Liz Twist

On 23 December 2021, we published ‘Our Vision for the Women’s Health Strategy for England’ with the results of the call for evidence survey. The analysis of the call for evidence showed that women have often felt they were not listened to by healthcare professionals with regards to pain related to menstruation and other gynaecological conditions. The Department will be informed by the views of women as we develop the Strategy, which will be published in spring 2022.

The National Institute for Health and Care’s guidelines for heavy menstrual bleeding suggest that hysteroscopy should be used as a diagnostic tool only when ultrasound results are inconclusive, for example, to determine the exact location of a fibroid or the exact nature of the abnormality. The Royal College of Obstetricians and Gynaecologists’ guidelines outlines best practice in outpatient hysteroscopy and identifies that outpatient treatment has both clinical and economic benefits. The Royal College is updating its clinical guidelines which are expected to be published in 2023.

On 22 December 2021, the Joint Committee on Vaccination and Immunisation (JCVI) provided advice on the primary vaccination of five to 11 year olds. The potential merits from vaccination were assessed according to the presence or absence of underlying health conditions that increase the risk of serious COVID-19. It advised that children aged five to 11 years in a clinical risk group, which includes complex respiratory and neurological conditions, or who were household contacts of someone who is immunosuppressed should be offered two 10 micrograms doses of the Pfizer-BioNTech COVID-19 vaccine (Comirnaty) with an interval of eight weeks between the first and second doses. The minimum interval between any vaccine dose and recent COVID-19 infection should be four weeks. Further advice regarding COVID-19 vaccination for other five to 11 year olds will be issued in due course following consideration of additional data.

On 22 December 2021, the Joint Committee on Vaccination and Immunisation (JCVI) provided advice on the primary vaccination of five to 11 year olds. The potential merits from vaccination were assessed according to the presence or absence of underlying health conditions that increase the risk of serious COVID-19. It advised that children aged five to 11 years in a clinical risk group, which includes complex respiratory and neurological conditions, or who were household contacts of someone who is immunosuppressed should be offered two 10 micrograms doses of the Pfizer-BioNTech COVID-19 vaccine (Comirnaty) with an interval of eight weeks between the first and second doses. The minimum interval between any vaccine dose and recent COVID-19 infection should be four weeks. Further advice regarding COVID-19 vaccination for other five to 11 year olds will be issued in due course following consideration of additional data.

The Department is assessing options for delivering a near Real Time Suspected Suicide Surveillance System as part of the national near Real Time Suicide Surveillance pilot (nRTSS). The next steps for establishing a national nRTSS system, including a timetable, will be considered once the findings from the current pilot project are available. The pilot project is due for completion at the end of March 2022. We have identified 16 areas in England where a system that aims to deliver near real time suspected suicide surveillance has been established. The Department is currently working with 37 of the local authorities covered by existing systems to develop and pilot a national system by the end of March 2022.

An effective national system has the potential to improve local bereavement support by reducing the time taken for suicide-related information to be made available to local service providers and commissioners. This could include proactive approaches to individuals and families who have been bereaved by suicide.

The ongoing funding requirement for a national near Real Time Suicide Surveillance system in England, and the potential contribution of coroners and the police will be assessed following the findings of the pilot. To date £360,000 of revenue funding has been spent or is committed to delivering the pilot by 31 March 2022. Capital funding of £140,000 is currently being distributed to the seven participating local areas, which are submitting bids against the remaining £700,000 of capital funding to meet further costs required to deliver the pilot this year.

The Department is assessing options for delivering a near Real Time Suspected Suicide Surveillance System as part of the national near Real Time Suicide Surveillance pilot (nRTSS). The next steps for establishing a national nRTSS system, including a timetable, will be considered once the findings from the current pilot project are available. The pilot project is due for completion at the end of March 2022. We have identified 16 areas in England where a system that aims to deliver near real time suspected suicide surveillance has been established. The Department is currently working with 37 of the local authorities covered by existing systems to develop and pilot a national system by the end of March 2022.

An effective national system has the potential to improve local bereavement support by reducing the time taken for suicide-related information to be made available to local service providers and commissioners. This could include proactive approaches to individuals and families who have been bereaved by suicide.

The ongoing funding requirement for a national near Real Time Suicide Surveillance system in England, and the potential contribution of coroners and the police will be assessed following the findings of the pilot. To date £360,000 of revenue funding has been spent or is committed to delivering the pilot by 31 March 2022. Capital funding of £140,000 is currently being distributed to the seven participating local areas, which are submitting bids against the remaining £700,000 of capital funding to meet further costs required to deliver the pilot this year.

The Department is assessing options for delivering a near Real Time Suspected Suicide Surveillance System as part of the national near Real Time Suicide Surveillance pilot (nRTSS). The next steps for establishing a national nRTSS system, including a timetable, will be considered once the findings from the current pilot project are available. The pilot project is due for completion at the end of March 2022. We have identified 16 areas in England where a system that aims to deliver near real time suspected suicide surveillance has been established. The Department is currently working with 37 of the local authorities covered by existing systems to develop and pilot a national system by the end of March 2022.

An effective national system has the potential to improve local bereavement support by reducing the time taken for suicide-related information to be made available to local service providers and commissioners. This could include proactive approaches to individuals and families who have been bereaved by suicide.

The ongoing funding requirement for a national near Real Time Suicide Surveillance system in England, and the potential contribution of coroners and the police will be assessed following the findings of the pilot. To date £360,000 of revenue funding has been spent or is committed to delivering the pilot by 31 March 2022. Capital funding of £140,000 is currently being distributed to the seven participating local areas, which are submitting bids against the remaining £700,000 of capital funding to meet further costs required to deliver the pilot this year.

The Department is assessing options for delivering a near Real Time Suspected Suicide Surveillance System as part of the national near Real Time Suicide Surveillance pilot (nRTSS). The next steps for establishing a national nRTSS system, including a timetable, will be considered once the findings from the current pilot project are available. The pilot project is due for completion at the end of March 2022. We have identified 16 areas in England where a system that aims to deliver near real time suspected suicide surveillance has been established. The Department is currently working with 37 of the local authorities covered by existing systems to develop and pilot a national system by the end of March 2022.

An effective national system has the potential to improve local bereavement support by reducing the time taken for suicide-related information to be made available to local service providers and commissioners. This could include proactive approaches to individuals and families who have been bereaved by suicide.

The ongoing funding requirement for a national near Real Time Suicide Surveillance system in England, and the potential contribution of coroners and the police will be assessed following the findings of the pilot. To date £360,000 of revenue funding has been spent or is committed to delivering the pilot by 31 March 2022. Capital funding of £140,000 is currently being distributed to the seven participating local areas, which are submitting bids against the remaining £700,000 of capital funding to meet further costs required to deliver the pilot this year.

The Department is assessing options for delivering a near Real Time Suspected Suicide Surveillance System as part of the national near Real Time Suicide Surveillance pilot (nRTSS). The next steps for establishing a national nRTSS system, including a timetable, will be considered once the findings from the current pilot project are available. The pilot project is due for completion at the end of March 2022. We have identified 16 areas in England where a system that aims to deliver near real time suspected suicide surveillance has been established. The Department is currently working with 37 of the local authorities covered by existing systems to develop and pilot a national system by the end of March 2022.

An effective national system has the potential to improve local bereavement support by reducing the time taken for suicide-related information to be made available to local service providers and commissioners. This could include proactive approaches to individuals and families who have been bereaved by suicide.

The ongoing funding requirement for a national near Real Time Suicide Surveillance system in England, and the potential contribution of coroners and the police will be assessed following the findings of the pilot. To date £360,000 of revenue funding has been spent or is committed to delivering the pilot by 31 March 2022. Capital funding of £140,000 is currently being distributed to the seven participating local areas, which are submitting bids against the remaining £700,000 of capital funding to meet further costs required to deliver the pilot this year.

The Department is assessing options for delivering a near Real Time Suspected Suicide Surveillance System as part of the national near Real Time Suicide Surveillance pilot (nRTSS). The next steps for establishing a national nRTSS system, including a timetable, will be considered once the findings from the current pilot project are available. The pilot project is due for completion at the end of March 2022. We have identified 16 areas in England where a system that aims to deliver near real time suspected suicide surveillance has been established. The Department is currently working with 37 of the local authorities covered by existing systems to develop and pilot a national system by the end of March 2022.

An effective national system has the potential to improve local bereavement support by reducing the time taken for suicide-related information to be made available to local service providers and commissioners. This could include proactive approaches to individuals and families who have been bereaved by suicide.

The ongoing funding requirement for a national near Real Time Suicide Surveillance system in England, and the potential contribution of coroners and the police will be assessed following the findings of the pilot. To date £360,000 of revenue funding has been spent or is committed to delivering the pilot by 31 March 2022. Capital funding of £140,000 is currently being distributed to the seven participating local areas, which are submitting bids against the remaining £700,000 of capital funding to meet further costs required to deliver the pilot this year.

The Department regularly discuss a range of issues with colleagues in the National Institute for Health and Care Excellence (NICE) and NHS England and NHS Improvement, including NICE’s methods review. However, NICE is an independent body and is responsible for its own methods and processes.

NICE has consulted on a range of proposals although it is too soon to comment on the changes that may be implemented. However, NICE expects to consult on the draft programme manual in the summer, with implementation of the changes from early 2022. NICE and NHS England and NHS Improvement are working together on the development of proposals for the Innovative Medicines Fund. We expect NHS England and NHS Improvement and NICE to lead an engagement exercise later this year. A detailed timescale for this will be confirmed in due course.

The Department regularly discuss a range of issues with colleagues in the National Institute for Health and Care Excellence (NICE) and NHS England and NHS Improvement, including NICE’s methods review. However, NICE is an independent body and is responsible for its own methods and processes.

NICE has consulted on a range of proposals although it is too soon to comment on the changes that may be implemented. However, NICE expects to consult on the draft programme manual in the summer, with implementation of the changes from early 2022. NICE and NHS England and NHS Improvement are working together on the development of proposals for the Innovative Medicines Fund. We expect NHS England and NHS Improvement and NICE to lead an engagement exercise later this year. A detailed timescale for this will be confirmed in due course.

The Department regularly discuss a range of issues with colleagues in the National Institute for Health and Care Excellence (NICE) and NHS England and NHS Improvement, including NICE’s methods review. However, NICE is an independent body and is responsible for its own methods and processes.

NICE has consulted on a range of proposals although it is too soon to comment on the changes that may be implemented. However, NICE expects to consult on the draft programme manual in the summer, with implementation of the changes from early 2022. NICE and NHS England and NHS Improvement are working together on the development of proposals for the Innovative Medicines Fund. We expect NHS England and NHS Improvement and NICE to lead an engagement exercise later this year. A detailed timescale for this will be confirmed in due course.

The amount of overtime worked is not held centrally. The total value of overtime worked by National Health Service staff working in the hospital and community health sector between March 2020 and December 2020 is £1,340 million.

All recommendations of the Independent Medicines and Medical Devices Safety Review are being considered carefully. The Government will respond in full to the report later this year.

The content of the Quality Outcomes Framework (QOF) asthma review, which ensures all general practitioner practices establish and maintain a register of patients with an asthma diagnosis, has been amended to incorporate the key elements of basic asthma care positively associated with better patient outcomes and self-management, including:

- An assessment of asthma control;

- A recording of the number of exacerbations;

- An assessment of inhaler technique; and

- A written personalised asthma action plan.

The QOF for 2021/22 has been implemented from April 2021 with these updated indicators for asthma.

The National Institute for Health and Care Excellence’s Rapid Guidance on severe asthma during the pandemic recommend using technology to reduce in-person appointments.

NHS England’s letter of 13 May 2021 outlined that patients and clinicians have a choice of consultation mode. Patients’ input into this choice should be sought and practices should respect preferences for face to face care unless there are good clinical reasons to the contrary. The letter is available at the following link:

https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/B0497-GP-access-letter-May-2021-FINAL.pdf

NHS England and NHS Improvement asked general practice to restore activity to usual levels where clinically appropriate and reach out proactively to clinically vulnerable patients and those whose care may have been delayed.

The cardiovascular disease and respiratory programme focussed its work in 2020/21 on the response to COVID-19 and has spent £5.5 million to support the response to the disease, including work on ‘long COVID-19’. This included bringing forward the implementation of respiratory clinical networks by one year. The networks are vital in promoting an integrated approach to respiratory care during COVID-19, in parallel with supporting delivery of the NHS Long Term Plan’s priorities.

The 2019 Voluntary Scheme for Branded Medicines Pricing and Access commits the National Institute for Health and Care Excellence (NICE) to publishing recommendations on all newly licensed treatments within 90 days of marketing authorisation wherever possible.

NICE may not always be able to meet this timescale for individual topics for a range of reasons, including where companies request a longer appraisal timescale. In addition, during the COVID-19 pandemic, NICE adapted its priorities to support the health and care system at a time of unprecedented pressure. This involved pausing the publication of topics that were not COVID-19 related or regarded as therapeutically critical during the period of March to June 2020.

No such assessment has been made.

No such assessment has been made.

Information on patients who were first made aware of their severe asthma via shielding letters is not held centrally. However, respiratory disease is a national clinical priority in the NHS Long Term Plan. NHS England and NHS Improvement are working in close partnership with patients and partners, including the British Lung Foundation, and are developing and implementing policy on provisions of respiratory services in England.

NHS England and NHS Improvement’s Accelerated Access Collaborative (AAC) programme supported by the severe asthma toolkit, is increasing treatment adherence, biologic choice, optimising multidisciplinary teams and has been shared widely with the severe asthma clinical community. The AAC programme for severe asthma biologics has increased uptake of asthma drugs including ones covered by the National Institute for Health and Care Excellence’s Technology Appraisals where it has been identified that there is suboptimal uptake.

Information on patients who were first made aware of their severe asthma via shielding letters is not held centrally. However, respiratory disease is a national clinical priority in the NHS Long Term Plan. NHS England and NHS Improvement are working in close partnership with patients and partners, including the British Lung Foundation, and are developing and implementing policy on provisions of respiratory services in England.

NHS England and NHS Improvement’s Accelerated Access Collaborative (AAC) programme supported by the severe asthma toolkit, is increasing treatment adherence, biologic choice, optimising multidisciplinary teams and has been shared widely with the severe asthma clinical community. The AAC programme for severe asthma biologics has increased uptake of asthma drugs including ones covered by the National Institute for Health and Care Excellence’s Technology Appraisals where it has been identified that there is suboptimal uptake.

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for providing evidence-based guidance for the National Health Service in England on whether medicines represent a clinically and cost-effective use of resources. Wherever possible, NICE aims to publish final guidance for new medicines, including those used to treat patients with severe asthma and other high risk conditions, within 90 days of licensing. NHS commissioners are legally required to make funding available for treatments recommended by NICE, normally within three months of the publication of NICE’s final guidance.

The amount of overtime worked is not held centrally. The total value of overtime worked by National Health Service staff working in the hospital and community health sector between March 2020 and September 2020 is £926.4 million.

Adults with asthma which requires continuous or repeated use of systemic steroids or with previous exacerbations requiring hospital admission, will be vaccinated in phase one, priority group six which includes all individuals aged 16 to 64 years old with underlying health conditions which put them at higher risk of serious disease and mortality. Individuals with more severe asthma may have been included in the clinically extremely vulnerable group, in which case they will be vaccinated in priority group four in phase one. All other adults aged 50 years old or above with asthma are being vaccinated within the phase one priority group associated with their age.

Adults with asthma which requires continuous or repeated use of systemic steroids or with previous exacerbations requiring hospital admission, will be vaccinated in phase one, priority group six which includes all individuals aged 16 to 64 years old with underlying health conditions which put them at higher risk of serious disease and mortality. Individuals with more severe asthma may have been included in the clinically extremely vulnerable group, in which case they will be vaccinated in priority group four in phase one. All other adults aged 50 years old or above with asthma are being vaccinated within the phase one priority group associated with their age.

Officials at the Department of Health and Social Care and HM Treasury have discussed alcohol duty and its impact on health in the context of the report and responses are currently being analysed.

A second national hospice grant of up to £125 million was provided until 31 March 2021 with provision to support 46,500 community contacts per day, which included supporting people at the end of their life within their own home. There are a range of resources available to support family members on providing end of life care in a variety of settings. This includes the end of life care toolkit for carers at home, created by the Helix Centre in conjunction with colleagues at the Central North West London NHS Trust which is available at the following link:

https://helixcentre.com/project-end-of-life-toolkit

The NHS Long Term Plan sets a clear ambition that where appropriate every person diagnosed with cancer should have access to personalised care by 2021. This includes providing personalised care and support planning, and information to support health and wellbeing. The key signs and symptoms of cancer recurrence are included in an end of treatment summary.

NHS England and NHS Improvement are supporting staff to offer personalised care to people affected by cancer by promoting awareness and understanding of the personalised care interventions. This includes providing resources such as a handbook on personalised stratified follow up, a checklist on health and wellbeing information and support, webinars, and a collaborative online workspace for staff. Cancer Alliances are leading programmes of work to embed personalised care within local providers.

The latest public data from December 2019 show that 94% of trusts offered personalised care and supporting planning for breast cancer patients.

The NHS Long Term Plan, which was published in January 2019 and followed on from the Cancer Taskforce Strategy, sets a clear ambition that where appropriate every person diagnosed with cancer should have access to personalised care by 2021. The key signs and symptoms of cancer recurrence are included in an end of treatment summary.

Public Health England (PHE) has studied the evidence on the efficacy of different types of face coverings, and some of these studies have compared face coverings with surgical masks, although not specifically FFP3s. This evidence, from laboratory studies, suggests that face coverings made of materials such as cotton and polyester materials might block droplets with a filtering efficiency similar to medical masks when folded in two or three layers. The PHE rapid review on this topic is available at the following link:

https://phe.koha-ptfs.co.uk/cgi-bin/koha/opac-retrieve-file.pl?id=5f043ca658db1188ffae74827fa650d9

FFP3s are classed as personal protective equipment (PPE), which is used by frontline health and social care workers in relevant settings. PHE has published guidance setting out who needs PPE and when, based on United Kingdom clinical expertise and World Health Organization standards. The guidance is available at the following link:

https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control

In 2017, we expanded the scope of the national suicide prevention strategy to include addressing self-harm as an issue in its own right, and we have funded the Multicentre Study of Self-harm – the most in-depth analysis and monitoring of self-harming trends in England.

The aim of the Multicentre Study’s work is to conduct a series of related studies on the epidemiology, causes, clinical management, outcome and prevention of self-harm.

The cross-Government Suicide Prevention Workplan includes a commitment to establish a wider mental health research programme to inform our thinking in many of the areas that may impact suicide and self-harm prevention. We continue to provide funding for research projects through the National Institute for Health Research including for suicide and self-harm prevention.

The National Institute for Health and Care Excellence’s clinical guideline ‘Self-harm in over 8s: long-term management (CG133)’ covers the initial management of self-harm and the provision of longer-term support for children and young people aged eight years and older and adults. It includes guidance on referring patients in primary and community care and in other specialist mental health settings for an assessment if presenting with a history of self-harm and a risk of repetition.

In the NHS Long Term Plan, we committed to establishing new models of integrated primary and community mental health care for adults and older adults with severe mental illnesses, with a new community-based offer explicitly including – among other elements – improved self-harm support. New models are currently being tested in 12 early implementer sites, and all areas are developing plans to expand and transform services from 2021/22.

Hospital trusts submit data for secondary breast cancer diagnoses through the Cancer Outcomes and Services Dataset (COSD) or Cancer Waiting Times (CWT) data collection mechanisms. Data on the reported number of people diagnosed with secondary breast cancers in 2014-2017 in England are available in the following table. Data for 2018 will be published in November 2020.

Notes:

1. Source:

http://www.ncin.org.uk/cancer_type_and_topic_specific_work/topic_specific_work/recurrence

2. Where a recurrence record has been reported by multiple trusts it will be included once per trust. This means the totals will include some double-counting of recurrences.
3. Counts from COSD and CWT cannot be combined as there will duplication between the datasets.

The number of reported cases is accepted as being significantly below the estimated number of secondary breast cancers. The National Cancer Registration and Analysis Service is working closely with cancer charities to improve data collection and submission by hospital trusts, looking at how they can help improve completion rates and thus gain a better picture of the burden of recurrence and metastatic disease across the health service.

Data for secondary breast cancer diagnoses are not available at constituency level. Data on how many people diagnosed with secondary breast cancer who were diagnosed less than and more than five years after a diagnosis of primary breast cancer are not available.

We recognise the hardship visiting restrictions pose for people with Alzheimer’s and dementia-related diseases.

We want to enable residents in care homes to have visits, while protecting them, other residents, staff and visitors from COVID-19. Clinical advice is clear that extra footfall in care homes increases risk. That is why we have published guidance to advise care homes on visiting during this period of new national restrictions, and how to reduce the risk. This guidance is intended to enable visiting, recognising the benefits to health and wellbeing of both residents and their loved ones.

The report, ‘Diagnostics: recovery and renewal’, was discussed at the NHS England and NHS Improvement public Board meeting on 1 October 2020. The report reflects the impact of COVID-19 on diagnostic provision and was published with the Board papers at the following link:

https://www.england.nhs.uk/wp-content/uploads/2020/10/BM2025Pu-item-5-diagnostics-recovery-and-renewal.pdf

As part of the Government’s continued commitment to ensure high-quality, accessible rehabilitation services for patients, NHS England has commenced work on refreshing this guidance. This has included engagement with professional bodies’ clinicians, alongside many other stakeholders, societies and third sector organisations who represent the patient voice.

The Joint Committee on Vaccination and Immunisation (JCVI), and the JCVI sub-committee on COVID-19 are currently reviewing evidence on clinical risk factors associated with serious disease and mortality from COVID-19. Following a review of the evidence the Committee will develop advice on risk groups for any future COVID-19 vaccination programme. The minutes of JCVI committee meetings and statements on COVID-19 vaccination are available on the JCVI website at the following link:

https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation

Gowns and overalls were ordered by the Royal Free Trust from a new supplier in Turkey. Further supply from the manufacturer was held in country as it was already clear looking at the first batches that the quality was suspect and not suitable for use in the National Health Service.

Once the first batches were seen and the quality was identified as a concern, the United Kingdom Embassy team in Turkey and the Turkish Government helpfully stepped in and provided some Turkish Government-sourced gowns which met UK standards to make up the order.

Discussions are underway between the Royal Free Trust and the UK distributor to agree a refund or acceptable alternative product.

We recognise that there is the potential for an increase in demand for mental health services amongst students as a result of COVID-19.

We are working with the Department for Education, the National Health Service, Public Health England and others to gather evidence and assess the potential longer-term mental health impacts of COVID-19, including on students.

It is a Care Quality Commission regulatory requirement for general practitioners to follow the Medicines and Healthcare products Regulatory Agency’s (MHRA) guidance on valproate prescribing. The MHRA advises that ‘Valproate medicines must no longer be used in women or girls of childbearing potential unless a Pregnancy Prevention Programme is in place’.

In 2019/20 NHS England implemented a quality improvement module worth approximately £44 million nationally to encourage practices to improve their prescribing safety. This aimed to improve engagement with women of childbearing age being prescribed sodium valproate and pregnancy prevention for these patients.

The standard of medical training is the responsibility of the General Medical Council (GMC), which is an independent statutory body.?The GMC has the general function of promoting high standards of education and co-ordinating all stages of education to ensure that medical students and newly qualified doctors are equipped with the knowledge, skills and attitudes essential for professional practice.

The Department of Health and Social Care has been working closely with the Department for Education to make sure students are safe at university. We understand that many students are keen to go home for Christmas and we are working together to ensure that they will have plenty of notice to make plans to do so, as announced by the Secretary of State for Education on Tuesday 29 September 2020.

We do not want to single out students for tougher restrictions than other members of society, as we all have our part to play in controlling this virus.

Within the terms of the valproate Pregnancy Prevention Programme, general practitioners (GPs) are required to identify all relevant women and girls in their practice who are taking valproate and refer them for specialist review annually. Specialists should review treatment and ensure that an Annual Risk Acknowledgement Form is signed by the prescriber and the patient and shared with the patient’s GP. GPs should check that the patient has a signed, up-to-date Annual Risk Acknowledgment Form each time a repeat prescription is issued. A GOV.UK toolkit on valproate use by women and girls is available at the following link:

https://www.gov.uk/guidance/valproate-use-by-women-and-girls.

Data on the general practitioner (GP) to patient ratio for female patients between the ages of 15 to 45 years old with epilepsy is not available at national or regional levels.

We allocate more testing to higher prevalence areas in line with the Joint Biosecurity Centre’s reporting. Allocation decisions are frequently and systematically reviewed to ensure we are using our testing where it can be most effective. We are working with Public Health England to manage the prioritisation process to ensure that we are able to provide appropriate testing for both outbreak management and surveillance purposes. We have exceeded our target of reaching 500,000 testing capacity by the end of October.

NHS England recently announced that people suffering from longer term symptoms of COVID-19 will be offered specialist help at clinics across England.

A range of professionals, including physiotherapists, other specialists and general practitioners will all help assess, diagnose and treat thousands of sufferers who have reported ongoing symptoms. £10 million will be invested this year in additional local funding to help initiate and designate ‘long COVID-19’ clinics in every area across England, to complement existing primary, community and rehabilitation care.

As at May 2020 there are 2,548 (14.4%) more full-time equivalent (FTE) physiotherapists and 861 (23.7%) more FTE support staff to physiotherapists than in May 2015 to provide care to patients.

NHS England recently announced that people suffering from longer term symptoms of COVID-19 will be offered specialist help at clinics across England.

A range of professionals, including physiotherapists, other specialists and general practitioners will all help assess, diagnose and treat thousands of sufferers who have reported ongoing symptoms. £10 million will be invested this year in additional local funding to help initiate and designate ‘long COVID-19’ clinics in every area across England, to complement existing primary, community and rehabilitation care.

As at May 2020 there are 2,548 (14.4%) more full-time equivalent (FTE) physiotherapists and 861 (23.7%) more FTE support staff to physiotherapists than in May 2015 to provide care to patients.

In total, 3,754 physiotherapists have joined the Health and Care Professions Council’s COVID-19 temporary register.

A recent survey of returners indicated that around 50% across all professions were interested in continuing to work in the health and social care system.

There are existing return to practice schemes designed to support physiotherapists who have been out of the workforce for a number of years to safely re-start their careers.

NHS England is working with the Department and other local employing organisations to consider a range of flexible options to make it easier for professionals including physiotherapists who are interested in re-joining the National Health Service workforce to do so.

There are currently no plans in place. The CA125 Blood test, followed by an ultrasound for raised CA125, is the current process recommended by the National Institute for Health and Care Excellence.

Rapid Diagnostic Centres (RDCs) are being rolled out across England as part of the NHS Long Term Plan. One of the key principles of RDCs is the coordination of testing, including implementation of multiple-same day testing to provide timely diagnosis of cancer.

We recognise that social distancing, self-isolation and shielding are likely to have increased the risk of loneliness and mental health issues for some people.

Mental health services have remained open for business throughout the COVID-19 pandemic, delivering support digitally, over the phone and face to face where possible. We are working with the National Health Service, Public Health England and others to understand the specific impacts and to improve support for people experiencing these issues as we move into the ‘recovery’ phase.

From 2019/20, we are investing £57 million in suicide prevention through the NHS Long Term Plan. This will see investment in all areas of the country by 2023/24 to support local suicide prevention plans and establish suicide bereavement support services plan.

The Cross-Government Suicide Prevention Workplan, published January 2019, set out that NHS England is working with the National Collaborating Centre for Mental Health to develop a framework for adult and older adult community mental health services, including for people who self-harm.

Following advice from members of NHS England’s Expert Reference Group, the framework replaced the planned pathways. It will consider the needs of people who self harm while being cared for in the community, giving due regard to existing National Institute for Health and Care Excellence guidance on the longer-term management of people who self harm.

The Framework was published in September 2019 and is available on the NHS England and NHS Improvement website.

For children and young people, the NHS Long Term Plan makes commitments to expand children and young people’s services to provide an enhanced crisis offer. This expansion includes further work to strengthen local pathways between community, crisis and inpatient services, which will improve the evidence based self-harm pathway.

The publication of the Exercise Cygnus report is currently subject to ongoing legal proceedings, so it would be inappropriate to comment at this point.

The Government accepted all the recommendations from Exercise Cygnus. The lessons identified from Exercise Cygnus have been incorporated into an ongoing programme of work on our pandemic flu response plans.

The lessons learned from Exercise Cygnus continue to be considered by the Government and a range of stakeholders, including expert advisory groups and local emergency planners. We continue to work across Government and with key stakeholders to develop coordinated multi-sector response plans for a future influenza pandemic.

The National Institute for Health and Care Excellence COVID-19 rapid guideline on severe asthma provides guidance on the use of oral corticosteroids and starting or continuing on biological treatments, which aim to minimise oral corticosteroid exposure, for people with severe asthma during the COVID-19 outbreak. The guideline is available at the following link:

https://www.nice.org.uk/guidance/ng166

The monitoring and prescribing of asthma medication are performed in accordance with guidance from the National Institute for Health and Care Excellence to manage the condition. The guidance is available at the following link:

https://www.nice.org.uk/guidance/ng80/chapter/Recommendations#self-management

The NHS England and NHS Improvement clinical guide for the management of respiratory patients during the COVID-19 pandemic states that the majority of community respiratory services should be switched to telephone or virtual consultation. Routine annual reviews should continue virtually to reassure patients and ensure they are happy with their management plans to avoid hospital attendance. The clinical guide is available at the following link:

https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0063-Specialty-guide-_Respiratory-and-Coronavirus-_v1_26-March.pdf

Respiratory disease is a clinical priority of the NHS Long Term Plan, acknowledging medicines optimisation as a key intervention for people with respiratory disease. Pharmacists in primary care networks will also undertake a range of medicine reviews, including educating patients on the correct use of inhalers.

The Quality and Outcomes Framework ensures all practices establish and maintain a register of patients with an asthma diagnosis in accordance with National Institute for Health and Care Excellence guidance.

Guidance on the management of treatment of pregnant women and unborn children for carbon monoxide poisoning is provided and accessible to healthcare professionals on TOXBASE and the United Kingdom Teratology Information Service (UKTIS) website.

If carbon monoxide poisoning is suspected, the initial management is the same as for a non-pregnant patient and consists of identifying and removing the patient from the source of exposure, followed by administration of high concentration oxygen. The patient’s carboxyhaemoglobin concentration should be measured initially and monitored. Treatment may need to be continued for longer in pregnant patients compared to a non-pregnant patient.

It is advised that all cases of carbon monoxide poisoning in pregnancy are discussed with the UKTIS.

Long-term exposure to carbon monoxide gas can damage an unborn baby. Babies exposed to carbon monoxide during pregnancy are at risk of a low birth weight; stillbirth; death that occurs within the first four weeks of birth; and behavioural problems.

Women are tested for the presence of carbon monoxide at the antenatal booking appointment and as appropriate throughout pregnancy to identify smokers, or those exposed to tobacco smoke, and offer them a referral for support from a trained stop smoking advisor. Carbon monoxide testing may also highlight a household problem and the need to take measures to prevent further exposure.

Long-term exposure to carbon monoxide gas can damage an unborn baby. Babies exposed to carbon monoxide during pregnancy are at risk of a low birth weight; stillbirth; death that occurs within the first four weeks of birth; and behavioural problems.

Women are tested for the presence of carbon monoxide at the antenatal booking appointment and as appropriate throughout pregnancy to identify smokers, or those exposed to tobacco smoke, and offer them a referral for support from a trained stop smoking advisor. Carbon monoxide testing may also highlight a household problem and the need to take measures to prevent further exposure.

All guidance, statements and public information released by the Government are readily available to read online. Information on COVID-19 from Public Health England and the Department is translated into British Sign Language videos can be found at the following link:

https://www.signhealth.org.uk/

In addition to this, the Chancellor has advised that the National Health Service will get whatever resources it needs to cope with a COVID-19 epidemic.

NHS England has undertaken significant communications activities to raise awareness of the Accessible Information Standard with organisations required to implement and follow it, including National Health Service trusts. A range of resources have been made available to support effective implementation and compliance. Conformance with the Standard is a specific legal duty – as set out in section 250 of the Health and Social Care Act 2012. It is also a requirement of the NHS Standard Contract.

In developing the Standard, we have worked alongside a number of partners, including the Care Quality Commission, who have stated that they will be looking at how services implement the Accessible Information Standard as part of their inspections.

The National Health Service produces a range of materials to promote the NHS 111 service (including ways for deaf people to access the service), which are available to all healthcare professionals. NHS England also engages with a wide number of charities and third-party organisations to promote NHS 111 to the deaf and hard of hearing community.

A deaf or hard of hearing person can speak to NHS 111 through a British Sign Language interpreting service. Relay UK is also available for people who have difficulty communicating or hearing whilst the online NHS 111 service can also be accessed if medical advice is required.

All guidance, statements and public information released by the Government are readily available to read online information on COVID-19 from Public Health England and the Department is translated into British Sign Language videos can be found at the following link:

https://www.signhealth.org.uk/

In addition to this, the Chancellor has advised that, the National Health Service will get whatever resources it needs to cope with a coronavirus epidemic.

All guidance, statements and public information released by the Government are readily available to read online information on COVID-19 from Public Health England and the Department is translated into British Sign Language videos can be found at the following link:

https://www.signhealth.org.uk/

In addition to this, the Chancellor has advised that, the National Health Service will get whatever resources it needs to cope with a coronavirus epidemic.

All guidance, statements and public information released by the Government are readily available to read online.

Information on COVID-19 from Public Health England and the Department is translated into British Sign Language. Videos can be found at the following link:

https://www.signhealth.org.uk/

NHS England operates an accessible information standard which sets out a specific, consistent approach to identifying, recording, flagging, sharing and meeting the information and communication support needs of patients, service users, carers and parents with a disability, impairment or sensory loss. More information can be found at the following link:

https://www.england.nhs.uk/ourwork/accessibleinfo/

We have been working across government on accessible housing provision and will consult shortly on options to raise accessibility standards in new homes.

The consultation will consider making higher accessibility standards mandatory, recognising the importance of suitable homes for older and disabled people.