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 …
Government response. 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 …
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 …
Government response. 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 …
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 …
Government response. 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 …
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 …
Government response. 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 …
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 …
Government response. 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.
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
Government response. 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.
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 …
Government response. 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 …
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 …
Government response. 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.
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 …
Government response. 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 …
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 …
Government response. 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 …
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 …
Government response. 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 …
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 …
Government response. 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.
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 …
Government response. 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.
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 …
Government response. 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.
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. …
Government response. 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 …
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 …
Government response. 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 …
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 …
Government response. 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 …
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 …
Government response. 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.
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, …
Government response. 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.
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 …
Government response. 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, …
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 …
Government response. 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 …
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 …
Government response. 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 …
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 …
Government response. 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.
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 …
Government response. 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.
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 …
Government response. 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.
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: …
Government response. 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.
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 …
Government response. 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.
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 …
Government response. 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.
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, …
Government response. 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.
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
Government response. 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.
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 …
Government response. 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.
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 …
Government response. 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 …
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 …
Government response. 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 …
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 …
Government response. 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.
HM Treasury