Recommendation 3

HM Government Accepted

Partially accept The government partially accepts this recommendation. Subject to the upcoming Spending Review, we will aim to issue multi–year PHG allocations from 2026/27 to support strategic service delivery over the longer term. The Government is committed to supporting local areas to work in an integrated way to plan care across their communities. In 2025/26 we are increasing funding through the ringfenced Public Health Grant, and the 100% retained business rate arrangement for local authorities in Greater Manchester, to £3.858 billion. This is a cash increase of £198 million compared to 24/25, providing local government with an average 5.4% cash increase and 3.0% real terms increase. This represents a significant turning point for local health services, marking the biggest real–terms increase after nearly a decade of reduced spending (between 2016 and 2024). There are already rules in place to improve tendering efficiency and reduce unnecessary competitive tendering for healthcare services at a local level, therefore no further assessment is planned at this stage. On 1 January 2024, the Provider Selection Regime (PSR) was introduced, governing procurement of healthcare services and aimed at reducing unnecessary competitive tendering for healthcare services in England. The PSR provides commissioners of healthcare services with greater flexibility to design and deliver well–coordinated systems to deliver more joined up care for patients and unlock opportunities to innovate through increased collaboration and integration of services. This includes continuing to promote the use of competitive tendering for healthcare services when this promotes efficiency and adds value for patients and the taxpayer. As a relevant authority under the regime, local authorities have the discretion to consider applying the PSR for the procurement of healthcare services if they deem it appropriate. By giving commissioners greater flexibility with how to award or re–award a contract for healthcare services the PSR enables commissioners to give providers more certainty of their position in the system. This may enable longer-term investment in service improvement, improved staff retention (and morale), and unlock opportunities to enter effective partnerships and integrate services within the health and care system. Having clarity over financial allocations is an important enabler of integrated working. In recent years, Public Health Grant allocations have been published in either February or March. To provide local government with greater certainty to plan ahead, subject to the upcoming spending review, we will aim to issue multi–year allocations from 2026/27. Recommendations 4 and 13 The provision of sexual health services is fragmented across the health system and can be complex to navigate. The Government should work with providers and commissioners to improve collaboration across reproductive and sexual healthcare to ensure effective cross– system support for young people and other groups at greatest risk of contracting an STI. These measures should be underpinned by a wider national strategy on sexual health. (Paragraph 36) The Government must ensure that the sexual healthcare system works more efficiently and effectively to arrest and reverse the trend in sexually transmitted infections. This will require longer term work to carefully consider how the different parts of the system can work together to achieve this. The Government should work with the British Association for Sexual Health and HIV, the Faculty of Sexual and Reproductive Health, NHS leaders, the Local Government Association and education bodies to develop the coherent, cross–sector strategy on sexual health it committed to in 2019. It is unacceptable that five years on, no progress has been made. Young people are at the start of their sexual journey. Such a strategy should begin by meeting their needs. (Paragraph 70) Response Partially accept The government partially accepts this recommendation. Whilst we have inherited a fragmented health system, we are taking active measures and working collaboratively with system partners to ensure that those in need, particularly young people and high–risk groups, are able to access the necessary services. DHSC, UKHSA, NHSE together with local government, the voluntary and community sector, and patients with lived experience, are working together to develop a new HIV Action Plan, which we aim to publish in 2025. This will lay out the pathways to our 2030 goal of ending HIV transmissions and include an objective to stabilise and support SRH system enablers, including improving collaboration and integration in the wider sexual and reproductive health system. We will continue to work with the system as a whole to support the wider SRH system so it works more effectively and to continue tackling the issues identified by the report. Collaboration is at the core of our new HIV Action Plan, and we are therefore engaging a wide r