Data for the workforce providing mental health therapy services in the community via the Improving Access to Psychological Therapies (IAPT) programme are available from the 2015 IAPT Workforce Census, which recorded 8,588 IAPT staff (by headcount, equivalent to 7,205 full time equivalents) as at 30 April 2015.

More recent data are not available.

The General Practitioner (GP) Forward View, published in 2016, set out plans to recruit an additional 1,500 clinical pharmacists into general practice by 2020/21.

Following a recent consultation, several changes have been made to the data processing and methodology for general practice workforce data back to September 2015. Figures produced under the old and new methodologies are not comparable and revised figures have so far been published for December 2017, September 2018 and December 2018 only. The remainder of the September 2015 to December 2018 data is planned for publication on 25 April 2019 and cannot be disseminated before this date. The number of pharmacists working in general practice in March 2019 will be published in May 2019.

The recently published five-year general practitioner (General Medical Services) contract included funding for the new Additional Roles Reimbursement Scheme, in Primary Care Networks (PCNs). PCNs will be guaranteed funding for up to an estimated 20,000 additional staff by 2023/24. This funds new roles for which there is both credible supply and demand. The scheme will meet a recurrent 70% of the costs of additional clinical pharmacists, physician associates, first contact physiotherapists, and first contact community paramedics; and 100% of the costs of additional social prescribing link workers. The scope of the scheme will extend gradually, reflecting available supply and funding. Funding will be available from July 2019 for clinical pharmacists through the scheme

No additional engagement has been undertaken by NHS England to that outlined in the previous response.

No figures are available specifically for biomedical scientists within screening laboratories, however, the available figures state that there were 1,505 leavers from the selected Healthcare Scientist Care Setting group in National Health Service trusts and clinical commissioning groups over the period 30 September 2017 to 30 September 2018. This staff group includes healthcare scientists within a care setting of blood sciences, cellular sciences, genetics and infection sciences.

The NHS Long Term Plan sets out specific workforce actions developed by NHS Improvement and others to have positive impact for workforces, including the screening and diagnostic workforce. NHS Improvement and the Department will discuss these actions when the education and training budget for Health Education England is set in 2019. This includes a proposal to recruit an additional 1,500 clinical and diagnostic staff across seven priority specialisms between 2018 and 2021.

Professor Sir Mike Richards is leading a major review of national cancer screening programme pathways as part of the NHS Long Term Plan’s renewed drive to improve care and save lives. Professor Richards’ review is due later this year.

Specifically, in relation to cervical cancer screening, to maintain the service and accommodate current staffing levels, a majority of existing pilot sites carrying out the new human papilloma virus (HPV) testing and some non-pilot sites have already converted more of their cervical screening activity to HPV primary screening, freeing up cytology capacity.

The latest published data for 2017/18 indicated that 58.6% of women received the results of their test within 14 days; 23% of women were waiting over three weeks.

The 2017/18 data indicates that 69.6% of women across London received their cervical screening results within 14 days. The following table shows the average waiting time for cervical screening results in laboratories linked to each National Health Service trust and foundation trust in London:

Prior to the agreement on the optimum number of centralised laboratories to deliver the new human papilloma virus (HPV) primary screening to replace cytology, consideration was given to how this would impact on the existing workforce. A survey of the existing workforce was undertaken by the British Association of Cytopathologists in 2017 and the outcomes of this arising was included amongst further consideration when confirming the maximum number of laboratories required to deliver the service across the country.

The planned introduction of HPV primary screening and reconfiguration of laboratories has impacted on cytology workforce retention and recruitment rates, which led to an increase in the waiting time for cervical screening results in 2016-17 and 2017-18.

Unpublished management data has also shown an improvement in turnaround times in the last quarter of 2018/19. As HPV testing takes over from cytology testing during 2019, it is expected that waiting times will reduce significantly.

Nevertheless, the 14-day turnaround time for test results to be provided remains a vital target for the NHS Cervical Screening Programme.

The roll-out of HPV primary screening into the NHS Cervical Cancer Screening Programme in England is due to be rolled out in December 2019. This could prevent around 600 cancers a year.

The number of prescription and dental penalty charge notices issued prior to universal credit (UC) rollout in Dudley by calendar year is provided in the following table:

The number of prescription and dental penalty charge notices issued since the rollout of UC in Dudley by calendar year is provided in the following table:

Notes:

- The following postcodes were used to collate data for the Dudley area: B62, B63, B64, B65, DY1, DY2, DY3, DY4, DY5, DY6, DY7, DY8, DY9, WV1, WV4

- UC commenced roll out in the Dudley area from July 2017 so this date has been used in the data collation. The data represents Penalty Charge Notices sent out against all exemption types ticked by the patient where an exemption could not be verified.

The number of prescription and dental penalty charge notices issued prior to universal credit (UC) rollout in Dudley by calendar year is provided in the following table:

The number of prescription and dental penalty charge notices issued since the rollout of UC in Dudley by calendar year is provided in the following table:

Notes:

- The following postcodes were used to collate data for the Dudley area: B62, B63, B64, B65, DY1, DY2, DY3, DY4, DY5, DY6, DY7, DY8, DY9, WV1, WV4

- UC commenced roll out in the Dudley area from July 2017 so this date has been used in the data collation. The data represents Penalty Charge Notices sent out against all exemption types ticked by the patient where an exemption could not be verified.

My Rt. hon. Friend the Secretary of State for Health and Social Care has not met with any representatives of Oxford University Hospitals NHS Foundation Trust, InHealth Group or Oxfordshire Clinical Commissioning Group.

The Department welcomes the Asda ‘Tickled Pink’ campaign which they are running with two cancer charities. The Department encourages all women to be breast aware, and urges anyone with any concerns to also discuss these with their general practitioner.

Public Health England has run its ‘Be Clear on Cancer’ campaigns in partnership with Cancer Research UK since 2011 and are supported by a number of charities, for example Breast Cancer Now, Breast Cancer Care and Cancer Research UK, and other public and private sector partners.

The Department welcomes the Asda ‘Tickled Pink’ campaign which they are running with two cancer charities. The Department encourages all women to be breast aware, and urges anyone with any concerns to also discuss these with their general practitioner.

Public Health England has run its ‘Be Clear on Cancer’ campaigns in partnership with Cancer Research UK since 2011 and are supported by a number of charities, for example Breast Cancer Now, Breast Cancer Care and Cancer Research UK, and other public and private sector partners.

The Government is committed to ending new transmissions of HIV in England by 2030. Work is underway with partners to discuss how this work will be taken forward.

NHS England established the United Kingdom Antimicrobial Resistance (AMR) Diagnostics Collaborative in 2018 to deliver the UK’s diagnostic ambitions for AMR. The Collaborative has played a valuable role in developing the diagnostic elements of the new five-year UK AMR national action plan, published in January this year.

The work of the Collaborative contributes directly to the Government’s commitments on AMR, and the Collaborative’s secretariat communicates with the Department on a regular basis and it has been represented by its secretariat and former chair in the UK AMR Programme’s governance groups.

The Collaborative’s chair remains vacant while NHS England develops detailed plans to support the implementation of the new national plan on AMR. As part of this work, the membership of the Collaborative is under review.

Current membership is drawn from a range of stakeholders across Government and its agencies, the devolved administrations, the health system, veterinary medicine, professional bodies, academia, the research community and industry. Members at or above ‘very senior manager’ (VSM) level and partner agencies involved in the Collaborative are listed in the following table.

NHS England is using extant systems to monitor use of the newly rescheduled unlicensed cannabis-based products for medicinal use in England. Scotland, Wales and Northern Ireland are in the process of setting up similar systems.

In England, these systems monitor the number of items dispensed and associated costs in primary care and the volume of products used and associated cost in secondary care. NHS England Controlled Drug Accountable Officers are also collecting local intelligence in both the National Health Service and independent sector. We expect this data to be available by end of March 2019.

NHS England is using extant systems to monitor use of the newly rescheduled unlicensed cannabis-based products for medicinal use in England. Scotland, Wales and Northern Ireland are in the process of setting up similar systems.

In England, these systems monitor the number of items dispensed and associated costs in primary care and the volume of products used and associated cost in secondary care. NHS England Controlled Drug Accountable Officers are also collecting local intelligence in both the National Health Service and independent sector. We expect this data to be available by end of March 2019.

NHS England commissions dialysis services at a national level as a specialised service, setting out what providers should have in place to deliver dialysis care, including at home, as part of its remit to deliver specialised services. National Commissioning supports equity of access to high quality dialysis care. The service delivery contract sets out that the principle should be that home haemodialysis should always be an option for patients and that solutions should be sought to overcoming barriers that might prevent this. Decisions should be made on an individual basis but in general, patients suitable for home haemodialysis will be those who:

- have the ability and motivation to learn to carry out the process and the commitment to maintain treatment;

- are stable on dialysis;

- are free of complications and significant concomitant disease that would render home haemodialysis unsuitable or unsafe;

- have good functioning vascular access;

- have a carer who has (or carers who have) also made an informed decision to assist with the haemodialysis unless the individual is able to manage on his or her own; and

- have suitable space and facilities or an area that could be adapted within their home environment.

NHS England’s renal services specifications can be found at the following link:

www.england.nhs.uk/commissioning/spec-services/npc-crg/group-a/a06/

NHS England Specialised Services use the Renal Registry Annual Report and data to support work with local dialysis services so they are aware where variation exists so this can be considered and addressed.

The Atlas of variation, published by Public Health England in 2015, showed that for clinical commissioning groups (CCGs) in England, the percentage of dialysis patients who were receiving dialysis in the home (home haemodialysis and peritoneal dialysis combined) ranged from 4.1% to 44.0% (10.6-fold variation). When the seven CCGs with the highest percentages and the seven CCGs with the lowest percentages are excluded, the range is 7.6–33.7%, and the variation is 4.4-fold. Variation by parliamentary constituency is not available.

Reasons for the degree of variation observed include differences in:

- access to, and timely assessment by, a specialist kidney unit – working with patients to help them decide between treatments takes time, but in some areas 30% of patients are not known to their kidney team for even 90 days before they start renal replacement therapy;

- access to a multi-professional team, including staff who regularly support patients undertaking home dialysis; and

- levels of support for people undertaking home dialysis to help them maintain their independence, including access to respite in-centre dialysis.

The Atlas can be found at the following link:

https://fingertips.phe.org.uk/profile/atlas-of-variation

According to the latest data from the UK Renal Registry (UKRR), there were 1,195 patients receiving home dialysis in the United Kingdom in 2014, 1,175 patients in 2015; and 1,256 patients in 2016. The UKRR collects, analyses and reports on data from 71 adult and 13 paediatric renal centres. Participation is mandated in England, via the national services specification published by NHS England.

The latest report from the UK Renal Registry can be found at the following link:

www.renalreg.org/publications-reports/

No specific assessment of the cost to the National Health Service of the provision of dialysis services in a patient’s home compared to a clinical setting has been undertaken. In its assessment of the evidence regarding cost, the National Institute for Health and Care Excellence (NICE) set out in its guideline, ‘Renal Replacement Therapy and Conservative Management’, published in October 2018, that there is uncertainty in current UK dialysis costs, but they may be lower at home. The committee acknowledged that these treatments can have very different effects on lifestyle and recommended patient choice. The NICE guideline can be found at the following link:

www.nice.org.uk/guidance/ng107/resources/renal-replacement-therapy-and-conservative-management-pdf-66141542991301

Regarding the benefits of home dialysis, there is good evidence that home dialysis therapies offer advantages for suitable patients. The limitations of thrice weekly standard in-centre haemodialysis have been recognised in recent years. However, it is very difficult to separate the effect of different case mix, the most up to date and comprehensive data does not show a survival difference between patients who received more frequent versus thrice weekly (standard regimen) haemodialysis.

The advantage of self-care haemodialysis includes not only those related to control and convenience but also the opportunity to conduct more frequent or longer sessions to optimise health prospects. The introduction of smaller more portable haemodialysis machines also provides opportunity for travel for employment or holidays. Furthermore, these therapies are cost effective in the UK when compared with hospital treatments and have been demonstrated to be safe. Information regarding a reduction in travel times and reliance on other medicines is not available.

The Department has not, in the context of work on the prevention Green paper, engaged specifically with groups representing patients of kidney care. However, conversations on this may have taken place elsewhere in the Department, outside the Green Paper. The Green Paper will consider options for preventing a wide range of physical and mental health problems and seek views on what actions are most needed.

NHS England commissions dialysis services at a national level as a specialised service, setting out what providers should have in place to deliver dialysis care, including at home, as part of its remit to deliver specialised services. National Commissioning supports equity of access to high quality dialysis care. The service delivery contract sets out that the principle should be that home haemodialysis should always be an option for patients and that solutions should be sought to overcoming barriers that might prevent this. Decisions should be made on an individual basis but in general, patients suitable for home haemodialysis will be those who:

- have the ability and motivation to learn to carry out the process and the commitment to maintain treatment;

- are stable on dialysis;

- are free of complications and significant concomitant disease that would render home haemodialysis unsuitable or unsafe;

- have good functioning vascular access;

- have a carer who has (or carers who have) also made an informed decision to assist with the haemodialysis unless the individual is able to manage on his or her own; and

- have suitable space and facilities or an area that could be adapted within their home environment.

NHS England’s renal services specifications can be found at the following link:

www.england.nhs.uk/commissioning/spec-services/npc-crg/group-a/a06/

NHS England Specialised Services use the Renal Registry Annual Report and data to support work with local dialysis services so they are aware where variation exists so this can be considered and addressed.

The Atlas of variation, published by Public Health England in 2015, showed that for clinical commissioning groups (CCGs) in England, the percentage of dialysis patients who were receiving dialysis in the home (home haemodialysis and peritoneal dialysis combined) ranged from 4.1% to 44.0% (10.6-fold variation). When the seven CCGs with the highest percentages and the seven CCGs with the lowest percentages are excluded, the range is 7.6–33.7%, and the variation is 4.4-fold. Variation by parliamentary constituency is not available.

Reasons for the degree of variation observed include differences in:

- access to, and timely assessment by, a specialist kidney unit – working with patients to help them decide between treatments takes time, but in some areas 30% of patients are not known to their kidney team for even 90 days before they start renal replacement therapy;

- access to a multi-professional team, including staff who regularly support patients undertaking home dialysis; and

- levels of support for people undertaking home dialysis to help them maintain their independence, including access to respite in-centre dialysis.

The Atlas can be found at the following link:

https://fingertips.phe.org.uk/profile/atlas-of-variation

According to the latest data from the UK Renal Registry (UKRR), there were 1,195 patients receiving home dialysis in the United Kingdom in 2014, 1,175 patients in 2015; and 1,256 patients in 2016. The UKRR collects, analyses and reports on data from 71 adult and 13 paediatric renal centres. Participation is mandated in England, via the national services specification published by NHS England.

The latest report from the UK Renal Registry can be found at the following link:

www.renalreg.org/publications-reports/

No specific assessment of the cost to the National Health Service of the provision of dialysis services in a patient’s home compared to a clinical setting has been undertaken. In its assessment of the evidence regarding cost, the National Institute for Health and Care Excellence (NICE) set out in its guideline, ‘Renal Replacement Therapy and Conservative Management’, published in October 2018, that there is uncertainty in current UK dialysis costs, but they may be lower at home. The committee acknowledged that these treatments can have very different effects on lifestyle and recommended patient choice. The NICE guideline can be found at the following link:

www.nice.org.uk/guidance/ng107/resources/renal-replacement-therapy-and-conservative-management-pdf-66141542991301

Regarding the benefits of home dialysis, there is good evidence that home dialysis therapies offer advantages for suitable patients. The limitations of thrice weekly standard in-centre haemodialysis have been recognised in recent years. However, it is very difficult to separate the effect of different case mix, the most up to date and comprehensive data does not show a survival difference between patients who received more frequent versus thrice weekly (standard regimen) haemodialysis.

The advantage of self-care haemodialysis includes not only those related to control and convenience but also the opportunity to conduct more frequent or longer sessions to optimise health prospects. The introduction of smaller more portable haemodialysis machines also provides opportunity for travel for employment or holidays. Furthermore, these therapies are cost effective in the UK when compared with hospital treatments and have been demonstrated to be safe. Information regarding a reduction in travel times and reliance on other medicines is not available.

NHS England commissions dialysis services at a national level as a specialised service, setting out what providers should have in place to deliver dialysis care, including at home, as part of its remit to deliver specialised services. National Commissioning supports equity of access to high quality dialysis care. The service delivery contract sets out that the principle should be that home haemodialysis should always be an option for patients and that solutions should be sought to overcoming barriers that might prevent this. Decisions should be made on an individual basis but in general, patients suitable for home haemodialysis will be those who:

- have the ability and motivation to learn to carry out the process and the commitment to maintain treatment;

- are stable on dialysis;

- are free of complications and significant concomitant disease that would render home haemodialysis unsuitable or unsafe;

- have good functioning vascular access;

- have a carer who has (or carers who have) also made an informed decision to assist with the haemodialysis unless the individual is able to manage on his or her own; and

- have suitable space and facilities or an area that could be adapted within their home environment.

NHS England’s renal services specifications can be found at the following link:

www.england.nhs.uk/commissioning/spec-services/npc-crg/group-a/a06/

NHS England Specialised Services use the Renal Registry Annual Report and data to support work with local dialysis services so they are aware where variation exists so this can be considered and addressed.

The Atlas of variation, published by Public Health England in 2015, showed that for clinical commissioning groups (CCGs) in England, the percentage of dialysis patients who were receiving dialysis in the home (home haemodialysis and peritoneal dialysis combined) ranged from 4.1% to 44.0% (10.6-fold variation). When the seven CCGs with the highest percentages and the seven CCGs with the lowest percentages are excluded, the range is 7.6–33.7%, and the variation is 4.4-fold. Variation by parliamentary constituency is not available.

Reasons for the degree of variation observed include differences in:

- access to, and timely assessment by, a specialist kidney unit – working with patients to help them decide between treatments takes time, but in some areas 30% of patients are not known to their kidney team for even 90 days before they start renal replacement therapy;

- access to a multi-professional team, including staff who regularly support patients undertaking home dialysis; and

- levels of support for people undertaking home dialysis to help them maintain their independence, including access to respite in-centre dialysis.

The Atlas can be found at the following link:

https://fingertips.phe.org.uk/profile/atlas-of-variation

According to the latest data from the UK Renal Registry (UKRR), there were 1,195 patients receiving home dialysis in the United Kingdom in 2014, 1,175 patients in 2015; and 1,256 patients in 2016. The UKRR collects, analyses and reports on data from 71 adult and 13 paediatric renal centres. Participation is mandated in England, via the national services specification published by NHS England.

The latest report from the UK Renal Registry can be found at the following link:

www.renalreg.org/publications-reports/

No specific assessment of the cost to the National Health Service of the provision of dialysis services in a patient’s home compared to a clinical setting has been undertaken. In its assessment of the evidence regarding cost, the National Institute for Health and Care Excellence (NICE) set out in its guideline, ‘Renal Replacement Therapy and Conservative Management’, published in October 2018, that there is uncertainty in current UK dialysis costs, but they may be lower at home. The committee acknowledged that these treatments can have very different effects on lifestyle and recommended patient choice. The NICE guideline can be found at the following link:

www.nice.org.uk/guidance/ng107/resources/renal-replacement-therapy-and-conservative-management-pdf-66141542991301

Regarding the benefits of home dialysis, there is good evidence that home dialysis therapies offer advantages for suitable patients. The limitations of thrice weekly standard in-centre haemodialysis have been recognised in recent years. However, it is very difficult to separate the effect of different case mix, the most up to date and comprehensive data does not show a survival difference between patients who received more frequent versus thrice weekly (standard regimen) haemodialysis.

The advantage of self-care haemodialysis includes not only those related to control and convenience but also the opportunity to conduct more frequent or longer sessions to optimise health prospects. The introduction of smaller more portable haemodialysis machines also provides opportunity for travel for employment or holidays. Furthermore, these therapies are cost effective in the UK when compared with hospital treatments and have been demonstrated to be safe. Information regarding a reduction in travel times and reliance on other medicines is not available.