Asked by: Sarah Wollaston (Liberal Democrat - Totnes)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, how much the Government plans to spend on health and social care apprenticeships in each of the next five years.
Answered by Philip Dunne
The new Apprenticeship Levy comes into operation in April 2017 and is set at a rate of 0.5% of an employer’s pay bill. Apprenticeship Levy contributions by National Health Service organisations are estimated as £200 million in 2017-18 and will change over the next five years as the NHS pay bill changes. Estimates are not available for social care.
Apprentices are employed and individual employers will decide which apprentices to employ to meet their workforce needs. The Department does not centrally collect the plans of how many apprentices each individual employer intends to recruit by the end of 2020.
The Department is working with a range of partner organisations, including Health Education England, NHS Improvement, Skills for Health and Skills for Care to ensure NHS and social care providers have access to the apprentice standards they need to develop their own workforce and to make full use of the apprentice levy.
Asked by: Sarah Wollaston (Liberal Democrat - Totnes)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, what assessment he has made of the effect of the abstinence based approach for the treatment of drug addiction on levels of deaths from drug misuse.
Answered by Baroness Blackwood of North Oxford
The provision of both harm reduction and abstinence based interventions is essential to any drug treatment system. Each local authority is responsible for ensuring there is a full range of drug treatment services available in their area to meet the needs of their local population.
During the recent Public Health England led inquiry into the rise in drug-related deaths, analysis of the treatment population did not establish a direct relationship between a policy focus on abstinence and drug-related deaths.
Asked by: Sarah Wollaston (Liberal Democrat - Totnes)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, for what reasons the Care Quality Commission closed its fit and proper persons requirement process on Paula Vasco-Knight, then Chief Executive of South Devon NHS Foundation Trust.
Answered by Philip Dunne
The Care Quality Commission (CQC) has advised that in October 2015 the CQC received information of concern regarding the appointment of Paula Vasco-Knight as Acting Chief Executive at St George’s University Hospital NHS Foundation Trust. These concerns related to Paula Vasco-Knight’s conduct whilst she was Chief Executive at South Devon Foundation Trust. The CQC followed this up directly with the trust to review whether they had followed appropriate recruitment processes and carried out robust checks to determine Paula Vasco-Knight’s fitness prior to her employment.
Based on the extensive evidence supplied by the trust and information provided separately from the Nursing and Midwifery Council the CQC concluded that the trust had not breached the fit and proper persons regulation at that time in relation to that appointment. The CQC informed the trust of this decision in February 2016 but reserved the right to reopen the case in light of any further information received. At the time of this decision, neither CQC nor the trust was aware of the fraud charges.
In April 2016 CQC received new information that led it to re-open the case. In early May 2016 both CQC and St George’s became aware for the first time of the criminal investigation and fraud charges being brought against Paula Vasco-Knight. The CQC were subsequently asked by NHS Protect to put the case on hold pending their criminal investigation. St George’s University Hospital NHS Foundation Trust suspended Paula Vasco-Knight at this time. These are matters of public record.
Asked by: Sarah Wollaston (Liberal Democrat - Totnes)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, in how many instances the Care Quality Commission has asked service providers to instigate fit and proper persons requirement (FPPR) investigations for each year since the FPPR came into force; and how many of those FPPR investigations resulted in a director being discharged from duty.
Answered by Philip Dunne
The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England.
The CQC has provided the following information:
The following actions have been taken in relation to Regulation 5 Fit and Proper Persons Requirement:
- CQC management reviews enable the CQC to reach a decision about the next course of action to take in response to a trigger for review, for example when we identify concerns around non-compliance with the regulations during an inspection, at the point of registration, or when we receive a safeguarding alert or concern. As at 8 February 2017 there have been 38 Adult Social Care (ASC), 14 Hospital, 5 Primary Medical Services and 37 Registration management reviews held regarding regulation 5.
There have been 28 enforcement actions under this regulation:
- 21 have been triggered by an enquiry, 16 of which were during the registration process.
- Seven were triggered by an inspection, four at ASC locations and three at Hospital locations.
- In seven cases registration was refused. In five cases registration was cancelled and in a further eight cases the providers were registered with agreed actions. The remainder included recommended fixed penalty notices, urgent and non-urgent imposition of conditions and warning notices.
Asked by: Sarah Wollaston (Liberal Democrat - Totnes)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, by what metrics the effectiveness of Regulation 5: Fit and proper persons: directors is measured; and if he will make a statement.
Answered by Philip Dunne
Regulation 5 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, The Fit and Proper Persons Requirement (FPPR) for Directors came into effect for National Health Service bodies on 27 November 2014 and was extended to cover all providers regulated by the Care Quality Commission (CQC) on 1 April 2015.
The regulations include a requirement that they must be reviewed every five years, beginning five years after 1 April 2015. As yet the Department has not undertaken a review of regulation 5. Any such review would be completed with input from the CQC.
The CQC has advised that it is the provider’s responsibility to ensure that all directors appointed are fit and proper for their role. The CQC’s responsibility is to check whether providers have the right systems and processes in place to assure themselves of fitness.
The CQC has not yet conducted a thorough assessment of the regulations’ effectiveness. However, in the first years of implementation, the CQC has received feedback on how the regulation is applied, often driven by an assumption that it is CQC’s role to assess fitness directly rather than to assess providers’ systems and processes.
In response to this feedback, the CQC has considered whether its current approach is in line with what can be reasonably expected of the CQC within the current regulations. The CQC has therefore begun a programme of work to improve its internal systems and processes for handling referrals under FPPR. There are three areas of CQC’s guidance and processes that it is strengthening:
- Passing on all details of FPPR concerns raised with the CQC to providers
Presently the CQC does not pass on all concerns raised with it to providers to ask for an explanation. Instead the CQC assesses whether there are concerns that a reasonable employer should be expected to investigate and if the CQC does not think there is a substantive concern it does not pass the material on. When the CQC does share concerns, it initially summarises the information and will later send on the full material if requested.
CQC’s intention is to change both of these steps so providers are notified of all concerns and receive all of the information immediately. The CQC will set out more clearly the type of investigation it expects providers to undertake, following notification.
- Interpretation of “serious mismanagement”
CQC believes there would be benefit in developing a clearer understanding of what type of behaviour constitutes ‘serious management’. The CQC has prepared some draft guidance that characterises serious mismanagement and will shortly be publishing this for consultation. The CQC will develop the finalised draft into internal and external guidance as to how it interprets and applies this element of the regulation.
- The way CQC manages and records information regarding FPPR
It is recognised internally that CQC needs to improve the data available to itself about CQC’s application of FPPR. The CQC is developing an approach to better enable it to track the volume of FPPR concerns shared with CQC by sector and the actions that result from these.
The CQC aims that, by undertaking the programme of improvements described above, CQC will be better placed to monitor the effectiveness of Regulation 5: Fit and Proper Persons in future.
Asked by: Sarah Wollaston (Liberal Democrat - Totnes)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, with reference to the National Audit Office's report, Progress in improving cancer services and outcomes in England, published in January 2015, what the total spend on cancer care in the NHS per newly diagnosed patient was for the most recent period for which figures are available.
Answered by David Mowat
The National Audit Office published an estimate of the total amount spent on cancer care in the National Health Service to show the relative scale of the cost of cancer services to the NHS. The NHS does not routinely publish estimates of the total amount spent on cancer patients as the large scale and highly complex range of services that cancer patients interact with makes this very difficult. Many of the services used by people with cancer, in particular diagnostic and rehabilitation services, but also some treatment services, are not specific to cancer patients.
Asked by: Sarah Wollaston (Liberal Democrat - Totnes)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, when the consultation on the role of Physician Associates announced in his keynote speech to the NHS Providers conference on 30 November 2016 will be launched.
Answered by Philip Dunne
The Department is currently considering options for a consultation on the regulation of Physician Associates, which will be published in due course.
Asked by: Sarah Wollaston (Liberal Democrat - Totnes)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, with reference to his announcement of 4 October 2016, that up to 1,500 extra medical training places will be made available from September 2018, whether those additional students will be supported by the same (a) undergraduate fee and (b) Higher Education Funding Council for England banding payments as existing medical students.
Answered by Philip Dunne
National Health Service providers will receive clinical placement funding for the minimum number of students that Health Education England forecast are required to meet the longer-term workforce needs of the NHS.
In early 2017, the Department plans to run a public consultation on its proposals to expand domestic undergraduate medical training places by up to 1,500 per year, from the academic year 2018-19.
For the 2017-18 academic year, undergraduate medical students undertaking the first four years of their courses will qualify for the same tuition fee loan and living costs support package from the Student Loans Company as other full-time undergraduate students. For years five and six of their courses, these students will continue to qualify for NHS bursaries and an additional reduced rate non-means tested loan for living costs from the Student Loans Company.
Teaching grants for medical students will also continue under the Office for Students (which is expected to assume Higher Education Funding Council for England’s funding responsibility from April 2018) reflecting the high-cost of the subject.
Asked by: Sarah Wollaston (Liberal Democrat - Totnes)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, with reference to his announcement of 4 October 2016, that up to 1,500 extra medical training places will be made available from September 2018, what increased Service Increment for Teaching funding will be provided to support the training of those additional medical students.
Answered by Philip Dunne
National Health Service providers will receive clinical placement funding for the minimum number of students that Health Education England forecast are required to meet the longer-term workforce needs of the NHS.
In early 2017, the Department plans to run a public consultation on its proposals to expand domestic undergraduate medical training places by up to 1,500 per year, from the academic year 2018-19.
For the 2017-18 academic year, undergraduate medical students undertaking the first four years of their courses will qualify for the same tuition fee loan and living costs support package from the Student Loans Company as other full-time undergraduate students. For years five and six of their courses, these students will continue to qualify for NHS bursaries and an additional reduced rate non-means tested loan for living costs from the Student Loans Company.
Teaching grants for medical students will also continue under the Office for Students (which is expected to assume Higher Education Funding Council for England’s funding responsibility from April 2018) reflecting the high-cost of the subject.
Asked by: Sarah Wollaston (Liberal Democrat - Totnes)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, what discussions his Department has had with National Ambulance Service medical directors on ensuring that the best practice system of flagging people with muscle-wasting conditions to ambulance crews in London, North West and North East Ambulance Services is used across all ambulance services.
Answered by Philip Dunne
The Department has not had any recent discussions with National Ambulance Service Medical Directors on this subject.
NHS England has advised that it is working with all ambulance services in England to ensure the right resource is allocated to the right 999 call at the right time.
Currently the flagging of patients with long term conditions or longer term care needs is not used universally. However the development of technology to allow real-time searching of the National Health Service number as a unique patient identifier will significantly increase the value of placing ‘flags’ on patients with specific clinical needs. This will then reliably allow any attending healthcare professional to access care plans and special patient notes to help inform individual patient management. This is a component of the 2017/19 ambulance service national Commissioning Quality and Innovation framework.