Select Committee · Health and Social Care Committee

Clearing the backlog caused by the pandemic

Status: Closed Opened: 20 Jul 2021 Closed: 25 May 2022 24 recommendations 10 conclusions 1 report

The Committee has launched a new inquiry to quantify the level of pent-up demand for key healthcare services; and to consider whether fundamental changes to the organisation and delivery of NHS services will be required to manage the backlog of cases caused by the pandemic. MPs will examine levels of funding, capacity, organisation and leadership … Show more

Reports

1 report
Title HC No. Published Items Response
Ninth report - Clearing the backlog caused by the pandemic HC 599 6 Jan 2022 34 Responded

Recommendations & Conclusions

34 items
1 Recommendation Ninth report - Clearing the backlog cau… Acknowledged

Our key new recommendation is that, by April 2022, the Department of Health and Social...

Our key new recommendation is that, by April 2022, the Department of Health and Social Care works with NHS England to produce a broader national health and care recovery plan that goes beyond the elective backlog to emergency care, mental health, primary care, community care and social care. It should … Read more

Government response AI summary
The government acknowledges the importance of integrated services, referencing existing plans and stating they will continue to develop and refine recovery plans, but does not commit to the specific broad national recovery plan by the specified deadline.
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Department of Health and Social Care
2 Conclusion Ninth report - Clearing the backlog cau… Accepted

It is not appropriate to set a numerical target for the proportion of appointments carried...

It is not appropriate to set a numerical target for the proportion of appointments carried out remotely in general practice. Instead practices should respond to the needs of their local populations and work together with patients to establish the most fitting medium for their consultations based on clinical outcomes. Remote … Read more

Government response AI summary
The government accepted the conclusion that setting numerical targets for remote general practice appointments is inappropriate, agreeing that practices should respond to local population needs.
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Department of Health and Social Care
3 Recommendation Ninth report - Clearing the backlog cau… Accepted

NHS England has already commissioned an evaluation of the role of digital tools in primary...

NHS England has already commissioned an evaluation of the role of digital tools in primary care. We recommend that it publishes that evaluation at the earliest opportunity and uses it as a basis to produce clear and consistent guidance on best practice in • Reducing bureaucracy and day-to-day IT administration … Read more

Government response AI summary
The government confirms NHS England's evaluation of digital tools in primary care has concluded, and it will publish clear guidance on best practice, including reducing bureaucracy and the use of remote consultations, in due course.
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Department of Health and Social Care
4 Recommendation Ninth report - Clearing the backlog cau… Accepted in Part

We further recommend that NHS England looks beyond primary care in its assessment of the...

We further recommend that NHS England looks beyond primary care in its assessment of the use of digital tools and considers the impact of an increased usage of such tools not only on patients, but also on other parts of the health and care system, especially at the primary care … Read more

Government response AI summary
The government states NHS England has concluded an evaluation of digital tools in primary care and will publish guidance on best practice, including reducing bureaucracy at the primary/secondary care interface and the use of remote consultations, partially addressing the recommendation to look beyond primary care.
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Department of Health and Social Care
5 Conclusion Ninth report - Clearing the backlog cau… Acknowledged

Managed well, we see enormous potential for a beefed-up version of 111 to regulate the...

Managed well, we see enormous potential for a beefed-up version of 111 to regulate the demands on emergency departments and ensure that patients get the right care, in the right place, at the right time. However, we acknowledge concerns that without sufficient clinical validation these objectives cannot be met. Without … Read more

Government response AI summary
The government states that NHS England is evaluating the NHS 111 First service and a final report assessing its impact on emergency departments and patient outcomes will be published in due course.
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Department of Health and Social Care
6 Recommendation Ninth report - Clearing the backlog cau… Accepted

We therefore recommend that NHS England completes and publishes evaluations of NHS 111 call first...

We therefore recommend that NHS England completes and publishes evaluations of NHS 111 call first services as soon as is practicable, including learning from those evaluations and the implications for any future iterations of the service.

Government response AI summary
The government states that NHS England is currently conducting detailed analysis of the NHS 111 First programme and expects the results to be published in 2023.
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Department of Health and Social Care
7 Recommendation Ninth report - Clearing the backlog cau… Accepted

The response to long covid shows both the kind of integrated, patient-centred care the NHS...

The response to long covid shows both the kind of integrated, patient-centred care the NHS can provide when systems work effectively, and the frustration and detriment experienced by patients who have to “fight” to access to the right care when systems do not work effectively. We heard that long covid … Read more

Government response AI summary
The government recognizes the importance of supporting long COVID sufferers, detailing existing investment of over £50 million in research and the establishment of over 90 specialist multidisciplinary clinics across the country to provide care.
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Department of Health and Social Care
8 Recommendation Ninth report - Clearing the backlog cau… Deferred

We therefore recommend that NHS England publishes, before the end of this financial year, a...

We therefore recommend that NHS England publishes, before the end of this financial year, a long covid plan covering the period until 2023. The plan must be developed in consultation with a wide range of stakeholders, including patient groups. NHS England should integrate this into its wider health and care … Read more

Government response AI summary
The government states NHS England included long COVID commitments in a March 2022 plan and is currently refreshing its long COVID strategy in consultation with stakeholders to determine next steps, but does not commit to the specific plan or deadline requested.
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Department of Health and Social Care
9 Recommendation Ninth report - Clearing the backlog cau… Accepted

It is not acceptable for patients awaiting planned treatment or feeling the debilitating effects of...

It is not acceptable for patients awaiting planned treatment or feeling the debilitating effects of long covid to feel “abandoned” by the NHS. We appreciate the uncertainty about the length of future waiting lists, but this is no excuse for lack of communication—whether this be confirmation of a patient’s next … Read more

Government response AI summary
The government agrees on the importance of patient communication, stating NHS England has already published guidance for providers on effective communication and is actively working to improve waiting list management.
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Department of Health and Social Care
10 Recommendation Ninth report - Clearing the backlog cau… Acknowledged

The national health and care recovery plan must set out a clear vision for what...

The national health and care recovery plan must set out a clear vision for what ‘success’ in tackling the backlog will look like, and what patients can expect their care to look like in their local area in the coming years. The plan must include minimum expectations for ICBs in … Read more

Government response AI summary
The government acknowledges the importance of setting a clear vision for success and patient communication, stating NHS England is responsible for this and is working on effective patient communication and waiting list management.
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Department of Health and Social Care
11 Recommendation Ninth report - Clearing the backlog cau… Accepted

Lastly, we heard that patient involvement in services was important to tackle long covid.

Lastly, we heard that patient involvement in services was important to tackle long covid. It should also be taking place in other areas. We have previously called for the Care Quality Commission’s assessments of Integrated Care Systems (ICSs) to include consultation with patient groups and patient outcomes, and we continue … Read more

Government response AI summary
The government accepts the principle of patient involvement, stating that the Care Quality Commission’s assessments of Integrated Care Systems already include consultation with patient groups and patient outcomes.
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Department of Health and Social Care
12 Recommendation Ninth report - Clearing the backlog cau… Accepted

We again recommend that the Care Quality Commission includes consultation with patient groups and details...

We again recommend that the Care Quality Commission includes consultation with patient groups and details of patient outcomes in its assessment of ICSs. (Paragraph 68) Funding and policies to tackle the backlog

Government response AI summary
The government agrees on the importance of patient involvement and states that the CQC's assessments of ICSs already include consultation with patient groups and patient outcomes.
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Department of Health and Social Care
13 Conclusion Ninth report - Clearing the backlog cau… Accepted

The pandemic has had a negative impact on health inequalities and highlighted the crucial importance...

The pandemic has had a negative impact on health inequalities and highlighted the crucial importance of effective public health services in supporting local populations. Public health services are therefore vital allies in tackling the backlog, and we are surprised at the decision merely to maintain current public health grant funding … Read more

Government response AI summary
The government acknowledges the importance of public health services and states that public health grant funding levels have been increased by £340 million in 2022/23 to £3.47 billion.
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Department of Health and Social Care
14 Recommendation Ninth report - Clearing the backlog cau… Accepted in Part

As part of its national health and care recovery plan, we recommend that the Government...

As part of its national health and care recovery plan, we recommend that the Government sets out the contribution that public health services will make, and ensures that this contribution is backed with a level of funding that acknowledges their crucial role. Read more

Government response AI summary
The government acknowledges the vital role of public health services and states that funding levels have been increased by £340 million in 2022/23 to £3.47 billion, but does not explicitly commit to setting out their contribution within a national recovery plan.
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Department of Health and Social Care
15 Conclusion Ninth report - Clearing the backlog cau… Accepted

We note that the Government decided to resist an amendment to the Health and Care...

We note that the Government decided to resist an amendment to the Health and Care Bill that would have required it to publish independently verified assessment of health, social care and public health workforce numbers at least once every two years, leaving a gap between its rhetoric about supporting frontline … Read more

Government response AI summary
The government acknowledges the importance of workforce assessments and states that it already publishes independently verified assessments of workforce numbers at least once every two years, and will continue this practice.
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Department of Health and Social Care
16 Recommendation Ninth report - Clearing the backlog cau… Accepted in Part

We repeat our recommendation that HEE must be required (whether in its own right or...

We repeat our recommendation that HEE must be required (whether in its own right or as part of NHS England) to publish objective, transparent and independently-audited annual reports on workforce projections that cover the next five, ten and twenty years, including an assessment of whether sufficient numbers of staff are … Read more

Government response AI summary
The government accepted in principle, stating it already publishes independently verified workforce assessments at least every two years (not annually as recommended), covering health, social care, and public health. It also affirmed that DHSC works with NHS England to incorporate workforce planning into all NHS …
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Department of Health and Social Care
17 Recommendation Ninth report - Clearing the backlog cau… Accepted in Part

We recommend that the Government undertake an urgent review of short-term recruitment and retention issues...

We recommend that the Government undertake an urgent review of short-term recruitment and retention issues within the health and care workforce, including productivity improvements, sharing of best practice through data, removal of professional demarcation, use of technology, additional training places and additional immigration measures. This should be published before the … Read more

Government response AI summary
The government accepted in principle the need to address recruitment and retention issues, stating NHS England will publish a refreshed People Plan for 2022/23 as soon as practicable to address these, including productivity improvements, technology use, and training.
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Department of Health and Social Care
18 Conclusion Ninth report - Clearing the backlog cau… Deferred

Investing resource in our health and care workforce will ultimately save money— for example through...

Investing resource in our health and care workforce will ultimately save money— for example through reduced locum and agency fees over time—and help build a better, safer health service. It will also give hope to staff—who are feeling increasing desperate and who face yet more challenges on top of those … Read more

Government response AI summary
The government acknowledges the importance of investing in the workforce and states that NHS England’s Long Term Workforce Plan, due in Spring 2023, will detail actions for recruitment, retention, and reform.
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Department of Health and Social Care
19 Recommendation Ninth report - Clearing the backlog cau… Accepted

We call on NHS England to demonstrate its ongoing commitment to staff wellbeing by publishing...

We call on NHS England to demonstrate its ongoing commitment to staff wellbeing by publishing a refreshed People Plan to cover the financial year 2022/23 as soon as is practicable.

Government response AI summary
The government states that NHS England is committed to staff wellbeing and will publish a refreshed People Plan for 2022/23 as soon as practicable, outlining support for wellbeing and addressing workforce shortages.
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Department of Health and Social Care
20 Conclusion Ninth report - Clearing the backlog cau… Acknowledged

An NHS running too ‘hot’ for patients to move from crowded emergency departments into wards...

An NHS running too ‘hot’ for patients to move from crowded emergency departments into wards cannot provide safe, efficient or effective care in the long- term. Furthermore, the advent of ICSs offers an opportunity to provide patients with more integrated care so that they can leave hospital promptly once medically … Read more

Government response AI summary
The government accepted in principle the committee's conclusion that an NHS running 'too hot' impacts care and that ICSs offer opportunities for integrated care, committing generally to support the NHS.
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Department of Health and Social Care
21 Recommendation Ninth report - Clearing the backlog cau… Accepted

As part of its broader health and care recovery plan, the Government must produce an...

As part of its broader health and care recovery plan, the Government must produce an independently-verified analysis of how many, and what type, of extra beds the NHS needs in order to provide safe and effective everyday care for patients, whilst also responding to need directly created by the pandemic. … Read more

Government response AI summary
The government accepted in principle, stating NHS England is working to produce an independently-verified analysis of the NHS's bed needs and will accompany this with sustainable, long-term plans to tackle delayed discharges.
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Department of Health and Social Care
22 Conclusion Ninth report - Clearing the backlog cau… Deferred

We welcome the £2.3bn pledged in the Spending Review to create around 100 new community...

We welcome the £2.3bn pledged in the Spending Review to create around 100 new community diagnostic hubs, but we are yet to see detailed plans for their implementation.

Government response AI summary
The government noted the committee's welcome of funding for new diagnostic hubs and stated that detailed implementation plans will be set out in due course.
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Department of Health and Social Care
23 Recommendation Ninth report - Clearing the backlog cau… Accepted

Ahead of the arrival of the new funding from the Spending Review in Spring 2022,...

Ahead of the arrival of the new funding from the Spending Review in Spring 2022, we recommend that Government provides more details on the 100 new community diagnostic hubs, including where they will be placed, who will staff them and how they will contribute to service improvement within and beyond … Read more

Government response AI summary
The government states that over 90 community diagnostic centres are now open, providing various services based on local need to support earlier diagnosis and treatment, making services more convenient and accessible.
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Department of Health and Social Care
24 Recommendation Ninth report - Clearing the backlog cau… Accepted

Access to care should not be dependent on where you live in the country.

Access to care should not be dependent on where you live in the country. Regional and national co-ordination will be necessary to ensure that strategies aimed at tackling the backlog do not have the unintended consequence of increasing health inequalities. Read more

Government response AI summary
The government states the Elective Recovery Taskforce is already working to adopt innovative solutions and foster collaboration across the country to ensure equitable access to care and prevent increased health inequalities from backlog strategies.
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Department of Health and Social Care
25 Recommendation Ninth report - Clearing the backlog cau… Acknowledged

We recommend that NHS England, together with ICBs and the new Office for Health Improvement...

We recommend that NHS England, together with ICBs and the new Office for Health Improvement and Disparities (OHID), work together to deliver regional and national coordination as the system tackles the backlog in elective care. If the independent sector is to prove an effective partner in tackling that backlog, the … Read more

Government response AI summary
The government stated the Elective Recovery Taskforce is working to ensure innovative solutions provide equitable access to care across the country, including promoting collaboration and patient travel for faster treatment.
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Department of Health and Social Care
26 Conclusion Ninth report - Clearing the backlog cau… Accepted

We have heard much about how a robust social care system that can support hospital...

We have heard much about how a robust social care system that can support hospital discharges and free up capacity is essential to clear the backlog. We welcome the inclusion of the social care workforce in the refreshed Framework 15. Social care, however, did not receive an adequate settlement in … Read more

Government response AI summary
The government recognizes the importance of social care and commits up to £7.5 billion over the next two years, including £5.4 billion from the Health and Social Care Levy and £500 million for hospital discharge.
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Department of Health and Social Care
27 Recommendation Ninth report - Clearing the backlog cau… Not Addressed

In light of the Government’s commitment to reform social care, we again recommend that it...

In light of the Government’s commitment to reform social care, we again recommend that it publishes a ten-year plan for social care, setting out how it in detail how it will tackle the structural and financial problems the sector faces in the short-term, and operationalise its longer-term ambitions. The Government … Read more

Government response AI summary
The government detailed £7.5 billion in funding for adult social care and discharge, including for workforce pressures, but did not address the recommendation to publish a ten-year social care plan or a social care People Plan.
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Department of Health and Social Care
28 Recommendation Ninth report - Clearing the backlog cau… Accepted in Part

To encourage better integration and mutual understanding across health and social care, we again recommend...

To encourage better integration and mutual understanding across health and social care, we again recommend that a duty is placed on ICSs so that where a decision by an ICS affects carers and the social care sector, the ICS must undertake a formal consultation with the groups and sectors affected. Read more

Government response AI summary
The government agrees on integration's importance, noting the Health and Care Act 2022 places a duty on ICBs to promote integration and that statutory guidance will clarify expectations for wide engagement, including with carers, without committing to a specific formal consultation duty.
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Department of Health and Social Care
29 Conclusion Ninth report - Clearing the backlog cau… Accepted

There is enormous potential for technology to support a transformation in NHS care that will...

There is enormous potential for technology to support a transformation in NHS care that will bring benefits for patients and staff alike. However, this potential will not be realised while many providers still struggle with basic IT infrastructure. The Wade-Gery report calls for a roadmap for the delivery of its … Read more

Government response AI summary
The government commits to publishing a roadmap in response to the Wade-Gery report in Autumn 2022, detailing how data, digital, and technology will transform the NHS and support IT infrastructure improvements.
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Department of Health and Social Care
30 Recommendation Ninth report - Clearing the backlog cau… Accepted

NHS England must produce its roadmap in response to the Wade-Gery report on Putting data,...

NHS England must produce its roadmap in response to the Wade-Gery report on Putting data, digital and tech at the heart of transforming the NHS at the earliest opportunity so that we and others are able to scrutinise it ahead of implementation.

Government response AI summary
The government commits to publishing a roadmap in response to the Wade-Gery report in Autumn 2022, outlining how data, digital, and technology will transform the NHS and improve IT infrastructure.
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Department of Health and Social Care
31 Conclusion Ninth report - Clearing the backlog cau… Accepted

The upcoming national introduction of ICBs provides the opportunity for local integration and innovation.

The upcoming national introduction of ICBs provides the opportunity for local integration and innovation. This opportunity must not be wasted, particularly in the context of the backlog. There must be clear incentives for ICBs to deliver integrated and innovative care, with ICSs held accountable for the care they deliver. Read more

Government response AI summary
The government agrees on the importance of ICBs delivering integrated and innovative care with accountability, stating that the Health and Care Act 2022 places relevant duties on ICBs, and NHS England will publish guidance on ICB assessment to ensure incentives.
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Department of Health and Social Care
32 Recommendation Ninth report - Clearing the backlog cau… Deferred

We have previously recommended that Care Quality Commission ratings include an assessment of the progress...

We have previously recommended that Care Quality Commission ratings include an assessment of the progress ICBs make on the integration of information technology between primary care, secondary care, and the social care sector. We repeat this recommendation here. Although the CQC is an independent body, we believe that including the … Read more

Government response AI summary
The government agrees on the importance of integrated care but states that the Care Quality Commission (CQC) is an independent body responsible for determining its ratings. It commits to working with CQC to ensure they are aware of the importance of integrated care and effective …
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Department of Health and Social Care
33 Recommendation Ninth report - Clearing the backlog cau… Accepted

We recommend the Government creates a platform to share examples of good practice and innovation...

We recommend the Government creates a platform to share examples of good practice and innovation at ICB level so that lessons can be learnt, and practices adapted in ways that reflect the health needs of local areas. Without this, the risk of regional inequalities in waiting lists and postcode lotteries … Read more

Government response AI summary
The government accepts the recommendation, stating NHS England is currently developing a platform to share good practice and innovation at ICB level, which is set to launch in Autumn 2022.
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Department of Health and Social Care
34 Recommendation Ninth report - Clearing the backlog cau… Accepted

We again recommend that a duty be placed on ICBs for them to have regard...

We again recommend that a duty be placed on ICBs for them to have regard to mental health and public health. (Paragraph 128) Clearing the backlog caused by the pandemic 39

Government response AI summary
The government agrees with the recommendation, noting that the Health and Care Act 2022 already places a duty on ICBs to reduce health inequalities and promote integration, which covers having regard to mental health and public health.
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Department of Health and Social Care

Oral evidence sessions

4 sessions
Date Witnesses
2 Nov 2021 Rt Hon Sajid Javid · Department of Health and Social Care View ↗
19 Oct 2021 Amanda Pritchard · NHS England, Ben Zaranko · Institute for Fiscal Studies, Professor Stephen Powis · NHS England, Sarah Lambrechts, Expert by experience, Siva Anandaciva · The Kings Fund View ↗
21 Sep 2021 Dr Adrian James · The Royal College of Psychiatrists, Dr Melissa Heightman · University College London Hospitals NHS Foundation Trust, Helen Lunt Davies, Expert by experience, Lere Fisher, Expert by experience, Ondine Sherwood · LongCovidSOS, Professor Martin Marshall CBE · Royal College of General Practitioners View ↗
7 Sep 2021 Anita Charlesworth · Health Foundation, Dr Andrew Goddard · Royal College of Physicians, Dr Katherine Henderson · Royal College of Emergency Medicine, James Wilkinson, expert by experience, Professor Neil Mortensen · Royal College of Surgeons of England, Shirley Cochrane, expert by experience View ↗

Who gave evidence

18 witnesses
WitnessOrganisationSessions
Amanda Pritchard · Chief Executive Officer NHS England 1
Anita Charlesworth · Senior Economic Adviser Health Foundation 1
Ben Zaranko · Research Economist Institute for Fiscal Studies 1
Dr Adrian James · President The Royal College of Psychiatrists 1
Dr Andrew Goddard · President Royal College of Physicians 1
Dr Katherine Henderson · President Royal College of Emergency Medicine 1
Dr Melissa Heightman · Clinical lead, Post-COVID assessment service University College London Hospitals NHS Foundation Trust 1
Helen Lunt Davies, Expert by experience 1
James Wilkinson, expert by experience 1
Lere Fisher, Expert by experience 1
Ondine Sherwood · Co-Founder LongCovidSOS 1
Professor Martin Marshall CBE · Chair Royal College of General Practitioners 1
Professor Neil Mortensen · President Royal College of Surgeons of England 1
Professor Stephen Powis · National Medical Director NHS England 1
Rt Hon Sajid Javid · Secretary of State Department of Health and Social Care 1
Sarah Lambrechts, Expert by experience 1
Shirley Cochrane, expert by experience 1
Siva Anandaciva · Director of Policy, Events and Partnerships The Kings Fund 1

Correspondence

2 letters
DateDirectionTitle
30 Nov 2021 To cttee Letter from the Secretary of State on CQC integrated care systems dated 12.11.21
19 Nov 2021 To cttee Letter from the Secretary of State on General Practitioners and PCR tests dated…