project is due for completion at the end of March 2022. We have identified 16 areas in England where a system that aims to deliver near real time suspected suicide surveillance has been established. The Department is currently working with 37 of the local authorities covered by existing systems to develop and pilot a national system by the end of March 2022.

An effective national system has the potential to improve local bereavement support by reducing the time taken for suicide-related information to be made available to local service providers and commissioners. This could include proactive approaches to individuals and families who have been bereaved by suicide.

The ongoing funding requirement for a national near Real Time Suicide Surveillance system in England, and the potential contribution of coroners and the police will be assessed following the findings of the pilot. To date £360,000 of revenue funding has been spent or is committed to delivering the pilot by 31 March 2022. Capital funding of £140,000 is currently being distributed to the seven participating local areas, which are submitting bids against the remaining £700,000 of capital funding to meet further costs required to deliver the pilot this year.

The Department is assessing options for delivering a near Real Time Suspected Suicide Surveillance System as part of the national near Real Time Suicide Surveillance pilot (nRTSS). The next steps for establishing a national nRTSS system, including a timetable, will be considered once the findings from the current pilot project are available. The pilot project is due for completion at the end of March 2022. We have identified 16 areas in England where a system that aims to deliver near real time suspected suicide surveillance has been established. The Department is currently working with 37 of the local authorities covered by existing systems to develop and pilot a national system by the end of March 2022.

An effective national system has the potential to improve local bereavement support by reducing the time taken for suicide-related information to be made available to local service providers and commissioners. This could include proactive approaches to individuals and families who have been bereaved by suicide.

The ongoing funding requirement for a national near Real Time Suicide Surveillance system in England, and the potential contribution of coroners and the police will be assessed following the findings of the pilot. To date £360,000 of revenue funding has been spent or is committed to delivering the pilot by 31 March 2022. Capital funding of £140,000 is currently being distributed to the seven participating local areas, which are submitting bids against the remaining £700,000 of capital funding to meet further costs required to deliver the pilot this year.

The Department is assessing options for delivering a near Real Time Suspected Suicide Surveillance System as part of the national near Real Time Suicide Surveillance pilot (nRTSS). The next steps for establishing a national nRTSS system, including a timetable, will be considered once the findings from the current pilot project are available. The pilot project is due for completion at the end of March 2022. We have identified 16 areas in England where a system that aims to deliver near real time suspected suicide surveillance has been established. The Department is currently working with 37 of the local authorities covered by existing systems to develop and pilot a national system by the end of March 2022.

An effective national system has the potential to improve local bereavement support by reducing the time taken for suicide-related information to be made available to local service providers and commissioners. This could include proactive approaches to individuals and families who have been bereaved by suicide.

The ongoing funding requirement for a national near Real Time Suicide Surveillance system in England, and the potential contribution of coroners and the police will be assessed following the findings of the pilot. To date £360,000 of revenue funding has been spent or is committed to delivering the pilot by 31 March 2022. Capital funding of £140,000 is currently being distributed to the seven participating local areas, which are submitting bids against the remaining £700,000 of capital funding to meet further costs required to deliver the pilot this year.

The Department is assessing options for delivering a near Real Time Suspected Suicide Surveillance System as part of the national near Real Time Suicide Surveillance pilot (nRTSS). The next steps for establishing a national nRTSS system, including a timetable, will be considered once the findings from the current pilot project are available. The pilot project is due for completion at the end of March 2022. We have identified 16 areas in England where a system that aims to deliver near real time suspected suicide surveillance has been established. The Department is currently working with 37 of the local authorities covered by existing systems to develop and pilot a national system by the end of March 2022.

An effective national system has the potential to improve local bereavement support by reducing the time taken for suicide-related information to be made available to local service providers and commissioners. This could include proactive approaches to individuals and families who have been bereaved by suicide.

The ongoing funding requirement for a national near Real Time Suicide Surveillance system in England, and the potential contribution of coroners and the police will be assessed following the findings of the pilot. To date £360,000 of revenue funding has been spent or is committed to delivering the pilot by 31 March 2022. Capital funding of £140,000 is currently being distributed to the seven participating local areas, which are submitting bids against the remaining £700,000 of capital funding to meet further costs required to deliver the pilot this year.

The Department is assessing options for delivering a near Real Time Suspected Suicide Surveillance System as part of the national near Real Time Suicide Surveillance pilot (nRTSS). The next steps for establishing a national nRTSS system, including a timetable, will be considered once the findings from the current pilot project are available. The pilot project is due for completion at the end of March 2022. We have identified 16 areas in England where a system that aims to deliver near real time suspected suicide surveillance has been established. The Department is currently working with 37 of the local authorities covered by existing systems to develop and pilot a national system by the end of March 2022.

An effective national system has the potential to improve local bereavement support by reducing the time taken for suicide-related information to be made available to local service providers and commissioners. This could include proactive approaches to individuals and families who have been bereaved by suicide.

The ongoing funding requirement for a national near Real Time Suicide Surveillance system in England, and the potential contribution of coroners and the police will be assessed following the findings of the pilot. To date £360,000 of revenue funding has been spent or is committed to delivering the pilot by 31 March 2022. Capital funding of £140,000 is currently being distributed to the seven participating local areas, which are submitting bids against the remaining £700,000 of capital funding to meet further costs required to deliver the pilot this year.

The Department regularly discuss a range of issues with colleagues in the National Institute for Health and Care Excellence (NICE) and NHS England and NHS Improvement, including NICE’s methods review. However, NICE is an independent body and is responsible for its own methods and processes.

NICE has consulted on a range of proposals although it is too soon to comment on the changes that may be implemented. However, NICE expects to consult on the draft programme manual in the summer, with implementation of the changes from early 2022. NICE and NHS England and NHS Improvement are working together on the development of proposals for the Innovative Medicines Fund. We expect NHS England and NHS Improvement and NICE to lead an engagement exercise later this year. A detailed timescale for this will be confirmed in due course.

The Department regularly discuss a range of issues with colleagues in the National Institute for Health and Care Excellence (NICE) and NHS England and NHS Improvement, including NICE’s methods review. However, NICE is an independent body and is responsible for its own methods and processes.

NICE has consulted on a range of proposals although it is too soon to comment on the changes that may be implemented. However, NICE expects to consult on the draft programme manual in the summer, with implementation of the changes from early 2022. NICE and NHS England and NHS Improvement are working together on the development of proposals for the Innovative Medicines Fund. We expect NHS England and NHS Improvement and NICE to lead an engagement exercise later this year. A detailed timescale for this will be confirmed in due course.

The Department regularly discuss a range of issues with colleagues in the National Institute for Health and Care Excellence (NICE) and NHS England and NHS Improvement, including NICE’s methods review. However, NICE is an independent body and is responsible for its own methods and processes.

NICE has consulted on a range of proposals although it is too soon to comment on the changes that may be implemented. However, NICE expects to consult on the draft programme manual in the summer, with implementation of the changes from early 2022. NICE and NHS England and NHS Improvement are working together on the development of proposals for the Innovative Medicines Fund. We expect NHS England and NHS Improvement and NICE to lead an engagement exercise later this year. A detailed timescale for this will be confirmed in due course.

The amount of overtime worked is not held centrally. The total value of overtime worked by National Health Service staff working in the hospital and community health sector between March 2020 and December 2020 is £1,340 million.

All recommendations of the Independent Medicines and Medical Devices Safety Review are being considered carefully. The Government will respond in full to the report later this year.

The National Institute for Health and Care Excellence’s Rapid Guidance on severe asthma during the pandemic recommend using technology to reduce in-person appointments.

NHS England’s letter of 13 May 2021 outlined that patients and clinicians have a choice of consultation mode. Patients’ input into this choice should be sought and practices should respect preferences for face to face care unless there are good clinical reasons to the contrary. The letter is available at the following link:

https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/B0497-GP-access-letter-May-2021-FINAL.pdf

NHS England and NHS Improvement asked general practice to restore activity to usual levels where clinically appropriate and reach out proactively to clinically vulnerable patients and those whose care may have been delayed.

The cardiovascular disease and respiratory programme focussed its work in 2020/21 on the response to COVID-19 and has spent £5.5 million to support the response to the disease, including work on ‘long COVID-19’. This included bringing forward the implementation of respiratory clinical networks by one year. The networks are vital in promoting an integrated approach to respiratory care during COVID-19, in parallel with supporting delivery of the NHS Long Term Plan’s priorities.

The content of the Quality Outcomes Framework (QOF) asthma review, which ensures all general practitioner practices establish and maintain a register of patients with an asthma diagnosis, has been amended to incorporate the key elements of basic asthma care positively associated with better patient outcomes and self-management, including:

- An assessment of asthma control;

- A recording of the number of exacerbations;

- An assessment of inhaler technique; and

- A written personalised asthma action plan.

The QOF for 2021/22 has been implemented from April 2021 with these updated indicators for asthma.

The 2019 Voluntary Scheme for Branded Medicines Pricing and Access commits the National Institute for Health and Care Excellence (NICE) to publishing recommendations on all newly licensed treatments within 90 days of marketing authorisation wherever possible.

NICE may not always be able to meet this timescale for individual topics for a range of reasons, including where companies request a longer appraisal timescale. In addition, during the COVID-19 pandemic, NICE adapted its priorities to support the health and care system at a time of unprecedented pressure. This involved pausing the publication of topics that were not COVID-19 related or regarded as therapeutically critical during the period of March to June 2020.

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for providing evidence-based guidance for the National Health Service in England on whether medicines represent a clinically and cost-effective use of resources. Wherever possible, NICE aims to publish final guidance for new medicines, including those used to treat patients with severe asthma and other high risk conditions, within 90 days of licensing. NHS commissioners are legally required to make funding available for treatments recommended by NICE, normally within three months of the publication of NICE’s final guidance.

No such assessment has been made.

No such assessment has been made.

Information on patients who were first made aware of their severe asthma via shielding letters is not held centrally. However, respiratory disease is a national clinical priority in the NHS Long Term Plan. NHS England and NHS Improvement are working in close partnership with patients and partners, including the British Lung Foundation, and are developing and implementing policy on provisions of respiratory services in England.

NHS England and NHS Improvement’s Accelerated Access Collaborative (AAC) programme supported by the severe asthma toolkit, is increasing treatment adherence, biologic choice, optimising multidisciplinary teams and has been shared widely with the severe asthma clinical community. The AAC programme for severe asthma biologics has increased uptake of asthma drugs including ones covered by the National Institute for Health and Care Excellence’s Technology Appraisals where it has been identified that there is suboptimal uptake.

Information on patients who were first made aware of their severe asthma via shielding letters is not held centrally. However, respiratory disease is a national clinical priority in the NHS Long Term Plan. NHS England and NHS Improvement are working in close partnership with patients and partners, including the British Lung Foundation, and are developing and implementing policy on provisions of respiratory services in England.

NHS England and NHS Improvement’s Accelerated Access Collaborative (AAC) programme supported by the severe asthma toolkit, is increasing treatment adherence, biologic choice, optimising multidisciplinary teams and has been shared widely with the severe asthma clinical community. The AAC programme for severe asthma biologics has increased uptake of asthma drugs including ones covered by the National Institute for Health and Care Excellence’s Technology Appraisals where it has been identified that there is suboptimal uptake.

The amount of overtime worked is not held centrally. The total value of overtime worked by National Health Service staff working in the hospital and community health sector between March 2020 and September 2020 is £926.4 million.

Adults with asthma which requires continuous or repeated use of systemic steroids or with previous exacerbations requiring hospital admission, will be vaccinated in phase one, priority group six which includes all individuals aged 16 to 64 years old with underlying health conditions which put them at higher risk of serious disease and mortality. Individuals with more severe asthma may have been included in the clinically extremely vulnerable group, in which case they will be vaccinated in priority group four in phase one. All other adults aged 50 years old or above with asthma are being vaccinated within the phase one priority group associated with their age.

Adults with asthma which requires continuous or repeated use of systemic steroids or with previous exacerbations requiring hospital admission, will be vaccinated in phase one, priority group six which includes all individuals aged 16 to 64 years old with underlying health conditions which put them at higher risk of serious disease and mortality. Individuals with more severe asthma may have been included in the clinically extremely vulnerable group, in which case they will be vaccinated in priority group four in phase one. All other adults aged 50 years old or above with asthma are being vaccinated within the phase one priority group associated with their age.

Officials at the Department of Health and Social Care and HM Treasury have discussed alcohol duty and its impact on health in the context of the report and responses are currently being analysed.

A second national hospice grant of up to £125 million was provided until 31 March 2021 with provision to support 46,500 community contacts per day, which included supporting people at the end of their life within their own home. There are a range of resources available to support family members on providing end of life care in a variety of settings. This includes the end of life care toolkit for carers at home, created by the Helix Centre in conjunction with colleagues at the Central North West London NHS Trust which is available at the following link:

https://helixcentre.com/project-end-of-life-toolkit

The NHS Long Term Plan sets a clear ambition that where appropriate every person diagnosed with cancer should have access to personalised care by 2021. This includes providing personalised care and support planning, and information to support health and wellbeing. The key signs and symptoms of cancer recurrence are included in an end of treatment summary.

NHS England and NHS Improvement are supporting staff to offer personalised care to people affected by cancer by promoting awareness and understanding of the personalised care interventions. This includes providing resources such as a handbook on personalised stratified follow up, a checklist on health and wellbeing information and support, webinars, and a collaborative online workspace for staff. Cancer Alliances are leading programmes of work to embed personalised care within local providers.

The latest public data from December 2019 show that 94% of trusts offered personalised care and supporting planning for breast cancer patients.

The NHS Long Term Plan, which was published in January 2019 and followed on from the Cancer Taskforce Strategy, sets a clear ambition that where appropriate every person diagnosed with cancer should have access to personalised care by 2021. The key signs and symptoms of cancer recurrence are included in an end of treatment summary.

Public Health England (PHE) has studied the evidence on the efficacy of different types of face coverings, and some of these studies have compared face coverings with surgical masks, although not specifically FFP3s. This evidence, from laboratory studies, suggests that face coverings made of materials such as cotton and polyester materials might block droplets with a filtering efficiency similar to medical masks when folded in two or three layers. The PHE rapid review on this topic is available at the following link:

https://phe.koha-ptfs.co.uk/cgi-bin/koha/opac-retrieve-file.pl?id=5f043ca658db1188ffae74827fa650d9

FFP3s are classed as personal protective equipment (PPE), which is used by frontline health and social care workers in relevant settings. PHE has published guidance setting out who needs PPE and when, based on United Kingdom clinical expertise and World Health Organization standards. The guidance is available at the following link:

https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control

In 2017, we expanded the scope of the national suicide prevention strategy to include addressing self-harm as an issue in its own right, and we have funded the Multicentre Study of Self-harm – the most in-depth analysis and monitoring of self-harming trends in England.

The aim of the Multicentre Study’s work is to conduct a series of related studies on the epidemiology, causes, clinical management, outcome and prevention of self-harm.

The cross-Government Suicide Prevention Workplan includes a commitment to establish a wider mental health research programme to inform our thinking in many of the areas that may impact suicide and self-harm prevention. We continue to provide funding for research projects through the National Institute for Health Research including for suicide and self-harm prevention.

The National Institute for Health and Care Excellence’s clinical guideline ‘Self-harm in over 8s: long-term management (CG133)’ covers the initial management of self-harm and the provision of longer-term support for children and young people aged eight years and older and adults. It includes guidance on referring patients in primary and community care and in other specialist mental health settings for an assessment if presenting with a history of self-harm and a risk of repetition.

In the NHS Long Term Plan, we committed to establishing new models of integrated primary and community mental health care for adults and older adults with severe mental illnesses, with a new community-based offer explicitly including – among other elements – improved self-harm support. New models are currently being tested in 12 early implementer sites, and all areas are developing plans to expand and transform services from 2021/22.

Hospital trusts submit data for secondary breast cancer diagnoses through the Cancer Outcomes and Services Dataset (COSD) or Cancer Waiting Times (CWT) data collection mechanisms. Data on the reported number of people diagnosed with secondary breast cancers in 2014-2017 in England are available in the following table. Data for 2018 will be published in November 2020.

Notes:

1. Source:

http://www.ncin.org.uk/cancer_type_and_topic_specific_work/topic_specific_work/recurrence

2. Where a recurrence record has been reported by multiple trusts it will be included once per trust. This means the totals will include some double-counting of recurrences.
3. Counts from COSD and CWT cannot be combined as there will duplication between the datasets.

The number of reported cases is accepted as being significantly below the estimated number of secondary breast cancers. The National Cancer Registration and Analysis Service is working closely with cancer charities to improve data collection and submission by hospital trusts, looking at how they can help improve completion rates and thus gain a better picture of the burden of recurrence and metastatic disease across the health service.

Data for secondary breast cancer diagnoses are not available at constituency level. Data on how many people diagnosed with secondary breast cancer who were diagnosed less than and more than five years after a diagnosis of primary breast cancer are not available.

We recognise the hardship visiting restrictions pose for people with Alzheimer’s and dementia-related diseases.

We want to enable residents in care homes to have visits, while protecting them, other residents, staff and visitors from COVID-19. Clinical advice is clear that extra footfall in care homes increases risk. That is why we have published guidance to advise care homes on visiting during this period of new national restrictions, and how to reduce the risk. This guidance is intended to enable visiting, recognising the benefits to health and wellbeing of both residents and their loved ones.

The report, ‘Diagnostics: recovery and renewal’, was discussed at the NHS England and NHS Improvement public Board meeting on 1 October 2020. The report reflects the impact of COVID-19 on diagnostic provision and was published with the Board papers at the following link:

https://www.england.nhs.uk/wp-content/uploads/2020/10/BM2025Pu-item-5-diagnostics-recovery-and-renewal.pdf

The Joint Committee on Vaccination and Immunisation (JCVI), and the JCVI sub-committee on COVID-19 are currently reviewing evidence on clinical risk factors associated with serious disease and mortality from COVID-19. Following a review of the evidence the Committee will develop advice on risk groups for any future COVID-19 vaccination programme. The minutes of JCVI committee meetings and statements on COVID-19 vaccination are available on the JCVI website at the following link:

https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation

As part of the Government’s continued commitment to ensure high-quality, accessible rehabilitation services for patients, NHS England has commenced work on refreshing this guidance. This has included engagement with professional bodies’ clinicians, alongside many other stakeholders, societies and third sector organisations who represent the patient voice.

Gowns and overalls were ordered by the Royal Free Trust from a new supplier in Turkey. Further supply from the manufacturer was held in country as it was already clear looking at the first batches that the quality was suspect and not suitable for use in the National Health Service.

Once the first batches were seen and the quality was identified as a concern, the United Kingdom Embassy team in Turkey and the Turkish Government helpfully stepped in and provided some Turkish Government-sourced gowns which met UK standards to make up the order.

Discussions are underway between the Royal Free Trust and the UK distributor to agree a refund or acceptable alternative product.

We recognise that there is the potential for an increase in demand for mental health services amongst students as a result of COVID-19.

We are working with the Department for Education, the National Health Service, Public Health England and others to gather evidence and assess the potential longer-term mental health impacts of COVID-19, including on students.

Data on the general practitioner (GP) to patient ratio for female patients between the ages of 15 to 45 years old with epilepsy is not available at national or regional levels.

Within the terms of the valproate Pregnancy Prevention Programme, general practitioners (GPs) are required to identify all relevant women and girls in their practice who are taking valproate and refer them for specialist review annually. Specialists should review treatment and ensure that an Annual Risk Acknowledgement Form is signed by the prescriber and the patient and shared with the patient’s GP. GPs should check that the patient has a signed, up-to-date Annual Risk Acknowledgment Form each time a repeat prescription is issued. A GOV.UK toolkit on valproate use by women and girls is available at the following link:

https://www.gov.uk/guidance/valproate-use-by-women-and-girls.

It is a Care Quality Commission regulatory requirement for general practitioners to follow the Medicines and Healthcare products Regulatory Agency’s (MHRA) guidance on valproate prescribing. The MHRA advises that ‘Valproate medicines must no longer be used in women or girls of childbearing potential unless a Pregnancy Prevention Programme is in place’.

In 2019/20 NHS England implemented a quality improvement module worth approximately £44 million nationally to encourage practices to improve their prescribing safety. This aimed to improve engagement with women of childbearing age being prescribed sodium valproate and pregnancy prevention for these patients.

The standard of medical training is the responsibility of the General Medical Council (GMC), which is an independent statutory body.?The GMC has the general function of promoting high standards of education and co-ordinating all stages of education to ensure that medical students and newly qualified doctors are equipped with the knowledge, skills and attitudes essential for professional practice.

The Department of Health and Social Care has been working closely with the Department for Education to make sure students are safe at university. We understand that many students are keen to go home for Christmas and we are working together to ensure that they will have plenty of notice to make plans to do so, as announced by the Secretary of State for Education on Tuesday 29 September 2020.

We do not want to single out students for tougher restrictions than other members of society, as we all have our part to play in controlling this virus.

We allocate more testing to higher prevalence areas in line with the Joint Biosecurity Centre’s reporting. Allocation decisions are frequently and systematically reviewed to ensure we are using our testing where it can be most effective. We are working with Public Health England to manage the prioritisation process to ensure that we are able to provide appropriate testing for both outbreak management and surveillance purposes. We have exceeded our target of reaching 500,000 testing capacity by the end of October.

In total, 3,754 physiotherapists have joined the Health and Care Professions Council’s COVID-19 temporary register.

A recent survey of returners indicated that around 50% across all professions were interested in continuing to work in the health and social care system.

There are existing return to practice schemes designed to support physiotherapists who have been out of the workforce for a number of years to safely re-start their careers.

NHS England is working with the Department and other local employing organisations to consider a range of flexible options to make it easier for professionals including physiotherapists who are interested in re-joining the National Health Service workforce to do so.

NHS England recently announced that people suffering from longer term symptoms of COVID-19 will be offered specialist help at clinics across England.

A range of professionals, including physiotherapists, other specialists and general practitioners will all help assess, diagnose and treat thousands of sufferers who have reported ongoing symptoms. £10 million will be invested this year in additional local funding to help initiate and designate ‘long COVID-19’ clinics in every area across England, to complement existing primary, community and rehabilitation care.

As at May 2020 there are 2,548 (14.4%) more full-time equivalent (FTE) physiotherapists and 861 (23.7%) more FTE support staff to physiotherapists than in May 2015 to provide care to patients.

NHS England recently announced that people suffering from longer term symptoms of COVID-19 will be offered specialist help at clinics across England.

A range of professionals, including physiotherapists, other specialists and general practitioners will all help assess, diagnose and treat thousands of sufferers who have reported ongoing symptoms. £10 million will be invested this year in additional local funding to help initiate and designate ‘long COVID-19’ clinics in every area across England, to complement existing primary, community and rehabilitation care.

As at May 2020 there are 2,548 (14.4%) more full-time equivalent (FTE) physiotherapists and 861 (23.7%) more FTE support staff to physiotherapists than in May 2015 to provide care to patients.

There are currently no plans in place. The CA125 Blood test, followed by an ultrasound for raised CA125, is the current process recommended by the National Institute for Health and Care Excellence.

Rapid Diagnostic Centres (RDCs) are being rolled out across England as part of the NHS Long Term Plan. One of the key principles of RDCs is the coordination of testing, including implementation of multiple-same day testing to provide timely diagnosis of cancer.

We recognise that social distancing, self-isolation and shielding are likely to have increased the risk of loneliness and mental health issues for some people.

Mental health services have remained open for business throughout the COVID-19 pandemic, delivering support digitally, over the phone and face to face where possible. We are working with the National Health Service, Public Health England and others to understand the specific impacts and to improve support for people experiencing these issues as we move into the ‘recovery’ phase.

From 2019/20, we are investing £57 million in suicide prevention through the NHS Long Term Plan. This will see investment in all areas of the country by 2023/24 to support local suicide prevention plans and establish suicide bereavement support services plan.

The Cross-Government Suicide Prevention Workplan, published January 2019, set out that NHS England is working with the National Collaborating Centre for Mental Health to develop a framework for adult and older adult community mental health services, including for people who self-harm.

Following advice from members of NHS England’s Expert Reference Group, the framework replaced the planned pathways. It will consider the needs of people who self harm while being cared for in the community, giving due regard to existing National Institute for Health and Care Excellence guidance on the longer-term management of people who self harm.

The Framework was published in September 2019 and is available on the NHS England and NHS Improvement website.

For children and young people, the NHS Long Term Plan makes commitments to expand children and young people’s services to provide an enhanced crisis offer. This expansion includes further work to strengthen local pathways between community, crisis and inpatient services, which will improve the evidence based self-harm pathway.

The Government accepted all the recommendations from Exercise Cygnus. The lessons identified from Exercise Cygnus have been incorporated into an ongoing programme of work on our pandemic flu response plans.

The lessons learned from Exercise Cygnus continue to be considered by the Government and a range of stakeholders, including expert advisory groups and local emergency planners. We continue to work across Government and with key stakeholders to develop coordinated multi-sector response plans for a future influenza pandemic.

The publication of the Exercise Cygnus report is currently subject to ongoing legal proceedings, so it would be inappropriate to comment at this point.

The National Institute for Health and Care Excellence COVID-19 rapid guideline on severe asthma provides guidance on the use of oral corticosteroids and starting or continuing on biological treatments, which aim to minimise oral corticosteroid exposure, for people with severe asthma during the COVID-19 outbreak. The guideline is available at the following link:

https://www.nice.org.uk/guidance/ng166

The monitoring and prescribing of asthma medication are performed in accordance with guidance from the National Institute for Health and Care Excellence to manage the condition. The guidance is available at the following link:

https://www.nice.org.uk/guidance/ng80/chapter/Recommendations#self-management

The NHS England and NHS Improvement clinical guide for the management of respiratory patients during the COVID-19 pandemic states that the majority of community respiratory services should be switched to telephone or virtual consultation. Routine annual reviews should continue virtually to reassure patients and ensure they are happy with their management plans to avoid hospital attendance. The clinical guide is available at the following link:

https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0063-Specialty-guide-_Respiratory-and-Coronavirus-_v1_26-March.pdf

Respiratory disease is a clinical priority of the NHS Long Term Plan, acknowledging medicines optimisation as a key intervention for people with respiratory disease. Pharmacists in primary care networks will also undertake a range of medicine reviews, including educating patients on the correct use of inhalers.

The Quality and Outcomes Framework ensures all practices establish and maintain a register of patients with an asthma diagnosis in accordance with National Institute for Health and Care Excellence guidance.

Long-term exposure to carbon monoxide gas can damage an unborn baby. Babies exposed to carbon monoxide during pregnancy are at risk of a low birth weight; stillbirth; death that occurs within the first four weeks of birth; and behavioural problems.

Women are tested for the presence of carbon monoxide at the antenatal booking appointment and as appropriate throughout pregnancy to identify smokers, or those exposed to tobacco smoke, and offer them a referral for support from a trained stop smoking advisor. Carbon monoxide testing may also highlight a household problem and the need to take measures to prevent further exposure.

Long-term exposure to carbon monoxide gas can damage an unborn baby. Babies exposed to carbon monoxide during pregnancy are at risk of a low birth weight; stillbirth; death that occurs within the first four weeks of birth; and behavioural problems.

Women are tested for the presence of carbon monoxide at the antenatal booking appointment and as appropriate throughout pregnancy to identify smokers, or those exposed to tobacco smoke, and offer them a referral for support from a trained stop smoking advisor. Carbon monoxide testing may also highlight a household problem and the need to take measures to prevent further exposure.

Guidance on the management of treatment of pregnant women and unborn children for carbon monoxide poisoning is provided and accessible to healthcare professionals on TOXBASE and the United Kingdom Teratology Information Service (UKTIS) website.

If carbon monoxide poisoning is suspected, the initial management is the same as for a non-pregnant patient and consists of identifying and removing the patient from the source of exposure, followed by administration of high concentration oxygen. The patient’s carboxyhaemoglobin concentration should be measured initially and monitored. Treatment may need to be continued for longer in pregnant patients compared to a non-pregnant patient.

It is advised that all cases of carbon monoxide poisoning in pregnancy are discussed with the UKTIS.

We have been working across government on accessible housing provision and will consult shortly on options to raise accessibility standards in new homes.

The consultation will consider making higher accessibility standards mandatory, recognising the importance of suitable homes for older and disabled people.

All guidance, statements and public information released by the Government are readily available to read online. Information on COVID-19 from Public Health England and the Department is translated into British Sign Language videos can be found at the following link:

https://www.signhealth.org.uk/

In addition to this, the Chancellor has advised that the National Health Service will get whatever resources it needs to cope with a COVID-19 epidemic.

NHS England has undertaken significant communications activities to raise awareness of the Accessible Information Standard with organisations required to implement and follow it, including National Health Service trusts. A range of resources have been made available to support effective implementation and compliance. Conformance with the Standard is a specific legal duty – as set out in section 250 of the Health and Social Care Act 2012. It is also a requirement of the NHS Standard Contract.

In developing the Standard, we have worked alongside a number of partners, including the Care Quality Commission, who have stated that they will be looking at how services implement the Accessible Information Standard as part of their inspections.

The National Health Service produces a range of materials to promote the NHS 111 service (including ways for deaf people to access the service), which are available to all healthcare professionals. NHS England also engages with a wide number of charities and third-party organisations to promote NHS 111 to the deaf and hard of hearing community.

A deaf or hard of hearing person can speak to NHS 111 through a British Sign Language interpreting service. Relay UK is also available for people who have difficulty communicating or hearing whilst the online NHS 111 service can also be accessed if medical advice is required.

All guidance, statements and public information released by the Government are readily available to read online information on COVID-19 from Public Health England and the Department is translated into British Sign Language videos can be found at the following link:

https://www.signhealth.org.uk/

In addition to this, the Chancellor has advised that, the National Health Service will get whatever resources it needs to cope with a coronavirus epidemic.

All guidance, statements and public information released by the Government are readily available to read online information on COVID-19 from Public Health England and the Department is translated into British Sign Language videos can be found at the following link:

https://www.signhealth.org.uk/

In addition to this, the Chancellor has advised that, the National Health Service will get whatever resources it needs to cope with a coronavirus epidemic.

All guidance, statements and public information released by the Government are readily available to read online.

Information on COVID-19 from Public Health England and the Department is translated into British Sign Language. Videos can be found at the following link:

https://www.signhealth.org.uk/

NHS England operates an accessible information standard which sets out a specific, consistent approach to identifying, recording, flagging, sharing and meeting the information and communication support needs of patients, service users, carers and parents with a disability, impairment or sensory loss. More information can be found at the following link:

https://www.england.nhs.uk/ourwork/accessibleinfo/

Treasury Ministers and officials regularly meet with representatives of the alcohol industry, and public health stakeholders, to discuss alcohol duty and related issues, including the health impacts of alcohol as part of the process of policy development and delivery.

Details of ministerial and permanent secretary meetings with external organisations on departmental business are published on a quarterly basis and are available at: https://www.gov.uk/government/collections/hmt-ministers-meetings-hospitality-gifts-and-overseas-travel

The Government has committed to an unprecedented package of support for individuals through this difficult time. This includes the introduction of the Coronavirus Job Retention Scheme, the Job Support Scheme, and the Self-Employment Income Support Scheme, as well as injecting an additional £9 billion into the welfare system according to Office for Budget Responsibility estimates.

If an employee earns average weekly earnings of at least £120 per week, they will be eligible for SSP if they are self-isolating under Government guidance and cannot work from home. This includes parents living in the same households as children self-isolating with symptoms of COVID-19. The Government has changed the rules so that SSP is now payable from day 1, not day 4, for COVID-19 cases.

Parents of children who are self-isolating under Government guidance may be eligible for “new style” contributory Employment and Support Allowance (ESA) if they are ineligible for SSP and unable to work from home. The Government has made it easier for people to claim by removing the seven-day waiting period which means people can get support from day one.

The welfare system is best placed to provide support for those not eligible for SSP. This group will benefit from changes to the welfare system to support the most vulnerable. These changes include a £20 per week increase to the UC standard allowance and Working Tax Credit basic element, and a nearly £1 billion increase in support for renters through increases to the Local Housing Allowance rates for UC and Housing Benefit claimants.

The latest available information on the number of families with children receiving Working Tax Credit at the parliamentary constituency level is for April 2020. In April 2020, the number of families with children receiving Working Tax Credit in Blaydon was 1,000.

https://www.gov.uk/government/statistics/child-and-working-tax-credits-statistics-provisional-awards-geographical-analyses-december-2013.

Information on following months is not readily available. The next update to this publication will provide statistics relating to December 2020 and will be available in January 2021.

Final annual information on families with children receiving Working Tax Credits is published once a year and updated each July.

https://www.gov.uk/government/statistics/child-and-working-tax-credits-statistics-finalised-annual-awards-2018-to-2019.

The Local Government Finance Settlement makes available £54.1 billion of taxpayer subsidy in 2022/23 for local government in England, an increase of up to £3.7 billion on 2021/22, including, over £1 billion specifically for councils to meet social care pressures.

Further announcements will be made on the proposed local Government finance settlement in the coming weeks ahead.

We are working closely with the sector, as we always do, to monitor the impact on service delivery and budgets.

The Local Government Finance Settlement makes available £54.1 billion of taxpayer subsidy in 2022/23 for local government in England, an increase of up to £3.7 billion on 2021/22, including, over £1 billion specifically for councils to meet social care pressures.

Further announcements will be made on the proposed local Government finance settlement in the coming weeks ahead.

We are working closely with the sector, as we always do, to monitor the impact on service delivery and budgets.

The Local Government Finance Settlement makes available £54.1 billion of taxpayer subsidy in 2022/23 for local government in England, an increase of up to £3.7 billion on 2021/22, including, over £1 billion specifically for councils to meet social care pressures.

Further announcements will be made on the proposed local Government finance settlement in the coming weeks ahead.

We are working closely with the sector, as we always do, to monitor the impact on service delivery and budgets.

The Local Government Finance Settlement makes available £54.1 billion of taxpayer subsidy in 2022/23 for local government in England, an increase of up to £3.7 billion on 2021/22, including, over £1 billion specifically for councils to meet social care pressures.

Further announcements will be made on the proposed local Government finance settlement in the coming weeks ahead.

We are working closely with the sector, as we always do, to monitor the impact on service delivery and budgets.

We recognise the growing pressure on family finances, and are continuing to work with local councils and sponsors to support them with their hosting arrangements.

The Government remains committed to levelling up the country and tackling non-decency. The Government has committed to review the Decent Homes Standard to make sure it is fit for the present day and responses from a recent consultation on a Decent Homes Standard for the private rented sector are currently being analysed.

For those who live in poor quality social housing, we have introduced new legislation to improve the quality and regulation of social housing, give residents performance information so they can hold their landlord to account and ensure that when residents make a complaint, landlords take quick and effective action to put things right.

The Government remains committed to ensuring more homes are built in the right places both to give people support where they need it and also to give more people the opportunity to own their own homes in the future.

With regards to social rent, the Government has committed £11.5 billion of taxpayer funded grant to the latest Affordable Housing Programme. This is intended to provide tons of thousands of new homes across the country. A substantial number of these will be for social rent.

An additional £11.5 billion of taxpayer-funded grant has been allocated to the Affordable Homes Programme, which is intended to provide tens of thousands of new homes across the country. Half the homes will be for Affordable and Social Rent, to help those in need

The Government has brought forward a range of interventions in recent years to promote home ownership. As an example, the First Homes programme is designed to help local first-time buyers and key workers on to the property ladder, by offering homes at a discount of at least 30% compared to the market price. The discount is passed on to all future purchasers in perpetuity, so these homes will keep helping first-time buyers onto the property ladder for generations to come.

In terms of housing and social housing, the Government has a clear set of policies:

• Build more social and affordable homes, including a further £11.5 billion of taxpayer funded grant to support that endeavour in the coming years. We are also using the programme to fund a First Homes pilot to help key workers and local first-time buyers on the property ladder. It will offer homes at a discount of at least 30% compared to market price.
• Support the delivery of the new model for Shared Ownership and extend it as widely as possible through the Affordable Homes Programme.
• Maintain the Right to Buy scheme for social housing tenants, which has helped over 2 million to become homeowners since 1980. We believe that anybody who works hard across the country and aspires to own their own home should have the opportunity to realise that dream.

Ministers will ensure that the House is updated on policy announcements in the usual way.

Parks and green spaces share joint responsibility between the Department for Levelling Up, Housing and Communities (DLUHC) and the Department for Environment, Food and Rural Affairs (DEFRA). DLUHC is responsible for urban parks and green spaces and I am the responsible minister. In DEFRA, the responsible minister for the domestic natural environment, is Rebecca Pow MP and Lord Benyon is responsible for landscape, including national parks.

Supporting the most vulnerable children and young people, and local authorities in maintaining their statutory services, continues to be a key priority for this Government.

The Spending Review 2020 confirmed that the Core Spending Power of local authorities will rise by 4.6% in cash terms from £49.0 billion in 2020-21 to up to £51.3 billion in 2021-22, which is a real terms increase. This real-terms increase builds on the largest year-on-year increase in spending power in a decade and recognises the resources councils need to meet their pressures and maintain children’s services, including their statutory duty to assess the social care needs of seriously ill children and young people, and to provide respite care where necessary.

The Government has also given over £6 billion in un-ringfenced funding directly to councils to support them with the immediate and longer-term impacts of Covid-19 spending pressures. This unprecedented level of funding is un-ringfenced in recognition that local authorities are best placed to decide how to meet service pressures in their local area, including for children and young people.

By April 2022, the Government will have invested over £4 billion through the Disabled Facilities Grant, which will have funded adaptations to almost 400,000 homes since 2010.

In addition, 10 per cent of units delivered under the new Affordable Homes Programme will be used to increase the supply of specialist or supported housing.

Our current planning rules mean councils must consider the needs of older people and those with disabilities when planning new homes, and the Government recently consulted on options that include introducing higher mandatory accessibility standards for all new homes.

In Planning for the Future we proposed a quicker and simpler framework for assessing environmental effects: one which does not compromise on environmental standards, and indeed encourages opportunities for environmental enhancements to be identified and pursued early in the development process. Proposals will leave an inheritance of environmental improvements with environmental assets protected, more green spaces provided, more sustainable development supported and new homes that are more energy efficient.

Though we are still considering the responses to the White Paper consultation, I can assure you that legal protection for landscape, habitat and wildlife will remain in force, and reforms will support the implementation of the proposals in the Environment Bill, including the commitment to a 10 per cent biodiversity net gain requirement. Consultation on the White Paper closed on 29 October 2020. The Government will publish its response following consideration of all the feedback received.

Our proposals are designed to put effective community engagement at the heart of planning. The current planning system has a poor record in this area, with information that is hard to find, and difficult to understand.

By taking a digital-first approach to modernise the planning process, we can use new tools and platforms to make it easier for people to understand what is being proposed, and to feed their views into the system at the right time. This will help ensure local people can have real influence over both the location and design of development, and have a meaningful say over its environmental implications.

They will be able to do this both at the plan-making stage – when the important decisions are being made about the scale and location of growth – and as the details of proposed developments come forward. We have proposed a quicker, simpler framework for assessing environmental effects to support this: one which will be easier for communities to engage with, while protecting what matters and leaving an inheritance of environmental improvement.

We are grateful for the many responses received to these proposals. They are being analysed at present, and we will take them into account as we consider how to move forward.

The stay on possession proceedings has been extended until 20 September 2020, meaning that in total no tenant can have been legally evicted for 6 months at the height of the pandemic.

Legislation has been introduced that means, from 29 August 2020, landlords must give tenants six months’ notice before they can evict in most circumstances, apart from the most egregious cases such as incidents of anti-social behaviour and domestic abuse perpetrators. This will be in force until 31 March 2021.

In addition, new court rules, which will come into force on 20 September, will mean landlords will need to set out in their claim any relevant information about a tenant’s circumstances, including information on the effect of the Covid-19 pandemic. Where this information is not provided, judges will have the ability to adjourn proceedings.

We will keep these measures under review?and decisions?will continue?to be guided by the latest public health advice.