Department of Health and Social Care

The Department of Health and Social Care has indicated that it will not be possible to answer this question within the usual time period. An answer is being prepared and will be provided as soon as it is available.

The Department of Health and Social Care has indicated that it will not be possible to answer this question within the usual time period. An answer is being prepared and will be provided as soon as it is available.

The Department of Health and Social Care has indicated that it will not be possible to answer this question within the usual time period. An answer is being prepared and will be provided as soon as it is available.

The Department of Health and Social Care has indicated that it will not be possible to answer this question within the usual time period. An answer is being prepared and will be provided as soon as it is available.

The Department of Health and Social Care has indicated that it will not be possible to answer this question within the usual time period. An answer is being prepared and will be provided as soon as it is available.

The Department of Health and Social Care has indicated that it will not be possible to answer this question within the usual time period. An answer is being prepared and will be provided as soon as it is available.

The Department of Health and Social Care has indicated that it will not be possible to answer this question within the usual time period. An answer is being prepared and will be provided as soon as it is available.

The Department of Health and Social Care has indicated that it will not be possible to answer this question within the usual time period. An answer is being prepared and will be provided as soon as it is available.

The Department of Health and Social Care has indicated that it will not be possible to answer this question within the usual time period. An answer is being prepared and will be provided as soon as it is available.

The Department of Health and Social Care has indicated that it will not be possible to answer this question within the usual time period. An answer is being prepared and will be provided as soon as it is available.

The Department of Health and Social Care has indicated that it will not be possible to answer this question within the usual time period. An answer is being prepared and will be provided as soon as it is available.

The Department does not hold data on the number of avoidable attendances to accident and emergency departments have been prevented by Pharmacy First. Pharmacy First is a complex service that links to multiple parts of the healthcare system. The service aims to offer eligible patients a complete episode of care in the pharmacy setting and to receive treatment for seven common health conditions releasing pressure on general practice appointments and the wider National Health Service. Since the service launched, there have been over 4.8 million consultations, with over 3.6 million consultations resulting in supply medicines.

The Department and NHS England have launched national campaigns to raise awareness of urgent National Health Services. The Pharmacy First campaign, from October 2025 to January 2026, encouraged people to seek treatment for seven common conditions at pharmacies, helping to relieve pressure on general practice over winter. It used various media channels, including television, radio, outdoor adverts, social media, and online platforms. The NHS 111 campaign, from November 2025 to March 2026, promoted the use of the 111 service for urgent medical needs, directing people to suitable care options, including urgent treatment centres and mental health support, through similar advertising channels. Government and NHS online resources also signpost people to the most appropriate urgent care services.

The Government is committed to improving care for everyone with dementia, which is why we have funded the work of Dementia 100: Assessment Tool Pathway programme. This brings together multiple resources into a single, consolidated tool and will help simplify best practice. A number of experts, including those with expertise in speech and language therapy and dementia care, provided independent, desktop analysis of the tool and this invaluable feedback was integrated into the tool. The D100: Pathway Assessment Tool can be found at the following link:

https://www.rcpsych.ac.uk/improving-care/nccmh/service-design-and-development/dementia-100-pathway-assessment-tool

We will also deliver the first ever Modern Service framework for Frailty and Dementia to deliver rapid and significant improvements in quality of care and productivity. This will be informed by phase one of the independent commission into adult social care, which is expected this year. The Frailty and Dementia Modern Service Framework will seek to reduce unwarranted variation and narrow inequality for those living with dementia and will set national standards for dementia care and redirect National Health Service priorities to provide the best possible care and support.

We are committed to publishing an interim product in September this year to feed into NHS and local government planning cycles, and will aim to publish the full modern service framework by the end of this calendar year as recommended by Baroness Casey.

The provision of dementia health care services is the responsibility of local integrated care boards (ICBs) and may include speech and language therapy. We expect ICBs to commission services based on local population needs, taking account of National Institute for Health and Care Excellence guidelines.

Patients can be referred to a speech and language therapist at any time after a diagnosis. The therapist will assess speech, language, and communication difficulties and how they are affecting the patient or making everyday life difficult. They can also help with eating, drinking, and swallowing difficulties.

Integrated care boards can already commission community-based eye care services. Improvements in IT connectivity and the development of single points of access between primary care optometry and secondary care will also support more care being delivered in the community, including under shared care arrangements.

The intention of Care Quality Commission (CQC) Regulation 19 Fit and proper persons employed of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 is to make sure providers only employ 'fit and proper' staff who are able to provide care and treatment appropriate to their role and to enable them to provide the regulated activity.

To meet this regulation, providers must operate robust recruitment procedures, including undertaking any relevant checks. They must have a procedure for ongoing monitoring of staff to make sure they remain able to meet the requirements, and they must have appropriate arrangements in place to deal with staff who are no longer fit to carry out the duties required of them.

The CQC can assess compliance with these regulations through assessment and monitoring activity. Where a breach of regulation or non-compliance is identified, The CQC can take regulatory action.

An Enhanced Disclosure and Barring Service (DBS) check must be undertaken prior to the recruitment of all care workers. In line with the CQC guidance for DBS checks, staff working with vulnerable adults can only start work before a DBS certificate is received if they have had a DBS Adult First Check, are appropriately supervised, and do not escort people away from the premises unless accompanied by someone with a DBS check.

The intention of Care Quality Commission (CQC) Regulation 19 Fit and proper persons employed of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 is to make sure providers only employ 'fit and proper' staff who are able to provide care and treatment appropriate to their role and to enable them to provide the regulated activity.

To meet this regulation, providers must operate robust recruitment procedures, including undertaking any relevant checks. They must have a procedure for ongoing monitoring of staff to make sure they remain able to meet the requirements, and they must have appropriate arrangements in place to deal with staff who are no longer fit to carry out the duties required of them.

In addition, an Enhanced Disclosure and Barring Service check must be undertaken prior to the recruitment of all care workers. If an individual has been barred, then they will be added to the Adults’ Barred List. If they knowingly engage, or seek to engage, in regulated activity with a vulnerable group from which they are barred then they would be committing a criminal offence, punishable by imprisonment and/or a fine. The same is true for employers who knowingly employ somebody who is on the barred list.

Decisions about care placements are made locally, based on individual assessments of need and personal circumstances. Under the Care Act 2014, local authorities are tasked with the duty to shape their care markets and commission services to meet the diverse needs of all local people. This includes commissioning a variety of different providers and specialist services that provide genuine choice to meet the needs of local people and that offer quality and value for money.

There is no single national assessment of the impact of out‑of‑area placements on access to family support networks. However, local authorities should engage with people who draw on care and support, and their families and carers, to inform commissioning decisions and to consider the outcomes which matter to them.

Under the Health and Care Act 2022, the Care Quality Commission has a statutory duty to assess how well local authorities are delivering their adult social care duties. However, we recognise that out-of-area placements can sometimes occur due to a lack of available provision in the area.

Decisions about care placements are made locally, based on individual assessments of need and personal circumstances. Under the Care Act 2014, local authorities are tasked with the duty to shape their care markets and commission services to meet the diverse needs of all local people. This includes commissioning a variety of different providers and specialist services that provide genuine choice to meet the needs of local people and that offer quality and value for money.

There is no single national assessment of the impact of out‑of‑area placements on access to family support networks. However, local authorities should engage with people who draw on care and support, and their families and carers, to inform commissioning decisions and to consider the outcomes which matter to them.

Under the Health and Care Act 2022, the Care Quality Commission has a statutory duty to assess how well local authorities are delivering their adult social care duties. However, we recognise that out-of-area placements can sometimes occur due to a lack of available provision in the area.

The Government intends to direct the National Institute for Health and Care Excellence to apply the new cost-effectiveness threshold increase from April.

The Medicines and Healthcare products Regulatory Agency (MHRA) is committed to continually strengthening the Yellow Card scheme to support patient safety. The MHRA regularly promotes awareness through public health campaigns, conferences, established networks, and new educational resources available on the Yellow Card website. Further information is available on the MHRA website at the following link:

https://www.gov.uk/government/organisations/medicines-and-healthcare-products-regulatory-agency

Reporting rates through spontaneous reporting systems, such as the Yellow Card Scheme, are highly variable, and dependent not just on the condition, but other factors such as the product, public interest, and media attention. As such, the MHRA does not hold estimates of under reporting rates for these conditions.

The MHRA is expanding and improving digital reporting routes. Every National Health Service webpage relating to a medicine or vaccine now links to the Yellow Card scheme, and the MHRA is working with NHS colleagues to enhance integration with the NHS App to increase visibility and reporting by the public. Yellow Card reporting is now embedded in almost all general practice clinical IT systems, enabling healthcare professionals to submit reports directly on behalf of patients.

Over recent years, the MHRA has delivered a major upgrade programme to modernise the Yellow Card scheme’s technology and infrastructure. This includes improving the quality and timeliness of submitted information, making it easier to report, adding conditional questions to reduce follow up, and support real time signal detection of safety issues.

The Yellow Card app has also been modernised to mirror the website, broaden reporting options, including defective and counterfeit medicines, and improve access to safety data. Multifactor authentication has been introduced to enhance account security and enable future integration with the NHS login. The app has also been upgraded to a progressive web application, providing a seamless and engaging user experience across devices.

Together, these improvements increase public awareness, make reporting, including of myocarditis and pericarditis, easier, and enhance the MHRA’s ability to identify and assess emerging safety concerns across healthcare products.

The Medicines and Healthcare products Regulatory Agency (MHRA) requires all staff to undertake a conflict-of-interest declaration upon joining the agency and then on a yearly basis. All declarations are assessed according to MHRA policy to ensure due consideration and agreement of required mitigations. The MHRA does not routinely record where staff move to when leaving the agency, however all staff are bound by the business appointment rules for crown servants and are required to seek prior agreement if they fall within the specified criteria. Further information on the business appointment rules for crown servants is available at the following link:

https://www.gov.uk/government/publications/business-appointment-rules-for-crown-servants/business-appointment-rules-for-crown-servants

In relation to staff joining the agency, the MHRA does not record the information in the manner requested, but a manual review of the records from new joiners between the financial years 2021 to 2026 indicates that 47 staff have declared previous employment in a pharmaceutical or industry funded body. The following table shows a breakdown of the 47 staff who have declared previous employment in a pharmaceutical or industry funded body from 2021/22 to 2025/26, and in total:

It should be noted that this assessment is a best estimate to match within the criteria requested and the number may be subject to change.

The UK COVID-19 Inquiry is an independent statutory inquiry. As an independent body, it is responsible for determining its own scope, lines of investigation, and the evidence it seeks. Decisions about whether to include examination of specific scientific or technical matters, such as the evidence base relating to spike proteins or lipid nanoparticles, fall within the inquiry’s discretion.

The Medicines and Healthcare products Regulatory Agency has not received any specific correspondence or instruction from the inquiry relating to spike proteins or lipid nanoparticles.

In the last five years, three internal whistleblowing reports relating to conflicts of interest have been made to the Medicines and Healthcare products Regulatory Agency’s (MHRA) nominated officers.

Nominated officers are trained individuals designated to give confidential advice, support, and guidance on whistleblowing concerns to staff, and to help staff escalate those concerns appropriately. The following table shows the number of whistleblowing reports related to conflicts of interest, from 2021/22 to 2025/26, up to 20 March 2026:

There are no requirements or plans to publish summaries of these whistleblowing reports. The MHRA submits data annually to the Cabinet Office on all whistleblowing investigations that have taken place and publishes a short summary of its internal whistleblowing actions, including the number of whistleblowing investigations, in its Annual Report and Accounts.

No such modelling has been undertaken.

The Department of Health and Social Care has indicated that it will not be possible to answer this question within the usual time period. An answer is being prepared and will be provided as soon as it is available.

The Department of Health and Social Care has indicated that it will not be possible to answer this question within the usual time period. An answer is being prepared and will be provided as soon as it is available.

The Department has not made a specific assessment of the impact of removing the caps on online requests on patient safety and general practice (GP) workload. Data on online consultation submissions is collected, monitored, and published.

This is because there is no change to clinical responsibility, triage processes, or same‑day requirements for clinically urgent care as a result of this clarification. Practices retain flexibility over how requests are prioritised and responded to, including the use of triage models and appropriate response times for non‑urgent requests. Evidence from practices shows that spreading demand more evenly across the day can support smoother workflows and reduce pressure on telephone access, rather than increasing overall workload.

The clarification on online access is being implemented alongside wider GP Contract changes for 2026/27, including £485 million in additional core funding and reforms intended to support practice capacity.

The NHS Newborn Blood Spot Programme consistently achieves very high coverage with the most recent figure at 98% in Quarter 2 of 2025/26. This not only indicates that eligible babies are being screened, but also that conclusive results are recorded on the Child Health Information Service system before or at 17 days of age, indicating that the programme is effective at reaching almost the entire eligible population and delivering results early enough to influence outcomes.

Coverage of babies who move into the area after birth is lower at 83%, so the programme is less effective for this subgroup, but numbers are much smaller.

A total of 570,865 babies were screened in 2024/25, demonstrating the programme is operating effectively at scale, and the system is robust enough to deliver screening across a large cohort.

Over one million babies have been screened for severe combined immunodeficiency since the launch of the in-service evaluation (ISE) in 2017. NHS England’s report on the 30-month ISE evaluation period found that screening detected 10 babies with the condition who would otherwise have gone undetected until infections developed, thus preventing serious illness.

It is important to note that comparisons of screening programmes with other health systems can be misleading. Some countries or regions reportedly screen for a condition when it is only at the pilot or research stage. Some ‘screening programmes’ just test for a condition rather than being end-to-end quality-assured programmes that include diagnosis, treatment, and care. And screening in some countries is delivered regionally, or even just by individual hospitals, rather than nationally. They are therefore not directly comparable to the national screening programmes offered in the United Kingdom.

For very rare conditions it is difficult to generate robust evidence to demonstrate the value of screening, because so few babies are affected. The UK National Screening Committee, which advises the Government on all screening matters, is working with experts and partner organisations to look at how to make it easier to develop the evidence needed to make robust recommendations on the addition of more rare diseases to the NHS Newborn Blood Spot Programme.

The new HIV Action Plan, published on World AIDS Day on 1 December 2025, sets out how the Government will enable every level of the healthcare system to work together to engage everyone in prevention, testing, and treatment, tackling stigma, and reaching our ambition to end new HIV transmissions by 2030. This includes a dedicated action to deliver tailored and targeted HIV prevention, treatment, and care services to meet the needs of local populations and address inequalities, including the challenges of HIV prevention and care in prisoners.

People entering prison receive healthcare assessments on reception which identify current healthcare needs and treatment. This includes identifying people who are receiving treatment for HIV. The healthcare team will use processes for accessing critical medicines to arrange an urgent supply of HIV medicines from the specialist clinic if required. The healthcare team will then ensure a referral to the local HIV specialist team if the patient is in a prison, in a location which lies outside of the area covered by their current specialist. HIV services have clear processes used to promptly transfer care between specialists.

The UK Health Security Agency is working with regional partners to carry out an audit to understand the provision of HIV diagnosis, prevention, and care in English prisons.

The Department’s National Supply Disruption Response, (NSDR), acts as the single point of contact for the medical supply industry. The NSDR has been engaged along with the Food Standards Agency to support the incident with infant formula products and specialised prescribable infant formula products, since early January this year, when we were first made aware.

Although no separate assessment was made of the localised impacts in Leicester, or any other single region, a national approach was taken to safeguard the clinical needs of the most vulnerable patients across the country. This involved securing unaffected stock for redistribution to those in the greatest needs in both hospital and home settings, whilst working closely with industry to identify suitable alternatives.

The original supply issue was resolved in mid-February 2026, and subsequently a letter was issued to all prescribing authorities to notify them that impacted prescribable items had returned to normal stock and were therefore available to prescribe again.

The Department continues to work closely with NHS England and other national agencies on the supply positions, operational impacts, and alternative products for all such incidents, using well-established coordination arrangements.

The rising costs of clinical negligence claims against the National Health Service in England are of great concern to the Government. Costs have more than doubled in the last 10 years and are forecast to continue rising, putting further pressure on NHS finances.

Although forecasts remain uncertain, it is likely that, without action to address it, the costs of clinical negligence will continue to grow substantially. The Government Actuary’s Department forecasts that annual payments for compensation and legal costs will increase from £3 billion in 2024/25 to £4.1 billion by 2029/30.

Between 2006/7 and 2024/25, the total volume of claims settled by NHS Resolution increased from 5,923 to 13,329. In 2025, the National Audit Office’s Costs of clinical negligence report stated that "settled claim volumes for hospital activity under CNST have remained relatively stable since 2016-17. Recent increases in clinical negligence claims are largely due to the introduction of two new indemnity schemes in 2019 covering both current and historic claims in primary medical services”.

As announced in the 10-Year Health Plan for England, David Lock KC is providing expert policy advice on the rising costs of clinical negligence and how we can improve patients’ experience of claims. The review is ongoing, following initial advice to ministers and the recent National Audit Office’s report. No decisions on policy have been taken at this point, and the Government will provide an update on the work done and next steps in due course.

The rising costs of clinical negligence claims against the National Health Service in England are of great concern to the Government. Costs have more than doubled in the last 10 years and are forecast to continue rising, putting further pressure on NHS finances.

Although forecasts remain uncertain, it is likely that, without action to address it, the costs of clinical negligence will continue to grow substantially. The Government Actuary’s Department forecasts that annual payments for compensation and legal costs will increase from £3 billion in 2024/25 to £4.1 billion by 2029/30.

Between 2006/7 and 2024/25, the total volume of claims settled by NHS Resolution increased from 5,923 to 13,329. In 2025, the National Audit Office’s Costs of clinical negligence report stated that "settled claim volumes for hospital activity under CNST have remained relatively stable since 2016-17. Recent increases in clinical negligence claims are largely due to the introduction of two new indemnity schemes in 2019 covering both current and historic claims in primary medical services”.

As announced in the 10-Year Health Plan for England, David Lock KC is providing expert policy advice on the rising costs of clinical negligence and how we can improve patients’ experience of claims. The review is ongoing, following initial advice to ministers and the recent National Audit Office’s report. No decisions on policy have been taken at this point, and the Government will provide an update on the work done and next steps in due course.

All colleagues within the Civil Service, across the Government, are required to follow guidance set out in the Civil Service Code of Conduct. This is available to all on the GOV.UK website. In addition, colleagues are also required to follow Guidance on Diversity and Inclusion and Impartiality for Civil Servants. This guidance is also available on the GOV.UK website.

There are no current plans to consider transplants, including stem cell and bone marrow transplants, as part of the Getting It Right First Time programme. The Department is aware of challenges around the timely provision of well-matched stem cell donors, particularly for people from mixed heritage or ethnic minority backgrounds, and therefore instead intends to review the factors underlying this and the system supporting stem cell donation.

Decisions about prescribing liothyronine are made by the responsible clinician. NHS England guidance, which aligns with National Institute for Health and Care Excellence guidance on the assessment and management of thyroid disease, is clear that liothyronine should not be routinely prescribed in primary care. Where clinically appropriate, liothyronine should only be initiated by a National Health Service consultant endocrinologist, and only where no clinically appropriate alternative treatment is available.

Integrated care boards are responsible for local commissioning arrangements and for supporting the application of national guidance, but it is for clinicians, working with their patients, to decide on the most appropriate treatment in line with that guidance.

The Department has not held discussions with the Human Tissue Authority (HTA) regarding the final report of the Evaluation of the Organ Donation (Deemed Consent) Act 2019.

The Organ Donation Joint Working Group, jointly chaired by the Department and NHS Blood and Transplant (NHSBT), made recommendations which ministers have noted, and which action owners are working together to implement. As part of this work, the Department, NHSBT, and HTA have met to discuss the report’s findings and actions. The HTA is currently at an early stage of reviewing its current statutory codes of practice and will revise them where necessary to ensure they remain clear, up to date, and effective.

NHSBT is actively progressing work to ensure that their family approach processes use clear, affirmative language that supports a family’s understanding of their loved one’s recorded donation decision. As part of this, NHSBT are reviewing their operational guidance and training materials for specialist nurses in organ donation to strengthen support offered to families by focussing on building trust and rapport with the family to explore the patient’s beliefs and values as a central reference point for the donation decision, rather than focusing on any last known expressed wishes.

The Department has not held discussions with the Human Tissue Authority (HTA) regarding the final report of the Evaluation of the Organ Donation (Deemed Consent) Act 2019.

The Organ Donation Joint Working Group, jointly chaired by the Department and NHS Blood and Transplant (NHSBT), made recommendations which ministers have noted, and which action owners are working together to implement. As part of this work, the Department, NHSBT, and HTA have met to discuss the report’s findings and actions. The HTA is currently at an early stage of reviewing its current statutory codes of practice and will revise them where necessary to ensure they remain clear, up to date, and effective.

NHSBT is actively progressing work to ensure that their family approach processes use clear, affirmative language that supports a family’s understanding of their loved one’s recorded donation decision. As part of this, NHSBT are reviewing their operational guidance and training materials for specialist nurses in organ donation to strengthen support offered to families by focussing on building trust and rapport with the family to explore the patient’s beliefs and values as a central reference point for the donation decision, rather than focusing on any last known expressed wishes.

The Department has made no assessment of the impact of the National Institute for Health and Care Excellence (NICE) guidelines on generalised anxiety and panic disorder or on access to treatment for marginalised groups.

NICE keeps its published guidelines under active surveillance and decisions on whether they should be updated in light of new evidence are taken by the NICE prioritisation board in line with its published prioritisation framework. NICE’s prioritisation board will be considering whether the guideline on generalised anxiety and panic disorder should be updated following a letter from the UK Council for Psychotherapy.

Where National Health Service accredited hospitals provide services commissioned by public health authorities which were previously part of the NHS but are now part of local government, any liability arising from clinical negligence is covered by the Clinical Negligence Scheme for Trusts (CNST). CNST is a state indemnity scheme administered by NHS Resolution.

The new HIV Action Plan sets out how the Government will enable every level of the healthcare system to work together to engage everyone in prevention, testing, and treatment, tackling stigma, and reaching our ambition to end new HIV transmissions by 2030. This includes a dedicated action to deliver tailored and targeted HIV prevention, treatment, and care services to meet the needs of local populations and address inequalities, including the challenges of HIV prevention and care in prisoners.

Sexual health services in prisons are commissioned by NHS England under the Section 7a Public Health Functions Agreement with the Department. They are required to deliver care and ensure access in accordance with the British Association for Sexual Health and HIV’s prison standards, helping to ensure that all individuals in custody receive equitable healthcare comparable to that available in the community.

Access to HIV pre-exposure prophylaxis in England is via commissioned level three sexual health services. These are commissioned by local authorities for people in the community. NHS England Health and justice commissioners arrange for these providers to enable access for detained people via referral for assessment. The service is accessed by the detained person via in-reach provision, where the sexual health team come on-site, or out-reach provision, where the individual goes out to clinic. The level three sexual health team use the same commissioning policy to provide the service on the same basis to detained people and people in the community.

HIV post exposure prophylaxis is accessed by prisoners in the same way as people in the community. They attend accident and emergency or access a Sexual Assault Referral Centre based on locally commissioned arrangements.

To inform future action, the UK Health Security Agency is working with regional partners to carry out an audit to understand the provision of HIV diagnosis, prevention, and care in English prisons.

We have not made a formal assessment of the adequacy of the powers and performance of the Care Quality Commission (CQC) in inspecting supported accommodation for people with autism.

Under the Health and Social Care Act 2008, a provider must register with the CQC if they provide a regulated activity. More specifically, supported living providers need to register with the CQC if they carry out the regulated activity of ‘personal care’. The CQC’s guidance Housing with Care provides further information on regulated activities and how they apply in the context of supported living services. A copy of the CQC’s guidance is attached.

The Government is tackling poor quality supported housing to ensure that residents get the care and support they need and is committed to the reforms set out in the Supported Housing (Regulatory Oversight) Act 2023 (the Act). The Act was enacted to address gaps in regulation and set standards for the support provided to prevent exploitation in the sector, ensuring that all providers deliver safe housing and necessary support services.

The Ministry for Housing, Communities and Local Government consulted on proposals for implementing the measures set out in the Act between February and May 2025. These include the introduction of new National Supported Housing Standards for all supported housing settings, enforced through a licensing regime, and a proposal to link the payment of higher rates of Housing Benefit to licensing in England. We are working to issue the Government response to the consultation as soon as possible.

The Neighbourhood Health Framework is designed to provide clarity and consistency to integrated care boards (ICBs), local authorities, and their partners, in developing and scaling neighbourhood health.

The framework outlines the national minimum aims and objectives of Neighbourhood Health Services. This includes improving health outcomes with specific focus on high-priority cohorts, including people with frailty. Whilst frailty and musculoskeletal overlap, we recognise that many people with conditions affecting their joints, bones, and muscles across their life course are not frail.

It is important that reforms are locally led, as ICBs and local authorities are best placed to design services that make sense for their local populations. Local systems can choose to go further than the minimum aims set out in the framework, and this could include musculoskeletal services.

We know there are areas where we need to go further. Delivering a Neighbourhood Health Service will be an incremental process as local understanding develops and national reforms progress.