The Trust Special Administration (TSA) Regime is a bespoke, time-limited measure to address failure in National Health Service foundation trusts or NHS trusts. The TSA Regime introduced the role of Trust Special Administrator who would take over the failed trust with a dual role of running it and making recommendations for a sustainable long-term solution for its services.

The Regime is intended to be used as a measure of last resort and under specific circumstances. Consequently, the Regime is likely to be used sparingly. There are a range of other measures which can be applied before the Regime is considered.

The power to place NHS foundation trusts into the TSA regime sits with Monitor which is now part of NHS Improvement. The power for placing NHS trusts into TSA sits with the Secretary of State for Health and Social Care.

Ambulance quality indicators, including response time performance and specific measures for stroke and heart attack patients, are published by NHS England at the following link:

https://www.england.nhs.uk/statistics/statistical-work-areas/ambulance-quality-indicators/

NHS England launched a 12 week public consultation on the proposed contracting arrangements for integrated care providers (ICPs) on 3 August 2018 which concluded on 26 October. More information is available at the following link:

https://www.engage.england.nhs.uk/consultation/proposed-contracting-arrangements-for-icps/

No ICP contracts have been placed in England. If, subject to the outcome of the consultation, NHS England decides to make the ICP Contract available for commissioners to use, it plans to study the impact of any ICP Contract arrangements.

The National Health Service must comply with its current obligations concerning National Institute for Health and Care Excellence (NICE) guidance. The Getting it Right First Time (GIRFT) team engage with NICE before publication of reports.

GIRFT clinical leads liaise with the Royal Colleges / professional societies relevant to the specialty, to review the data and findings and to develop recommendations that fulfil improvements for a range of partners, including: clinicians, trusts, commissioners, sustainability and transformation partnerships, professional bodies, and national public bodies.

Getting it Right First Time has published the following six reports:

Orthopaedic Surgery - March 2015

General Surgery - 4 August 2017

Vascular Surgery - 1 March 2018

Cardiothoracic Surgery - 12 April 2018

Cranial Neurosurgery - 22 June 2018

Urology - 11 July 2018

A further six reports are expected to be published shortly:

Oral and Maxillofacial Surgery

Spinal Surgery

Ophthalmology

Ear, Nose and Throat Surgery

Paediatric Surgery

Obstetrics and Gynaecology

One National Health Service foundation trust has been placed into Trust Special Administration: Mid Staffordshire NHS Foundation Trust was placed into Trust Special Administration by Monitor in April 2013.

One NHS trust has been placed into Trust Special Administration: South London Healthcare NHS Trust was placed into Trust Special Administration by the then Secretary of State for Health (Andrew Lansley) in July 2012.

The Government’s Mandate to NHS England for 2018-19 is clear that it is to maintain and improve performance against core patient access standards including accident and emergency, cancer and planned operations and care.

The Government expects the National Health Service to deliver the actions set out in the NHS Planning Guidance for 2018-19 in full, as key steps towards fully recovering performance against core access standards. We gave the NHS top priority in the 2017 budget with an additional £2.8 billion of funding for the NHS between 2017-18 and 2019-20, and this was reflected in the mandate.

To provide the NHS with further financial stability, the longer-term plan will increase NHS funding by £20.5 billion per year by 2023/24, the end of the first five years, compared with today.

We are clear that accident and emergency (A&E) departments must deliver timely assessments and treatment to avoid delays in treating incoming patients, including those arriving by ambulance. Intensive support is in place to improve A&E performance and lessen the impact of handover delays on East Midlands Ambulance Service. Performance improvement plans are in place at 11 hospital sites, with progress being closely monitored by NHS Improvement. There is still work to do, but significant progress is being made.

Fewer trusts are in deficit, the size of those deficits are down (compared to 2015-16). But problems in a minority of trusts do still exist, and tackling that challenge is key to the success of the National Health Service’s plan.

The underlying deficit for NHS trusts is exclusively an NHS Improvement-derived measure as set out in their NHS annual planning guidance. We agree that calculating a baseline position is a useful technique for organisations to build a credible plan for the year. As stated in the audited Departmental 2017/18 Annual Accounts, NHS providers reported an aggregate deficit of just under £1 billion in 2017-18, however this overall deficit, the size of individual deficits and the number of trusts reporting a deficit have all significantly improved since 2015-16 and the NHS financial reset.

Fewer trusts are in deficit, the size of those deficits are down (compared to 2015-16). But problems in a minority of trusts do still exist, and tackling that challenge is key to the success of the National Health Service’s plan.

The underlying deficit for NHS trusts is exclusively an NHS Improvement-derived measure as set out in their NHS annual planning guidance. We agree that calculating a baseline position is a useful technique for organisations to build a credible plan for the year. As stated in the audited Departmental 2017/18 Annual Accounts, NHS providers reported an aggregate deficit of just under £1 billion in 2017-18, however this overall deficit, the size of individual deficits and the number of trusts reporting a deficit have all significantly improved since 2015-16 and the NHS financial reset.

I am hearing deeply concerning reports about ambulance waits outside Worcestershire Acute Hospitals NHS Trust, and the Minister is aware of these concerns. We welcome the capital funding that is going into this trust, but will he meet me to discuss what more can be done to improve patient handover, which is concerning for my constituents?

A constituent has just written to me saying that his diabetic care has been moved from John Coupland

Hospital to Lincoln Hospital under the mistaken bureaucratic belief that bigger is better. United Lincolnshire Hospitals NHS Trust, which covers Lincoln Hospital, is struggling. It is treating only 69% of people in A&E within four hours, when the figure should be 95%. What is the Minister going to do to ensure that large rural areas get the best and the same healthcare as large cities?

The service from the East Midlands Ambulance Service NHS Trust has been a considerable disappointment for many of my constituents in recent months. When I met them about the service, they told me that on a huge number of occasions they have ambulances sat waiting outside accident and emergency departments, rather than getting to the next call. What more can the Government do to make sure we get these A&Es cleared?

The Government has made significant progress in negotiations with the European Union and remains confident we will leave with a good deal for both sides, that supports existing and future healthcare collaboration, including on the ongoing supply of medicines, including medical radioisotopes, to the United Kingdom. However, the Government is continuing to prepare for all scenarios, including the possible outcome that we will leave the EU without any deal in March 2019. We are confident that our precautionary planning now will mean that in the event of a no deal outcome we will be able to continue to provide a seamless supply of medicines to National Health Service patients from the moment we leave the EU.

My Rt. hon. Friend the Secretary of State for Health and Social Care discusses a wide range of issues with a number of stakeholders and other Government Departments. The Department of Health and Social Care continues to take a UK-wide cross-Government approach to ensuring continuity of medicines supply, including medical radioisotopes, in all EU exit scenarios, including working very closely with the Department for Exiting the European Union.

The Government has made significant progress in negotiations with the European Union and remains confident we will leave with a good deal for both sides, that supports existing and future healthcare collaboration, including on the ongoing supply of medicines, including medical radioisotopes, to the United Kingdom. However, the Government is continuing to prepare for all scenarios, including the possible outcome that we will leave the EU without any deal in March 2019. We are confident that our precautionary planning now will mean that in the event of a no deal outcome we will be able to continue to provide a seamless supply of medicines to National Health Service patients from the moment we leave the EU.

My Rt. hon. Friend the Secretary of State for Health and Social Care discusses a wide range of issues with a number of stakeholders and other Government Departments. The Department of Health and Social Care continues to take a UK-wide cross-Government approach to ensuring continuity of medicines supply, including medical radioisotopes, in all EU exit scenarios, including working very closely with the Department for Exiting the European Union.

Medical radioisotopes are essential in the effective treatment of many cancer patients and the Government believes it is vital to ensure consistent and timely access to these products for United Kingdom patients.

As a responsible Government, we continue to prepare proportionately for all European Union exit scenarios, including the possible outcome that we leave the EU without any deal in March 2019. That is why on 23 August the Government announced details of its approach to no deal EU exit medicines contingency planning.

Since writing to pharmaceutical companies, we have received good engagement from the industry who share our aims of ensuring patients maintain continuity of medicines supply. The Department continues to work closely with these companies to ensure that their UK supplies of medicines, including for cancer patients, are sufficient to cope with any potential delays at the border that may arise in the short term from the possible event of a no-deal Brexit.

We recognise that medical radioisotopes and some other medicinal products have short shelf lives and cannot be stockpiled. Where such products are at present imported to the UK from the EU/European Union Economic Area (EEA) via road haulage and roll-on, roll-off sea, road and rail routes, the Department is asking suppliers to ensure they have plans in place to air freight those products to avoid any border delays that may arise at the end of March next year in the event of a no deal exit from the EU. We will consider how the Department may support suppliers in making arrangements to meet this expectation.

The Government has also provided information to the public and Parliament on the likely impact of the UK’s withdrawal from the EU and Euratom on the importation of radioisotopes for medical use in the possible event that the UK leaves the EU without agreement, via a series of Technical Notices. Within these, the Government confirmed that in order to ensure continuity of supply in medicines, the UK will continue to accept batch testing of human medicines carried out in EU countries, other EEA countries and those third countries with which the EU has a Mutual Recognition Agreement.

The Sustainable Development Unit (SDU) in Public Health England and NHS England, working with NHS Improvement, issued guidance in June to National Health Service providers to support improvements in environmental best practice. This can be found at:

https://www.sduhealth.org.uk/resources/default.aspx

In November 2017 the SDU also published the Sustainable Development Assessment Tool that helps organisations build and monitor progress against robust and comprehensive Sustainable Development Management Plans (SDMPs). The tool is aligned to the United Nations Sustainable Development Goals, United Kingdom Government and NHS policy and strategy. It can be found at the following link:

https://www.sduhealth.org.uk/sdat/

In early 2018 the SDU also updated the criteria/scope on sustainability reporting, for NHS organisations in line with Treasury best practice. This can be found at the following link:

https://www.sduhealth.org.uk/resources/default.aspx

I have also held meetings with both NHS England and NHS Improvement to discuss how best to reduce the use of plastics across the NHS.

Both the SDU and NHS Improvement hold a repository of best practice case studies across areas including energy and carbon, travel, waste and behaviour change. New case studies are published regularly and promoted to NHS organisations through monthly ebulletins and social media, which can be found at the following link:

https://www.sduhealth.org.uk/resources/case-studies.aspx

All NHS providers that are party to the Long Form NHS Standard Contract are required to have in place and report annually on a SDMP. SDMPs are board adopted plans that set out how NHS organisations will minimise negative impacts and maximise positive impacts on the environment, society and economy.

Information about individual trust board appointments is not held centrally. Annual sustainability reports are now also required from all trusts and must be signed off by boards as part of the Annual Reporting process. Environmental data submitted through trusts Estates Record Information Collection (ERIC) must also be signed off by a board level representative. Information about individual trusts’ SDMPs, approved by the trust board, and about Sustainability Reports and environmental data from ERIC, at a trust level, can be found at the following link:

https://www.sduhealth.org.uk/policy-strategy/reporting/organisational-summaries.aspx

Ministers have had no recent meetings with the medical Royal Colleges or medical equipment suppliers about reducing the use of plastic in the NHS. The NHS, in common with all other healthcare systems, has to use some single-use plastic devices and other plastic items to deliver effective care to patients. NHS trusts do, however, minimise the impact of healthcare on the environment.

Information on those NHS trusts that produce their own energy is collected annually through ERIC. Overall, 36% of the energy consumed by those sites is produced by them. Details are shown in the attached table.

All ERIC data is published at the following link:

https://digital.nhs.uk/data-and-information/publications/statistical/estates-returns-information-collection

The Sustainable Development Unit (SDU) in Public Health England and NHS England, working with NHS Improvement, issued guidance in June to National Health Service providers to support improvements in environmental best practice. This can be found at:

https://www.sduhealth.org.uk/resources/default.aspx

In November 2017 the SDU also published the Sustainable Development Assessment Tool that helps organisations build and monitor progress against robust and comprehensive Sustainable Development Management Plans (SDMPs). The tool is aligned to the United Nations Sustainable Development Goals, United Kingdom Government and NHS policy and strategy. It can be found at the following link:

https://www.sduhealth.org.uk/sdat/

In early 2018 the SDU also updated the criteria/scope on sustainability reporting, for NHS organisations in line with Treasury best practice. This can be found at the following link:

https://www.sduhealth.org.uk/resources/default.aspx

I have also held meetings with both NHS England and NHS Improvement to discuss how best to reduce the use of plastics across the NHS.

Both the SDU and NHS Improvement hold a repository of best practice case studies across areas including energy and carbon, travel, waste and behaviour change. New case studies are published regularly and promoted to NHS organisations through monthly ebulletins and social media, which can be found at the following link:

https://www.sduhealth.org.uk/resources/case-studies.aspx

All NHS providers that are party to the Long Form NHS Standard Contract are required to have in place and report annually on a SDMP. SDMPs are board adopted plans that set out how NHS organisations will minimise negative impacts and maximise positive impacts on the environment, society and economy.

Information about individual trust board appointments is not held centrally. Annual sustainability reports are now also required from all trusts and must be signed off by boards as part of the Annual Reporting process. Environmental data submitted through trusts Estates Record Information Collection (ERIC) must also be signed off by a board level representative. Information about individual trusts’ SDMPs, approved by the trust board, and about Sustainability Reports and environmental data from ERIC, at a trust level, can be found at the following link:

https://www.sduhealth.org.uk/policy-strategy/reporting/organisational-summaries.aspx

Ministers have had no recent meetings with the medical Royal Colleges or medical equipment suppliers about reducing the use of plastic in the NHS. The NHS, in common with all other healthcare systems, has to use some single-use plastic devices and other plastic items to deliver effective care to patients. NHS trusts do, however, minimise the impact of healthcare on the environment.

Information on those NHS trusts that produce their own energy is collected annually through ERIC. Overall, 36% of the energy consumed by those sites is produced by them. Details are shown in the attached table.

All ERIC data is published at the following link:

https://digital.nhs.uk/data-and-information/publications/statistical/estates-returns-information-collection