Recommendations & Conclusions
7 items
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
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
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
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
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
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