Recommendations & Conclusions
19 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
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
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
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