We have no plans at present to hold discussions with NHS Clinical Commissioners concerning speech and language therapy service specifications. Clinical commissioning groups have responsibility for commissioning services to meet the needs of their local population, drawing on National Institute for Health and Care Excellence guidance to agree the specifications for communication support. The protection and safeguarding of children and young people from harm is of paramount importance to all parts for the health care system. All providers should have their own governance arrangements in place for responding to non-attendance at appointments.

The information requested is not collected centrally.

There are currently no plans to introduce a single model of joint commissioning for children and young people with speech, communication and language needs. However, we monitor the effectiveness of local joint arrangements via a rolling programme of inspections by Ofsted and the Care Quality Commission. These began in 2016, and over five years, will visit every local area, and assess how well commissioners work together to support children and young people with special educational needs.

The Government is working with the Royal College of Speech and Language Therapists and I CAN through the Expert Advisory Group established by Public Health England and the Department for Education, as part of the latter’s Social Mobility Action Plan for Education, ‘Unlocking Talent, Fulfilling Potential’.

A model speech, language and communication pathway for services for children aged 0-5 years, built on the best evidence and experience of implementation in practice, is currently in development. This will encourage joint commissioning and service provision.

No discussions have been held about councils being unable to provide accurate data on funding for contraceptive services. Data on local authority expenditure on contraception is reported to the Ministry of Housing, Communities and Local Government as part of General Fund Revenue Account Outturn data on Social Care and Public Health service spend. Public Health England works with the Ministry of Housing, Communities and Local Government to validate the data reported by local authorities before publication.

Work is ongoing to update the FP10 prescription form, to include a new exemption tick box for use by Universal Credit claimants, at the earliest opportunity. In advance of this update Universal Credit claimants who meet the criteria for free National Health Service prescriptions, should tick box ‘K’ for income-based Jobseeker’s Allowance.

NHS Digital publishes quarterly information on the number of adults who have seen a National Health Service dentist in the previous 24 months and children who have seen an NHS dentist in the previous 12 months.

There are no current plans to change the age breakdown of the data that is routinely published.

In England, local authorities are responsible for assessing oral health needs and improving the oral health of their local population including those over the age of 65.

To support local authorities in this role Public Health England (PHE) published Commissioning better oral health for vulnerable older people: An evidence-informed toolkit for local authorities which gives an overview of the impact of oral diseases in vulnerable older people and presents the evidence of what works to improve their oral health. The toolkit for local authorities is attached. It is supported by an evidence review and a resource compendium to support oral health improvement of vulnerable older people in all settings.

Timing of the next Adult and Child Dental Health Survey has yet to be confirmed.

While we are currently unable to confirm exact details of the Green Paper, NHS England has a legal duty to commission National Health Service dental services to meet local need including people living in care homes.

The forthcoming Green Paper will be based on a number of principles including whole-person, integrated care with the NHS and social care systems operating as one.

The National Institute for Health and Care Excellence Oral health in care homes quality standard provides guidance to care home staff on assessing the oral health needs of patients on admission and advises on the need for residents to be helped to find a dentist if they do not already have one. A copy of the quality standard is attached.

Data collected on sexual health expenditure by local authority as part of the Ministry of Housing, Communities and Local Government General Fund Revenue Account Outturn data on Social Care and Public Health service spend show that 94 of the 152 local authorities spent less on sexual health services in 2017-18 than in 2016-17.

Returns from the Sexual and Reproductive Health Activity Dataset (SRHAD) data show that in 2017-18, there was a reduced number of services in 49 local authority areas compared to 2016-17. Other services may provide contraception but not complete a SRHAD return. Ongoing reconfiguration of individual sexual and reproductive health services can vary which means that reduction in number of services need not necessarily equate to reduction in overall provision. Contraception is also widely available free of charge through general practice. No assessment has been made on the impact of these changes.

The Government has mandated local authorities in England to commission comprehensive open access sexual health services, including advice on, and reasonable access to, a broad range of contraceptive substances and appliances. It is for local authorities to assess and understand local needs, including assessing the impact locally of reductions due to service reconfiguration, and determine how funding is spent to deliver services that meet those needs.

We will seek to use the trailblazer programme as the opportunity to link mental health support teams within schools and colleges, with the range of professionals already working with young people, including speech and language therapists where appropriate. The design of the new mental health support teams should in particular enable better joint working between health and education services, as well as working with other services.

Updated Government guidance National Minimum Wage and National Living Wage: Calculating the minimum wage was published on 8 November setting out the implications for paying workers for sleep-in shifts following the ruling by the Court of Appeal in Royal Mencap Society v Tomlinson-Blake and Shannon v Rampersad. The Government sent advance notice of the publication to local government representatives. A copy of the guidance is attached.

The Government is sending a clear message that the judgment should not be used as an opportunity to make ad-hoc changes to the fees paid to providers. Commissioners and providers should be working together to determine a fair rate of pay for sleep-in shifts to fit their local labour market conditions.

The Government has given councils access to up to £3.6 billion more, dedicated for adult social care in 2018-19 and up to £3.9 billion for 2019-20. Overall, councils are able to increase spending on adult social care by 9% in real terms from 2015/16 to 2019/20. The Government encourages employers to pay more than the minimum wage wherever possible but recognises that employers’ ability to do so will depend on a range of factors.

Updated Government guidance National Minimum Wage and National Living Wage: Calculating the minimum wage was published on 8 November setting out the implications for paying workers for sleep-in shifts following the ruling by the Court of Appeal in Royal Mencap Society v Tomlinson-Blake and Shannon v Rampersad. The Government sent advance notice of the publication to local government representatives. A copy of the guidance is attached.

The Government is sending a clear message that the judgment should not be used as an opportunity to make ad-hoc changes to the fees paid to providers. Commissioners and providers should be working together to determine a fair rate of pay for sleep-in shifts to fit their local labour market conditions.

The Government has given councils access to up to £3.6 billion more, dedicated for adult social care in 2018-19 and up to £3.9 billion for 2019-20. Overall, councils are able to increase spending on adult social care by 9% in real terms from 2015/16 to 2019/20. The Government encourages employers to pay more than the minimum wage wherever possible but recognises that employers’ ability to do so will depend on a range of factors.

NHS Resolution handles clinical negligence claims on behalf of National Health Service organisations and independent sector providers of NHS care in England.

NHS Resolution annually reviews and updates five-year forecasts for the cost of clinical negligence following an actuarial review of activity and key assumptions that underpin those costs, e.g. claims inflation, claims volumes. These key assumptions are published in the organisation’s Annual Report and Accounts. Clinical negligence costs relate to four indemnity schemes operated by NHS Resolution: Clinical Negligence Scheme for Trusts (CNST), which covers NHS providers of secondary health care, and the Existing Liabilities, Ex-Regional Health Authorities, and the Department of Health and Social Care’s Clinical schemes, all of which relate to legacy organisations.

The cost of clinical negligence claims covered by the figures in this response are damages, claimant legal costs, defence legal costs, and NHS Resolution’s administration costs. The costs reported here do not include costs incurred locally by NHS providers in dealing with claims, such as their own administration costs.

NHS Resolution’s Statement of Net Expenditure estimates costs of clinical negligence at £11.7 billion in its 2020-21 accounts. This the total of the two dimensions in relation to “costs” in the context of Government budgeting:

- Department Expenditure Limit costs – these are the costs of settling claims during the financial year and the administration of those claims. This is estimated to be £2.6 billion for 2020-21; and

- Annually Managed Expenditure costs – this is the change in the value of the liability arising from clinical negligence claims, both from those that have been received, and those that are expected to be received in relation to incidents up to 31 March 2021. This is estimated to be £9.1 billion for 2020-21.

The costs for 2020-21 have been estimated on the basis of the current personal injury discount rate of minus 0.75%. However, once the Civil Liability Bill becomes law, the Lord Chancellor is expected to review the rate promptly. The figures provided here may therefore, change as a result. NHS Resolution will also review its five-year forecasts again following the production of its 2018-19 Annual Report and Accounts, and any changes in the underpinning actuarial assumptions are likely to result in revised projections. The figures quoted should therefore be considered as broad estimates based on the latest available information and subject to change in the future.

Notes:

The Department Expenditure Limit costs are lower than the £3.2 billion costs for CNST only reported by the National Audit Office in their report Managing the costs of clinical negligence in trusts, published in September 2017. The £3.2 billion represents the 2016 forecast for CNST based on a personal injury discount rate of 2.5%. Actuarial reviews of assumptions undertaken by NHS Resolution in 2017 and 2018 have resulted in favourable movements in key assumptions.

The figures provided do not include claims brought against general practitioners, who are covered by separate indemnity arrangements through medical defence organisations and for which data is not centrally available.

The Comprehensive Health Assessment Tool Quality Assurance Audit is due to complete by the end of January 2019. It was commissioned as an internal review by NHS England to support their functioning as a commissioner and as such will not be published.

In March 2017, the Department issued guidance to the alcohol industry setting out how the guidelines can best be communicated on the labels of alcoholic drinks. The Department agreed a transitional period with the industry until 1 September 2019 to reflect the new guidelines on labelling.

The Government currently has no plans to include a commitment in the Alcohol Strategy to issue cancer warnings on alcohol labels. The UK Chief Medical Officers’ Low Risk Drinking Guidelines highlight that the risk of developing a range of health problems, including cancer, increases the more you drink on a regular basis. Information on the low risk guidelines is also available online.

In March 2017, the Department issued guidance to the alcohol industry setting out how the guidelines can best be communicated on the labels of alcoholic drinks. The Department agreed a transitional period with the industry until 1 September 2019 to reflect the new guidelines on labelling.

The Government currently has no plans to include a commitment in the Alcohol Strategy to issue cancer warnings on alcohol labels. The UK Chief Medical Officers’ Low Risk Drinking Guidelines highlight that the risk of developing a range of health problems, including cancer, increases the more you drink on a regular basis. Information on the low risk guidelines is also available online.

The UK National Screening Committee completed a public consultation on 4 November 2017 on whether a proposal for a practical evaluation of Severe Combined Immunodeficiency (SCID) was supported. It has since recommended a practical evaluation of SCID screening to be undertaken in the National Health Service. This evaluation will be considered as part of the 2019/20 funding decisions.

We remain committed to rolling out our new approach as set out in the Green Paper on children and young people’s mental health, including creating Designated Senior Leads in schools and new mental health support teams, to at least a fifth to a quarter of the country by the end of 2022/23. The first wave of trainees who will staff the mental health support teams start training in January 2019. The first wave of mental health support teams will be fully operational by the end of 2019.

We will test and pilot the implementation of the Green Paper plans to ensure we learn as we go. Data about the prevalence of mental health conditions in Mental Health of Children and Young People in England 2017 will be used as part of the evidence base to inform all planning and activity around children and young people’s mental health, including the roll-out of the Green Paper plans. The precise roll-out will also be informed by the evaluation of the initial trailblazers.