Question to the Department of Health and Social Care:

To ask the Secretary of State for Health, pursuant to the Answer of 25 October 2016 to Question 49671, the Answer of 31 October 2016 to Question 50008 and the Answer of 8 November 2016 to Question 51652, what the role is of NHS England in ensuring that clinical commissioning groups (CCGs) are fulfilling their statutory role when changing local policy or local guidelines related to access to medical nutrition; what mechanisms are in place to ensure that when CCGs do not follow NICE guidance there is a clear clinical case for not doing so; and what oversight NHS England has in making sure that CCG decisions are consistent with NICE and NHS England guidance on commissioning.

NHS England has a statutory duty to carry out an annual performance assessment of each clinical commissioning group (CCG) and in 2016/17 it has introduced the CCG Improvement and Assessment Framework.

The Framework assesses CCGs against a range of indicators which consider their financial performance, delivery of commitments, improved health outcomes for their populations and whether they are well led organisations. This provides assurance that CCGs are well led, effective commissioning organisations. There is also a strong focus on improvement and, where necessary, NHS England is supported by legislation in exercising formal powers of direction if it is satisfied that a CCG is failing or is at risk of failing to discharge its functions.

CCGs should pay regard to the National Institute for Health and Care Excellence (NICE) Clinical Guidelines and Quality Standards, when planning and delivering services, as part of their general duty to secure a continuous improvement in quality. However, while England does have a duty of regard in relation to quality standards prepared by NICE, these are not mandatory. CCGs cannot ignore NICE guidance without having a clear clinical case for doing so, as they are based on the best available evidence. In the event of this happening there would have to be a clear documented rationale signed off through CCG governance.