Recommendations & Conclusions
34 items
2
Conclusion
25th Report - DHSC Annual Report and Ac…
Accepted
The Department’s accounts do not provide sufficient information on key long–term financial pressures facing the health and social care system. Despite it being jointly responsible for health and social care in England, the Department’s accounts overwhelmingly focus on health services and do not give a clear overarching narrative on social …
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The Department’s accounts do not provide sufficient information on key long–term financial pressures facing the health and social care system. Despite it being jointly responsible for health and social care in England, the Department’s accounts overwhelmingly focus on health services and do not give a clear overarching narrative on social care. The Department’s accounts contain very little information in key areas of interest to us, and to Parliament. This includes a lack of financial data on the prevention of ill health in the first place, which has the biggest long–term impact on health outcomes, and on technological advances, which are needed to improve future productivity for the NHS. While the Performance Report section of the Department’s Annual Report and Accounts contains some high level information on these areas, there is a lack of detailed financial data to set out how money has been spent in these areas. The Department’s accounts also do not provide information in enough detail to allow Parliament or the public to establish whether legal costs relating to exit packages and employment tribunals represent a good use of public funds, or provide the best outcomes. The Department is unable to tell us how much is spent on palliative and end–of–life care, nor what outcomes were delivered through this spending. recommendation a. In line with its Treasury Minute response, the Department should write to the Committee to set out its plans to improve the transparency and usability of its Annual Report and Accounts in the following areas: social care; productivity; prevention; digital and artificial intelligence; palliative and end–of–life care; severance and clinical negligence payments; and any new and emerging areas of Parliamentary and public interest. b. All future annual reports and accounts should be very clear about what productivity and efficiency gains have been made during the year and how. Also, a prediction for future years should be included.
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Government response AI summary
The government agrees and commits to improving the transparency and usability of its Annual Report and Accounts (ARA) by covering the specified areas, including social care, productivity, and prevention, in its 2024-25 ARA. The department will provide an update to the Committee on this progress …
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HM Treasury
3
Recommendation
25th Report - DHSC Annual Report and Ac…
Accepted
There is little to show for the £400 million spent so far on the development of Harlow Health Security Campus, with no decision yet on the future of the site. This is an example of a poorly overseen project to replace the UK’s critical public health infrastructure. UKHSA’s high containment …
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There is little to show for the £400 million spent so far on the development of Harlow Health Security Campus, with no decision yet on the future of the site. This is an example of a poorly overseen project to replace the UK’s critical public health infrastructure. UKHSA’s high containment laboratories are central to protecting the population against potentially highly infectious diseases. The current facilities at Porton Down and Colindale are nearing the end of their life. The programme to build new facilities at Harlow has been underway for over a decade, and the cost of the current plan has risen from the initial estimate of £530 million to an eye–watering projected £3.2 billion. UKHSA has developed an 5 alternative proposal involving modernising the existing facilities at Porton Down and Colindale. The decision between these two options is complex. The final decision is currently being made by Ministers and is expected in the second part of the spending review. But this is still some 3 years after the programme was suspended. As well as having cost implications, these delays could risk leaving the nation without adequate protection against emerging new diseases. UKHSA estimates its current facilities could continue to operate for 15 years, and in 2024 the NAO reported that the earliest date for having a fully operational new or upgraded site is 2036, 11 years from now. Time is running out for UKHSA to decide on the best course of action in order to avoid exposing the public to any unnecessary risk. recommendation a. In line with the recommendations this Committee made in May 2024, UKHSA should urgently outline how it will ensure that the UK continues to have the infrastructure it needs to protect public health, and confirm its plans for its high containment laboratories, including setting out full costs and timeline for completion. In light of spending review, and given UKHSA’s poor record of delivering new facilities, it should set out as soon as possible, exa
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Government response AI summary
The government states the recommendation is implemented, explaining that the department already possesses well-established governance structures to oversee investment decisions and delivery of major health infrastructure projects. These existing structures include cost and value-for-money tests and are subject to regular review.
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HM Treasury
4
Recommendation
25th Report - DHSC Annual Report and Ac…
Accepted
It is unacceptable that the Department is yet to develop a plan to deal with the cost of clinical negligence claims, and so much taxpayers’ money is being spent on legal fees. The Department has set aside an astounding £58.2 billion to cover the potential costs of clinical negligence events …
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It is unacceptable that the Department is yet to develop a plan to deal with the cost of clinical negligence claims, and so much taxpayers’ money is being spent on legal fees. The Department has set aside an astounding £58.2 billion to cover the potential costs of clinical negligence events occurring prior to 1 April 2024, the second largest liability across government. Some £9.3 billion of that £58.2 billion relates to events occurring in 2023–24, when it also paid out £2.8 billion on clinical negligence claims. Behind these jaw–dropping amounts lie many tragic incidents of patient harm. The Department has only recently written to us in response to the previous Committee’s recommendation which was to set out, by summer 2024, the key reasons for patient harm and the actions it will take to address these. In addition, the Department says that an astronomical 19% of the money awarded to claimants goes to their lawyers, on top of the fees payable for the Department’s defence team. We are disappointed that huge improvements still need to be made to better protect both patients and public money. 6 recommendation Within the next 6 months, the Department should set out a plan with clear actions to: • Reduce tragic incidences of patient harm to as low a level as possible; and • Manage the costs of clinical negligence more effectively, including introducing a mechanism to reduce legal fees. • Improve patient safety across the NHS and in particular in maternity services.
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Government response AI summary
The government agrees and outlines several specific actions to reduce patient harm and manage clinical negligence costs, including implementing NHS England's 3-year maternity plan. It has announced a national, independent investigation into maternity and neonatal care, expected to report by December 2025, and will establish …
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HM Treasury
5
Conclusion
25th Report - DHSC Annual Report and Ac…
Accepted
We are disappointed by the Department’s continued failure to return to publishing its accounts before the summer Parliamentary recess. Timely production of accounts is essential to understanding public finances and supporting accountability and Parliament expects Departments’ accounts to be published before the summer recess each year. Yet the Department has …
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We are disappointed by the Department’s continued failure to return to publishing its accounts before the summer Parliamentary recess. Timely production of accounts is essential to understanding public finances and supporting accountability and Parliament expects Departments’ accounts to be published before the summer recess each year. Yet the Department has failed to deliver its accounts on time for each of the last five years, which hampers effective and timely accountability of taxpayers’ money. The Department is making some progress and published its 2023–24 accounts on 17 December 2024, nearly six weeks earlier than its 2022–23 accounts. But this is still five months later than the timescale needed to meet the expected pre–summer recess delivery. Weaknesses in basic financial accounting at UKHSA, together with delays in the completion of local NHS audits have continued to cause the accounts to be late. The absorption of NHS England into the department will need to be carefully planned in the accounts production and auditing process, otherwise timelines could slip backwards. recommendation By the start of September 2025, the Department must write to us with a realistic and credible plan to produce audited accounts before the summer Parliamentary recess. This must include how it will: • Effectively support and hold group bodies to account to ensure they produce accounts of appropriate quality on a timely basis; and • Work with stakeholders across the local audit system to build capacity, resilience and ensure deadlines are met in particular given organisational changes.
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Government response AI summary
The government agrees and is working on a multi-year plan to publish audited accounts before the summer recess, acknowledging challenges due to private sector audit firm capacity. It commits to writing to the Committee in September 2025 with further details on this plan, associated risks, …
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HM Treasury
6
Recommendation
25th Report - DHSC Annual Report and Ac…
Accepted
NHS England does not have a coherent plan to better protect taxpayers’ money and prevent future unapproved exit packages. There remain far too many special severance payments where approval has only been sought after the payment has been made. Five such unapproved payments 7 totalling £180,868 were made by NHS …
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NHS England does not have a coherent plan to better protect taxpayers’ money and prevent future unapproved exit packages. There remain far too many special severance payments where approval has only been sought after the payment has been made. Five such unapproved payments 7 totalling £180,868 were made by NHS trusts in 2023–24. Without approval, this expenditure has not been spent in line with Parliament’s expectations. NHS England’s plan to stop such payments occurring in future has been to remind providers of the rules in place. However, it has acknowledged that solely reminding providers is not enough to guarantee future unapproved payments will not happen. NHS England is also unable to identify any meaningful consequences for trusts that would act as a deterrent. recommendation As part of its Treasury Minute response, NHS England should set out how it will ensure that all exit packages receive the appropriate approvals in advance of payment being made, including details of consequences for non–compliance with the rules. Given the proposed scale of redundancies it should set out how its new approvals mechanism can be enforced to prevent even more unauthorised severance payments. This should include how it will ensure that this corporate knowledge and any lessons learned are not lost when it is abolished and its functions are taken on by the Department. 8 1 The operation of the Department and its reporting Introduction
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Government response AI summary
The government commits to publishing new comprehensive guidance on all types of exit packages and communicating it via regional teams and the NHS England website, aiming for impact from 2025-26. It also outlines existing lesson-learning for non-compliance.
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HM Treasury
1
Conclusion
25th Report - DHSC Annual Report and Ac…
Accepted
On the basis of a report by the Comptroller and Auditor General (C&AG), we took evidence from the Department of Health and Social Care (the Department), the UK Health Security Agency (UKHSA) and NHS England on the Department’s Annual Report and Accounts for 2023–24.2
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On the basis of a report by the Comptroller and Auditor General (C&AG), we took evidence from the Department of Health and Social Care (the Department), the UK Health Security Agency (UKHSA) and NHS England on the Department’s Annual Report and Accounts for 2023–24.2
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Government response AI summary
The government broadly aligns with the committee's general observation, describing ongoing initiatives to improve patient care through partnership working and system efficiency, and referring to upcoming plans in a 10 Year Health Plan.
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HM Treasury
7
Conclusion
25th Report - DHSC Annual Report and Ac…
Acknowledged
We asked the Department about reports that its headcount would also be cut by 50%. The Department told us that it aimed to become “smaller and leaner”. It said that it was not in a position to put a number on the reduction in size of its headcount, confirming only …
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We asked the Department about reports that its headcount would also be cut by 50%. The Department told us that it aimed to become “smaller and leaner”. It said that it was not in a position to put a number on the reduction in size of its headcount, confirming only that there would be a reduction. The Department told us that it had announced a voluntary exit scheme in early March 2025 and that it was also operating a cap on new external appointments. It anticipated that these actions would equate to savings worth £15 million per year which could then be used for frontline services.10
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Government response AI summary
The government agrees with the observation, describing ongoing work to create a single new organization and develop staff transfer plans. Specific headcount information is likely to be confirmed in Autumn 2025, with further details provided to the Committee Chair in July 2025.
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HM Treasury
8
Recommendation
25th Report - DHSC Annual Report and Ac…
Deferred
We observed that the scale of change was bigger in NHS England than the Department, and so asked NHS England about its plans to reduce its workforce. It confirmed that it did not currently have a detailed plan to achieve that reduction. It told us it that it had implemented …
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We observed that the scale of change was bigger in NHS England than the Department, and so asked NHS England about its plans to reduce its workforce. It confirmed that it did not currently have a detailed plan to achieve that reduction. It told us it that it had implemented a recruitment freeze, which it expected to reduce headcount by 10% as staff left and were not replaced, but acknowledged that a redundancy scheme might be required to achieve the remaining 40% reduction. We noted that redundancy and reorganisation would cost money, and asked if NHS England had estimated how much money it might need to spend on any redundancy programmes to deliver the required headcount reduction. NHS England told us that it did not have a firm estimate of this, but noted 8 Department of Health and Social Care 2022–23 Annual Report and Accounts, HC 459, 29 April 2024, pages 214–242 9 Qq 9, 13; NHS England, NHS England board members stepping down, 10 March 2025 10 Qq 2–4, 8 27 11 that “at best” it would assume that it would need to “pay on average the annual salary if a redundancy package is required”, although its turnover rate would mean that not everyone would be required to be made redundant.11
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Government response AI summary
The government agrees with the recommendation regarding NHS England's workforce reduction plans and is currently developing its plans for staff transfers, with information on the size of resource functions expected to be confirmed in Autumn 2025.
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HM Treasury
9
Conclusion
25th Report - DHSC Annual Report and Ac…
Acknowledged
We asked how the 50% headcount reduction will be applied to ICBs, noting that some were already working efficiently and the importance of the place–based approach in ensuring effective working between local councils, directors of public health and local GPs. The Department expected that the changes to ICBs would not …
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We asked how the 50% headcount reduction will be applied to ICBs, noting that some were already working efficiently and the importance of the place–based approach in ensuring effective working between local councils, directors of public health and local GPs. The Department expected that the changes to ICBs would not lead to more centralisation. However, NHS England was unable to clarify whether the 50% reduction in ICBs represented a 50% reduction for each ICB individually or across system as a whole. NHS England explained that the detail of the expectations on ICBs would become clear as the 10–year plan for the NHS was finalised.12
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Government response AI summary
The government agrees with the observation, reiterating principles of empowering local leaders and strong partnerships. However, specific details on how the headcount reduction will apply to ICBs remain linked to the forthcoming 10 Year Health Plan and are subject to future primary legislation.
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HM Treasury
10
Recommendation
25th Report - DHSC Annual Report and Ac…
Accepted
It had previously been announced that NHS England’s Chief Executive, Chief Financial Officer, Chief Operating Officer, National Medical Director and Chief Delivery Officer and National Director for Vaccination and Screening would step down from their roles.13 During our evidence session, the Prime Minister announced that the Department and NHS England …
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It had previously been announced that NHS England’s Chief Executive, Chief Financial Officer, Chief Operating Officer, National Medical Director and Chief Delivery Officer and National Director for Vaccination and Screening would step down from their roles.13 During our evidence session, the Prime Minister announced that the Department and NHS England would merge. In the context of these changes, we asked how the institutional memory of NHS England would be preserved. NHS England could not explain specifically how this would be retained. It stated that those remaining at NHS England had a significant amount of experience, and that these people would give continuity of knowledge.14
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Government response AI summary
The government agrees with the committee's recommendation, outlining a process for the Department and NHS England merger that includes assessing functions, agreeing senior structures, and planning staff transfers. This structured approach aims to preserve institutional memory, with further details expected by Autumn 2025.
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HM Treasury
11
Recommendation
25th Report - DHSC Annual Report and Ac…
Acknowledged
We asked the Department whether the current locally–led approaches would be retained as part of the new structure to allow better local accountability, and whether previous commitments about public health and prevention would also be retained. The Department said that the ideal set–up for an ICB to meet its commitments …
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We asked the Department whether the current locally–led approaches would be retained as part of the new structure to allow better local accountability, and whether previous commitments about public health and prevention would also be retained. The Department said that the ideal set–up for an ICB to meet its commitments and be held to account was through a good balance of stakeholders, including local authorities, primary, secondary, community, and other care providers, to maintain local, but joined up, accountability.15 11 Qq 9–10, 14 12 Q 17 13 NHS England, NHS Chief to stand down at end of March, 25 February 2025; NHS England, England’s top doctor to stand down after over seven years, 6 March 2025; NHS England, NHS England board members stepping down, 10 March 2025 14 Qq 20, 27 15 Q 26 12 The development of the Harlow Health Security Campus
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Government response AI summary
The government agrees to retain locally-led approaches, stating that reforms empower local leaders and NHS England has already clarified that Integrated Care Boards should foster strong relationships with local government to improve outcomes. The 10 Year Health Plan will further address shifting healthcare to the …
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HM Treasury
12
Recommendation
25th Report - DHSC Annual Report and Ac…
Deferred
UKHSA’s purpose is to prevent, prepare for and respond to infectious diseases and environmental hazards, and to provide scientific and operational leadership to protect the public’s health and to build the nation’s health security capability.UKHSA owns high containment science laboratories at Porton Down and Colindale, which are nearing the end …
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UKHSA’s purpose is to prevent, prepare for and respond to infectious diseases and environmental hazards, and to provide scientific and operational leadership to protect the public’s health and to build the nation’s health security capability.UKHSA owns high containment science laboratories at Porton Down and Colindale, which are nearing the end of their operational life.16 These laboratories are a critical part of UKHSA’s health protection mission and are required for protecting the nation against highly infectious diseases. In 2024, UKHSA assured the previous Committee that, with ongoing maintenance, its laboratories should be able to continue operating for another fifteen years.17 However, the laboratories are currently dependent upon remedial investment to keep them in operation, resulting in periods of time where facilities are unavailable as they are being updated. In 2024, UKHSA acknowledged that reliance on these ageing facilities presents a significant but managed risk to public health.18
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Government response AI summary
The government agrees that an urgent decision is needed regarding the future location of UKHSA’s high-containment laboratories, but defers this decision until after the spending review and plans for the delivery model to be fully implemented by Spring 2026.
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HM Treasury
13
Conclusion
25th Report - DHSC Annual Report and Ac…
Accepted
The need for a planned replacement to these facilities was initially identified in 2006 and Public Health England (UKHSA’s predecessor public body) was given approval to purchase the land in 2017. However, in February 2024 the NAO found that work on a replacement laboratory at Harlow had been intermittent since …
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The need for a planned replacement to these facilities was initially identified in 2006 and Public Health England (UKHSA’s predecessor public body) was given approval to purchase the land in 2017. However, in February 2024 the NAO found that work on a replacement laboratory at Harlow had been intermittent since the land was purchased, with the programme suspended from 2022 after the Department reallocated funding to other departmental priorities amid uncertainty about the programme. The earliest date at which the Harlow campus could be ready was estimated at 2036. The NAO found that estimates of the projected cost of building the facility had spiralled upward, from an initial estimate of £530 million in 2015 to £3.2 billion in 2023. This increase was partly due to factors such as rising inflation but also due to the numerous delays encountered by the programme.19 UKHSA’s 2023–24 Annual Report and Accounts show that it has so far spent some £400 million on work at Harlow, but has written off £297 million of this spend to date, reflecting the costs of building work already done that it cannot be certain will be completed.20 16 UKHSA Annual Report and Accounts 2023–24, HC 427, 16 December 2024, pages 4 and 35 17 Letter from Dame Meg Hillier to Shona Dunn and Professor Dame Jenny Harries, 24 May 2024 18 Report by the Comptroller and Auditor General, Investigation into the UK Health Security Agency’s health security campus programme, HC 553, 20 February 2024, page 14 19 C&AG’s Report, Investigation into the UK Health Security Agency’s health security campus programme, pages 8–11, 27 20 UKHSA Annual Report and Accounts 2023–24, page 141 13
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Government response AI summary
The government agrees with the committee's findings, recognizing the urgent need for a decision on UKHSA’s high-containment laboratories. A decision will be made following the spending review, with UKHSA finalizing the delivery model and commercial strategy by Spring 2026.
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HM Treasury
14
Recommendation
25th Report - DHSC Annual Report and Ac…
Accepted
We asked UKHSA what progress it had made in deciding what it would do with the site. UKHSA told us that it was waiting for Ministers to decide whether to continue development at Harlow or to change course to a phased delivery option providing high containment facilities at Porton Down …
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We asked UKHSA what progress it had made in deciding what it would do with the site. UKHSA told us that it was waiting for Ministers to decide whether to continue development at Harlow or to change course to a phased delivery option providing high containment facilities at Porton Down with later refurbishment of supporting infrastructure at Porton Down and Colindale. UKHSA told us that this decision was under “active review” by Ministers and that it expected a decision to be made in the second part of the spending review. It recognised that this was “now quite a critical decision in terms of timeframe, because it takes a long time to build … [and] commission them into service.” UKHSA informed us that that the decision–making process was difficult and prolonged because the relative costs and benefits of each option are finely balanced and difficult to compare. To ensure that it was ready for a decision either way, UKHSA said that it was working with the Infrastructure and Projects Authority to ensure its model for overseeing the programme included sufficient technical expertise.21 The Department should clarify the arrangements for accountability, oversight, and the involvement and status of delivery partners as soon as possible. 21 Qq 47–50 14 2 Protecting taxpayers’ money The continuing impact of clinical negligence
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Government response AI summary
The government accepts the recommendation, committing to finalise the delivery model and associated commercial strategy, including accountability and oversight arrangements, by Spring 2026, following a decision on UKHSA's high-containment laboratory location and completion of a programme business case.
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HM Treasury
15
Conclusion
25th Report - DHSC Annual Report and Ac…
Acknowledged
The Department recognised that each incidence of clinical negligence has a tragedy behind it involving a patient. It told us that while the optimal number of clinical negligence cases would be zero, this will never be a practical target. Clinical negligence also comes with a monetary cost to the taxpayer. …
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The Department recognised that each incidence of clinical negligence has a tragedy behind it involving a patient. It told us that while the optimal number of clinical negligence cases would be zero, this will never be a practical target. Clinical negligence also comes with a monetary cost to the taxpayer. The Department is required to make compensation payments for pain suffered and the impact on the everyday lives of those who have suffered negligence. In 2023–24, NHS Resolution, which administers claims of clinical negligence for the Department, paid £2.8 billion in cash to claimants.22
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Government response AI summary
The government agrees with the committee's findings, stating it will continue to prioritize patient safety and a learning culture through ongoing work under the NHS Patient Safety Strategy. This strategy, which aims to reduce harmful patient events, will be reviewed and updated in autumn 2025.
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HM Treasury
16
Conclusion
25th Report - DHSC Annual Report and Ac…
Acknowledged
The Department recognises an amount for potential future compensation payments for incidents of clinical negligence in its financial statements as a liability. This is reported in the accounts of NHS Resolution and is consolidated into the Departmental Group accounts. The Department recognised a liability of £58.2 billion in its 2023–24 …
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The Department recognises an amount for potential future compensation payments for incidents of clinical negligence in its financial statements as a liability. This is reported in the accounts of NHS Resolution and is consolidated into the Departmental Group accounts. The Department recognised a liability of £58.2 billion in its 2023–24 accounts to cover the expected potential future costs of compensation for clinical negligence, which included £9.3 billion set aside to cover incidents that occurred in 2023–24. The Department has identified a further £24.6 billion of clinical negligence claims which it does not recognise as a liability but may need to pay in the future.23 The Department’s clinical negligence liability is the second largest liability across government.24 22 Q 59; Department of Health and Social Care Annual Report and Accounts 2023–24, pages 262, 308; NHS Resolution, Annual Report and Accounts 2023/24, HC 73, 23 July 2024, pages 29, 166–167 23 Department of Health and Social Care Annual Report and Accounts 2023–24, pages 262, 306; NHS Resolution, Annual Report and Accounts 2023/24, HC 73, 23 July 2024, pages 166–167, 188–189 24 Whole of Government Accounts, year ended 31 March 2023, HC 289, 26 November 2024, page 67 15
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Government response AI summary
The government agrees with the committee's findings, stating it will continue to prioritize patient safety and a learning culture through ongoing work under the NHS Patient Safety Strategy. This strategy, which aims to reduce harmful patient events, will be reviewed and updated in autumn 2025.
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HM Treasury
17
Recommendation
25th Report - DHSC Annual Report and Ac…
Deferred
The previous Committee were concerned that the Department was spending billions of pounds of taxpayers’ money without an effective plan to minimise future costs of the clinical negligence scheme.25 In April 2024, the Committee recommended that, by summer 2024, “the Department should set out the key reasons for patient harm …
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The previous Committee were concerned that the Department was spending billions of pounds of taxpayers’ money without an effective plan to minimise future costs of the clinical negligence scheme.25 In April 2024, the Committee recommended that, by summer 2024, “the Department should set out the key reasons for patient harm and the actions it will take to address these, ensuring that its plans will reduce health disparities, ensure better patient outcomes, and reduce the costs for taxpayers”. In September 2024, in its response to the Committee’s report, the Department committed to writing to us by the end of 2024 to “set out the actions it is taking with NHS England and other system partners to reduce patient harm and advance patient safety in the NHS and improve outcomes for patients and the taxpayer”.26 It sent us a letter outlining its plans in February 2025.27 We therefore asked the Department what it was doing to reduce patient harm and advance patient safety. In response, the Department, whilst acknowledging that it should get safety as close to perfect as possible, did not set out specific actions that it was taking to progress in this area. The Department told us that the number of claims of clinical negligence remains static year on–year.28
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Government response AI summary
The government agrees to prioritize patient safety and will continue ongoing work under the existing NHS Patient Safety Strategy. However, a review and update of this strategy, which will set out further actions, is deferred until after the overarching Quality Strategy is published in autumn …
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HM Treasury
18
Conclusion
25th Report - DHSC Annual Report and Ac…
Deferred
The Department told us that around 19% of the total compensation payments made in 2023–24 by NHS Resolution go to the claimants’ lawyers. This equates to £536 million of the total £2.8 billion paid to claimants in 2023–24 , which is over one–and–a–half times the amount spent by the Government …
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The Department told us that around 19% of the total compensation payments made in 2023–24 by NHS Resolution go to the claimants’ lawyers. This equates to £536 million of the total £2.8 billion paid to claimants in 2023–24 , which is over one–and–a–half times the amount spent by the Government Legal Department (the government’s principal legal advisers) in totality across all of its legal activities in the same period.29 The previous government announced plans to place limits on how much lawyers receive from lower damages clinical negligence claims from April 2024, but the required legislation was not introduced. The Department told us that to reduce legal costs by moving to a no–fault compensation model would likely be more expensive overall, whilst potentially not distinguishing between those suffering as a result of negligence and those as a result of an accident.30 25 Committee of Public Accounts, Thirty–First Report of Session 2023–24, Department of Health and Social Care 2022–23 Annual Report and Accounts, HC 459, 29 April 2024, page 6 26 Treasury Minutes, Government Response to the Committee of Public Accounts on the Twenty-sixth to the Twenty-ninth, the Thirty-first, and the Thirty-third to the Thirty-eighth reports from Session 2023–24, CP 1151, September 2024, page 18, paragraph 4.4 27 Letter from the Interim Permanent Secretary of the Department for Health and Social Care relating to the 31st Report of Session 2023–24, DHSC 2022–23 Annual Report and Accounts, Recommendation 4, 25 February 2025 28 Qq 58–59 29 Qq 58–59; NHS Resolution, Annual Report and Accounts 2023/24, HC 73, 23 July 2024, pages 166–167; Government Legal Department Account Report and Accounts 2023–24, HC 74, 18 July 2024, page 64 30 Q 61; Department of Health and Social Care, Government to introduce legal costs cap to support victims, 16 September 2023 16 Unapproved special severance payments
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Government response AI summary
The government agrees with the committee's concerns regarding rising clinical negligence costs, stating ministers will examine the drivers of costs and reform options, with a further response and implementation date to be advised.
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HM Treasury
19
Recommendation
25th Report - DHSC Annual Report and Ac…
Accepted
Exit packages are payments made in relation to redundancy and other departure costs for employees. Special severance payments are a subset of exit packages, relating to any non–contractual payments to employees.31 We have repeatedly raised issues with the Department or its organisations making inappropriate or unapproved payments. In June 2022, …
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Exit packages are payments made in relation to redundancy and other departure costs for employees. Special severance payments are a subset of exit packages, relating to any non–contractual payments to employees.31 We have repeatedly raised issues with the Department or its organisations making inappropriate or unapproved payments. In June 2022, the previous Committee found that three Clinical Commissioning Groups (CCGs) had approved and paid special severance payments without following the required authorisation process. One of these payments resulted in the C&AG qualifying his regularity audit opinion on the NHS England 2020–21 Annual Report and Accounts. The previous Committee warned in 2022 that planned large–scale NHS restructuring increased the risk of future payoffs and further non–compliance with the rules. It recommended that the Department should set out how it would monitor and control the approval of all redundancy payments made by entities within the Departmental Group.32 The Department agreed with our recommendation, and told us in its response to our report that detailed written guidance relating to exit payment processes and approvals had been circulated to CCGs and the (then) proposed ICBs, and that separate arrangements were in place for NHS Trusts and Foundation Trusts.33
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Government response AI summary
The government accepts the recommendation, stating NHS England is redrafting guidance on exit packages and approval mechanisms, which will be communicated and impact exits from 2025-26.
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HM Treasury
20
Conclusion
25th Report - DHSC Annual Report and Ac…
Accepted
Special severance payments always require prior HM Treasury approval, as they are usually novel or contentious.34 In 2023–24, two NHS Trusts and two NHS Foundation Trusts between them made five special severance payments totalling £180,868 without the required approval. In his report on the 2023–24 Consolidated Provider Account, the C&AG …
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Special severance payments always require prior HM Treasury approval, as they are usually novel or contentious.34 In 2023–24, two NHS Trusts and two NHS Foundation Trusts between them made five special severance payments totalling £180,868 without the required approval. In his report on the 2023–24 Consolidated Provider Account, the C&AG reported that, while most NHS providers were following the correct procedures when proposing to enter a special severance payment arrangement, some NHS providers were still not following the requirements set by HM Treasury.35
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Government response AI summary
The government agrees with the committee's findings, stating NHS England is redrafting guidance on all exit packages and approval mechanisms. This new guidance will be communicated by end of Summer 2025 via regional workforce teams and the NHS England website, to impact exits from 2025-26 …
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HM Treasury
21
Recommendation
25th Report - DHSC Annual Report and Ac…
Accepted
We asked NHS England what progress it had made in addressing the approvals and ensuring that payments being made without being approved did not happen again. NHS England recognised that “every case that is 31 Report by the Comptroller and Auditor General, Consolidated NHS Provider Accounts 2023–24, HC 399, 26 …
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We asked NHS England what progress it had made in addressing the approvals and ensuring that payments being made without being approved did not happen again. NHS England recognised that “every case that is 31 Report by the Comptroller and Auditor General, Consolidated NHS Provider Accounts 2023–24, HC 399, 26 November 2024, page 47; Department of Health and Social Care Annual Report and Accounts 2023–24, pages 164, 189 32 Committee of Public Accounts, Sixth Report of Session 2022–23, Department of Health and Social Care 2020–21 Annual Report and Accounts, HC 253, 10 June 2022 33 HM Treasury, Treasury Minutes: Government Response to the Committee of Public Accounts on the Second, and the Fourth to the Eighth reports from Session 2022–23, CP 708, August 2022 34 HM Treasury, Managing Public Money, May 2023, page 142 35 Report by the Comptroller and Auditor General, Consolidated NHS Provider Accounts 2023–24, HC 399, 26 November 2024, page 47; Department of Health and Social Care Annual Report and Accounts 2023–24, HC 476, 17 December 2024, page 164 17 not properly approved is wrong”. It told us that it continued to work with providers and ICBs to “remind them of their duties” including through regular training sessions. NHS England told us that it considered its current approach of reminding NHS providers of the requirements to be proportionate, but was unable to guarantee that there will not be future examples where NHS bodies fail to follow the process and obtain the required approvals.36
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Government response AI summary
The government agrees with the committee's recommendation, stating NHS England is redrafting guidance on exit packages and approval mechanisms, which will be communicated by end of Summer 2025. This aims to improve compliance, reiterate rules, and ensure payments are properly approved.
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HM Treasury
22
Conclusion
25th Report - DHSC Annual Report and Ac…
Accepted
We noted that the accounts showed there had been 240 cases where retrospective approval had been sought for special severance payments, and asked NHS England whether there were any consequences for making these payments without the necessary approvals. NHS England said that this was down to “a judgement about how …
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We noted that the accounts showed there had been 240 cases where retrospective approval had been sought for special severance payments, and asked NHS England whether there were any consequences for making these payments without the necessary approvals. NHS England said that this was down to “a judgement about how proportionate the response is in each case”. It said that, depending on the sum involved and what had happened, it would “talk to the organisation and make sure that people are spoken to”. We therefore asked whether any action had been taken against anyone for making payments without the proper approval. NHS England did not identify any specific actions beyond reminding individuals of the authorisations required, and that it could not guarantee that this would not happen in future given the size of the NHS.37
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Government response AI summary
The government agrees with the committee's findings, stating NHS England is redrafting guidance on exit packages and approval mechanisms, to be communicated by end of Summer 2025. This new guidance aims to improve compliance and reduce instances of payments made without the necessary approvals.
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HM Treasury
23
Recommendation
25th Report - DHSC Annual Report and Ac…
Accepted
When the previous Committee reported on this in June 2022, it warned that that the (then planned) large–scale restructuring of commissioning within the NHS could increase the risk of further unapproved payments being made.38 Given the announcements about the restructuring of NHS England and the potential for large numbers of …
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When the previous Committee reported on this in June 2022, it warned that that the (then planned) large–scale restructuring of commissioning within the NHS could increase the risk of further unapproved payments being made.38 Given the announcements about the restructuring of NHS England and the potential for large numbers of redundancies, we asked the Department whether it planned to introduce a new mechanism to approve these. Given the potential for many more unapproved payments being made due to the scale of the redundancies the enforcement of this mechanism needs to be carefully considered. The Department told us that this had yet to be decided, but that when it had run similar schemes, HM Treasury had approved the overarching business case for the overall numbers, cost and time of the people due to leave the organisation, and then processes had been set up inside the Department and NHS England to manage it and ensure that appropriate governance was in place. It told us that it “imagine[d] that … will happen again”.39 36 Qq 52–3, 55 37 Q 55 38 Committee of Public Accounts, Sixth Report of Session 2022–23, Department of Health and Social Care 2020–21 Annual Report and Accounts, HC 253, 18 May 2022 39 Qq 53–55 18 3 Transparency and accountability for the Department’s spending Usability of the Department’s Annual Report and Accounts document
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Government response AI summary
The government agrees with the committee's recommendation, stating NHS England is redrafting guidance on exit packages and associated approval mechanisms. This new guidance, to be communicated by end of Summer 2025, aims to strengthen oversight during restructuring and potential redundancies.
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HM Treasury
24
Recommendation
25th Report - DHSC Annual Report and Ac…
Accepted
The Department was renamed the Department of Health and Social Care (from the Department of Health) in January 2018, with the intention of delivering a greater focus on adult social care.We observed that social care is only reflected in “a lot of little bits” in the Department’s Annual Reports and …
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The Department was renamed the Department of Health and Social Care (from the Department of Health) in January 2018, with the intention of delivering a greater focus on adult social care.We observed that social care is only reflected in “a lot of little bits” in the Department’s Annual Reports and Accounts. We therefore asked how social care delivery for users was being improved. NHS England told us that “a lot of work is already going on” including moving towards having joint social care and NHS assessment teams. It explained that this created a single process for assessing the care package needed for each patient and how it should be delivered, which should also result in earlier discharge from hospital. It also told us that it had undertaken work over the last 18 months to consider how it could improve intermediate care, focusing on physical rehabilitation when patients were leaving hospital, which it planned to roll out in 2026.40
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Government response AI summary
The government commits to improving the transparency and informativeness of its 2024-25 Annual Report and Accounts to include coverage of social care delivery, with an update to the Committee by September 2025.
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HM Treasury
25
Recommendation
25th Report - DHSC Annual Report and Ac…
Accepted
The Department’s Annual Report and Accounts also does not contain analysis of the Department’s progress in improving productivity and efficiency. We asked, given the importance of productivity to ensuring that NHS expenditure was sustainable, if it would pay more attention to this in future. The Department told us that productivity …
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The Department’s Annual Report and Accounts also does not contain analysis of the Department’s progress in improving productivity and efficiency. We asked, given the importance of productivity to ensuring that NHS expenditure was sustainable, if it would pay more attention to this in future. The Department told us that productivity was “absolutely one of the top priorities” as part of the 10–year plan and the spending review, and committed to addressing this issue.41
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Government response AI summary
The government commits to improving its 2024-25 Annual Report and Accounts to include analysis of the Department's progress in improving productivity and efficiency, and will provide an update to the Committee by September 2025.
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HM Treasury
26
Recommendation
25th Report - DHSC Annual Report and Ac…
Accepted
We similarly asked about the Department’s progress on technological and digital developments and the use of artificial intelligence (AI), as key areas which could improve productivity. We were surprised that the Department’s Annual Report and Accounts contains such little information on those 40 Q 71; National Audit Office, Departmental Overview: …
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We similarly asked about the Department’s progress on technological and digital developments and the use of artificial intelligence (AI), as key areas which could improve productivity. We were surprised that the Department’s Annual Report and Accounts contains such little information on those 40 Q 71; National Audit Office, Departmental Overview: Department of Health & Social Care, October 2018, page 3 41 Q 68 19 areas and asked for fuller details to be provided in future. The Department explained that it was “absolutely developing a refreshed tech plan as part of the productivity plan” and committed to place more focus on these areas in its next Annual Report and Accounts.42
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Government response AI summary
The government commits to improving its 2024-25 Annual Report and Accounts to include fuller details on technological and digital developments and the use of AI, and will provide an update to the Committee by September 2025.
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HM Treasury
27
Recommendation
25th Report - DHSC Annual Report and Ac…
Accepted
The NHS Long Term Plan states that ill health prevention helps the public to stay healthy, as well as moderating demands on the NHS. The Department recognised in its 2023–24 Annual Report that there “is still much work to do to make a shift towards prevention in the NHS”.43 We …
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The NHS Long Term Plan states that ill health prevention helps the public to stay healthy, as well as moderating demands on the NHS. The Department recognised in its 2023–24 Annual Report that there “is still much work to do to make a shift towards prevention in the NHS”.43 We observed that, with the exception of a very short paragraph, the Department’s 2023–24 Annual Report does not include a section on preventative work, or information on outcomes arising from this spend. We asked the Department to ensure that next year’s accounts had more importance paid to prevention, which it agreed to.44 We also commented that it was difficult to find information in its Annual Report and Accounts on how much the Department was spending on palliative and end–of–life care, or what outcomes this spend was delivering, which felt like a “huge omission”. The Department was unable to provide a figure for this spending on our session, but told us that it would “definitely change that for next year … [and] add more prominence to it”.45
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Government response AI summary
The government commits to improving its 2024-25 Annual Report and Accounts to include more information on preventative work and spending/outcomes for palliative and end-of-life care, and will provide an update to the Committee by September 2025.
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HM Treasury
28
Recommendation
25th Report - DHSC Annual Report and Ac…
Accepted
NHS England’s Annual Report and Accounts and the Consolidated NHS Provider Accounts show that there were 3,877 exit packages in the NHS in 2023–24, costing a total of £98 million. We asked NHS England whether the use of exit packages had been increasing or decreasing. NHS England was unable to …
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NHS England’s Annual Report and Accounts and the Consolidated NHS Provider Accounts show that there were 3,877 exit packages in the NHS in 2023–24, costing a total of £98 million. We asked NHS England whether the use of exit packages had been increasing or decreasing. NHS England was unable to provide this information in our session but told us that it would confirm the precise number separately. Some 96 exit packages arose following employment tribunals or court orders against NHS England, NHS Trusts or NHS Foundation Trusts, at a cost of £1.3 million. We observed that there was no breakdown of the legal costs relating to employment tribunals and exit packages at NHS bodies within the Department’s or NHS England’s Annual Reports and Accounts. We requested that the Department provide this information to enable us to determine whether these were a good use of public funds.46 42 Q 69; Department of Health and Social Care Annual Report and Accounts 2023–24, HC 476, 17 December 2024, pages 38–39 43 Department of Health and Social Care Annual Report and Accounts 2023–24, HC 476, 17 December 2024, page 78; The NHS Long Term Plan, January 2019, page 7 44 Qq 28, 72 45 Qq 28, 72 46 Q 53; NHS England Annual Report and Accounts 2023–24, HC 251, 10 October 2024, pages 96–97; Consolidated NHS Provider Accounts 2023/24, HC 399, 26 November 2024, pages 82–83 20 Lack of timeliness of reporting
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Government response AI summary
The government commits to improving its 2024-25 Annual Report and Accounts to include a breakdown of legal costs relating to employment tribunals and exit packages, and will provide an update to the Committee by September 2025.
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HM Treasury
29
Recommendation
25th Report - DHSC Annual Report and Ac…
Deferred
Timely production of accounts is essential to understanding public finances and supporting accountability.47 All Departments should aim to lay their accounts and those of their agencies no later than prior to the Parliamentary summer recess. Departments have a statutory deadline of 30 November to provide their accounts to the C&AG, …
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Timely production of accounts is essential to understanding public finances and supporting accountability.47 All Departments should aim to lay their accounts and those of their agencies no later than prior to the Parliamentary summer recess. Departments have a statutory deadline of 30 November to provide their accounts to the C&AG, and of 31 January to publish their annual report and accounts.48 The Department published its accounts covering 2019–20 to 2022–23 in January each year, six months after this deadline. When the previous Committee examined the Department’s 2022–23 Annual Report and Accounts, it found that the Department had not published its Group Accounts until 25 January 2024, 10 months after the financial year end. It concluded that its continued failure to deliver its accounts to an earlier timetable hampered effectively and timely accountability of taxpayers’ money. It warned that the Department’s plans to return to a pre–summer recess timetable were becoming less and less ambitious and would result in it taking until 2029 to achieve a pre–summer recess publication rather than the 2025–26 financial year it previously committed to.49 Given the scale of work that will be required to integrate NHS England into the departmental accounts following NHS England’s abolition, the accounts production and audit process will need to be carefully planned otherwise timelines could slip further back.
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Government response AI summary
The government agrees with the recommendation to lay accounts earlier, outlining a multi-year plan to incrementally bring forward publication despite significant capacity challenges in private sector audit firms, and will provide further details on this plan in September 2025.
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HM Treasury
30
Conclusion
25th Report - DHSC Annual Report and Ac…
Acknowledged
The Department published its 2023–24 accounts on 17 December 2024, five months after the summer Parliamentary recess deadline. The Department has reported that there continues to be significant challenges in bringing the laying of its accounts back to a pre–summer recess timetable.50
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The Department published its 2023–24 accounts on 17 December 2024, five months after the summer Parliamentary recess deadline. The Department has reported that there continues to be significant challenges in bringing the laying of its accounts back to a pre–summer recess timetable.50
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Government response AI summary
The government agrees with the committee's observation and highlights its existing multi-year plan to return to a pre-recess timetable, stating it will provide further details on the plan and risks to the Committee in September 2025.
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HM Treasury
31
Conclusion
25th Report - DHSC Annual Report and Ac…
Acknowledged
The delays to the accounts were the result of challenges in preparing the accounts of UKHSA and delays in completion of local NHS audits.51 UKHSA was subject to a disclaimed audit opinion in 2021–22 and 2022–23, with significant remedial work being required to complete the 2023–24 accounts, causing delays. NHS …
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The delays to the accounts were the result of challenges in preparing the accounts of UKHSA and delays in completion of local NHS audits.51 UKHSA was subject to a disclaimed audit opinion in 2021–22 and 2022–23, with significant remedial work being required to complete the 2023–24 accounts, causing delays. NHS England and the Consolidated NHS 47 Committee of Public Accounts, Thirty–First Report of Session 2023–24, Department of Health and Social Care 2022–23 Annual Report and Accounts, HC 459, 10 May 2024 48 HM Treasury, Dear Accounting Officer letter, Accounts Directions 2023–24, 14 December 2023 49 Committee of Public Accounts, Thirty–First Report of Session 2023–24, Department of Health and Social Care 2022–23 Annual Report and Accounts, HC 459, 10 May 2024 50 Report by the Comptroller and Auditor General, Department of Health and Social Care Annual Report and Accounts 2023–24, page 3; Department of Health and Social Care Annual Report and Accounts 2023–24, page 138 51 Department of Health and Social Care Annual Report and Accounts 2023–24, HC 476, 17 December 2024, page 138 21 Provider Accounts rely on the individual audits of 42 NHS Commissioners and 211 NHS providers respectively, which are incorporated into their own group accounts.52
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Government response AI summary
The government agrees with the committee's observation, detailing its multi-year plan to accelerate accounts publication, while noting dependency on private sector audit firms. It commits to providing further plan details to the Committee in September 2025.
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HM Treasury
32
Recommendation
25th Report - DHSC Annual Report and Ac…
Deferred
NHS England set a deadline of 28 June 2024 for the completion of the financial audits of NHS Commissioners and NHS Providers. Almost a fifth (18.0%) of NHS Providers and a tenth (9.5%) of NHS Commissioners missed the 28 June 2024 deadline.53 The previous Committee called on the Department to …
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NHS England set a deadline of 28 June 2024 for the completion of the financial audits of NHS Commissioners and NHS Providers. Almost a fifth (18.0%) of NHS Providers and a tenth (9.5%) of NHS Commissioners missed the 28 June 2024 deadline.53 The previous Committee called on the Department to strengthen its governance and financial controls and set out a clear plan to restore timely accountability across its group and improve its financial reporting.54 The C&AG reported that the Department’s timetable for completion of the NHS provider and ICB audits will need to be significantly advanced, and the remaining weaknesses in the UKHSA control environment will need to be addressed, to meet its target of a pre–summer recess sign–off by 2026–27.55
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Government response AI summary
The government agrees to strengthen governance and financial controls to restore timely accountability and improve financial reporting, outlining a multi-year plan to incrementally bring forward publication of its Annual Report and Accounts, with further details to be provided in September 2025.
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HM Treasury
33
Recommendation
25th Report - DHSC Annual Report and Ac…
Accepted in Part
We asked the Department and NHS England why so many NHS commissioners and NHS providers missed the deadline for completing their financial audits, and what it was doing to ensure that this improved. NHS England recognised that the number of organisations who were meeting the June deadline was lower than …
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We asked the Department and NHS England why so many NHS commissioners and NHS providers missed the deadline for completing their financial audits, and what it was doing to ensure that this improved. NHS England recognised that the number of organisations who were meeting the June deadline was lower than before the COVID–19 pandemic, but told us that this was improving. It told us that one of the reasons for the delays was “definitely the overall pressure on the local audit market” and the trade–off audit firms were making between undertaking local authority accounts and NHS accounts. It told us that “there are no systemic problems” with NHS bodies that were contributing to delays, and that it expected to see continual improvement.56
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Government response AI summary
The government agrees with the recommendation to improve audit timeliness and outlines a multi-year plan to return to pre-recess laying of annual reports. It is working with stakeholders to build capacity and resilience in the local audit market but acknowledges a dependency on private sector …
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HM Treasury
34
Recommendation
25th Report - DHSC Annual Report and Ac…
Deferred
In September 2024, the Department told us that its aim was to lay its accounts in Parliament at least a month earlier each year and that its target was to reach a pre–summer recess laying for the 2026–27 financial year.57 Given the issues within local authority audit, we asked NHS …
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In September 2024, the Department told us that its aim was to lay its accounts in Parliament at least a month earlier each year and that its target was to reach a pre–summer recess laying for the 2026–27 financial year.57 Given the issues within local authority audit, we asked NHS England whether it was working with the Ministry of Housing, Communities 52 UKHSA Annual Report and Accounts 2023–24, HC 427, 16 December 2024, page 154–155; NHS England Annual Report and Accounts 2023–24, page 178; Consolidated NHS Provider Accounts 2023/24, page 48 53 NHS England Annual Report and Accounts 2023–24, HC 251, 10 October 2024, page 124; Consolidated NHS Provider Accounts 2023/24, HC 399, 26 November 2024, page 45 54 Committee of Public Accounts, Thirty–First Report of Session 2023–24, Department of Health and Social Care 2022–23 Annual Report and Accounts, HC 459, 29 April 2024, paragraph 3 55 Department of Health and Social Care 2022–23 Annual Report and Accounts, HC 459, 29 April 2024, page 239 56 Qq 64–65 57 Treasury Minutes, Government Response to the Committee of Public Accounts on the Twenty-sixth to the Twenty-ninth, the Thirty-first, and the Thirty-third to the Thirty-eighth reports from Session 2023–24, CP 1151, September 2024, page 16, paragraph 2.2. 22 and Local Government (MHCLG) to improve the position of local audit in future and help prevent delays. NHS England told us that it was working with MHCLG, the Department, and the NAO to make sure that future audit arrangements were sustainable for both the NHS and local authorities. The Department and NHS England told us they were closely linked to the MHCLG consultation process on reforms to the local audit market and that their views, concerns, and requirements had been taken into account. The Department emphasised, though, that moving towards pre–summer recess certification would require a sizable change in the capacity of the local audit market. NHS England told us, however, that there was no firm timeframe of w
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Government response AI summary
The government agrees with the recommendation to achieve timely laying of accounts and addresses the need to improve local audit, outlining a multi-year plan to incrementally bring forward publication, and will provide further details on this plan in September 2025.
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HM Treasury