The Department is clear that learning disability should never be a reason for a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision and that blanket DNACPR decisions for whole groups of people are completely inappropriate.

The Department does not hold data centrally on the numbers or basis for DNACPR decisions. In October 2020, the Department asked the Care Quality Commission to review how DNACPR decisions were made during the COVID-19 pandemic, including for people with a learning disability. The report, published on the 18 March, looked at how DNACPR decisions were made in the earlier stages of the pandemic. The 2020/21 General Medical Services contract Quality and Outcomes Framework now includes a requirement for all DNACPR decisions for people with a learning disability to be reviewed. The fifth annual report of the Learning Disabilities Mortality Review programme published on 10 June 2021, reported that in 2020, of the people with a learning disability who were reported as dying from COVID-19, 81% had a DNACPR decision.

The Department is clear that learning disability should never be a reason for a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision and that blanket DNACPR decisions for whole groups of people are completely inappropriate.

The Department does not hold data centrally on the numbers or basis for DNACPR decisions. In October 2020, the Department asked the Care Quality Commission to review how DNACPR decisions were made during the COVID-19 pandemic, including for people with a learning disability. The report, published on the 18 March, looked at how DNACPR decisions were made in the earlier stages of the pandemic. The 2020/21 General Medical Services contract Quality and Outcomes Framework now includes a requirement for all DNACPR decisions for people with a learning disability to be reviewed. The fifth annual report of the Learning Disabilities Mortality Review programme published on 10 June 2021, reported that in 2020, of the people with a learning disability who were reported as dying from COVID-19, 81% had a DNACPR decision.

The Government recognizes that this has been an incredibly difficult time to grieve, with the challenging, yet necessary, measures put in place to slow the spread of COVID-19 affecting the complexity of grief for many people.

Since March 2020, the Government has given £10.2 million to mental health charities, including bereavement support charities, to support adults and children struggling with their mental wellbeing due to the impact of covid-19. We have also published our Mental Health Recovery Action Plan, backed by a one-off targeted investment of £500 million, to ensure that we have the right support in place this year.

A wide range of support continues to be available for the bereaved, and we will continue to work closely with bereavement services to assess how further support can be provided.

The circumstances in which a medical practitioner must notify a death to the coroner are set out in the Notification of Death Regulations 2019. It is a judicial decision of the coroner as to whether they have a duty under section 1 of the Coroners and Justice Act 2009 to investigate a death referred to them.

Medical practitioners are expected to state the cause of death to the best of their knowledge and belief on the medical certificate of cause of death (MCCD). Revised guidance published by the General Register Office and the Office for National Statistics to medical practitioners completing MCCD during the period of the pandemic confirms that COVID-19 is an acceptable direct or underlying cause of death for the purposes of completing the MCCD. This guidance also confirms that COVID-19 is not a reason of itself to refer a death to a coroner under the Coroners and Justice Act 2009. The guidance is available at the following link:

https://www.gov.uk/government/publications/guidance-notes-for-completing-a-medical-certificate-of-cause-of-death

The Office for National Statistics (ONS) is responsible for collecting information on deaths, including any where an eating disorder may have played a role. The ONS has advised that official statistics on deaths are based on the data collected as part of civil registration, which are based in turn on the medical certificate of cause of death completed by a doctor or the conclusions of a coroner following an inquest.

Doctors determine the cause of death according to their professional knowledge and belief. They can record the sequence of health problems or events leading to a death and any other health conditions that contributed but were not directly the cause. If the certifier believes, on the basis of the evidence available to them, that an eating disorder was involved, they can record this as a contributing factor in the cause of death.

The Office for National Statistics (ONS) is responsible for collecting information on deaths, including any where an eating disorder may have played a role. The ONS has advised that official statistics on deaths are based on the data collected as part of civil registration, which are based in turn on the medical certificate of cause of death completed by a doctor or the conclusions of a coroner following an inquest.

Doctors determine the cause of death according to their professional knowledge and belief. They can record the sequence of health problems or events leading to a death and any other health conditions that contributed but were not directly the cause. If the certifier believes, on the basis of the evidence available to them, that an eating disorder was involved, they can record this as a contributing factor in the cause of death.

There are no immediate plans to update the guidance further as trusts are required to review and publish locally the numbers of deaths, evidence of what they have learned and the actions taken to prevent such deaths in future in their annual Quality Accounts.

The Department works closely with NHS England and NHS Improvement to ensure that there are independent and transparent systems in place to support those affected by patient safety incidents.

Following an assessment of the current systems, NHS England and NHS Improvement are piloting a new Patient Safety Incident Response Framework to replace the current Serious Incident Framework used for investigations. An update on the development of the Patient Safety Incident Response Framework is available at the following link:

https://www.england.nhs.uk/patient-safety/serious-incident-framework/

Data on the number of deaths from COVID-19 following a definite healthcare acquired infection is not routinely collected.

We are now in the process of establishing the board and the purpose of its function. We will develop the details of its governance arrangements, timescales for implementation, family engagement and success criteria in due course.

The Government has initiated inquiries and investigations in the past, where there has been evidence of serious harm relating to specific healthcare settings and there is an important opportunity for system-wide learning. We will continue to consider cases where there is merit and there is an opportunity for learning and improving the quality of care for patients. However, we have no plans to undertake a national inquiry into unresolved historical cases.

NHS England and NHS Improvement are currently piloting a new Patient Safety Incident Response Framework to replace the current Serious Incident Framework.

The information is not held in the format requested.

A four-week waiting standard for adult community mental health services, including eating disorder services, is being piloted and considered as part of the clinically led review of National Health Service access standards. It is expected that NHS England and NHS Improvement will share further information on the definition of a potential standard in 2021/22.

The information requested is not held centrally.

We have made no such estimates. Any person in need of mental health support should receive that support as soon as possible and clinical commissioning groups and mental health providers should ensure that people have access to timely support.

We are unable to meet with SUDEP action and MBRRACE-UK at this time.

In light of the MBRRACE-UK Confidential Enquiry into Maternal Deaths, the Medicines and Healthcare products Regulatory Agency (MHRA) is reviewing available data and arranging to meet with key patient support organisations specialising in communication of maternal epilepsy mortality risks and clinicians to explore how information provided to women on important risks can be improved. The MHRA is also working with the wider healthcare network to explore additional ways of improving the reach of regulatory communications.

The conclusions of a safety review by the Commission of Human Medicines of the risks of epilepsy medicines in pregnancy have recently been published to aid discussions about suitable treatment options and support a balanced message on benefits and risks of each.

We are unable to meet with SUDEP action and MBRRACE-UK at this time.

In light of the MBRRACE-UK Confidential Enquiry into Maternal Deaths, the Medicines and Healthcare products Regulatory Agency (MHRA) is reviewing available data and arranging to meet with key patient support organisations specialising in communication of maternal epilepsy mortality risks and clinicians to explore how information provided to women on important risks can be improved. The MHRA is also working with the wider healthcare network to explore additional ways of improving the reach of regulatory communications.

The conclusions of a safety review by the Commission of Human Medicines of the risks of epilepsy medicines in pregnancy have recently been published to aid discussions about suitable treatment options and support a balanced message on benefits and risks of each.

No such discussions with the Secretary of State for Work and Pensions have taken place to date. However, research into the long-term health symptoms and impacts of COVID-19 is ongoing and we continue to collaborate across Government to monitor emerging evidence including statistics on the prevalence of ‘long’ COVID-19.

The Department has not made an assessment of ‘credible risk’ as defined by the Health and Safety Executive’s Enforcement Management Model.

Since March 2020, the Government has given over £10.2 million to mental health charities, including bereavement support charities, to support adults and children struggling with their mental wellbeing due to the impact of COVID-19. This includes funding for bereavement support helplines, counselling and signposting services to ensure that grieving families and individuals who have lost loved ones have access to the bereavement support they need, when they need it. We continue to take a cross-Government approach to assess what is needed to provide support to bereaved families and individuals.