Select Committee · Health and Social Care Committee

Delivering Core NHS and Care Services during the Pandemic and Beyond

Status: Closed Opened: 22 Apr 2020 Closed: 10 Feb 2021 15 recommendations 16 conclusions 1 report

The Committee held its last oral evidence session in connection with this inquiry on Tuesday 30 June 2020.

Reports

1 report
Title HC No. Published Items Response
Second Report - Delivering core NHS and care services durin… HC 320 1 Oct 2020 31 Responded

Recommendations & Conclusions

31 items
1 Conclusion Second Report - Delivering core NHS and… Not Addressed

The pandemic has presented an unprecedented challenge to the NHS and the Government.

The pandemic has presented an unprecedented challenge to the NHS and the Government. Whilst we have no doubt that often communication to patients was as effective as could reasonably be expected in the context of a pandemic, this was not always the case. As we set out in our letter … Read more

Government response AI summary
The government's response addresses a different recommendation regarding workforce burnout and inclusive recruitment, and does not engage with the committee's conclusion about poor patient communication and anxiety.
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Department of Health and Social Care
2 Recommendation Second Report - Delivering core NHS and… Accepted

Notwithstanding the actions taken to date, we recommend that NHS England & Improvement review, as...

Notwithstanding the actions taken to date, we recommend that NHS England & Improvement review, as a matter of priority, the directions given to NHS Trusts about how to communicate with patients about the progress of their treatment and important medical guidance in any future spike or second wave. As part … Read more

Government response AI summary
The government recognizes the importance of effective communication and dignity, stating that existing NHS Standard Contracts mandate this and NHSE/I will reinforce these requirements. It notes ongoing work with patient groups to develop resources, but does not explicitly commit to the recommended priority review, assessment, …
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Department of Health and Social Care
3 Conclusion Second Report - Delivering core NHS and… Accepted

The pandemic has placed an unprecedented burden on the delivery of core NHS and care...

The pandemic has placed an unprecedented burden on the delivery of core NHS and care services. This has resulted in the delay, suspension or cancellation of services which in turn has inevitably led to a significant increase in waiting times, the backlog of appointments and pent-up demand for medical treatments. … Read more

Government response AI summary
The government recognizes the pandemic's burden and the committee's concern, stating that NHSE/I has already launched campaigns to reassure patients that NHS services are safe to access, detailing steps like social distancing and face masks.
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Department of Health and Social Care
4 Conclusion Second Report - Delivering core NHS and… Not Addressed

We recognise the commitment of policy makers and the NHS leadership to restoring core NHS...

We recognise the commitment of policy makers and the NHS leadership to restoring core NHS services and the ongoing efforts to manage the backlog. We are also grateful for the hard work of all staff and the use of innovative methods to support core NHS services during the pandemic, including: … Read more

Government response AI summary
The government's response only reiterates the committee's initial recognition of commitment and gratitude for staff's efforts and innovations, failing to address the expressed concern about core health services operating with limited capacity or instructions not being adhered to.
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Department of Health and Social Care
5 Conclusion Second Report - Delivering core NHS and… Accepted

During our session on 30 June 2020, Sir Simon Stevens told us that he “expects”...

During our session on 30 June 2020, Sir Simon Stevens told us that he “expects” waiting times for and referrals to core health services to “go up quite significantly over the second half of the year.” We also heard from Sir Simon, Amanda Pritchard and Professor Steve Powis of the … Read more

Government response AI summary
The government provides details on measures to address the backlog, including increasing elective activity via 'phase 3' guidance and allocating £1bn from the 2021/22 Spending Review to tackle the elective backlog and fund up to one million extra procedures.
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Department of Health and Social Care
6 Recommendation Second Report - Delivering core NHS and… Accepted

We recommend that the Department of Health & Social Care and NHSE/I provide an update...

We recommend that the Department of Health & Social Care and NHSE/I provide an update on what steps they have, individually and collectively, taken and are planning to take to quantify and address the overall impact of the pandemic on waiting times, the backlog of appointments and pent-up, and as … Read more

Government response AI summary
The government provides a detailed update on waiting times for elective care and cancer treatments, detailing recovery efforts, and outlines specific steps to manage demand, including a new £150 million fund for GP capacity expansion and adaptations for remote care.
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Department of Health and Social Care
7 Recommendation Second Report - Delivering core NHS and… Accepted

We also recommend that NHSE/I provides us with a more broader update on what positive...

We also recommend that NHSE/I provides us with a more broader update on what positive innovations or changes have taken place in the NHS during the pandemic, and how it seeks to ensure all the positive changes that have occurred are captured and potentially implemented across the entire NHS. We … Read more

Government response AI summary
The government outlines its "Adopt & Adapt" approach, including hub working models and £1bn funding for elective recovery in 2021/22, to support positive changes and tackle the elective backlog.
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Department of Health and Social Care
8 Conclusion Second Report - Delivering core NHS and… Acknowledged

We further conclude that the delivery of dental services in England has been significantly hindered...

We further conclude that the delivery of dental services in England has been significantly hindered by the pandemic. This has been largely due to the need to protect both patients and staff from COVID-19 which has, in turn, presented financial challenges to both NHS and private dental practices. We welcome … Read more

Government response AI summary
The government acknowledges the pandemic's impact on dental services and is working to increase service levels, noting updated guidance allows reduced room resting time. They are also exploring future use of Point of Care testing to increase patient throughput, but this is in early stages.
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Department of Health and Social Care
9 Recommendation Second Report - Delivering core NHS and… Deferred

We are concerned that there does not appear to be a plan for the restoration...

We are concerned that there does not appear to be a plan for the restoration of dental services in England. We recommend that Sara Hurley (Chief Dental Officer for England) sets out her assessment of the challenges facing dentistry services in England, and clarifies what steps will be taken to … Read more

Government response AI summary
The government redirects responsibility for operational delivery and contracting of dental services away from the Chief Dental Officer, stating it lies with DHSC and NHS. It references an existing plan for resumption of dental services published in June 2020 and ongoing work on future contract …
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Department of Health and Social Care
10 Conclusion Second Report - Delivering core NHS and… Accepted

We recognise the unprecedented scale of the challenge facing the Government and NHSE/I to keep...

We recognise the unprecedented scale of the challenge facing the Government and NHSE/I to keep NHS and care staff safe during the pandemic. As in other countries facing the pandemic there were, however, persistent failures with the procurement and supply of appropriate personal protective equipment (PPE) to some NHS and … Read more

Government response AI summary
The government expresses confidence in a consistent PPE supply for winter, detailing substantial items on order and a strategic stockpile, and reiterates its commitment to addressing practical difficulties and incorporating user feedback, implying ongoing efforts address the concerns.
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Department of Health and Social Care
11 Recommendation Second Report - Delivering core NHS and… Acknowledged

We request an update from the Department of Health & Social Care by the end...

We request an update from the Department of Health & Social Care by the end of November 2020 on what steps are being taken to ensure that there is a consistent and reliable supply of appropriately fitting PPE to all NHS staff in advance of the onset of winter and … Read more

Government response AI summary
The government is confident in a consistent PPE supply for winter, citing 32 billion items on order and a 4-month strategic stockpile. They are committed to addressing fitting difficulties by understanding user needs and incorporating feedback, especially for face masks.
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Department of Health and Social Care
12 Conclusion Second Report - Delivering core NHS and… Acknowledged

We are grateful to Professor Chris Whitty (Chief Medical Officer) and his expert colleagues for...

We are grateful to Professor Chris Whitty (Chief Medical Officer) and his expert colleagues for their continued and constructive engagement with our work. We also recognise that the Government, following the advice of the Chief Medical Officer and others, has taken a considered approach to implementing the SIREN study. We … Read more

Government response AI summary
The government acknowledges the committee's gratitude to Professor Whitty and reiterates its intention to use the SIREN study to inform the frequency and circumstances of NHS staff coronavirus testing.
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Department of Health and Social Care
13 Recommendation Second Report - Delivering core NHS and… Not Addressed

We accept the advice we have received from many eminent scientists that there is a...

We accept the advice we have received from many eminent scientists that there is a significant risk that not testing NHS staff routinely could lead to higher levels of nosocomial infections in any second spike. We therefore urge the Government to set out clearly why it is yet to implement … Read more

Government response AI summary
The government acknowledges the committee's concerns about the risks of not routinely testing NHS staff and states that asymptomatic testing is an important protective measure, but does not explain why weekly testing has not been implemented as urged.
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Department of Health and Social Care
14 Conclusion Second Report - Delivering core NHS and… Acknowledged

We note that Professor Chris Whitty has said that the testing of asymptomatic staff may...

We note that Professor Chris Whitty has said that the testing of asymptomatic staff may be necessary in the future and that if there is a “surge in winter” of coronavirus cases then he would be likely to advise that routine testing of NHS staff should take place. However, we … Read more

Government response AI summary
The government recognizes the Committee's concerns regarding routine asymptomatic testing of NHS staff and acknowledges its importance as a protective measure for staff, patients, and visitors from COVID-19 infection.
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Department of Health and Social Care
15 Recommendation Second Report - Delivering core NHS and… Not Addressed

We ask that Professor Whitty sets out to what extent testing capacity has impacted the...

We ask that Professor Whitty sets out to what extent testing capacity has impacted the advice he and his colleagues have provided to the Government on routine testing of NHS staff. We further ask Professor Whitty to clarify whether he has advised the Government to introduce routine testing of all … Read more

Government response AI summary
The government acknowledges the concerns regarding routine testing for NHS staff and states its importance as a protective measure, but does not provide the specific information requested about Professor Whitty's advice on testing capacity or routine testing in hotspots.
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Department of Health and Social Care
16 Recommendation Second Report - Delivering core NHS and… Acknowledged

We conclude that the case for routine testing of all NHS staff in all parts...

We conclude that the case for routine testing of all NHS staff in all parts of the country (including clinical staff as well as cleaners, porters and so forth) is compelling and should be introduced as quickly as capacity allows and before the winter-flu season begins. Those who—either directly or … Read more

Government response AI summary
The government recognises the committee's concerns and acknowledges that routine asymptomatic testing is an important component of protecting NHS staff and patients, but does not commit to introducing it rapidly or expanding capacity as recommended.
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Department of Health and Social Care
17 Recommendation Second Report - Delivering core NHS and… Not Addressed

We recommend that, by the end of October 2020, the Government and NHSE/I set out:...

We recommend that, by the end of October 2020, the Government and NHSE/I set out: i) what current capacity there is for testing all NHS staff, ii) what further capacity (if any) will be required and iii) how long it is likely to take to secure sufficient capacity to offer … Read more

Government response AI summary
The government acknowledges concerns about routine testing for NHS staff and states its importance as a protective measure, but fails to provide the requested information on current testing capacity, future requirements, or timelines for securing sufficient capacity.
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Department of Health and Social Care
18 Conclusion Second Report - Delivering core NHS and… Accepted

We are extremely grateful to all NHS and care staff for their hard work and...

We are extremely grateful to all NHS and care staff for their hard work and dedication in trying to meet patient needs in such exceptional circumstances. This includes those who have returned to the NHS (such as clinicians returning from academia, retirement and other industries); students who have left their … Read more

Government response AI summary
The government responds by highlighting the NHS People Plan 2020/21, which emphasizes staff wellbeing, mental health, and addressing inequalities, stating that these existing commitments align with the committee's concerns about staff burnout.
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Department of Health and Social Care
19 Conclusion Second Report - Delivering core NHS and… Acknowledged

We are grateful for NHSE/I’s continued support of NHS staff and welcome the further measures...

We are grateful for NHSE/I’s continued support of NHS staff and welcome the further measures set out in the People Plan (July 2020) for the 2020–21 period. In particular, we welcome the important and ambitious measures set out in the People Plan which show a clear desire to address workforce … Read more

Government response AI summary
The government acknowledges the need to mitigate the psychological impact of pressures on staff and to increase workforce supply and improve retention, promising to provide further details on these efforts in another section of the letter.
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Department of Health and Social Care
20 Recommendation Second Report - Delivering core NHS and… Acknowledged

We recommend that NHSE/I set out in detail what further specific steps it would like...

We recommend that NHSE/I set out in detail what further specific steps it would like to take over the coming years to support the mental and physical wellbeing of all staff and a plan to deal with the specific issue of sustained workplace pressure due to the current pandemic and … Read more

Government response AI summary
The government acknowledges the importance of mitigating psychological pressures and continuing to increase workforce supply and retention, stating that measures have been outlined and promising further details in another section of the letter, but does not commit to setting out a specific plan to the …
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Department of Health and Social Care
21 Recommendation Second Report - Delivering core NHS and… Not Addressed

We further recommend that NHSE/I should develop a full and comprehensive definition of “workforce burnout”,...

We further recommend that NHSE/I should develop a full and comprehensive definition of “workforce burnout”, and set out how the wellbeing of all NHS staff is being monitored and assessed. This information should be made available to us by the middle of October 2020, to enable us to scrutinise it … Read more

Government response AI summary
The government's response focuses on mitigating psychological pressures, increasing workforce supply, and improving staff retention, without addressing the specific request for a definition of 'workforce burnout' or how staff wellbeing is being monitored and assessed.
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Department of Health and Social Care
22 Conclusion Second Report - Delivering core NHS and… Deferred

We note, meanwhile, that there is no equivalent of the NHS People Plan for the...

We note, meanwhile, that there is no equivalent of the NHS People Plan for the social care workforce. We will have more to say about support for those working in social care in our forthcoming report on Social care: workforce and funding. (Paragraph 141) Support for BAME NHS staff members Read more

Government response AI summary
The government agrees with the Committee's comments that there is no equivalent of the NHS People Plan for social care and commits to addressing the social care workforce in the upcoming White Paper for Social Care Reform.
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Department of Health and Social Care
23 Conclusion Second Report - Delivering core NHS and… Acknowledged

The NHS is founded on the principle of equality and is one of the most...

The NHS is founded on the principle of equality and is one of the most diverse and inclusive organisations in the UK. It hugely benefits from the diversity of its staff as in turn so does the nation. In recent months, there has been a much-needed focus on supporting NHS … Read more

Government response AI summary
The government acknowledges the committee's comments by outlining its approach to eradicating racism and discrimination, which aligns with legal definitions from the Equalities Act 2010 and Race Relations Act 1976, stating that its work in this area is multi-faceted.
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Department of Health and Social Care
24 Conclusion Second Report - Delivering core NHS and… Acknowledged

We have also heard that some BAME NHS staff face discrimination and racism in the...

We have also heard that some BAME NHS staff face discrimination and racism in the NHS and that, across the NHS, the levels of diversity must be improved. We accept Sir Simon Stevens’ comments that “there are systemic features to discrimination and racism, and the NHS is both part of … Read more

Government response AI summary
The government aligns its definition of racism and discrimination with the Race Relations Act 1976 and Equalities Act 2010, confirming their approach to addressing the issues of discrimination faced by BAME NHS staff.
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Department of Health and Social Care
25 Recommendation Second Report - Delivering core NHS and… Accepted in Part

The NHS must increase its efforts to eradicate all forms of discrimination and racism from...

The NHS must increase its efforts to eradicate all forms of discrimination and racism from in its organisation. We therefore recommend that NHSE/I provide a full and comprehensive definition of the “racism and discrimination” that it seeks to eradicate from the NHS. We invite NHSE/I and the Department for Health … Read more

Government response AI summary
The government aligns its approach to racism and discrimination with existing legal definitions (Race Relations Act 1976 and Equalities Act 2010) and outlines current multi-faceted work, including the WRES and a programme to address the impact of COVID-19 on BAME staff, but does not commit …
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Department of Health and Social Care
26 Conclusion Second Report - Delivering core NHS and… Accepted

Historically, accident and emergency departments have been over-stretched, over- burdened and running over capacity.

Historically, accident and emergency departments have been over-stretched, over- burdened and running over capacity. We have heard that the initial decline in patient attendances at A&E departments during the pandemic to some extent “cured” the problem of “corridor care”. However, as presentations at A&E begin to increase, the Government and … Read more

Government response AI summary
The government recognises the importance of managing A&E demand and states that NHSE/I has been working with NHS Trusts on plans including increasing capacity, improving patient flow, and reducing unnecessary admissions.
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Department of Health and Social Care
27 Recommendation Second Report - Delivering core NHS and… Acknowledged

We welcome the news that the Government and NHSE/I are piloting a ‘111 dial first’...

We welcome the news that the Government and NHSE/I are piloting a ‘111 dial first’ scheme to support the triaging of patients before they attend A&E departments. The introduction of an expectation that a patient will call first before walking into an A&E department is a sensible change to support … Read more

Government response AI summary
The government welcomes support for the ‘111 dial first’ scheme and states that pilots are being monitored and evaluated to inform wider rollout, but does not provide the requested update or specific plans for A&E departments.
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Department of Health and Social Care
28 Conclusion Second Report - Delivering core NHS and… Acknowledged

We welcome the support of the Secretary of State and the Chief Executive of NHSE/I...

We welcome the support of the Secretary of State and the Chief Executive of NHSE/I for technological innovation in the NHS. The use of technology and digital alternatives (“telemedicine”), although it has had a mixed response from some patients and medical practitioners, shows that the NHS is innovating. We also … Read more

Government response AI summary
The government welcomes the committee's support for technological innovation and is committed to supporting wider technology deployment, but does not address the call for a comprehensive assessment of digital exclusion risks or methods to bring forward successful innovations.
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Department of Health and Social Care
29 Recommendation Second Report - Delivering core NHS and… Accepted

We recommend that NHSE/I and the Department for Health & Social Care set out their...

We recommend that NHSE/I and the Department for Health & Social Care set out their assessment of how effective the use of technology and digital alternatives (“telemedicine”) has been across all health and care services. As part of this assessment, we ask that both NHSE/I and the Department to clearly … Read more

Government response AI summary
The government states that NHS England and NHS Improvement are currently undertaking a review to assess the effectiveness of telemedicine and identify risks to patient wellbeing, including how to ensure patients are not digitally excluded.
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Department of Health and Social Care
30 Conclusion Second Report - Delivering core NHS and… Acknowledged

We commend the efforts of the Government, NHSE/I and the independent sector for stepping up...

We commend the efforts of the Government, NHSE/I and the independent sector for stepping up and securing independent sector capacity (i.e. beds, staff and facilities) which has been crucial to supporting the NHS during the pandemic. It is clear that such independent sector capacity will be needed over the coming … Read more

Government response AI summary
The government agrees that independent sector capacity will be needed and states it has secured this capacity through agreements to ensure the NHS can meet patient demand.
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Department of Health and Social Care
31 Recommendation Second Report - Delivering core NHS and… Not Addressed

We recommend, in addition to our recommendations in Chapter 2, that the Government and NHSE/I...

We recommend, in addition to our recommendations in Chapter 2, that the Government and NHSE/I clarify what plans there are to continue to use independent bed capacity and other independent resources as the winter period approaches. We further recommend that the Government and NHSE/I set out i) what the current … Read more

Government response AI summary
The government provides a general statement about maximising treatment capacity and noting prior elective recovery, but does not clarify its plans for independent sector use or provide the specific capacity assessments requested by the committee.
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Department of Health and Social Care

Oral evidence sessions

4 sessions
Date Witnesses
30 Jun 2020 Amanda Pritchard · NHS England, Chris Hopson · NHS England, Professor Andrew Goddard · Royal College of Physicians, Professor Stephen Powis · NHS England, Sir Simon Stevens · NHS England and NHS Improvement View ↗
16 Jun 2020 Charlotte Augst · National Voices, Daloni Carlisle, cancer treatment patient, Dr Katherine Henderson · Royal College of Emergency Medicine, Dr Layla McCay · NHS Confederation, Mick Armstrong · British Dental Association, Professor Derek Alderson · Royal College of Surgeons, Rob Martinez, joint replacement patient, Sir Robert Francis · HealthWatch England View ↗
14 May 2020 Chris Hopson · NHS England, Jennifer Dixon · Health Foundation, Nigel Edwards · The Nuffield Trust, Richard Murray · The King's Fund View ↗
1 May 2020 Claire Murdoch · NHS England, Dame Cally Palmer · NHS England, Gill Walton · Royal College of Midwives, Professor Martin Marshall · Royal College of General Practitioners View ↗

Who gave evidence

20 witnesses
WitnessOrganisationSessions
Chris Hopson · Chief Strategy Officer NHS England 2
Amanda Pritchard · Chief Executive Officer NHS England 1
Charlotte Augst · Chief Executive National Voices 1
Claire Murdoch · National Director for Mental Health NHS England 1
Daloni Carlisle, cancer treatment patient 1
Dame Cally Palmer · National Cancer Director NHS England 1
Dr Katherine Henderson · President Royal College of Emergency Medicine 1
Dr Layla McCay · Director NHS Confederation 1
Gill Walton · Chief Executive Royal College of Midwives 1
Jennifer Dixon · Chief Executive Officer Health Foundation 1
Mick Armstrong · Chair British Dental Association 1
Nigel Edwards · Chief Executive The Nuffield Trust 1
Professor Andrew Goddard · President Royal College of Physicians 1
Professor Derek Alderson · President Royal College of Surgeons 1
Professor Martin Marshall · Chair Royal College of General Practitioners 1
Professor Stephen Powis · National Medical Director NHS England 1
Richard Murray · Chief Executive The King's Fund 1
Rob Martinez, joint replacement patient 1
Sir Robert Francis · Chair HealthWatch England 1
Sir Simon Stevens · Chief Executive NHS England and NHS Improvement 1

Correspondence

16 letters
DateDirectionTitle
16 Dec 2020 To cttee Letter from the NHS Chief Executive on core NHS services during the Covid pande…
15 Dec 2020 To cttee Letter from the NHS Chief People Officer on recommendations in the Delivering c…
30 Nov 2020 From cttee Letter to the Secretary of State, Chief Executive of NHS England and Improvment…
24 Nov 2020 To cttee Letter from Prerana Issar on staff burnout and resilience
24 Nov 2020 To cttee Response from Prerana Issar to the Committee's Report on Delivering core NHS an…
24 Nov 2020 To cttee Letter from the Secretary of State for Health and Social Care and the NHS Chief…
12 Nov 2020 From cttee Letter to the Secretary of State for Health and Social Care and the Chief Execu…
10 Nov 2020 To cttee Further letter from Prof Stephen Prowis on Covid-19 testing of NHS staff
5 Nov 2020 Correspondence with Prof Chris Whitty and Prof Stephen Prowis on Covid-19 testi…
8 Sep 2020 Correspondence with Sir Simon Stevens on NHS third stage response to Covid-19
2 Sep 2020 NHS England and NHS Improvement follow up response to 30 June evidence session
2 Sep 2020 To cttee Letter from the Secretary of State on the Delivering core NHS and care services…
23 Jul 2020 To cttee Letter from Chair to Matt Hancock and Sir Simon Stevens on Delivering core NHS …
3 Jun 2020 From cttee Letter to Tim Farron from Dame Cally Palmer on radiotherapy
5 May 2020 Correspondence with the National Cancer Director on proton beam therapy
5 May 2020 Correspondence with the Chief Dental Officer on guidance for dental practitione…