Philippa Whitford

Neurology is a popular specialty and generally achieves a 100% fill rate for training places, with no significant attrition issues. A new curriculum is being introduced with increased emphasis on working and training in internal medicine and stroke as well as neurology, which will increase the number of trainees in the acute areas of neurology.

To improve the retention of all National Health Service staff, the NHS People Plan focuses on actions for organisations to build a more compassionate and inclusive culture. This includes a focus on staff health and wellbeing, support for flexible working and a renewed commitment to tackling inequality. The NHS Retention Programme is seeking to understand why staff leave, resulting in targeted interventions to support staff to stay whilst keeping them well.

The NHS RightCare progressive neurological conditions toolkit states that patients with a neurological condition will be offered a regular review of their emotional and psychological status and supported to access information and mental health services when needed. Support may include counselling, cognitive behavioural therapy, written advice or a neuro-psychological specialist if required. In addition, people living with multiple sclerosis and other neurological conditions may be referred to the Improving Access to Psychological Therapies service.

We are investing an additional £2.3 billion a year for mental health services by 2023/24. The Mental Health Recovery Action Plan also provided £500 million of targeted investment in 2021/22. This will enable an extra two million people in England to access National Health Service-funded mental health support, with an additional 27,000 mental health professions recruited to support this expansion.

The National Institute for Health and Care Excellence (NICE) appraises all new medicines, including for multiple sclerosis, and is committed where possible, to publishing draft guidance at the time of licensing with final guidance published within three months. NICE has published guidance recommending a number of medicines for multiple sclerosis for routine use in the National Health Service. The NHS in England is legally required to fund medicines recommended by NICE.

The United Kingdom Chief Medical Officers’ low risk drinking guidelines do not include specific guidelines on consumption of alcohol by children and young people. However, advice on alcohol consumption is available at NHS.UK, the Talk to FRANK online resource, and GOV.UK.

The National Health Service provides advice that alcohol use in teenage years is related to a range of health and social problems and recommends that children and young people do not drink alcohol before the age of 18 years old. This guidance is available at the following link:

https://www.nhs.uk/common-health-questions/childrens-health/should-my-child-drink-alcohol/

Education on alcohol use is also a statutory component of relationships education, relationships and sex education and health education in England.

No assessment has yet been made as data on the impact of the COVID-19 pandemic on alcohol consumption by children and young people is not currently available. NHS Digital’s Smoking, Drinking and Drugs among Young People Survey provides information on drinking behaviours and attitudes among children aged 11 to 15 years old. The last survey was carried out in 2018. Field work for the 2021 survey began in autumn 2021.

The United Kingdom Chief Medical Officers’ low risk drinking guidelines do not include specific guidelines on consumption of alcohol by children and young people. However, advice on alcohol consumption is available at NHS.UK, the Talk to FRANK online resource, and GOV.UK.

The National Health Service provides advice that alcohol use in teenage years is related to a range of health and social problems and recommends that children and young people do not drink alcohol before the age of 18 years old. This guidance is available at the following link:

https://www.nhs.uk/common-health-questions/childrens-health/should-my-child-drink-alcohol/

Education on alcohol use is also a statutory component of relationships education, relationships and sex education and health education in England.

Immunocompromised individuals are a priority cohort for research into therapeutic and prophylaxis treatments, such as monoclonal antibody therapies and repurposed compounds.  The RAPID C-19 collaboration has enabled active multi-agency oversight of national and international trial evidence as it emerges for COVID-19 therapies, both in potential treatment and prophylactic indications. Where material evidence is identified, this has enabled the rapid formation and implementation of United Kingdom-wide clinical access policies. The RAPID C-19 collaboration actively reviews all promising compounds. To date, the evidence has most strongly supported treatment use, but the evidence around prophylactic use will continue to be actively reviewed.

NHS England and Improvement and NHS Blood and Transplant regularly assess the impact of COVID-19 hospitalisations on NHS transplant services and are working with transplant units to restore transplantation services to pre-pandemic levels.

Whilst specific data for 26 January 2022 is not available, as of 23 January 2022, deceased donation represents 86% of pre-pandemic levels and living donation has since resumed to delivering quarterly matching runs through the UK Living Kidney Sharing Scheme. NHS Blood and Transplant and NHS England and NHS Improvement continue to work with transplant units to optimise the uptake of every organ that becomes available.

Data on the number of modellers is not held. The Joint Committee on Vaccination and Immunisation formulates advice and recommendations based on appraisal of the best scientific and other evidence available and has no specific allocated modelling resource. Modelling is commissioned from a range of resources as and when required.

There are no plans to increase the routine immunisations modelling capacity at present. Modellers from academic institutions, public bodies and the Government have been focused on supporting efforts against COVID-19 through the Scientific Pandemic Influenza Group on Modelling and the Scientific Advisory Group for Emergencies.

The Joint Committee on Vaccination and Immunisation formulates advice and recommendations based on appraisal of the best scientific and other evidence available and has no specific allocated modelling resource. Modelling is commissioned from a range of resources as and when required.

There are no plans to increase capacity at present. Modellers in academic institutions, public bodies and the Government have been focused on supporting efforts against COVID-19 through the Scientific Pandemic Influenza Group on Modelling and the Scientific Advisory Group for Emergencies.

Currently, the NHS Health Check programme aims to raise awareness of the risk factors that affect both heart and brain health. This aims to prevent heart disease, stroke, diabetes and kidney disease, and some cases of dementia among adults aged 40 to 74 years old.

We will be setting out our future plans on dementia for England in 2022. The Office for Health Improvement and Disparities is contributing to the development of the new strategy which will include a focus on prevention and risk reduction. As part of this, the concept of brain health in encouraging people to reduce their dementia risk, is being explored. Officials are engaging with a range of stakeholders on the new strategy including members of the Dementia Programme Board and other Government departments.

Funding for dementia research is allocated via the National Institute for Health Research (NIHR) and UK Research and Innovation (UKRI) through the Medical Research Council (MRC) and the Economic and Social Research Council (ESRC). The following table shows spending on research into dementia prevention by each organisation in each of the last three years. Spending by the MRC in 2020/21 is not yet available.

The following table shows spending on research into ‘brain health’ in each of the last three years. Figures for the MRC’s spend reflect research into neurodegeneration, epilepsy and stroke which is directly relevant to brain health research, as the MRC does not have a specific brain health research portfolio. Spending by the MRC in 2020/21 is not yet available.

The Government has committed to invest £375 million in neurodegenerative disease research over the next five years to fund projects into a range of diseases, including dementia. We will be setting out our plans on dementia for England for future years in 2022. This will include our ambitions for dementia research.

The Joint Committee on Vaccination and Immunisation is currently considering whether there is sufficient evidence to recommend delivering the second dose of the MMR vaccine at 18 months. We will be guided by their advice.

The Joint Committee on Vaccination and Immunisation (JCVI) relies on modelling work from a variety of sources to support its advice, including the UK Health Security Agency and academic groups.

Varicella is a ‘business as usual’ item that the JCVI will consider in the short to medium term. However, as modelling capacity is finite and resources are supporting the COVID-19 pandemic response, the JCVI are unable to provide an expected timeframe. The modelling Quality-Adjusted Life Year meeting to discuss varicella will be scheduled once evidence becomes available.

The Joint Committee on Vaccination and Immunisation (JCVI) relies on modelling work from a variety of sources to support its advice, including the UK Health Security Agency and academic groups.

Varicella is a ‘business as usual’ item that the JCVI will consider in the short to medium term. However, as modelling capacity is finite and resources are supporting the COVID-19 pandemic response, the JCVI are unable to provide an expected timeframe. The modelling Quality-Adjusted Life Year meeting to discuss varicella will be scheduled once evidence becomes available.

In partnership with the Alzheimer’s Society, Alzheimer’s Scotland and Alzheimer’s Research UK, the National Institute for Health Research (NIHR) delivers Join Dementia Research (JDR), an online platform recruiting people into dementia research studies, which is open to all who wish to participate. Through the Innovations in Clinical Trial Design and Delivery for the Under-served programme, the NIHR is actively seeking to improve participation in research by providing resources and examples of good practice to support researchers seeking to engage with and include under-served groups.

No specific assessment has been made.

As of February 2021, the number of full time equivalent clinical oncologists has increased by 20.5% since February 2015 – an increase of 250 clinical oncologists working in the National Health Service. Health Education England funded an extra 50 places in clinical oncology and an extra 36 in medical oncology in 2021.

The next Spending Review will set out further details of the Government’s spending plans for non-NHS budgets for future years, which includes funding for the NHS workforce.

No specific assessment has been made.

As of February 2021, the number of full time equivalent clinical oncologists has increased by 20.5% since February 2015 – an increase of 250 clinical oncologists working in the National Health Service. Health Education England funded an extra 50 places in clinical oncology and an extra 36 in medical oncology in 2021.

The next Spending Review will set out further details of the Government’s spending plans for non-NHS budgets for future years, which includes funding for the NHS workforce.

Plans for increasing funding for dementia research and delivering a moonshot are subject to Spending Review settlements. We will be setting out our plans on dementia for England for future years in due course.

The National Institute for Health Research has commissioned the National Immunisation Schedule Evaluation Consortium to undertake the Com-CoV trial. This trial is gathering data on the long-term immune response of using different COVID-19 vaccines for the first and second dose.

Public Health England has also undertaken follow up on people given mixed schedules as part of routine care to monitor self-reported side effects and antibody response. The antibody results will be published in due course.

The Joint Committee on Vaccination and Immunisation (JCVI) published interim advice on a potential Covid-19 booster vaccination programme on 30th June 2021, which can be found at the following link:

https://www.gov.uk/government/publications/jcvi-interim-advice-on-a-potential-coronavirus-covid-19-booster-vaccine-programme-for-winter-2021-to-2022

The JCVI’s interim advice is that COVID-19 boosters should first be offered to the most vulnerable. The JCVI advises a two staged approach, with individuals in Stage 1 offered a COVID-19 booster vaccine, and flu vaccine, as soon as possible from September, and individuals in Stage 2 offered a COVID-19 booster vaccine as soon as practicable after Stage 1, with equal emphasis on deployment of the flu vaccine where eligible.

Final decisions on the timing and scope and cohort eligibility, including the groups listed above, of any COVID-19 vaccine booster programme will be confirmed once the JCVI have provided their final advice, alongside considerations related to COVID-19 vaccine supply and approvals by the Medicines and Healthcare products Regulatory Agency.

As part of the Trade and Cooperation Agreement (TCA), the United Kingdom may request access to the European Union’s Early Warning and Response System (EWRS) in respect of a serious cross-border health threat. The UK was given access to the EWRS for COVID-19 from 1 January 2021.

The TCA also provides for continued cooperation on scientific and technical matters between the European Centre for Disease Prevention and Control (ECDC) and the UK body responsible for surveillance, epidemic intelligence and scientific advice on infectious disease. We are currently developing a Memorandum of Understanding with ECDC to formalise future cooperation.

As part of the Trade and Cooperation Agreement (TCA), the United Kingdom may request access to the European Union’s Early Warning and Response System (EWRS) in respect of a serious cross-border health threat. The UK was given access to the EWRS for COVID-19 from 1 January 2021.

The TCA also provides for continued cooperation on scientific and technical matters between the European Centre for Disease Prevention and Control (ECDC) and the UK body responsible for surveillance, epidemic intelligence and scientific advice on infectious disease. We are currently developing a Memorandum of Understanding with ECDC to formalise future cooperation.

Children under 16 years of age, even if they are clinically extremely vulnerable (CEV), are at low risk of serious morbidity and mortality from COVID-19. There is also a lack of safety and efficacy data for COVID-19 vaccines in children. Most children under the age of 16, including those who are CEV, are therefore not recommended for routine vaccination.

Given the very high risk of exposure to infection and outbreaks in residential settings, vaccination may be appropriate for those with severe neuro-disabilities who require frequent care in these settings. This option should be discussed between parents or guardians and the child’s clinician.

As of 1 April, due to low prevalence, shielding advice has been paused for all clinically extremely vulnerable people, including children and young people. All CEV pupils should attend their school unless they are one of the very small number of pupils under paediatric or other specialist care and have been advised by their GP or clinician not to attend. Pupils who live with someone who is CEV should continue to attend school as normal.

More information on children and COVID-19 vaccination can be found at the following link: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/984310/Greenbook_chapter_14a_7May2021.pdf

Current guidance to individuals who are clinically extremely vulnerable, including children, can be found at the following link: https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

England’s national vaccine strategy is being refreshed to include new developments from the COVID-19 vaccine programme and the extended National Health Service flu programme. The vaccine strategy will be published in due course.

The Department is funding several studies of immune responses to COVID-19 including the SARS-CoV-2 Immunity and Reinfection EvaluatioN (SIREN) study in health care workers; the Vivaldi study in care home residents and workers; and the COVID-19 Infection Survey led by the Office for National Statistics of repeat household visits looking at those who have antibodies to COVID-19, either from vaccination or previous infection.

The National Institute for Health Research’s Health Protection Research Unit in Respiratory Infections is also looking at the size and longevity of the immune response and Public Health England is monitoring antibody levels in individuals who have received either the Pfizer or Oxford/AstraZeneca vaccine.

The Department’s National Institute for Health Research (NIHR) is supporting the National Health Service to deliver clinical research through the Clinical Research Network (CRN).

The NIHR’s CRN reports that of the 92 breast cancer clinical trials that it was supporting on 21 May 2020, 36 or 39% were paused as a result of the COVID-19 pandemic. As of 15 April 2021, 30 or 83% of these paused breast cancer trials have restarted and 30 new breast cancer trials have entered the portfolio since 21 May 2020.

To enable clinical research studies that have been paused to restart and recruit successfully, including breast cancer trials, plans are being developed to manage the delivery of non-COVID-19 studies to ensure successful recovery of the portfolio. Details of these plans will be published shortly.

The right of referral to research is one action aimed at increasing participation in research. NHS England and NHS Improvement have indicated that this work has been delayed and they are looking to consider it further as they work with other partners, including the Department, to develop the England specific action plan that will underpin the vision. Increasing participation in research is a key strand of the national vision for clinical research published on 23 March, The Future of UK Clinical Research Delivery, which is available at the following link:

https://www.gov.uk/government/publications/the-future-of-uk-clinical-research-delivery

The Department’s National Institute for Health Research is supporting the National Health Service to deliver life-saving research through the Clinical Research Network which provides the infrastructure that allows high-quality clinical research funded by charities, the life-sciences industry and the public sector to be undertaken throughout the health and care system.

To enable research studies that have been paused to restart, plans are being developed to transition and manage the delivery of non-COVID-19 studies to ensure successful recovery of the portfolio.

The Department’s National Institute for Health Research Clinical Research Network reports that of the 92 breast cancer clinical trials it was supporting on 21 May 2020, 36 or 39% were paused as a result of the COVID-19 pandemic. As of 26 March 2021, 30 or 83% of these paused breast cancer trials have restarted and 25 new breast cancer trials have entered the portfolio since 21 May 2020.

The Department’s National Institute for Health Research Clinical Research Network reports that of the 92 breast cancer clinical trials it was supporting on 21 May 2020, 36 or 39% were paused as a result of the COVID-19 pandemic. As of 26 March 2021, 30 or 83% of these paused breast cancer trials have restarted and 25 new breast cancer trials have entered the portfolio since 21 May 2020.

The United Kingdom-wide Infection Prevention Control (IPC) Cell has recently reviewed the evidence in relation to the transmission route for COVID-19 and the IPC precautions required. The IPC guidance was updated most recently on 21 January and the Cell agreed that no changes to the current personal protective equipment requirements were needed.

There is also consensus across the UK Chief Medical Officers that existing guidance regarding the use of face masks and FFP3 masks by healthcare workers is correct.

Public Health England discusses the personal protective equipment (PPE) guidance for healthcare workers with the Health and Safety Executive and other committee members as part of the decision making committee for PPE, chaired by Department. Advice has been sought from and agreed with the Health and Safety Executive in relation to type and specification for PPE required during the pandemic. These discussions are fed back to the UK-wide Infection Prevention Control Cell, who develop the PPE guidance for healthcare workers.

Following the identification of new COVID-19 variants, the United Kingdom Infection Prevention Control Cell conducted a comprehensive review of available evidence to inform any necessary changes to the guidance for health workers in England including recommended levels of personal protective equipment (PPE). Based on the evidence, they concluded that current guidance and PPE recommendations remain appropriate. Emerging evidence and data on variant strains will be continually monitored and reviewed and the guidance amended accordingly if needed.

There are no plans to extend the Cancer Recovery Plan.

From March, local systems will be expected to carry out local plans formed as part of the Cancer Services Recovery Plan and continue the progress that has already been made.

Arrangements for distributing the £1 billion funding, announced in the recent Spending Review, are still under consideration as the National Health Service continues to work through the current COVID-19 surge. In addition, the review also confirmed that there will be £325 million of new investment in NHS diagnostics equipment to improve clinical outcomes.

No specific assessment has been made. Throughout the COVID-19 pandemic, the NHS in England has maintained access to urgent and emergency care, including for patients with multiple sclerosis (MS). For non-urgent care, providers have been rolling out remote consultations using video, telephone, email and text message services as a priority where appropriate.

The National Institute for Health and Care Excellence guideline Multiple sclerosis in adults: management, updated November 2019, sets out best practice for clinicians in the treatment of MS, which includes guidance on the usage of oral and intravenous treatments for patients with relapse remitting MS.

Full details on funding allocations towards National Health Service workforce budgets, including relating to the cancer workforce, in 2021-22 are subject to a detailed financial planning exercise and will be finalised in due course.

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 clinical and cost-effective use of resources.

NICE is currently developing guidance for the NHS in England on the use of ozanimod for treating relapsing remitting multiple sclerosis. NICE recently consulted stakeholders on its initial draft recommendations on ozanimod and NICE will carefully consider the comments received in developing its final recommendations.

No specific assessment has been made. Throughout the COVID-19 pandemic, the National Health Service in England has maintained access to urgent and emergency care, including treatments for patients with multiple sclerosis (MS). For non-urgent care, remote consultations using video, telephone, email and text message services have been made available as a priority where appropriate.

On 23 December 2020, NHS England and NHS Improvement outlined priorities for the remainder of 2020-2021 and into 2021-2022, including maximising the NHS’s capacity to treat non-COVID-19 patients. This capacity includes services for people with neurological conditions, including for MS treatments across their disease course, whether they are for their overall quality of life or other individual needs - for example, physiotherapy, occupational therapy, and speech and language therapy.

The vaccination strategy, published on 13 January 2021, estimated that there are 0.4 million staff working in care homes for older adults in England.

We are working with the vaccination programme in NHS England to monitor progress on the vaccination of care home staff. NHS England now publish weekly data on the vaccination of care home staff, which is available at the following link:

https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-vaccinations/

Statistics on the total number of residents and the number vaccinated in elderly care home residents are available at the following link:

https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-vaccinations/

Data on the proportion of adult care home residents who have received the first dose of their vaccine by 3 January 2021 is not available. This data has been published since 4 February 2021.

NHS England publishes weekly data on the vaccination of residents and staff in older adult care homes which is available at the following link:

https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-vaccinations/

NHS England and NHS Improvement are working closely with Public Health England and the Department to drive improvements in immunisation uptake and coverage in all routine childhood immunisations. The Department intends to publish a vaccination strategy in the near future to maintain and develop the United Kingdom’s immunisation programme.

The human papillomavirus (HPV) vaccination is routinely administered in schools, with a target of 90% coverage for 13 to 14 year old females. Where full HPV coverage has not been attained in schools, HPV vaccination can be administered in general practice up to the age of 25 to support high levels of population coverage. A review of vaccination and immunisations in 2019 has led to reformed general practice contractual arrangements to support the delivery of vaccination activity to increase coverage. In addition, all practices are required to have a named vaccination lead, to support maximisation of uptake.

We are taking a cross-Government approach to address bereavement support and help ensure that families and friends of those deceased get the support they need – particularly during this difficult time. We are engaging with specialist bereavement organisations to assess how we can support them in doing their important work, which includes providing support to bereaved employees.

We are committed to ensuring National Health Service staff have the support and resources they need to respond to the pandemic. We established the Clinical Negligence Scheme for Coronavirus to handle pandemic claims not falling under existing state indemnity schemes and we communicated these plans in a letter of 2 April to NHS staff and providers. We have also taken steps, working with the NHS, professional regulators and across Government to ensure that claims, complaints and court processes can appropriately take into account the unprecedented context NHS staff are working within in response to COVID-19.

We have no plans to establish alternative arrangements to oversee claims, complaints and litigation against doctors as a result of the response to COVID-19.

We are committed to ensuring National Health Service staff have the support and resources they need to respond to the pandemic. We established the Clinical Negligence Scheme for Coronavirus to handle pandemic claims not falling under existing state indemnity schemes and we communicated these plans in a letter of 2 April to NHS staff and providers. We have also taken steps, working with the NHS, professional regulators and across Government to ensure that claims, complaints and court processes can appropriately take into account the unprecedented context NHS staff are working within in response to COVID-19.

We have no plans to establish alternative arrangements to oversee claims, complaints and litigation against doctors as a result of the response to COVID-19.

The rising costs of clinical negligence are unsustainable and we are committed to tackling this issue, working with the Ministry of Justice, other Government departments and NHS Resolution. This is a complex issue and the work is ongoing. We will bring forward a publication in due course.

The Government’s number one priority for adult social care is for everyone who relies on care to get the care they need throughout the COVID-19 pandemic.

We are committed to bringing forward a plan for social care to ensure that everyone is treated with dignity and respect and to find long-term solutions for one of the biggest challenges we face as a society. There are complex questions to address and it is important that we give these issues our full consideration in the light of current circumstances.

The flu vaccination programme is a crucial part of preparing the United Kingdom for winter. The vaccine is already available to those most at risk of flu, children aged 2-3, all primary school aged children and all healthcare workers. In 2019/20 over 14.6 million doses of the flu vaccine were administered to these groups.

As part of our planning for this coming winter, we are seeking to increase uptake for all the cohorts who are currently eligible for flu vaccination and extend who is eligible. Information on the ambitions for flu vaccine uptake will be published in the second annual flu letter 2020/21.

General practitioners and community pharmacists are directly responsible for ordering flu vaccine from suppliers for the adult flu programme, and advice was issued to them about ordering sufficient doses of vaccine for their patient groups.

It is the Government’s long-term ambition to recruit more people into social care to meet the future needs of society. In the short term, in order to attract people into social care now, we launched a new national recruitment campaign, ‘Care for others; Make a difference’, which ran across broadcast, digital and social media. We have also launched a new online platform to fast-track recruitment into the adult social care sector, which will sit alongside the many local initiatives that have been put in place to recruit staff.

The new Health and Care visa will make it cheaper, quicker and easier for eligible social care professions such as social workers, occupational therapists and nurses from around the world to come to work the United Kingdom. In addition all social care workers will now be permanently exempt from paying the Immigration Health Surcharge.

We are working to expand the supply of personal protective equipment (PPE) from overseas and improve domestic manufacturing capability. We are expanding and improving the logistics network for delivering to the front line.

Since 25 February we have delivered over 2.3 billion items of PPE across the health and social care system within England. Almost 30 billion items of PPE have been ordered from United Kingdom-based manufacturers and international partners to provide a continuous supply in the coming months.

We continue to model future demand for PPE to cover a range of possible scenarios, working closely with the Scientific Advisory Group for Emergencies to ensure it is underpinned by the latest science. We are confident in the stocks and sources of supply of PPE to meet the needs of health and social care over the next seven and 90 days and are increasingly looking further ahead. We have moved from an emergency situation a few months ago to a stable situation which allows us to prepare with resilience for any second spike or a new wave in the autumn or winter.

We are making sure our stockpile is ready for any future wave of the pandemic by ensuring we use lessons learnt and are informed by expert scientific advice.

No assessment has been made at this time.

On 8 June 2020, the National Cancer Director and the National Clinical Director for Cancer issued a further letter of guidance to National Health Service cancer services on Second phase of NHS response to COVID-19 for cancer services. The letter notes that the work for local systems and Cancer Alliances to identify ring-fenced diagnostic and surgical capacity for cancer should now be well advanced, so that referrals, diagnostics and treatment can be brought back to pre-pandemic levels at the earliest opportunity to minimise potential harm, and to reduce the scale of the post-pandemic surge in demand. The new guidance is based on three key principles: capacity, fairness and confidence. Cancer Alliances should work with their regional teams to provide such services.

On 8 June 2020, the National Cancer Director and the National Clinical Director for Cancer issued a further letter of guidance to National Health Service cancer services on Second phase of NHS response to COVID-19 for cancer services. The letter notes that the work for local systems and Cancer Alliances to identify ring-fenced diagnostic and surgical capacity for cancer should now be well advanced, so that referrals, diagnostics and treatment can be brought back to pre-pandemic levels at the earliest opportunity to minimise potential harm, and to reduce the scale of the post-pandemic surge in demand. The new guidance is based on three key principles: capacity, fairness and confidence. Cancer Alliances should work with their regional teams to provide such services.

On 8 June 2020, the National Cancer Director and the National Clinical Director for Cancer issued further guidance to NHS cancer services on the second phase of the NHS response to COVID-19 for cancer services. The states that the work for local systems and Cancer Alliances to identify ring-fenced diagnostic and surgical capacity for cancer should now be well advanced, so that referrals, diagnostics and treatment can be brought back to pre-pandemic levels at the earliest opportunity to minimise potential harm, and to reduce the scale of the post-pandemic surge in demand. Cancer Alliances should work with their regional teams to provide these essential services.

This includes focussing on reducing the number of over 62-day waiters on cancer pathways, particularly rescheduling diagnostic procedures or treatment for those who have had their care delayed by the pandemic.

Data on cancer referrals and treatments is collected and published by NHS England and available at the following link:

https://www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting-times/

Latest data available is April 2020, data for May 2020 will be published on 9 July 2020.

The National Health Service has continued to provide urgent and emergency services throughout the outbreak and has run the ‘Open for Business’ media campaign to encourage people with potentially serious health issues, such as cancer, to continue to seek medical advice and attend essential appointments. Cancer Alliances and Cancer Hubs have identified surgical capacity to meet demand for cancer services and treatments at this time.

We have been clear that we will continue to be guided by the latest scientific advice and will give the National Health Service whatever it needs, as we have done throughout this unprecedented pandemic.

Thanks to the dedication of NHS staff, hospitals have not been overwhelmed and intensive care capacity continues to meet the needs of patients.

Effective local management of any outbreak is the first line of protection against a second wave. In the event the local response is not sufficient to contain outbreaks, the Government would reintroduce measures if necessary, to contain the virus and stop it spreading to the wider population.

Using data from Royal Mail the number of home tests conducted in this time frame are shown in the following table. It should be noted that the Royal Mail’s data captures when the kit is delivered at their delivery office near the laboratory. For example, if the kit is ‘scanned as delivered’ on 4 May, it will then make it to the laboratory the following morning, 5 May, at the agreed ‘drop-off’ time.

Tests returned are counted and reported only once they have been processed by the laboratory and will appear in the data for pillar 2.

Data on the number of tests processed by pillar is available at the following link:

https://coronavirus.data.gov.uk/testing

Information on the methodology of how testing data is compiled is available at the following link:

https://www.gov.uk/government/publications/nhs-test-and-trace-statistics-england-methodology/nhs-test-and-trace-statistics-england-methodology

I refer the hon. Member to the answer I gave to Question 43048 on 16 June.

We take parliamentary scrutiny incredibly seriously and it is fundamentally important that hon. Members are provided with accurate and timely information to enable them to hold the Government to account. We are working rapidly to provide all Members with accurate answers to their questions, as well as supporting the Government’s response to the unprecedented challenge of the COVID-19 pandemic.

The hon. Member’s Question 43049 will be answered as soon as possible.

66,648 test samples were sent to a laboratory in the United States of America. 38,196 were successfully completed and 28,452 were void.

We worked hard to get complete tests for people under difficult circumstances. In many cases this worked and we are grateful for the team for their efforts. In some cases, it did not and the correct judgement was made to void the tests. Everyone affected was offered a new test immediately and we worked quickly to restore full capacity in the United Kingdom.

Various representations were received on the alleged omission of recommendations from Public Health England’s report entitled ‘COVID-19: review of disparities in risks and outcomes’, published on 2 June 2020. No recommendations were removed.

Alongside the epidemiological review, Professor Fenton undertook a rapid evidence review and external stakeholder engagement with a significant number of individuals and organisations within the black, Asian and minority ethnic community, to hear their views, concerns and ideas about the impact of COVID-19 on their communities. The results of that work have now been published and will inform the Government’s next steps being taken forward by the Parliamentary Under-Secretary of State for Equalities (Kemi Badenoch MP).

The United Kingdom has been an international exemplar in preparedness and our pandemic stockpile of personal protective equipment (PPE) and vital supplies is considered a very high-quality mark in international terms. At the start of the pandemic, Public Health England already had large stockpiles of PPE as part of its ongoing contingency measures to prepare for an outbreak. There were also supplies of PPE held through the NHS Supply Chain.

The Government has massively expanded both our supply of PPE from overseas and our domestic manufacturing capability and we are confident in the stocks and sources of supply of PPE to meet the needs of health and social care staff over the next seven and 90 days.

The Government has now signed contracts for over 2 billion items of PPE through UK-based manufacturers, ensuring we build and maintain a domestic base for the future.

The Department’s National Institute for Health Research (NIHR) Clinical Research Network (CRN) has information on 92 breast cancer clinical trials which it was supporting in March 2020. Half (50%) of these trials paused their recruitment as a result of the COVID-19 pandemic, 45% have continued and 5% have closed.

We have now entered a new phase of the pandemic, where the number of new cases of COVID-19 is declining so the NIHR, including the CRN, is working towards the restoration of research funded and/or supported by the NIHR - including clinical trials on breast cancer. To help initiate this process, the NIHR has developed a ‘Framework for Restart’, which provides a structure to guide the restart, while maintaining local decision-making and flexibility to respond to COVID-19. Further information is available at the following link:

https://www.nihr.ac.uk/documents/restart-framework/24886

As of 9 June 2020, 211 National Health Service staff deaths involving COVID-19 have been reported in England. The number of NHS worker deaths is verified from direct reports from NHS employing organisations and the number of individuals identified as deceased healthcare workers by non-NHS organisations. This information is investigated and triangulated by NHS England to give a high level of confidence of validity.

Public Health England analysis of mortality data from the Office for National Statistics (ONS) shows that at least 214 deaths involving COVID-19 among social care workers were registered 21 March to 8 May 2020 (in England, of those aged 20-64 years). The ONS will be publishing an updated figure in due course.

We introduced large-scale home testing at the end of April to make testing more accessible to individuals. Between 27 April – 5 May over 95,000 home tests were dispatched to users. In that same time period, nearly 21,000 test samples were processed by our labs. The difference in these numbers is due to the number of days between test dispatch, through to the sample being taken and then being collected by courier to be sent to the lab. This means that the 21,000 test samples processed will not correlate to tests dispatched on these dates.

Between 27 April 2020 and 5 May 2020, a total of 168,050 Home Test Kits were sent out. Between 5 May 2020 and 6 August 2020, a further 5,514,897 Home Test Kits were sent out.

Officials have been working closely with the General Medical Council (GMC) to ensure it has a plan in place to use its powers to support delivery of essential health and care services during an epidemic, if this is required. When registering professionals, the GMC Registrar has the power to add conditions that restrict the types of activities that a doctor can carry out. Additionally, any emergency registered retired doctors who are deployed, will be subject to oversight by local employing organisations to ensure the safe delivery of care.

If doctors or nurses return to the National Health Service in England for the purposes of assisting with the COVID-19 outbreak and carry out work on behalf of an NHS trust or a general practitioner (GP) practice, they would be covered for clinical negligence indemnity via one of the following state indemnity schemes:

- The Clinical Negligence Scheme for Trusts, if they are engaged by an NHS trust to provide NHS services; and

- The Clinical Negligence Scheme for General Practice, if they are engaged by a GP practice to provide NHS services (i.e. a GP practice, the main business of which is the provision of primary medical services for the NHS).

A full list of all trusts along with the number of hip and knee replacement procedures and the average waiting time is attached.

The data shows the number of procedures between the period April 2018 until March 2019.

It should be noted the data does not show individual patients as the same person may have been admitted into a National Health Service hospital on more than one occasion.

The UK is a longstanding supporter to the UN Relief and Works Agency (UNRWA). Our annual contribution to UNRWA's core programme budget helps UNRWA provide basic education to more than 533,000 children a year (half of which are girls), access to health services for 3.5 million Palestinian refugees and social safety net assistance for around 255,000 of the most vulnerable across the region. The UK Embassy in Tel Aviv also regularly raises the importance of access to essential services with the Israeli authorities.

The UK remains firmly committed to ensuring access to essential healthcare services for Palestinians. We are a longstanding supporter to the UN Relief and Works Agency (UNRWA) which provides core services, including healthcare to Palestinian refugees. Our future spending allocations will be set in the next Spending Review and full budgets for 2021 will be published in due course, including in our regular Statistics on International Development website and in the Foreign Commonwealth and Development Office Annual Report and Accounts.

Following Official Development Assistance (ODA) prioritisation exercises undertaken in March 2021, the UK no longer provides direct funding to the Palestinian Authority to support the salaries of education workers and health professionals. The UK remains firmly committed to ensuring access to essential healthcare services for Palestinians. We are a longstanding supporter to the UN Relief and Works Agency (UNRWA) which provides core services, including healthcare to Palestinian refugees.

Cooperation is key to tackling Covid-19. The British Embassy Tel Aviv and the British Consulate-General Jerusalem are in regular contact with both parties and continue to urge them to coordinate on vaccine access.

We have made clear our concern about the ongoing humanitarian situation in Gaza, including the significant damage and destruction of civilian infrastructure, hospitals and clinics. The UK Embassy in Tel Aviv regularly raises the importance of access to healthcare, including critical health services, with the Israeli authorities, most recently on 1 June. We are urging the Government of Israel to ensure this access is maintained. The long-lasting movement restrictions and the serious constraints imposed by the occupation can impact the provision of medical care. The wounded and critically ill in Gaza should be able to access the urgent medical care they need.

We welcome the steps that the Israeli and Palestinian authorities have taken so far to coordinate responses to the COVID-19 pandemic and encourage further dialogue in this regard. The UK is committed to global equitable access to effective vaccines as demonstrated by our £548 million contribution to the COVAX Advance Market Commitment (AMC) - the international initiative to support global equitable access to vaccines. The Occupied Palestinian Territories (OPTs) were among the first to benefit from the COVAX scheme with its first delivery of vaccines on 17 March 2021. Since that initial shipment, we are pleased that several further deliveries have arrived in the OPTs, including most recently on 25 August 2021.

All viruses change constantly through mutation, and many thousands of variants of the virus that causes COVID-19 have been detected across the world. Most have little to no impact on the virus's ability to cause infections and disease, but some can pose higher risks. Variants are more likely to arise in areas of high transmission. In addition to basic public health measures, the World Health Organisation has advised that ensuring equitable access to COVID-19 vaccines will reduce virus circulation. This will ultimately lead to fewer mutations and variants.

The UK is committed to rapid, equitable access to safe and effective vaccines. We are among the largest donors to the COVAX Advance Market Commitment (AMC), committing £548 million, which leveraged $1 billion from other donors in 2020 through match funding. This support to COVAX has been critical to it supplying COVID-19 vaccines to over 120 countries, and economies. We have also committed to share the majority of our supply of any surplus vaccine doses with COVAX.

The UK remains committed to rapid, equitable access to safe and effective vaccines, and the Prime Minister has said that we will share the majority of any doses that are surplus to UK needs with COVAX. As the multilateral mechanism set up to support international cooperation on vaccines, COVAX remains best-placed for allocating vaccines where they are most needed, and will be most effective. We have already committed £548 million to the COVAX Advance Market Commitment, which specifically supports vaccine access for at least 500 million people in up to 92 low and middle income countries in 2021. Our wider support for COVAX has enabled the mechanism to reach over 120 countries.

The UK is a founding member, and one of the largest donors to the COVAX Advance Market Commitment, contributing £548 million for global equitable access. This £548 million spend, and the vital work it supports, has been assessed as ODA eligible, and will be met under our commitment to spend 0.5% of UK GNI on ODA.

The UK is committed to rapid, equitable access to safe and effective vaccines, treatments, and tests globally. The Prime Minister, Foreign Secretary, and I continue to speak to our international counterparts, discussing the shared fight against coronavirus.

For example, at the recent G7 Foreign and Development Ministerial Meeting, we agreed a statement on Equitable Access and Collaboration that recognised COVAX as "the key mechanism for global sharing of vaccines…to enable the rapid equitable deployment of vaccines." We committed to supporting access to safe, effective vaccines, with distribution guided by principles of equity and public health data.

The UK is committed to rapid equitable access to safe and effective vaccines. We are among the largest donors to the COVAX Advance Market Commitment (AMC), committing £548 million, which leveraged $1 billion from other donors through match funding in 2020. This support to COVAX has been critical in supplying COVID-19 vaccines to over 120 countries and economies. The Prime Minister has also committed to sharing the majority of any surplus vaccines with COVAX.

The UK is committed to our G7 Presidency championing equitable access to vaccines, therapeutics, and diagnostics to help the world fight COVID-19, and build back better from this pandemic. We are engaging, including with our G7 partners, on COVAX's approach for 2022, and beyond, and continue to advocate for further financial contributions to COVAX to support equitable access to COVID-19 vaccines

As the multilateral mechanism set up to support international co-operation on vaccines, and to ensure that the most vulnerable countries have access, COVAX remains best-placed to allocate any surplus doses that the UK may have where they are most needed, and will be most effective. However, it is too early to determine how many doses of the vaccines that the UK has ordered will not be needed for the UK population. This is under constant review.

The UK is concerned by the continued demolitions of Palestinian property and infrastructure by Israeli authorities. In all but the most exceptional of circumstances demolitions are contrary to International Humanitarian Law. The practice causes unnecessary suffering to ordinary Palestinians and is harmful to the peace process.

The UK regularly raises demolitions with the Government of Israel. I raised my concerns about demolitions of Palestinian and humanitarian structures with the Israeli Ambassador on 29 October 2020, and the UK Ambassador to Israel outlined the UK's position to the Israeli Authorities in Jerusalem on the same day. UK senior officials raised demolitions with the Israeli Ambassador to the UK on 10 November 2020. The UK also urged the Government of Israel to end demolitions of property in the West Bank at the UN Security council on 21 December 2020. UK officials from the British Consulate in Jerusalem have made regular visits to areas at risk of demolition and eviction to reiterate UK support for those communities, including to Khan al Ahmar on 20 November, Givat Hamatos on 22 October, the South Hebron Hills on 19 October, and Ras al Tin on 16 October. We are focused on preventing demolitions from happening in the first place through our legal aid programme, which supports Bedouin communities and Palestinians facing demolition or home eviction in both the West Bank and East Jerusalem. We continue to urge the Government of Israel to develop improved mechanisms for zoning, planning and permitting in Area C for the benefit of the Palestinian population, including by facilitating local Palestinian participation in such processes.

The UK is concerned by the continued demolitions of Palestinian property and infrastructure by Israeli authorities. In all but the most exceptional of circumstances demolitions are contrary to International Humanitarian Law. The practice causes unnecessary suffering to ordinary Palestinians and is harmful to the peace process.

The UK regularly raises demolitions with the Government of Israel. I raised my concerns about demolitions of Palestinian and humanitarian structures with the Israeli Ambassador on 29 October 2020, and the UK Ambassador to Israel outlined the UK's position to the Israeli Authorities in Jerusalem on the same day. UK senior officials raised demolitions with the Israeli Ambassador to the UK on 10 November 2020. The UK also urged the Government of Israel to end demolitions of property in the West Bank at the UN Security council on 21 December 2020. UK officials from the British Consulate in Jerusalem have made regular visits to areas at risk of demolition and eviction to reiterate UK support for those communities, including to Khan al Ahmar on 20 November, Givat Hamatos on 22 October, the South Hebron Hills on 19 October, and Ras al Tin on 16 October. We are focused on preventing demolitions from happening in the first place through our legal aid programme, which supports Bedouin communities and Palestinians facing demolition or home eviction in both the West Bank and East Jerusalem. We continue to urge the Government of Israel to develop improved mechanisms for zoning, planning and permitting in Area C for the benefit of the Palestinian population, including by facilitating local Palestinian participation in such processes.

The UK remains concerned about the ongoing humanitarian situation in Gaza and the impact of COVID-19 on an already fragile healthcare system. Recognising the severity of the situation, we were one of the first donors to provide funding to support the health and humanitarian response to the COVID-19 pandemic in the Occupied Palestinian Territories (OPTs). We have provided £1.25 million funding (the World Health Organisation with £630,000 and the United Nations Children's Fund with £620,000) to purchase and co-ordinate delivery of medical equipment, treat critical care patients, train frontline health workers and scale up laboratory testing capacity - mainly in Gaza.

In addition, we are providing £2.5 million to the World Food Programme to provide food and cash assistance for the most vulnerable Palestinians to help alleviate the humanitarian situation. We have also contributed £1 million to the United Nations Relief and Works Agency's Emergency Appeal in the OPTs which will help provide emergency food to over one million food-insecure refugees in Gaza.

The UK remains concerned about the ongoing humanitarian situation in Gaza, compounded by the impact of COVID-19.

We recognise the importance of tackling food insecurity. To support, we are providing £2.5 million to the World Food Programme to provide food and cash assistance to the most vulnerable Palestinians. We have also contributed £1 million to the United Nations Relief and Works Agency's Emergency Appeal in the Occupied Palestinian Territories which will help provide emergency food to over one million food-insecure refugees in Gaza.

We remain concerned about the capacity of the Palestinian health system to cope with the increasing number of COVID-19 cases, especially in Gaza. We welcome the recent 30% increase in hospital beds for patients suffering critical and severe cases, and the recent procurement by World Health Organisation of two additional oxygen generators. The UK continues to monitor the situation closely.

We remain concerned about the capacity of the Palestinian health system to cope with the increasing number of COVID-19 cases. We are aware of the temporary cessation of COVID-19 testing in Gaza on 6th December and welcome reports from the World Health Organisation that further testing kits arrived in Gaza on 7th December and testing resumed.

We have already delivered vital support to respond to the COVID-19 outbreak in the Occupied Palestinian Territories through £1.25 million in funding (World Health Organisation with £630,000 and United Nations Children's Fund with £620,000). This funding helped to provide over 20,000 testing kits, mainly in Gaza.

Disability inclusion is an important issue for the FCDO, and the Ministerial team remains committed to embedding it across all our work, including as we respond to the ongoing impact of COVID-19.

The UK is committed to supporting people with disabilities across our programmes in the OPTs. Following the outbreak of COVID-19, we have approved additional programming to strengthen disability inclusion across Palestinian society, which aims to ensure people with disabilities (PwD) are accounted for in the COVID-19 crisis response through reviewing laws, regulations, HR policies and bylaws in public sector to analyse barriers to PwDs' participation in decision making. This will be followed by an advocacy campaign targeting the gaps identified in the analysis. We also engage frequently with the Israelis on issues affecting ordinary Palestinians, including the impact of COVID-19.

Disability inclusion is an important issue for the FCDO, and the Ministerial team remains committed to embedding it across all our work, including as we respond to the ongoing impact of COVID-19.

The UK is committed to supporting people with disabilities across our programmes in the OPTs. Following the outbreak of COVID-19, we have approved additional programming to strengthen disability inclusion across Palestinian society, which aims to ensure people with disabilities (PwD) are accounted for in the COVID-19 crisis response through reviewing laws, regulations, HR policies and bylaws in public sector to analyse barriers to PwDs' participation in decision making. This will be followed by an advocacy campaign targeting the gaps identified in the analysis. We also engage frequently with the Israelis on issues affecting ordinary Palestinians, including the impact of COVID-19.

Disability inclusion is an important issue for the FCDO, and the Ministerial team remains committed to embedding it across all our work, including as we respond to the ongoing impact of COVID-19.

The UK is committed to supporting people with disabilities across our programmes in the OPTs. Following the outbreak of COVID-19, we have approved additional programming to strengthen disability inclusion across Palestinian society, which aims to ensure people with disabilities (PwD) are accounted for in the COVID-19 crisis response through reviewing laws, regulations, HR policies and bylaws in public sector to analyse barriers to PwDs' participation in decision making. This will be followed by an advocacy campaign targeting the gaps identified in the analysis. We also engage frequently with the Israelis on issues affecting ordinary Palestinians, including the impact of COVID-19.

The UK remains concerned about the capacity of an already fragile health system in Gaza. We have provided £1.25 million funding (WHO with £630,000 and UNICEF with £620,000) to purchase and co-ordinate delivery of medical equipment, treat critical care patients, train frontline health workers and scale up laboratory testing capacity – mainly in Gaza. This funding helped to provide over 20,000 testing kits, 59,500 PPE items for around 4,900 health workers.

The British Consulate General also supported the delivery of 24 respirators to the Palestinian Ministry of Health for several hospitals across the West Bank and Gaza to help provide support for critical cases.

The UK remains concerned about the capacity of an already fragile health system in Gaza. We have provided £1.25 million funding (WHO with £630,000 and UNICEF with £620,000) to purchase and co-ordinate delivery of medical equipment, treat critical care patients, train frontline health workers and scale up laboratory testing capacity – mainly in Gaza. This funding helped to provide over 20,000 testing kits, 59,500 PPE items for around 4,900 health workers.

The British Consulate General also supported the delivery of 24 respirators to the Palestinian Ministry of Health for several hospitals across the West Bank and Gaza to help provide support for critical cases.

The Government has provided a comprehensive economic response that is one of the most generous of its kind in the world, taking unprecedented steps to support families, businesses and the most vulnerable. As well as the Coronavirus Job Retention Scheme (CJRS) and Self-Employment Income Support Scheme (SEISS), this package includes Government-backed loans and grants to businesses, tax deferrals, rental support and mortgage and consumer credit holidays.

This package also includes extra funding for the welfare safety net to help those through this outbreak who are unable to access other forms of support. The temporary welfare measures include increases to Universal Credit and Local Housing Allowance, a relaxation of the Universal Credit minimum income floor, and making Statutory Sick Pay easier to access.

Now, the Government’s new Plan for Jobs will support, protect and create jobs. This plan will make available up to £30 billion to help kickstart the nation’s economic recovery ahead of a fuller package of medium-term recovery measures in the forthcoming Autumn Budget and Spending Review.

The UK government is applying the Barnett formula in the normal way to the additional funding for charities announced by the Chancellor, with the Scottish Government receiving at least £55 million in Barnett consequentials in relation to the £750 million package.

Funding for charities is a devolved matter and it is for the Scottish Government to decide how to support charities in Scotland.