Recommendations & Conclusions
41 items
2
Recommendation
30th Report - Antimicrobial resistance:…
Accepted
Government has missed most of the targets in the 2019–24 National Action Plan (NAP) and the ambition of the new targets is much more modest. While the government previously set targets for reductions of 50% in Gram-negative bloodstream infections1 and 10% in drug-resistant infections, the 2024–29 NAP targets are only …
Government response. The government agreed and stated it already conducts biannual formal reporting and annual reviews of AMR targets, with analysis of surveillance trends and expert advice informing potential revisions to ambition. New sector-specific targets for livestock are also expected in late …
HM Treasury
3
Recommendation
30th Report - Antimicrobial resistance:…
Accepted
Government has not been sufficiently transparent about what it is achieving against its AMR targets and commitments. Only one of the five domestic targets in the 2019–24 NAP was achieved, relating to reducing the use of antibiotics in food-producing animals. The other four, relating to reducing numbers of infections, reducing …
Government response. The government agreed and stated it has established a new process for assessing chronic risks, publishing the Chronic Risks Analysis in July 2025 alongside the Resilience Strategy. The Cabinet Office will publish an updated analysis before the end of this …
HM Treasury
4
Recommendation
30th Report - Antimicrobial resistance:…
Accepted
DHSC has made slow progress in implementing diagnostic tools that could help reduce AMR. Inappropriate prescribing of antibiotics in primary care is estimated to be around 20% of antibiotic prescriptions, which is too high and could drive AMR. ‘Inappropriate’ includes prescribing antibiotics or other antimicrobials when they are unnecessary (for …
Government response. The government commits to several actions, including an infection diagnostics framework by 2027, producing a rapid review pipeline, and scoping pilot schemes for point-of-care tests under Pharmacy First to launch in Q3 2025-26 and report in 2026-27. It also highlights …
HM Treasury
5
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
Addressing the threat of AMR should be a core part of all of the NHS’s work, including the fundamentals that reduce the spread of infection. Infection prevention and control measures, such as good hygiene practices, aseptic techniques and high standards of cleanliness, are vital for reducing AMR infections in the …
Government response. The government agrees to use the modular ward to generate evidence, inform hospital design, enhance existing guidance, and deliver training for infection prevention and control specialists. This ongoing work, including studying environmental reservoirs of AMR and informing the New Hospital …
HM Treasury
6
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
It is vital that government keeps up to date with scientific developments that might help tackle the threat of AMR. Research can help identify better ways of mitigating AMR and treating those with AMR infections, including through the use of artificial intelligence, genomic sequencing, and vaccinations. DHSC and UKHSA fund …
Government response. The government states the recommendation is implemented, detailing how it invests over £88 million in AMR research through NIHR, funds biosecurity capabilities, and supports various research units and initiatives. It also highlights how NHSE publishes monthly AMR evidence bulletins and …
HM Treasury
7
Recommendation
30th Report - Antimicrobial resistance:…
Accepted
The government deserves credit for introducing an antibiotic subscription model, and it now needs to evaluate its impact on the usage of antibiotics and pharmaceutical companies’ efforts to bring new antibiotics to the market. The UK was one of the first countries to develop a subscription model, under which pharmaceutical …
Government response. The government commits to encouraging other countries to adopt an antibiotic subscription model through forums like the G7 and G20 and by sharing UK learnings. It has commissioned an evaluability assessment from July 2025 to early 2026, which will inform …
HM Treasury
8
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
Mismanagement of wastewater and sewage is a serious public health concern and heightens the threat of AMR. Storm overflows involve sewage getting into waterways such as rivers. They increase the prevalence and diversity of resistant pathogens in the environment and are a serious public health concern. In 2016, 862 storm …
Government response. Defra commits to providing a full response via a White Paper in Autumn 2025, outlining its approach to embedding public health across the water system and addressing public health goals. It highlights ongoing research on AMR in sewage sludge, with …
HM Treasury
9
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
There are shortcomings in data collection and sharing, hindering efforts to tackle AMR. The UK government operates a ‘One Health’ approach to AMR, encompassing human health, animal health, food safety and the environment, and intended to facilitate collaboration between these sectors. However, there are significant gaps in the collection of …
Government response. The government agrees to prioritize better data collection and sharing, highlighting that UKHSA launched a new data dashboard in February 2025 with further AMR indicators to be uploaded by Autumn 2025. It also commits to developing a joint data strategy …
HM Treasury
1
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care (DHSC), NHS England, the UK Health Security Agency (UKHSA) and the Veterinary Medicines Directorate (VMD) at the Department for Environment, Food and Rural Affairs (Defra) on the …
Government response. The government states the "recommendation is implemented", outlining its existing efforts to tackle AMR, including the 2024-29 UK National Action Plan, driving international action through UNGA and trade agreements, and ensuring AMR is captured as a chronic risk on the …
HM Treasury
10
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
We asked DHSC about whether AMR should be a component of trade negotiations. DHSC told us that the UK starts from a position of wanting to minimise the risk of antibiotic contamination of food and antibiotic-resistant organisms entering the UK market via food and that some countries use a lot …
Government response. The government states the recommendation is "implemented" and explains that AMR measures are already secured in recent trade agreements, departments contribute to negotiations, and new FTAs are assessed to ensure consistency with UK statutory protections related to AMR.
HM Treasury
15
Recommendation
30th Report - Antimicrobial resistance:…
Accepted
We asked VMD whether the targets set for animal health in the 2019–24 NAP were challenging enough given that they were successfully achieved. VMD acknowledged that while reaching the targets was a big success, it also considered that this was a result of some “quick wins”.38 The 2024–29 NAP does …
Government response. The government accepts the recommendation, outlining processes for monitoring and reviewing human health targets by Winter 2025, and stating that VMD will incorporate new, ambitious sector-specific targets for animal health by late 2025 if sufficiently challenging.
HM Treasury
17
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
The 2019–24 NAP’s commitments were tracked internally, and the government has not published information on its progress across all of its commitments.44 While some data on the 2019–24 NAP’s quantitative targets is available through publications by UKHSA and Defra, this information has not been brought together in one publication and …
Government response. The government agrees and commits to publishing a short annual report by Autumn, summarising progress against the 2024-2029 National Action Plan for AMR, building on existing data publications by UKHSA and VMD.
HM Treasury
18
Recommendation
30th Report - Antimicrobial resistance:…
Accepted
The government categorises AMR as one of 26 ‘chronic’ risks facing the UK, which means that it poses a long-term, continuous challenge to the UK, as opposed to an ‘acute’ risk which is an immediate threat which may require an emergency response.48 Chronic risks can manifest as acute risks themselves …
Government response. The government agrees, stating that Antimicrobial Resistance (AMR) has been incorporated as a chronic risk in the 2025 National Risk Register and Chronic Risks Analysis, and a new process for identifying and assessing chronic risks has been established by Summer …
HM Treasury
19
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
We also asked DHSC about the UK’s preparedness for addressing the chronic risk of AMR and the possibility of it becoming an acute risk. DHSC told us that the UK has a strong base which would make the initial response positive, however it may be more challenging to scale up …
Government response. The government states AMR has been incorporated into the 2025 National Risk Register and Chronic Risks Analysis, and describes ongoing processes for identifying and assessing chronic risks, including future publications and inter-departmental collaboration.
HM Treasury
20
Recommendation
30th Report - Antimicrobial resistance:…
Accepted
On transparency, the government provided a brief summary of the risk presented by AMR in the National Risk Register 2023 edition.52 In 2024, the government completed an analysis of the 26 chronic risks facing the UK. However, this analysis is currently an internal, classified document and has not been published. …
Government response. The government agrees and confirms that the Chronic Risks Analysis, which includes AMR, was published in July 2025 alongside the Resilience Strategy, aiming to raise public awareness and understanding of chronic risks.
HM Treasury
21
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
Misuse and overuse of antimicrobials in humans can occur when they are prescribed inappropriately. Inappropriate use is when antimicrobials are prescribed when they are unnecessary (such as using antibiotics, which are only effective against bacteria, to treat a viral infection), using the wrong antimicrobials (not prescribing the most suitable one …
Government response. The government agrees with the conclusion, setting a target implementation date of Spring 2027 for related initiatives. They are developing an infection diagnostics framework by 2027, launching point-of-care test pilots in Q3 2025-2026, and exploring rapid laboratory tests to improve …
HM Treasury
22
Recommendation
30th Report - Antimicrobial resistance:…
Accepted
Better use of diagnostic tools can reduce inappropriate prescribing.56 Diagnostic tools are those which can help diagnose what infection a patient has, thereby helping clinicians determine with accuracy whether a patient needs an antimicrobial treatment and, if so, which one.57 For example, diagnostic tests can check whether an infection is …
Government response. The government accepts the recommendation to improve diagnostic tools by Spring 2027, outlining £18 million in research investment, an infection diagnostics framework by 2027, and pilot schemes for point-of-care tests in primary care.
HM Treasury
23
Recommendation
30th Report - Antimicrobial resistance:…
Accepted
The 2019–24 NAP had a target to be able, by 2024, to report on the percentage of prescriptions supported by a diagnostic test or decision support tool. However, this was not achieved due to continuing limitations with data, including diagnostic test results not being recorded digitally, as well as a …
Government response. The government accepts the recommendation to improve diagnostic reporting and availability by Spring 2027, detailing £18 million in research investment, an infection diagnostics framework by 2027, and pilot schemes for point-of-care tests to reduce avoidable antimicrobial use.
HM Treasury
24
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
Lord O’Neill told us that although DHSC and its arm’s-length bodies have done a decent job in some key areas, they have not really progressed diagnostics. He is of the view that diagnostics should be embedded across the entire health system, which would improve productivity as well as addressing AMR.62 …
Government response. The government agrees with the conclusion, setting a target implementation date of Spring 2027 for related diagnostic initiatives. They are developing an infection diagnostics framework by 2027, launching point-of-care test pilots in Q3 2025-2026, and exploring rapid laboratory tests to …
HM Treasury
25
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
NHS England told us that it is more optimistic about the future use of diagnostics. It told us that there would be “an explosion” of point of care diagnostic tests as well as a very bright future for their use once the evidence base is ready. It agreed that it …
Government response. The government agrees with the conclusion, setting a target implementation date of Spring 2027 for related diagnostic initiatives. They are developing an infection diagnostics framework by 2027, launching point-of-care test pilots in Q3 2025-2026, and exploring rapid laboratory tests to …
HM Treasury
26
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
Under the Pharmacy First scheme introduced in early 2024, patients can now consult pharmacists directly for several minor illnesses and conditions that previously required a GP visit and the pharmacist can prescribe medicines if necessary. NHS England commented that early evidence from Pharmacy First was that GPs were following the …
Government response. The government agrees with the conclusion, setting a target implementation date of Spring 2027 for related diagnostic initiatives. They are developing an infection diagnostics framework by 2027, launching point-of-care test pilots in Q3 2025-2026, and exploring rapid laboratory tests to …
HM Treasury
27
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
An essential part of reducing the threat of AMR in humans is the day-to- day work of the NHS in preventing and controlling infections, such as good hygiene practices, aseptic technique and high standards of cleanliness, which can limit the need to use antimicrobials in the first place.67 A lot …
Government response. The government commits to publishing an Infection Prevention and Control (IPC) Workforce and Education Strategy by September 2025, a 10-year workforce plan, and integrating AMR prevention into undergraduate and postgraduate training for those graduating in 2026.
HM Treasury
28
Recommendation
30th Report - Antimicrobial resistance:…
Accepted
We asked about issues with infection prevention and whether some of the basics were not being upheld as much as they should. DHSC said that we should not underestimate how much of the battle against AMR “is really basic things”, including cleaning, handwashing and hospital design. It told us that …
Government response. The government agrees to prioritize infection control by embedding AMR into strategies, publishing an Infection Prevention and Control Workforce and Education Strategy by September 2025, integrating AMR prevention into medical training from 2026, and researching environmental controls and hospital design.
HM Treasury
29
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
A significant obstacle to preventing infections is also the poor condition of the NHS estate.73 Dr Partridge told us that in many hospitals patients are close together and share toilets in facilities that are difficult to clean, and that this increases the risk of infections spreading. He said that in …
Government response. The government agrees with the conclusion, setting a Summer 2026 target. They are embedding AMR in strategies and plans, developing an IPC Workforce and Education Strategy by September 2025, integrating AMR prevention into training for 2026 graduates, and using UKHSA's …
HM Treasury
30
Recommendation
30th Report - Antimicrobial resistance:…
Accepted
Another challenge relates to the NHS workforce. There is a shortfall of professionals in this area, including of medical microbiologists and virologists.77 According to the Royal College of Pathologists, there is a 20% shortfall in consultant medical microbiologists and a 14% shortfall in consultant virologists.78 UKHSA told us that these …
Government response. The government accepts the recommendation to address workforce shortfalls by Summer 2026, outlining plans to prioritise AMR and infection control, publish an IPC Workforce and Education Strategy by September 2025, and integrate AMR prevention into undergraduate and postgraduate medical training …
HM Treasury
31
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
UKHSA has run professional engagement campaigns to try to improve clinicians’ understanding of AMR, however it has struggled to sustain their impact. In 2024, a survey found that only 62% of UK healthcare workers could answer a set of seven key questions on AMR. Improving healthcare professionals’ knowledge on AMR …
Government response. The government commits to publishing an Infection Prevention and Control (IPC) Workforce and Education Strategy by September 2025, a 10-year workforce plan, and integrating AMR prevention into undergraduate and postgraduate training for those graduating in 2026.
HM Treasury
32
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
Taking advantage of scientific research and developments will be very important in addressing the threat of AMR. Research and development can improve tools such as diagnostics to improve prescribing of antimicrobials, as well as producing new antimicrobials and vaccines.82 It can also promote innovative forms of mitigating and treating AMR, …
Government response. The government agrees with the conclusion, stating it is implemented by existing efforts. They detail their commitment to using evidence for AMR policy, including ongoing research funding aligned with NAP priorities, collaboration, and considering international activity, highlighting significant investments and …
HM Treasury
33
Recommendation
30th Report - Antimicrobial resistance:…
Accepted
Another area of research interest is phage therapy, which involves using viruses as antimicrobials to kill bacteria and is less likely to lead to resistance.84 Dr Partridge told us that in his view phage therapy holds great promise as a way of treating infections, but also that there are numerous …
Government response. The government states the recommendation has been implemented, committing over £88 million to AMR research, funding horizon scanning for innovations like phage therapy, and supporting various research units and high-priority AMR trials.
HM Treasury
34
Recommendation
30th Report - Antimicrobial resistance:…
Accepted
Several organisations carry out research on AMR, including DHSC and UKHSA who are responsible for funding some of this research, for example through the National Institute for Health and Care Research (NIHR) which reported that it funded £88 million of AMR research as part of the 2019–24 NAP.87 Much AMR …
Government response. The government agrees with the recommendation and states it is implemented. They commit to ensuring evidence informs AMR policy through ongoing research funding aligned with NAP priorities, public sector collaboration, and considering international activity, detailing significant existing investments and research …
HM Treasury
35
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
As part of the 2019–24 NAP, the government introduced a subscription- based model to pay for antibiotics. Instead of paying pharmaceutical companies based on the quantity of antibiotics used, the model pays out a flat-rate subscription fee.92 The aim of the model is to provide sufficient funding to incentivise pharmaceutical …
Government response. The government agrees to promote its antibiotic subscription model internationally, has commissioned an evaluability assessment from July 2025 to early 2026 to inform a future evaluation, and will publish assessment scores for contracted products from Spring 2026.
HM Treasury
36
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
NHS England estimates that the subscription model will cost £1.9 billion over 16 years. This is a significant investment that requires ongoing monitoring to ensure the benefits can be maximised. The model will be evaluated by the NIHR, which is part of DHSC.94
Government response. The government agrees with the conclusion, setting a Spring 2026 target. They have commissioned an evaluability assessment from July 2025 to early 2026 to inform a future evaluation of the subscription model and will publish assessment scores from Spring 2026 …
HM Treasury
37
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
In particular, it not yet clear whether the subscription model will be effective in driving investment in new antibiotics, especially as the UK makes up only 3% of the global market for antibiotics. When we asked NHS England about this, it told us that it agrees the UK’s subscription model …
Government response. The government agrees and will continue to encourage other countries to implement pull incentives for antibiotics via G7/G20, while also commissioning an evaluability assessment from July 2025 to early 2026 and committing to publish assessment scores for contracted products from …
HM Treasury
38
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
Wastewater is water that has been affected by domestic, commercial or industrial activities, as well as agricultural run-off and hospital waste.96 Sewage is wastewater that contains human waste. Sewage discharges are the release of raw, untreated sewage into waterways such as rivers.97 Metals, biocides, pesticides, and antimicrobial residues can build …
Government response. The government agrees, committing to providing a White Paper in Autumn 2025 in response to the Independent Water Commission's recommendations on public health in water systems and continuing the Chemical Investigations Programme, with further research commissioned by Summer 2026.
HM Treasury
39
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
Storm overflow valves are designed to release water from the sewer network into watercourses and the sea when the volume of water is too high for the system.100 In 2016, 862 storm overflow sites were monitored for spills of untreated sewage, and they averaged 15 spill events each in the …
Government response. The government agrees with the conclusion, setting an Autumn 2027 target. They will publish a White Paper in Autumn 2025 to embed public health in the water system, continue research on AMR and sewage sludge (reporting 2027), and commission further …
HM Treasury
40
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
The 2019–24 NAP contained limited ambitions regarding AMR and the environment, although it was based on a ‘One Health’ approach. An independent evaluation of the 2019–24 NAP by the Policy Innovation and Research Unit was particularly critical of the UK’s management of wastewater, and highlighted a lack of data and …
Government response. The government commits to publishing a White Paper by Autumn 2025 outlining its approach to embedding public health across the water system, continuing the Chemical Investigations Programme (Phase 4 reporting in 2027), and commissioning further research on human health and …
HM Treasury
41
Recommendation
30th Report - Antimicrobial resistance:…
Accepted
We asked DHSC and VMD if they were concerned about the dumping of sewage.105 DHSC noted that there are a lot of storm overflows and that these are one of the main routes by which resistant pathogens get into waterways. It told us that the other main route was through …
Government response. The government agrees to the recommendation to address sewage dumping as a public health issue, stating it will respond to the Independent Water Commission's recommendation for public health to be a statutory objective for water companies via a White Paper …
HM Treasury
42
Recommendation
30th Report - Antimicrobial resistance:…
Accepted
Defra and Ofwat have been working together to determine an investment plan for the water industry, setting expectations to reduce the number of storm overflows by 45% compared with 2021 and to upgrade over 1,700 water treatment works. Defra expects to receive recommendations from 100 House of Commons Library, Sewage …
Government response. The government agrees to the recommendation to improve wastewater management, stating it will provide a full response via a White Paper in Autumn 2025 to the Independent Water Commission's recommendations, including commissioning further research into AMR and wastewater by Summer …
HM Treasury
43
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
The UK government’s ‘One Health’ approach encompasses human health, animal health, food safety, and the environment and is intended to facilitate collaboration between these sectors.108 DHSC commended the very close relationship in the UK between human health experts and vets, something which was not generally the case internationally.109 There are, …
Government response. The government agrees and is implementing actions to strengthen data collection and sharing across One Health sectors, including launching a new UKHSA data dashboard by Autumn 2025, developing a joint data strategy with NHSE, and undertaking novel AMR surveillance pilots …
HM Treasury
44
Recommendation
30th Report - Antimicrobial resistance:…
Accepted
Lord O’Neill told us there is an underlying data problem in the health sphere, with many data systems not connecting properly.111 Better data in health would make it easier for clinicians making decisions on infection management and prescribing antimicrobials. The ability to link the results of diagnostic tests to prescription …
Government response. The government accepts the recommendation, detailing plans to strengthen data collection and sharing across One Health sectors by Autumn 2026, including new data dashboards, joint data strategies, and novel surveillance pilots extending to 2029.
HM Treasury
45
Conclusion
30th Report - Antimicrobial resistance:…
Accepted
There are strong indications that AMR is also a health inequalities issue. The most deprived quintile of the population being nearly 50% more likely to get a drug-resistant bloodstream infection than the least deprived quintile (38.1 people per 100,000 as opposed to 26.7 people per 100,000). Babies, the elderly, patients …
Government response. The government agrees with the conclusion, setting an Autumn 2026 target. They are strengthening data collection, with UKHSA launching a new dashboard in February 2025 and adding more indicators by Autumn 2025, and NHSE developing a joint data strategy with …
HM Treasury
46
Recommendation
30th Report - Antimicrobial resistance:…
Accepted
For the clinical surveillance of animal health, VMD is very reliant on private testing of animals. Some infections of some species are reportable by law but VMD’s access to other data can be difficult.116 VMD told us that its routine surveillance of animals covered only pigs and poultry, which was …
Government response. The government agrees to strengthen data collection and sharing across One Health sectors, including launching new data dashboards, and initiating novel AMR surveillance pilots in healthy animals like dogs, cats, and equines until 2029, alongside ongoing work with private veterinary …
HM Treasury