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.

We recognise the devastating impact an eating disorder such as bulimia can have on someone’s life, and the earlier treatment is provided, the greater the chance of recovery. NHS England continues to work with clinical experts, provider collaboratives, and patient groups to strengthen pathways for eating disorder care, including ensuring that specialised services remain accessible to those with the most severe presentations across the full spectrum of eating disorders.

On 20 January 2026, NHS England published its refreshed Eating Disorder Services for Children and Young People national guidance for integrated care boards and providers, setting out how to design collaborative, integrated services that support all children, young people, and their families and carers. Whilst the guidance focuses on improving community pathways for children and young people, the national specialised adult service model continues to provide access to highly specialist inpatient treatment for adults with complex eating disorders, including bulimia, through the Specialised Adult Eating Disorder Units network. These units deliver multidisciplinary care that typically includes psychiatric assessment and treatment, psychological therapies, medical monitoring, dietetic support and structured rehabilitation, and can provide inpatient care for adults with severe and enduring eating disorders, including bulimia, where required.

We have also commissioned an evaluation of the care pathway for children and young people with bulimia, binge eating disorder, and anorexia, in England, including a subsequent economic evaluation. The overall aim is to map out what eating disorder care pathways look like for children and young people and to develop an economic model of resource use, to quantify the relative value for money of each of the pathway elements.

No recent assessment has been made of trends in the level of regional variations in waiting times for diagnostic imaging appointments.

We are committed to transforming diagnostic services and are supporting the National Health Service to increase diagnostic capacity to bring down the size of the list and reduce waiting times, including for imaging diagnostic tests.

We set out in the 10-Year Health Plan for England that over the next three years we will create 1,000 new specialty training posts, with a focus on specialties where there is the greatest need. We will set out next steps in due course.

The Government is committed to training the staff we need, including doctors, to ensure patients are cared for by the right professional, when and where they need it. We will publish a 10 Year Workforce Plan to set out action to create a workforce ready to deliver the transformed services set out in the 10-Year Health Plan.

The Government is committed to transparency in reporting patient harm in the National Health Service. The Learn from Patient Safety Events (LFPSE) service provides a national database of patient safety incidents, whereby frontline workers in NHS providers are able to record and analyse their own patient safety events to identify trends. NHS England reviews hundreds of incidents each week via LFPSE, looking for risks that can be acted on, including by issuing National Patient Safety Alerts and collaborating with partners to address issues identified.

We recognise that urgent and emergency care performance has not consistently met expectations in recent years and are committed to restoring waiting time standards set out in the NHS Constitution by the end of this Parliament, as outlined in the Medium-Term Planning Framework, which is available at the following link:

https://www.england.nhs.uk/publication/medium-term-planning-framework-delivering-change-together-2026-27-to-2028-29/

NHS England has also published guidance on the Model Emergency Department, setting out core principles and pathways for high‑performing emergency departments, including a national model for extended emergency medicine ambulatory care to support faster decision‑making, improved patient flow and reduced overcrowding. This guidance is available at the following link:

https://www.england.nhs.uk/long-read/the-model-emergency-department-high-performing-urgent-and-emergency-care-pathways/

We are also taking action to tackle corridor care by introducing new reporting arrangements and are committing to publishing data on its prevalence for the first time, improving transparency and driving operational improvement. Where corridor care cannot be avoided, updated guidance has been published to support trusts to deliver it safely, while maintaining patient dignity and privacy, with further information available at the following link:

https://www.england.nhs.uk/long-read/principles-for-providing-patient-care-in-corridors/

We have committed to ensuring that 92% of all patients wait no longer than 18 weeks from Referral to Treatment (RTT) by March 2029. Since the Government came into office, the waiting list for routine appointments, operations, and procedures in England has now been cut by 374,083, and RTT performance has improved by 2.6%. This is despite 33.3 million referrals onto the waiting list.

In ophthalmology, the national waiting list stands at 602,163 pathways, with 69.8% of those having waited 18 weeks or less. This marks a 3.7% improvement in RTT performance since the Government came into office.

We are committed to expanding the number of surgical hubs, which provide dedicated and protected elective capacity to drive improvement in six specialities, including ophthalmology. We are reducing missed appointments through enhanced two-way communication between hospitals and patients, supported by artificial intelligence prediction tools. We are also expanding the use of remote monitoring and patient-initiated follow up, where appropriate, to offer patients more flexibility over their care.

Improved IT connectivity between primary and secondary eye care services and the development of single points of access has also shown its ability to improve the referral and triage of patients and support more care being delivered in the community.

As the majority of hospices are independent charitable organisations, neither the Government nor NHS England collect or hold their data, including information on how many prisoners have been moved into a hospice.

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

Hospices operate as autonomous bodies, managing their own funding structures and the provision of their services. This autonomy allows them to maintain their independence and offer services beyond the statutory NHS offer.

The Department is in the process of providing a response to the Mohamed Abdisamad: Prevention of Future Deaths report. The Department will respond by the extended deadline and meet with external groups if necessary.

No assessment has been made regarding doctors who have been struck off the medical register for dangerous circumcisions, nor the case of Zuber Bux. No safeguarding assessment has been made regarding the rite of metzitzah b’peh.

The Children’s Rights Alliance and National Society for the Prevention of Cruelty to Children report, You feel like you’re nothing, was published in 2006 under a previous administration and there are no current plans to implement the recommendation highlighted regarding working with religious communities to defer ritual male circumcision so that the informed consent of the child can be sought.

The Government would encourage anyone seeking non-therapeutic male circumcision (NMTC) services for themselves, or for someone else, to use the services of a regulated healthcare professional. If an NMTC procedure is carried out by a regulated healthcare professional, they are subject to regulatory oversight by the relevant regulators such as the General Medical Council or the Nursing and Midwifery Council. Even if a healthcare professional is acting in a religious or spiritual role, they cannot ‘opt out’ of their core duties and responsibilities and therefore any registered healthcare professional wishing to carry out NTMC must be registered with the Care Quality Commission to carry out the regulated activity of surgical procedures.

The Department is in the process of providing a response to the Mohamed Abdisamad: Prevention of Future Deaths report. The Department will respond by the extended deadline and meet with external groups if necessary.

No assessment has been made regarding doctors who have been struck off the medical register for dangerous circumcisions, nor the case of Zuber Bux. No safeguarding assessment has been made regarding the rite of metzitzah b’peh.

The Children’s Rights Alliance and National Society for the Prevention of Cruelty to Children report, You feel like you’re nothing, was published in 2006 under a previous administration and there are no current plans to implement the recommendation highlighted regarding working with religious communities to defer ritual male circumcision so that the informed consent of the child can be sought.

The Government would encourage anyone seeking non-therapeutic male circumcision (NMTC) services for themselves, or for someone else, to use the services of a regulated healthcare professional. If an NMTC procedure is carried out by a regulated healthcare professional, they are subject to regulatory oversight by the relevant regulators such as the General Medical Council or the Nursing and Midwifery Council. Even if a healthcare professional is acting in a religious or spiritual role, they cannot ‘opt out’ of their core duties and responsibilities and therefore any registered healthcare professional wishing to carry out NTMC must be registered with the Care Quality Commission to carry out the regulated activity of surgical procedures.

The Department is in the process of providing a response to the Mohamed Abdisamad: Prevention of Future Deaths report. The Department will respond by the extended deadline and meet with external groups if necessary.

No assessment has been made regarding doctors who have been struck off the medical register for dangerous circumcisions, nor the case of Zuber Bux. No safeguarding assessment has been made regarding the rite of metzitzah b’peh.

The Children’s Rights Alliance and National Society for the Prevention of Cruelty to Children report, You feel like you’re nothing, was published in 2006 under a previous administration and there are no current plans to implement the recommendation highlighted regarding working with religious communities to defer ritual male circumcision so that the informed consent of the child can be sought.

The Government would encourage anyone seeking non-therapeutic male circumcision (NMTC) services for themselves, or for someone else, to use the services of a regulated healthcare professional. If an NMTC procedure is carried out by a regulated healthcare professional, they are subject to regulatory oversight by the relevant regulators such as the General Medical Council or the Nursing and Midwifery Council. Even if a healthcare professional is acting in a religious or spiritual role, they cannot ‘opt out’ of their core duties and responsibilities and therefore any registered healthcare professional wishing to carry out NTMC must be registered with the Care Quality Commission to carry out the regulated activity of surgical procedures.

The Department is in the process of providing a response to the Mohamed Abdisamad: Prevention of Future Deaths report. The Department will respond by the extended deadline and meet with external groups if necessary.

No assessment has been made regarding doctors who have been struck off the medical register for dangerous circumcisions, nor the case of Zuber Bux. No safeguarding assessment has been made regarding the rite of metzitzah b’peh.

The Children’s Rights Alliance and National Society for the Prevention of Cruelty to Children report, You feel like you’re nothing, was published in 2006 under a previous administration and there are no current plans to implement the recommendation highlighted regarding working with religious communities to defer ritual male circumcision so that the informed consent of the child can be sought.

The Government would encourage anyone seeking non-therapeutic male circumcision (NMTC) services for themselves, or for someone else, to use the services of a regulated healthcare professional. If an NMTC procedure is carried out by a regulated healthcare professional, they are subject to regulatory oversight by the relevant regulators such as the General Medical Council or the Nursing and Midwifery Council. Even if a healthcare professional is acting in a religious or spiritual role, they cannot ‘opt out’ of their core duties and responsibilities and therefore any registered healthcare professional wishing to carry out NTMC must be registered with the Care Quality Commission to carry out the regulated activity of surgical procedures.

The Department is in the process of providing a response to the Mohamed Abdisamad: Prevention of Future Deaths report. The Department will respond by the extended deadline and meet with external groups if necessary.

No assessment has been made regarding doctors who have been struck off the medical register for dangerous circumcisions, nor the case of Zuber Bux. No safeguarding assessment has been made regarding the rite of metzitzah b’peh.

The Children’s Rights Alliance and National Society for the Prevention of Cruelty to Children report, You feel like you’re nothing, was published in 2006 under a previous administration and there are no current plans to implement the recommendation highlighted regarding working with religious communities to defer ritual male circumcision so that the informed consent of the child can be sought.

The Government would encourage anyone seeking non-therapeutic male circumcision (NMTC) services for themselves, or for someone else, to use the services of a regulated healthcare professional. If an NMTC procedure is carried out by a regulated healthcare professional, they are subject to regulatory oversight by the relevant regulators such as the General Medical Council or the Nursing and Midwifery Council. Even if a healthcare professional is acting in a religious or spiritual role, they cannot ‘opt out’ of their core duties and responsibilities and therefore any registered healthcare professional wishing to carry out NTMC must be registered with the Care Quality Commission to carry out the regulated activity of surgical procedures.

The Department is in the process of providing a response to the Mohamed Abdisamad: Prevention of Future Deaths report. The Department will respond by the extended deadline and meet with external groups if necessary.

No assessment has been made regarding doctors who have been struck off the medical register for dangerous circumcisions, nor the case of Zuber Bux. No safeguarding assessment has been made regarding the rite of metzitzah b’peh.

The Children’s Rights Alliance and National Society for the Prevention of Cruelty to Children report, You feel like you’re nothing, was published in 2006 under a previous administration and there are no current plans to implement the recommendation highlighted regarding working with religious communities to defer ritual male circumcision so that the informed consent of the child can be sought.

The Government would encourage anyone seeking non-therapeutic male circumcision (NMTC) services for themselves, or for someone else, to use the services of a regulated healthcare professional. If an NMTC procedure is carried out by a regulated healthcare professional, they are subject to regulatory oversight by the relevant regulators such as the General Medical Council or the Nursing and Midwifery Council. Even if a healthcare professional is acting in a religious or spiritual role, they cannot ‘opt out’ of their core duties and responsibilities and therefore any registered healthcare professional wishing to carry out NTMC must be registered with the Care Quality Commission to carry out the regulated activity of surgical procedures.

The full responsibility for developing and setting the National Tariff, which is a set of rules, prices, and guidance that determine how providers of National Health Service funded healthcare are paid for the services they provide, was given to NHS England through the Health and Social Care Act 2012. The Health and Care Act 2022 confirmed this responsibility and renamed the ‘National Tariff’ to the ‘NHS Payment Scheme’. The legislation relating to the NHS Payment Scheme is set out in schedule 10 of the 2022 Act.

Under NHS England’s ‘Scheme of Delegation’, responsibility for approving the NHS Payment Scheme rests with the Chief Executive Officer of NHS England, delated to the Chief Financial Officer of NHS England. Ministerial agreement of the consultation is not currently a requirement of the regulations set out in the act.

NHS England will continue to work with policy teams at the Department and wider stakeholders to further develop currencies and consider appropriate payment options for attention deficit hyperactivity disorder and autism, in line with the overall direction set by ministers.

No specific assessment of delays in access to elective treatment for heart valve disease has been made.

The Government is committed to returning to the National Health Service constitutional standard that 92% of patients are treated within 18 weeks of referral to consultant-led care, including cardiology services and cardiothoracic surgery, by March 2029. As of January 2026, there were 388,626 incomplete cardiology pathways, and 63.9% of patients on cardiology service waiting lists were seen within 18 weeks, up from 60.2% in January 2025. For cardiothoracic surgery services, 72.1% of patients were seen within 18 weeks as of January 2026, up from 68.5% in January 2025.

The Government has made commitments to improve outcomes of cardiovascular disease (CVD). The 10-Year Health Plan sets out our commitment to achieve a 25% reduction in premature mortality due to CVD and stroke across England. To accelerate progress and tackle variation across the country, a new CVD Modern Service Framework is currently in development and will be published in 2026. In 2025 The Getting It Right First Time programme published new and revised cardiology pathways​ to support evidence-based, efficient, and consistent care across primary and secondary settings, including for aortic stenosis. This supports early recognition of high-risk features, fast-track referral for those with severe symptomatic disease, and coordinated multidisciplinary evaluation. ​

NHS Online, launching in 2027, will be a publicly owned National Health Service organisation, giving patients on certain pathways the choice of getting the specialist care they need from their home. It will offer the latest innovations in digital healthcare, nationally scaled for the benefit of patients in every part of the country, helping to reduce patient waiting times through delivering the equivalent of up to 8.5 million appointments and assessments in its first three years.

The Government recognises the role independent sector providers have in supporting the NHS as trusted partners to recover elective services by using additional capacity to tackle the backlog whilst delivering value for money.

The NHS Online programme is actively engaging with both NHS organisations and the independent sector, including through representative bodies such as the Independent Healthcare Providers Network, to support the development of NHS Online.

National Health Service organisations, as independent employers, have their own internal grievance and disciplinary procedures which should comply with employment law and relevant Advisory, Conciliation and Arbitration Service codes and guidance. Any allegations of dishonesty would be considered to be a conduct issue and investigated in accordance with the employer’s disciplinary policy and procedures.

Maintaining High Professional Standards provides a national framework for the handling of concerns about doctors and dentists in the NHS. NHS trusts may also report any concerns about doctors to the General Medical Council (GMC).

The GMC is independent of Government, is directly accountable to Parliament, and is responsible for operational matters concerning the discharge of its statutory duties. The Medical Practitioners Tribunal Service (MPTS) is a statutory committee of the GMC. The United Kingdom’s model of healthcare professional regulation is founded on the principle of regulators operating independently from the Government.

In cases relating to dishonesty, the GMC’s Guidance for MPTS tribunals notes that, whilst a range of behaviour can be seen, the nature of the departure from the standards expected may mean that a concern or allegation relating to dishonesty falls at the high end of the spectrum of seriousness. Sanctions for dishonesty range from suspension to erasure, depending on the seriousness of the case.

National Health Service organisations, as independent employers, have their own internal grievance and disciplinary procedures which should comply with employment law and relevant Advisory, Conciliation and Arbitration Service codes and guidance. Any allegations of dishonesty would be considered to be a conduct issue and investigated in accordance with the employer’s disciplinary policy and procedures.

Maintaining High Professional Standards provides a national framework for the handling of concerns about doctors and dentists in the NHS. NHS trusts may also report any concerns about doctors to the General Medical Council (GMC).

The GMC is independent of Government, is directly accountable to Parliament, and is responsible for operational matters concerning the discharge of its statutory duties. The Medical Practitioners Tribunal Service (MPTS) is a statutory committee of the GMC. The United Kingdom’s model of healthcare professional regulation is founded on the principle of regulators operating independently from the Government.

In cases relating to dishonesty, the GMC’s Guidance for MPTS tribunals notes that, whilst a range of behaviour can be seen, the nature of the departure from the standards expected may mean that a concern or allegation relating to dishonesty falls at the high end of the spectrum of seriousness. Sanctions for dishonesty range from suspension to erasure, depending on the seriousness of the case.

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 National Institute for Health and Care Excellence (NICE) is re-evaluating brexucabtagene autoleucel following managed access through the Cancer Drugs Fund to determine whether it should be recommended for routine National Health Service funding. NICE’s draft guidance, published in December, does not recommend it as a clinically and cost-effective use of National Health Service resources. The Government recognises that any potential withdrawal for future patients with mantle cell lymphoma will be concerning, but these decisions are rightly taken independently and based on the available evidence. Under an arrangement between NHS England and the company, if NICE’s final guidance does not recommend routine use, patients who started treatment during the managed access period can continue their treatment.

NICE is an England-only body. Medicine availability decisions in the devolved administrations are for the relevant devolved governments.

The National Institute for Health and Care Excellence (NICE) is re-evaluating brexucabtagene autoleucel following managed access through the Cancer Drugs Fund to determine whether it should be recommended for routine National Health Service funding. NICE’s draft guidance, published in December, does not recommend it as a clinically and cost-effective use of National Health Service resources. The Government recognises that any potential withdrawal for future patients with mantle cell lymphoma will be concerning, but these decisions are rightly taken independently and based on the available evidence. Under an arrangement between NHS England and the company, if NICE’s final guidance does not recommend routine use, patients who started treatment during the managed access period can continue their treatment.

NICE is an England-only body. Medicine availability decisions in the devolved administrations are for the relevant devolved governments.

The Government has made no such assessment. National Institute for Health and Care Excellence (NICE) guidelines are developed independently by experts based on a thorough assessment of the available evidence and through extensive engagement with a wide range of stakeholders. They represent best practice and healthcare professionals are expected to take them fully into account in the care and treatment of their patients. NICE keeps its guidance under active surveillance and decisions on whether published guidelines should be updated in light of new evidence are taken by the NICE prioritisation board, chaired by the NICE Chief Medical Officer, in line with its published prioritisation framework. There are currently no plans to update the guideline on generalised anxiety or panic disorder.

We recognise that being sent to a hospital far away from home, family, and support networks means a poorer experience of care for patients and increased safety risks, which is why we are working to end this practice. We have invested £75 million of capital funding in 2025/26 to improve inpatient care and help stop mental health patients being sent far from home for treatment. A national quality improvement programme is in place across England to improve the culture of care in all mental health hospitals.

Through the 10-Year Health Plan we will move care closer to home by reducing ‘out of area placements’ for mental health patients by March 2027. The NHS England Capital Guidance for 2026/27 to 2029/30, published in November 2025, makes £473 million of capital funding available for systems and encourages them to establish community based mental health centres, alongside other capital priorities. These include eliminating inappropriate out of area placements.

Article 8 of the European Convention on Human Rights protects the right to a family life. All patients have the right to maintain contact with, and be visited by, anyone they wish to see, subject to carefully limited exceptions. The value of visits in maintaining links with family and community networks is recognised as a key element in a patient’s care, treatment, and recovery. Every effort should be made to assist patients to maintain contact with friends and family, including considering the need to travel for visits when the patient is placed out of area.

Where the patient is detained under the Mental Health Act, the Code of Practice sets out that commissioners should consider whether they can provide any assistance where there are difficulties visiting because of distance. Local authorities should also consider whether it would be appropriate to provide financial support to enable families to visit children and young people placed in hospital, taking into account their duties to promote contact between children and young people and their families. Such duties arise when children and young people are being looked after by local authorities as well as when they are accommodated in hospital for three months or more. Consideration of any transfer to another hospital must include whether the transfer would give the patient greater access to carers or have the opposite effect.

The Drug Tariff, a monthly publication, sets out reimbursement prices to be paid to pharmacy contractors for the medicines that they dispense. Whilst we do not look at specific areas of the United Kingdom or specific medicines, we do have arrangements in place to mitigate against rising medication costs for pharmacies, that ensure they are paid enough overall above what it costs them to purchase medicines.

Where prices increase significantly and rapidly, concessionary prices can be granted by the Department to ensure that pharmacy contractors are paid fairly, and can access medicines for their patients, even when market prices increase.

Concessionary prices are set using 'real time' market data provided to the Department under the Health Service Products (Provision and Disclosure of Information) Regulations 2018 on prices and stock levels intended for retail pharmacy businesses in England. This ensures that prices set are reflective of the market and aims to reimburse pharmacy contractors fairly.

For branded medicine such as Actimorph the Department sets maximum list prices which are controlled through the Voluntary scheme for branded medicines Pricing, Access and Growth and the statutory scheme.

The Drug Tariff, a monthly publication, sets out reimbursement prices to be paid to pharmacy contractors for the medicines that they dispense. Whilst we do not look at specific areas of the United Kingdom or specific medicines, we do have arrangements in place to mitigate against rising medication costs for pharmacies, that ensure they are paid enough overall above what it costs them to purchase medicines.

Where prices increase significantly and rapidly, concessionary prices can be granted by the Department to ensure that pharmacy contractors are paid fairly, and can access medicines for their patients, even when market prices increase.

Concessionary prices are set using 'real time' market data provided to the Department under the Health Service Products (Provision and Disclosure of Information) Regulations 2018 on prices and stock levels intended for retail pharmacy businesses in England. This ensures that prices set are reflective of the market and aims to reimburse pharmacy contractors fairly.

For branded medicine such as Actimorph the Department sets maximum list prices which are controlled through the Voluntary scheme for branded medicines Pricing, Access and Growth and the statutory scheme.

Newly licensed medicines are appraised by the National Institute for Health and Care Excellence (NICE), which is the independent body responsible for developing evidence-based guidance for the National Health Service on whether new medicines represent a clinically and cost-effective use of resources. NICE aims wherever possible to issue draft guidance on new medicines close to the time of licensing. The NHS in England is legally required to fund drugs recommended by NICE, usually within three months of final guidance.

NICE is currently evaluating potential new treatments for metabolic dysfunction-associated steatohepatitis (MASH) in anticipation of the medicines being granted a marketing authorisation by the Medicines and Healthcare products Regulatory Agency with guidance expected later this year. NHS England is actively preparing to support the potential introduction of new treatments for MASH, including fatty liver disease with fibrosis, alongside the ongoing NICE appraisal process.

The Department and NHS England will continue to work to ensure that, once approved, effective new treatments for fatty liver disease are introduced in a way that is fair, affordable, and which protects the wider NHS, while ensuring that patients with the greatest clinical need are able to benefit as quickly as possible.

In the period from 2023 to 2025, three full calendar years, the National Patient Safety Team issued seven National Patient Safety Alerts.

Whilst none of those originated from a single incident occurring in an emergency department, one alert in January 2023 was issued in response to a general concern that increasing pressure on the urgent and emergency care system was impacting the delivery of oxygen therapy to patients in clinical areas. To optimise the safe delivery of oxygen via portable oxygen cylinders, an alert was issued by the National Patient Safety Team, with further information available at the following link:

https://www.england.nhs.uk/2023/01/use-of-oxygen-cylinders-where-patients-do-not-have-access-to-medical-gas-pipeline-systems/

The alert asked providers to review NHS England guidance and conduct a risk assessment for all patient escalation/transient areas without piped oxygen and for trust medical gas committees to review and act on findings. Further information on the guidance is available at the following link:

https://www.england.nhs.uk/wp-content/uploads/2023/01/Official-sensitive-Oxygen-Cylinder-Comms-24-Jan-2023-UPDATE.pdf

Compliance with all National Patient Safety Alerts is overseen by the Care Quality Commission.

The National Institute for Health and Care Excellence (NICE) has issued technology appraisal guidance recommending several medicines for use in the treatment of wet age-related macular generation. The National Health Service in England is legally required to fund medicines in line with NICE’s recommendations, normally within three months of the publication of final guidance.

NICE has also published a clinical guideline that provides comprehensive guidance on best practice in the management of patients with this condition, which is available at the following link:

https://www.nice.org.uk/guidance/ng82

NICE clinical guidelines are not mandatory, but NHS commissioners are expected to take them fully into account in ensuring that local services meet the needs of their populations.

Integrated care boards (ICBs) are responsible for commissioning services to meet the health needs of their local population, and responsibility for providing equipment and wheelchairs to disabled people typically falls to local authorities and the National Health Service.

Local authorities in England have a statutory duty to make arrangements for the provision of community equipment for disabled people in their area. Responsibility for managing the market for these services, including commissioning and oversight of delivery, rests with local authorities. The NHS is responsible for providing wheelchairs for people with longer-term, complex needs.

The Medium Term Planning Framework, published in October 2025, requires that from 2026/27 all ICBs and community health services must actively manage and reduce the proportion of waits across all community health services over 18 weeks and develop a plan to eliminate all 52-week waits. These targets will guide systems to reduce longest waits.

NHS England is supporting ICBs to reduce delays and regional variation in the quality and provision of NHS wheelchairs. Since July 2015, NHS England has collected quarterly data from clinical commissioning groups, now ICBs, on wheelchair provision, including waiting times, to enable targeted action if improvement is required.

We already have two arrangements in place to reduce community pharmacies dispensing at a loss and to ensure that overall, they are paid enough as part of their Community Pharmacy Contractual Framework (CPCF) funding. These are the medicine margin arrangements and concessionary prices.

Regarding the medicine margin arrangements, the medicine margin is the difference between the reimbursement price and the price the pharmacy was charged by the supplier. Community pharmacy reimbursement arrangements include an amount of medicines margin that pharmacies are allowed to retain as part of CPCF funding. The Department assesses the medicine margin through a quarterly medicine margin survey, which ensures that in totality, pharmacies are paid the allowed medicine margin above what it cost them to purchase medicines overall.

For concessionary prices, the Department relies on competition and efficient purchasing by community pharmacies to keep prices of medicines down. This has led to some of the lowest prices in Europe and allows prices to react to the market. In an international market this ensures that when demand is high and supply is low, prices in the United Kingdom can increase to help secure the availability of medicines for UK patients. When the market price of a medicine suddenly increases, concessionary prices can be granted in that month, increasing the reimbursement price above the Drug Tariff price, with the aim of mitigating pharmacy contractors dispensing at a loss. In addition, there is a ‘retrospective top-up payment for concessionary prices’, which provides an additional payment to contractors when the margin survey indicates that despite a concessionary price, there was an under payment for a specific product.

More broadly, medicine supply chains are complex, global, and highly regulated. There are a number of reasons why supply can be disrupted, many of which are not specific to the UK and outside of Government control, including manufacturing difficulties, access to raw materials, sudden demand spikes or distribution issues, and regulatory issues. There are approximately 14,000 licensed medicines and the overwhelming majority are in good supply.

While we can’t always prevent supply issues from occurring, we have a range of well-established processes and tools to manage them when they arise and to mitigate risks to patients. These include close and regular engagement with suppliers, and use of alternative strengths or forms of a medicine to allow patients to remain on the same product and expediting regulatory procedures. In addition, we utilise sourcing unlicensed imports from abroad, adding products to the restricted exports and hoarding list, use of Serious Shortage Protocols, and issuing National Health Service communications to provide management advice and information on the issue to healthcare professionals, including pharmacists, so they can advise and support their patients.

We already have two arrangements in place to reduce community pharmacies dispensing at a loss and to ensure that overall, they are paid enough as part of their Community Pharmacy Contractual Framework (CPCF) funding. These are the medicine margin arrangements and concessionary prices.

Regarding the medicine margin arrangements, the medicine margin is the difference between the reimbursement price and the price the pharmacy was charged by the supplier. Community pharmacy reimbursement arrangements include an amount of medicines margin that pharmacies are allowed to retain as part of CPCF funding. The Department assesses the medicine margin through a quarterly medicine margin survey, which ensures that in totality, pharmacies are paid the allowed medicine margin above what it cost them to purchase medicines overall.

For concessionary prices, the Department relies on competition and efficient purchasing by community pharmacies to keep prices of medicines down. This has led to some of the lowest prices in Europe and allows prices to react to the market. In an international market this ensures that when demand is high and supply is low, prices in the United Kingdom can increase to help secure the availability of medicines for UK patients. When the market price of a medicine suddenly increases, concessionary prices can be granted in that month, increasing the reimbursement price above the Drug Tariff price, with the aim of mitigating pharmacy contractors dispensing at a loss. In addition, there is a ‘retrospective top-up payment for concessionary prices’, which provides an additional payment to contractors when the margin survey indicates that despite a concessionary price, there was an under payment for a specific product.

More broadly, medicine supply chains are complex, global, and highly regulated. There are a number of reasons why supply can be disrupted, many of which are not specific to the UK and outside of Government control, including manufacturing difficulties, access to raw materials, sudden demand spikes or distribution issues, and regulatory issues. There are approximately 14,000 licensed medicines and the overwhelming majority are in good supply.

While we can’t always prevent supply issues from occurring, we have a range of well-established processes and tools to manage them when they arise and to mitigate risks to patients. These include close and regular engagement with suppliers, and use of alternative strengths or forms of a medicine to allow patients to remain on the same product and expediting regulatory procedures. In addition, we utilise sourcing unlicensed imports from abroad, adding products to the restricted exports and hoarding list, use of Serious Shortage Protocols, and issuing National Health Service communications to provide management advice and information on the issue to healthcare professionals, including pharmacists, so they can advise and support their patients.

Integrated care boards (ICBs) are responsible for the provision and commissioning of local wheelchair services. This includes both temporary wheelchair provision to support hospital discharge and National Health Service wheelchair services which support people of all ages with long-term mobility needs.

NHS England supports ICBs to reduce delays and regional variation in the quality and provision of NHS wheelchairs. Since July 2015, NHS England has collected quarterly data from clinical commissioning groups, now ICBs, on wheelchair provision, including waiting times, to enable targeted action if improvement is required. On 9 April 2025, NHS England published the Wheelchair Quality Framework, which sets out quality standards and statutory requirements for ICBs, such as offering personal wheelchair budgets, and aims to tackle inequalities in outcomes, experience, and access. The framework is available at the following link:

https://www.england.nhs.uk/long-read/wheelchair-quality-framework/

In October 2025, we published the NHS medium-term planning framework, requiring all ICBs and community health services to actively manage and reduce waits above 18 weeks and to develop a plan to eliminate all 52-week waits. The community health services situation report will be used to monitor ICB performance against waiting-time targets in 2026/27, and it currently monitors waiting times for children, young people and adults under “Wheelchair, orthotics, prosthetics and equipment”. These targets will guide systems to reduce longest waits and improvement initiatives to meet these targets may affect waits that are over 18 weeks and 52 weeks.

The General Register Office oversees the policy for registration of births, deaths, and marriages. However, a death must be certified before it can be registered and since 9 September 2024, all non-coronial deaths are independently scrutinised by a medical examiner who completes the medical certificate of cause of death, and which is then sent to the registrar. The Department has engaged extensively over several years with representatives of faith communities during implementation of the 2024 death certification reforms. The Department is monitoring the introduction of the reforms and listening to faith communities to inform policy and operational decision making and to encourage collaborative working. Officials continue to meet faith group representatives to understand their perspectives on death certification and registration and to identify any emerging issues.

Responsibility for ensuring that medical examiner services respond to local needs sits with trusts. Most medical examiners’ work can be undertaken during normal office hours with cover for weekends and public holidays likely to be required in most areas. Arrangements at each office should reflect local health priorities and the needs of communities, particularly if there is regular demand for the urgent release of bodies at weekends and public holidays. The National Medical Examiner provides guidance to medical examiner offices for weekend and public holiday cover and for the urgent release of a body in circumstances including where a bereaved families may have particular reasons to request urgent release of the deceased’s body for burial. This guidance is available at the following link:

https://www.rcpath.org/static/3590bf7f-a43e-4248-980640c5c12354c4/Good-Practice-Series-Urgent-release-of-a-bodyFor-Publication.pdf

Data indicates that 90% of urgent requests for swift scrutiny are met. The chief reason why requests were not met is because the cause of death is complex and therefore additional time was required to determine the cause.