Lord Bradley

The Health and Care Act 2022 requires that one “ordinary” integrated care board (ICB) board member, excluding the Chair or Chief Executive, must have “knowledge and experience in connection with services relating to the prevention, diagnosis and treatment of mental illness”. All ICBs must comply with this legal requirement, but neither the Department nor NHS England collects this information.

Guidance for ICBs is available on the NHS.UK website in an online only format, and states that “the chair must exercise their approval function of the ordinary members with a view to ensuring that at least one of the ordinary members has knowledge and experience in connection with services relating to the prevention, diagnosis and treatment of mental illness”. For the ICB to achieve ongoing compliance with this requirement, the constitution should include a board position that can only be filled by candidates who meet these criteria:

• a partner member, jointly nominated by all trusts/foundation trusts, and this must be an additional partner member to the one required as a minimum by the act;
• an ‘other’ board member, that is, not jointly nominated but likewise normally a mental health trust/foundation trust chief executive; and
• an ICB executive director for mental health.

The 10-Year Health Plan sets out our vision for a Neighbourhood Health Service that moves care closer to home. The Neighbourhood Health Service will embody our new preventative principle, that care should happen as locally as it can, digitally by default, in a patient’s home if possible, in a neighbourhood health centre when needed, and only in a hospital if necessary.

Neighbourhood Health Services will bring together teams of professionals closer to people’s home, including nurses, doctors, social care workers, pharmacists, health visitors and more, to work together to provide comprehensive care in the community.

We expect neighbourhood teams and services to be designed in a way that meets the needs of local populations. Rather than applying a rigid, one-size fits all model, the population base for Neighbourhood Health Services is intentionally flexible and locally determined. The geography of a ‘neighbourhood’ will be determined locally by integrated care boards in partnership with their strategic partners, particularly local authorities.

The plan introduces two new contracts, including one to create multi-neighbourhood providers covering populations of approximately 250,000 people, that will unlock the advantages and efficiencies possible from greater scale working across all general practices and small neighbourhood providers in their footprint.

In the future, there will also be neighbourhood health plans drawn up by local government, the National Health Service, and its partners. The integrated care board will bring together these plans into a population health improvement plan for their footprint and use it to inform commissioning decisions.

To support the delivery and spread of neighbourhood health, we have launched the National Neighbourhood Health Implementation Programme (NNHIP). The NNHIP will support systems across the country to test new ways of working, share learning, and scale what works.

Palliative care and end of life care are broad, holistic approaches provided through a range of professionals and providers, both generalist and specialist, across the National Health Service, social care, and voluntary sector organisations. Therefore, the number of beds specifically used for palliative care is difficult to measure as relevant consultations and tasks are not always coded as such.

We do not hold central data on the number of palliative care beds provided by the NHS, charities, or the private sector in any region of England. Charitable and private sector palliative care and end of life care providers, including most hospices in England, are independent and autonomous organisations, and as such, they are not legally required to share such information with the Department.

The Government has not published any guidance following the English Devolution White Paper on the election of governors to National Health Service foundation trusts.

The Model Election Rules set out the process by which governors are elected and are included in every NHS foundation trust's constitution. The NHS Foundation Trust Model Core Constitution, a copy of which is attached, published in 2013 by Monitor, now NHS England, requires NHS foundation trusts to comply with these rules.

The most recent estimate of the cost of free prescriptions for the population of England is £10 billion for 2023/24. This is based on the difference between there being no prescription charge for all and requiring all patients to pay the then single charge of £9.65 per item.

These figures do not correspond to the revenue that would be raised if any exemptions were removed, because some people would buy a pre-payment certificate, and some might not follow up to get the medication.

This information would be held at a local level by the prison healthcare providers.

The Department does not hold information on the total number of speech and language therapists employed in each integrated care board area in England. Therapists will be employed by National Health Service trusts, where data is held, but will also be directly employed by other providers, including schools, local authorities, and third sector or charitable organisations, for which data is not held centrally. The following table shows the number of full time equivalent (FTE) speech and language therapists employed by NHS trusts and integrated care boards in England, as of January 2025, by integrated care board area:

These staff will provide services in a range of settings, but the Department does not hold information on how many may work in criminal justice settings.

The information requested is not held centrally by NHS England, regarding prisons in England. Prison healthcare in Wales is devolved to the Welsh administration.

Having a criminal record does not necessarily mean that a person cannot work in the National Health Service. Local employers should have robust and effective recruitment and background check requirements aligned with the NHS Employment Check Standards issued by NHS Employers, to ensure individuals they employ are suitable, skilled, competent and safe to carry out the role they are being appointed to do. This includes a criminal record check for all eligible positions.

Employers must consider the Rehabilitation of Offenders Act 1974 and the Rehabilitation of Offenders (Exceptions) Order 1975 when asking for criminal record information. Any recruitment decision needs to be made on a case-by-case basis balancing the risks associated with any given role. The exception to this rule is where recruiting to a regulated activity under the Safeguarding Vulnerable Groups Act, as amended by the Protection of Freedoms Act 2012, and where individuals are prohibited from working with adults and/or children who are in receipt of health care or services.

Due to the size of the data, a table showing the names of the current healthcare providers for each prison in England is attached. This does not include providers sub-contracted to provide services for substance use, neurodiversity, mental health, or dental, amongst other services.

This information is held on a local level by the healthcare providers for each respective prison.

The information requested is not held centrally.

In July, my Rt Hon. Friend, the Secretary of State for Health and Social Care asked Dr Penny Dash to carry out a review, looking at patient safety across the health and care landscape in England, within the context of the wider regulation and improvement of the quality of care. The guidance, Review of patient safety across the health and care landscape: terms of reference, published on 15 October 2024, is available on the GOV.UK website, in an online-only format.

Healthwatch England is the independent statutory national champion for people who use health and social care services. Its functions include gathering and communicating the views of the public on their needs and experiences of health and social care services. Healthwatch England also provides support and assistance to the 152 Local Healthwatch organisations in England.

As part of ongoing considerations, NHS England intends to launch a pilot in the coming months extending the Electronic Prescription Service to specific Detained Estate health services in England. Amendments to the National Health Service (Charges for Drugs and Appliances) Regulations 2015 will be made in the autumn, subject to parliamentary time.

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

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

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

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

The Department will continue to proactively engage with our stakeholders, including the voluntary sector and independent hospices, on an ongoing basis, in order to understand the issues they face.

NHS England is considering extending the Electronic Prescription Service (EPS) to Detained Estate health services in England, and the Department is engaging with them on this work.

As set out in the NHS Priorities and Operational Planning Guidance for 2024/25, NHS England is continuing to expand access to mental health services. This includes increasing the number of children and young people accessing comprehensive mental health support, as well as the number of adults and older adults completing a course of treatment for anxiety and depression via NHS Talking Therapies, some of whom having speech, language, and communication needs. Support may include provision of speech and language therapy as part of a local offer, however decisions about service provision are down to local determination by integrated care boards, to meet locally identified need.

As set out in the Equality Act 2010, all organisations, including those in health and social care, must take steps to remove the barriers individuals face because of disability. The National Health Service must make it as easy for disabled people to use health services as it is for people who are not disabled. NHS organisations and publicly funded social care providers must also comply with the Accessible Information Standard, to meet the communication needs of patients and carers with a disability, impairment, or sensory loss.

NHS England’s Regional Health and Justice teams directly commission the primary healthcare services within prisons, and oversee the healthcare delivery based on the primary care service specifications for prisons. In line with the specifications, healthcare providers should provide healthcare which includes supporting people’s mental health, as well as communication, speech, and language needs.

Healthcare services in the children and young people secure estate are commissioned locally by Regional Health and Justice commissioners using core outcome-based specifications, which are benchmarked by the Healthcare Standards for Children and Young People in Secure Settings. These include several individual standards that reference speech, language, and communication needs, as part of the overall complex needs that are common in children held in these settings.

NHS England recently held an event for regional Health and Justice neurodiversity leads and commissioners on neurodiversity specialist recruitment, to support with recruitment and training in specialist areas such as speech and language therapists. This included a presentation from the Royal College of Speech and Language Therapist’s prisons lead. In addition, NHS England has allocated additional funding to Health and Justice regions which has been ring-fenced for use on their adult prison custodial neurodiversity pathways.

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

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

NHS England has advised that work is currently underway with the 15 Adult Secure Provider Collaboratives across England to speed up the safe and timely transfer of appropriately assessed people from prison. This includes identifying existing capacity, including workforce estates and location, that can be reconfigured at pace; identifying where additional capacity, including workforce and estates, may be required; and, scoping at pace, the creation of alternative clinically safe service models.

There are currently no such plans at this time to change the way that deaths of patients detained in secure settings under the Mental Health Act 1983 are investigated.

The Mental Health Bill will deliver our manifesto commitment to modernise the Mental Health Act 1983. It will give patients greater choice, autonomy, enhanced rights and support, and ensure everyone is treated with dignity and respect throughout treatment. The Bill will make the Act fit for the 21st century, redressing the balance of power from the system to the patient and ensuring people with the most severe mental health conditions get better, more personalised, care.

The Patient Safety Incident Response Framework sets out the NHS’s approach to developing and maintaining effective systems and processes for responding to patient safety incidents for the purpose of learning and improving patient safety. The Framework became a requirement in the NHS standard contract from April 2024. Under this framework a locally-led patient safety incident investigation is required for deaths of patients detained under the Mental Health Act (1983) or where the Mental Capacity Act (2005) applies, where there is reason to think that the death may be linked to problems in care (i.e., the incident meets the “learning from deaths” criteria, the investigation explores decisions or actions as they relate to the safety event).

In addition, all deaths among people detained under the Mental Health Act 1983 are reported to the Care Quality Commission and referred to the Coroners Office.

Women’s centres provide vital information, advice and support to women in contact with the criminal justice system, including those serving community sentences.

His Majesty’s Prison and Probation Service (HMPPS) currently funds specialist support for women on probation through Commissioned Rehabilitative Services (CRS) delivered by third sector organisations, including providers of women’s centres. HMPPS is committed to ensuring CRS contracts deliver holistic, gender-specific support that meets women’s needs, informed by service users, stakeholders and providers.

The Ministry of Justice is providing a further £7.2 million this year to support the women’s community sector. This funding is aimed at building sustainability, expanding interventions and increasing capacity, including residential provision where needed. Funding for future years is subject to internal allocations.

All probation regions in England provide women-only arrangements. The impact of partnerships, geography and environmental variables mean that these arrangements comprise of a mixture of dedicated times, trauma informed spaces and co-location with partner agencies to create women-only environments.

The Women’s Policy Framework (2024) sets out our shared HM Prison and Probation Service principles for working with women in the criminal justice system to enable better outcomes, ensuring that staff are supported, and the work is evidence based.

The document includes the options of being supervised by a female probation practitioner; being seen in a women-only environment; and not being placed in what would otherwise be an all-male work environment when undertaking Unpaid Work as part of a community order, or when undertaking any group work.

The Probation Service is working to increase the availability of women-only reporting spaces, either within probation offices or where co-located with partner agencies.

The percentage of women remanded in custody that were not sentenced to prison was 52% in 2022 and 2023. This increased slightly to 54% in 2024.

Percentage of women remanded in custody not receiving immediate custodial sentence

• Prisoners’ sentences are counted only once in these figures, at the court where they were sentenced: either at Magistrates’ or Crown Court.

• Separate Magistrates’ and Crown Court figures are included in the table to show the varying custodial sentence rates, which are reflective of the different types of case sentenced at Magistrates’ and Crown courts.

• Prisoners were remanded at some point in the proceedings, for any length of time (i.e. not necessarily remanded throughout court proceedings).

• Further important caveats are found in the ‘Notes’ tab of the data source "Remands data tool: 2017 to 2024" (particularly notes 27-31), which is available through the following link: Criminal Justice System statistics quarterly: December 2024 - GOV.UK.

Information relating to the total time spent on custodial remand is not centrally held by the Ministry of Justice, due to the considerable complexity in interpreting custodial journeys, which may include multiple cases in parallel. Although the Department has released estimates in the past, it has since been identified that results from the methodology previously used may no longer be accurate, and on that basis the Ministry of Justice cannot continue to use them. The Department is, however, working to improve its data and insights around this cohort of prisoners.

The Ministry of Justice completed a review of registered intermediary (RI) provision in 2023 which was summarised in the 2023 Witness Intermediary Scheme (WIS) Annual Report (also attached).

We have made good progress on the recommended actions, revising the definition of the RI role in guidance and working with criminal justice organisations and professional bodies such as the Bar Council to improve understanding of how to work with RIs.

We have also streamlined the Witness Intermediary Scheme’s governance and quality assurance arrangements through the creation of a Governance and Standards Board, responsible for both the strategic direction of the Scheme and overseeing the quality of registered intermediary practise.

Demand is growing for registered intermediaries, who play an important part in enabling thousands of vulnerable victims and witnesses to give their best evidence in criminal proceedings. We remain committed to considering how intermediary services are delivered across the justice sector and exploring options for how these might be delivered in future to help inform a better understanding of current usage and future demand for intermediaries across all justice settings.

The requested information is shown in the table below.

Pelargonic acid vanillylamide incapacitant (PAVA) spray is made available to protect staff and prisoners in the adult estate in the event of serious violence, or where there is an imminent risk of serious violence. Clear guidance has been issued to staff, to ensure it is used only where appropriate. Our hardworking prison officers are brave public servants doing exceptionally difficult jobs, this Government will do everything we can to keep them safe.

The Ministry of Justice completed a review of intermediary provision in 2023 which was summarised in the 2023 Witness Intermediary Scheme (WIS) Annual Report.

The review recommended actions to enhance the role, accessibility, and quality of intermediary services, including:

• Revising the definition of registered intermediaries and devising a communication plan to build better understanding of the intermediary role.

• Seeking improved data collection and analysis around intermediary usage; and

• Building relationships with stakeholders to ensure consistent quality of intermediary services across criminal, family and civil jurisdictions as well as continuing to increase understanding of vulnerable users’ needs.

We have no plans to conduct a further review at this stage, as we are progressing the above actions.