Underinvestment in Primary Prevention

#14 —

Health and Social Care Committee

Recommendation: As part of its national health and care recovery plan, we recommend that the Government sets out the contribution that public health services will make, and ensures that this contribution is backed with a level of funding that acknowledges their …

Gov response: Partially accept. The Government recognises the crucial importance of effective public health services in supporting local populations, and the negative impact that the pandemic has had on health inequalities. Public health services are vital in …

Under Consideration

#24 — Overall NHS productivity remains low despite increased elective activity and community investments.

Public Accounts Committee

Recommendation: Despite carrying out 15% more elective activity than before the pandemic, the NHS is less productive overall once the activities of mental health trusts, community trusts and GPs are considered.42 NHSE told us that, while government has had a long-term …

Gov response: 6.2 NHS investment in primary medical care and community services (including continuing care) increased faster than overall ICB spend in 2023-24. 6.3 DHSC and NHSE have prioritised mental health in its plans for 2025-26, requiring …

Not Addressed

#22 — Inadequate definition and tracking of prevention spending impedes accurate assessment of policy progress.

Public Accounts Committee

Recommendation: Currently, NHSE does not even track spend and activity on prevention by ICBs at local levels, due to unavailability of data and the lack of consistency about what counts as prevention spending. While DHSC funds some prevention activities that sit …

Gov response: 5.4 Prevention is one of the 'three shifts' the Secretary of State has set out as strategic ambitions for the health systemin England. Measures for supporting the prevention shift are being considered in context of …

Not Addressed

#21 — DHSC believes prevention requires cultural and legislative change, not solely additional resource allocation.

Public Accounts Committee

Recommendation: DHSC told us it did not view providing more resources, or redirecting them from elsewhere, as a substantive part of the solution to the lack of progress with prevention. Instead, it considers that a shift towards prevention might be achieved …

Gov response: 5.4 Prevention is one of the 'three shifts' the Secretary of State has set out as strategic ambitions for the health systemin England. Measures for supporting the prevention shift are being considered in context of …

Not Addressed

#20 — Progress on health prevention hindered by acute care focus and reduced public health grants.

Public Accounts Committee

Recommendation: Senior ICB leaders reported to the National Audit Office a continued lack of progress with the government’s long-standing aim to move towards preventing ill health rather than treating it. One of the most important reasons cited by ICBs has been …

Gov response: 5.4 Prevention is one of the 'three shifts' the Secretary of State has set out as strategic ambitions for the health systemin England. Measures for supporting the prevention shift are being considered in context of …

Not Addressed

#13 — DHSC acknowledges long-term healthcare shifts but prioritises immediate acute service pressures.

Public Accounts Committee

Recommendation: DHSC and NHSE told us that they were fully supportive of the new government’s aims to shift healthcare spending from treatment towards prevention, from hospitals to the community, and from analogue to digital. However, DHSC contended that these shifts would …

Gov response: 2.2 The underlying financial position of the NHS providers and systems is significantly improved in 2024-25 compared to 2023-24 with an end of year deficit of around £600 million compared to £1.5 billion in the …

Not Addressed

#6 — Ensure greater NHSE funding for community services, preventing redirection to hospitals.

Public Accounts Committee

Recommendation: NHSE’s long-held ambition to move more care from hospitals to the community has stalled. There would have been more investment and progress in mental health and community services, particularly GP surgeries and dental services, in 2023–24 had NHSE not redirected …

Gov response: The government is considering this recommendation. care) increased faster than overall ICB spend in 2023-24. DHSC and NHSE have prioritised mental health in its plans for 2025-26, requiring ICBs to meet the Mental Health Investment …

Under Consideration

#5 — Define government health prevention spending and increase flexible funding for local systems.

Public Accounts Committee

Recommendation: Given the constraints on public spending, it is highly likely that re- focusing attention from sickness to prevention cannot be achieved without re-allocating existing NHS funds in the same direction. Senior ICB leaders report a continued lack of progress with …

Gov response: The government is considering this recommendation. ambitions for the 10 Year Health Plan. Funding for 2026-27 onwards will be determined following Spending Review Phase 2 and will be aligned to support the delivery of the …

Under Consideration

#12 — Government commits to preventative oral healthcare measures including supervised toothbrushing and water fluoridation

Public Accounts Committee

Recommendation: The new government’s commitment to contract reform includes reference to a focus on prevention,27 and also to a programme of supervised toothbrushing for three, four, and five–year olds “most in need”.28 Tooth decay is a leading cause of hospital admissions …

Gov response: 1.8 The government agrees with the Committee’s recommendation. Recommendation implemented: December 2024 1.9 The Plan for Change has already set out the government’s commitment to addressing the main underlying drivers of ill-health and tackling persistent …

Accepted

#14 — Spending shifts from preventative to late intervention services, increasing later costs and worsening outcomes.

Public Accounts Committee

Recommendation: MHCLG recognises the importance of investing in prevention but also the challenge of funding it when finances are constrained.34 Preventative services help stop, delay or reduce the need for statutory services and can help to deliver better outcomes.35 Over the …

Gov response: 3.1 The government agrees with the Committee’s recommendation. Recommendation implemented 3.2 As outlined in HM Treasury’s Permanent Secretary’s letter to the Committee on 7 August 2025, the government’s approach to public sector reform is informed …

Accepted

#11 — Prioritise funding and support for local preventative services to reduce acute service demand.

Housing, Communities and Local Government Committee

Recommendation: The Ministry must prioritise funding and support for local preventative services to fix the foundations, reduce the demand for acute services, and bring down costs in the longer term. (Recommendation, Paragraph 50)

Gov response: 40. At autumn Budget 2024, the Government set aside funding to support the public sector with the additional cost of employer National Insurance Contributions (NICs). The total support funding for the whole of the public …

Under Consideration

#10 — Temporary central government funding is required to rebuild damaged preventative services.

Housing, Communities and Local Government Committee

Recommendation: Rebuilding and strengthening damaged preventative services will require temporary increases in central government funding before the demand for acute services starts to drop. (Conclusion, Paragraph 49)

Gov response: 38. The New Burdens Doctrine exists to ensure that where central government places new statutory duties or instructs changes in how existing responsibilities must be delivered, local authorities are properly funded. The Government has explored …

Under Consideration

#14 — Fund urgent research into FGM reconstructive surgery effectiveness, with NHS provision if proven beneficial.

Women and Equalities Committee

Recommendation: The Government should facilitate and fund research into the effectiveness of reconstructive surgery for FGM survivors as a matter of priority. If evidence indicates that the surgery is effective, then the NHS should provide it. (Recommendation, Paragraph 44) Estimating the …

Gov response: We agree this is an important area of research and are in the process of taking the recommendation forward. The National Institute for Health and Care Research (NIHR) is developing a call in this area …

Accepted

#13 — Government obstructs FGM reconstructive surgery by failing to fund necessary research.

Women and Equalities Committee

Recommendation: Many women who have undergone FGM seek reconstructive surgery to reverse FGM as far as possible. It is clear that the NHS is equipped to perform this surgery as it delivers it for other medical conditions. We acknowledge that the …

Gov response: We agree this is an important area of research and are in the process of taking the recommendation forward. The National Institute for Health and Care Research (NIHR) is developing a call in this area …

Accepted

#73 — Refocus High Needs Block funding towards early intervention and identification in mainstream settings.

Education Committee

Recommendation: The High Needs Block should be refocused to enable and incentivise earlier intervention. Currently, a significant proportion of this funding is directed towards supporting high-cost, specialist provision once needs have escalated. While such provision is vital for some, a more …

Gov response: Supporting children with SEND is central to the early years agenda. The government recognises the important role the early years sector plays in early intervention to ensure the right support is put in place for …

Partially Accepted

#72 — Prioritise strategic funding deployment for early intervention in SEND to improve outcomes.

Education Committee

Recommendation: Funding must be strategically deployed to deliver the best outcomes for children and young people with SEND. This should include prioritised investment in early intervention. Timely and targeted support is essential 170 and can prevent some needs such as speech …

Gov response: Supporting children with SEND is central to the early years agenda. The government recognises the important role the early years sector plays in early intervention to ensure the right support is put in place for …

Accepted

#32 — Increase government support for grassroots initiatives enabling Muslim women's participation in social activity.

Women and Equalities Committee

Recommendation: The Government should increase its support for community-led grassroots initiatives aimed at supporting Muslim women and girls to participate in social activity. (Recommendation, Paragraph 118) 54

Gov response: 85. The Government recognises the importance of community-led initiatives in fostering social cohesion and bringing people together. By supporting locally driven programmes we aim to strengthen community connection and cohesion to build resilience. These initiatives …

No Published Response

#13 — Commission community pharmacies to provide HIV-prevention PrEP and all routine adult and child immunisations.

Health and Social Care Committee

Recommendation: In the shorter term, and in light of the large body of evidence and long-running calls for these services to be offered in community pharmacy settings, we recommend that NHS England commissions community pharmacies to provide the HIV-prevention medication PrEP …

Gov response: This Government inherited a system that has been neglected for too long. We are committed to exploring opportunities to make use of technology as we look to develop and support our NHS in line with …

Partially Accepted

#13 —

Health and Social Care Committee

Recommendation: The pandemic has had a negative impact on health inequalities and highlighted the crucial importance of effective public health services in supporting local populations. Public health services are therefore vital allies in tackling the backlog, and we are surprised at …

Gov response: Partially accept. The Government recognises the crucial importance of effective public health services in supporting local populations, and the negative impact that the pandemic has had on health inequalities. Public health services are vital in …

Under Consideration

#24 — Diagnostics require further investment and greater integration across the entire health system.

Public Accounts Committee

Recommendation: 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 …

Gov response: 4.1 The government agrees with the Committee’s recommendation. Target implementation date: Spring 2027 4.2 The government is working to fulfil Outcome 6 of the NAP, which commits to cross- sector working to develop diagnostics as …

Accepted

#5 — Pensioners face increased health risks and unsustainable care demand without a preventative, whole-system approach

Work and Pensions Committee

Recommendation: As pensioners are generally on a fixed income, they face challenges responding to cost-of-living increases. Those on low incomes are likely to respond by cutting back on food, energy use and social interactions, adding to existing health risks. Various social …

Gov response: The Government recognise that pensioner poverty is often the result of compounding disadvantages that start long before retirement which is why state support is provided accordingly. For example, we have increased the National Living Wage …

Accepted

#26 —

Culture, Media and Sport Committee

Recommendation: We recommend that the Government make physical education a core subject within the national curriculum. (Recommendation, Paragraph 76)

Response Pending

#2 —

Culture, Media and Sport Committee

Recommendation: We recognise the pressures on the public finances. Investing in sport, however, by creating a more active population, will eventually lead to significant savings, particularly in the health and welfare budgets. We recommend that the Government increase the 0.3% (£3.8 …

Response Pending

#1 —

Culture, Media and Sport Committee

Recommendation: The evidence shows that funding community sport and physical activity is an investment with high returns, including savings on healthcare costs, productivity gains, and wider wellbeing benefits. The consequences of under‑investment are costly. Ageing infrastructure, higher operating costs, and reduced …

Response Pending

#1 —

Housing, Communities and Local Government Committee

Recommendation: The failure to properly fund children’s and adult social care, especially adult social care, is the single biggest threat facing local government financial resilience. Given that the cost of providing social care consumes between 60% and 70% of the budgets …

Gov response: Since the start of the pandemic, we have committed over £12 billion in financial support to councils to tackle the impacts of COVID-19, including over £6 billion of un-ringfenced grants (£4.6 billion for 2020/21 and …

Under Consideration

#8 —

Public Accounts Committee

Recommendation: We are also concerned about the lack of progress on preventing ill-health rather than simply treating it.17 There also do not appear to be effective joint working arrangements between different government departments to tackle the causes of ill-health.18 The Department …

Not Addressed

#24 — Investment in research for drivers of substance misuse behaviours remains inadequate

Public Accounts Committee

Recommendation: Dame Carol and Ms Wiseman told us that there was little investment in research into the behaviours and factors that lead to substance misuse.80 The JCDU pointed to the £5 million investment in the ‘innovation fund’ which is looking at …

Gov response: 6.1 The government agrees with the Committee’s recommendation. Target implementation date: April 2025 6.2 The Drug Strategy highlighted the need to build the evidence in the initial phase to support the government’s thinking on what …

Accepted

#3 — Ensure RSHE teachers receive training and deliver comprehensive reproductive health education early

Women and Equalities Committee

Recommendation: The Government should ensure teachers tasked with delivering the menstrual and gynaecological health element of RSHE receive the training necessary to deliver it effectively. Information on women’s reproductive health conditions should be taught early on in secondary education, preferably around …

Gov response: We must ensure high-quality health information and signposting is available for everyone across the country. We know that many women access health information through online sources, including the NHS website and social media, as well …

Under Consideration

#2 — Revise draft RSHE guidance on menstrual health due to insufficient and late teaching

Women and Equalities Committee

Recommendation: However, we are concerned that the teaching of the menstrual health element of relationships, sex and health education is insufficient and inconsistent. It is often delivered too late in a child’s development to be of use and by teachers who …

Gov response: We agree that all students, including both girls and boys, should receive comprehensive education on menstrual health, and that all girls and women should be informed on what a ‘normal’ period is. Relationships, sex and …

Not Addressed

#23 — NHSE's top-down guidance significantly hinders local health systems' intended resource allocation autonomy.

Public Accounts Committee

Recommendation: Local areas would value more flexibility about where they can direct their resources to achieve greatest impact, including how they fund measures to prevent ill health. ICBs were supposed to have greater autonomy in determining how to allocate resources locally …

Gov response: 5.11 The department and NHSE recently announced changes to the NHS operating model to move power from the health centre to local leaders. In keeping with this change, 2025-26 Operational Planning Guidance removed many ringfences, …

Accepted

#6 — Government lacks consistent cross-departmental strategy for older people, conflicting with preventative health goals

Work and Pensions Committee

Recommendation: The Government says it is taking a cross-department approach to address the challenges faced by older people. We were interested in arguments that it would help to have a strategy where the Government set out its objectives for older people …

Gov response: The Government recognise that pensioner poverty is often the result of compounding disadvantages that start long before retirement which is why state support is provided accordingly. For example, we have increased the National Living Wage …

Not Addressed

#66 — Declining adult education funding threatens efforts to upskill workforce and achieve social goals

Education Committee

Recommendation: Funding for adult education and skills has declined sharply since the early 2000s, particularly in classroom-based learning. The Government’s reduction in adult education funding for 2025–26 will further undermine efforts to upskill the existing workforce and to support those who …

Gov response: UNDER REVIEW Skills England will play a key role in supporting informed decisions on funding priorities by providing timely, relevant and high-quality data and analysis. As outlined in Skills England’s recently updated remit letter, this …

Not Addressed

#19 — Restore dedicated ring-fenced funding for maternity care Service Development Fund to £95 million.

Health and Social Care Committee

Recommendation: We strongly recommend that the Government restore the dedicated ring- fenced funding for the Service Development Fund for maternity care to £95 million. Properly targeted we believe this investment has the potential to reduce the substantial cost of maternity negligence …

Gov response: This government has instructed the NHS to improve maternity services, as part of a drive to improve quality, as a priority in the Medium Term Planning Framework. Maternity funding has not been cut. The same …

Not Accepted

#39 —

Culture, Media and Sport Committee

Recommendation: Sport and physical activity remain underrecognised within national health policy, despite strong evidence of their value for prevention, wellbeing and the management of longterm conditions, and despite the Government’s stated support. While England is regarded as a leader in social …

Response Pending

#25 —

Culture, Media and Sport Committee

Recommendation: We recommend that the Government require schools to have a policy to give every child the opportunity to achieve at least 60 minutes of physical activity a day. We further recommend that the Government set clear expectations for activity to …

Response Pending

#9 —

Culture, Media and Sport Committee

Recommendation: We were concerned about reports that the Department for Health and Social Care (DHSC) had sought to renege on commitments to provide funding for physical education. Given the importance of PE and sport to improving health outcomes, and the potential …

Response Pending

#71 —

Environmental Audit Committee

Recommendation: To increase education on biodiversity we: a) Support the establishment of a Natural History GCSE; b) Recommend the Department for Education re-evaluate the opportunities for nature visits and teaching outside, as part of its support to schools recovering from the …

Gov response: (31a) The Department for Education (DfE) is exploring the option of introducing a new GCSE in Natural History after receiving a proposal from exam board OCR. Initial discussions with OCR have taken place. DfE, and …

Not Addressed

#70 —

Environmental Audit Committee

Recommendation: For biodiversity to be protected, it has to be appreciated and valued. But our increasing detachment from nature stops many of us knowing and directly experiencing it. This starts at a young age; children are spending less and less time …

Gov response: (31a) The Department for Education (DfE) is exploring the option of introducing a new GCSE in Natural History after receiving a proposal from exam board OCR. Initial discussions with OCR have taken place. DfE, and …

Not Addressed

#34 —

Health and Social Care Committee

Recommendation: We again recommend that a duty be placed on ICBs for them to have regard to mental health and public health. (Paragraph 128) Clearing the backlog caused by the pandemic 39

Gov response: The Government agrees that it is important that ICBs have regard to mental health and public health. The Health and Care Act 2022 places a duty on ICBs to have regard to the need to …

Under Consideration

#4 —

International Development Committee

Recommendation: Nutrition is a keystone investment. It builds resilience in health, improves education outcomes and strengthens the economy through labour market participation. Moreover, investing in it represents very real value for money

Gov response: FCDO should focus education spending on the most impactful programmes for poverty reduction, particularly early years and primary education. All programmes should be disability inclusive, recognising the additional barriers disabled children face when accessing education. …

Accepted

#40 — DHSC's neglect of long-term NHS sustainability led to a record maintenance backlog.

Public Accounts Committee

Recommendation: This committee has highlighted many times in the years since 2016 that DHSC has focused on short-term survival of NHS services, while neglecting long-term sustainability, 78 Qq 49–51 79 Q 94 80 Q 91; C&AG’s Report, para 4.2 81 C&AG’s …

Gov response: 8.1 The government agrees with the Committee’s recommendation. Recommendation implemented 8.2 The government recognises the importance of capital investment in the NHS and the role it plays in an effective and productive healthcare system. The …

Accepted

#18 — Reduced Maternity Service Development Fund risks widening disparities and compromising critical reforms.

Health and Social Care Committee

Recommendation: We are concerned by the Government’s decision to cut the Maternity Service Development Fund from £95 million to £2 million. While ICBs still have access to this funding, maternity services must now compete with other local priorities. While performance metrics …

Gov response: This government has instructed the NHS to improve maternity services, as part of a drive to improve quality, as a priority in the Medium Term Planning Framework. Maternity funding has not been cut. The same …

Not Accepted

#24 —

Culture, Media and Sport Committee

Recommendation: We recommend that the Government strengthen the national curriculum by confirming that as part of the new approach to school sport announced in June 2025, a minimum of two hours of high‑quality PE each week will be mandatory. (Recommendation, Paragraph …

Response Pending

#3 —

Culture, Media and Sport Committee

Recommendation: Year on year, we continue to see persistent gaps in activity levels between different demographics. This issue has been exacerbated by the Covid-19 pandemic and certain groups in society continue to be disproportionately impacted. We acknowledge the support provided through …

Gov response: The Government agrees with the intentions of the recommendation in the importance of providing funding for tackling inequalities in participation. The Government has already provided a significant amount of funding in this area as set …

Accepted

#2 —

Culture, Media and Sport Committee

Recommendation: The proportion of children and young people not achieving the minimum amount of daily activity recommended by the Chief Medical Officer is of significant concern. Before the end of this year, the Government should initiate a nation-wide communications campaign, similar …

Gov response: The Government agrees with the committee that it is important to encourage children and young people to engage in regular physical activity and intends to look further at this in our refreshed sport strategy. We’ve …

Accepted

#1 —

Culture, Media and Sport Committee

Recommendation: The impact of successive lockdowns on activity levels was not as bad as initially feared but the Committee is concerned about the consequences of the final lockdown from December 2020 onwards which has not yet been covered by an Active …

Gov response: The Government agrees with the intent behind this recommendation to encourage participation in organised sport, however it believes that the focus should be on allowing exercise and investing heavily to ensure community facilities are there, …

Accepted

#18 —

International Development Committee

Recommendation: Consequently, the FCDO should continue to fund programmes which tackle nutrition challenges, such as stunting within Pakistan, especially amongst girls.

Gov response: Response: The UK are convenors of the Health, Population, and Nutrition Development Partners Group in Pakistan, and in this role we facilitate health sector policy coordination between donors, multilateral agencies and NGOs, including on nutrition …

Accepted

#23 — Set out details and funding for five-year consumer education on healthy food choices

Environment, Food and Rural Affairs Committee

Recommendation: Better informing consumers about healthy, and unhealthy, food to help them to make the right choices is without doubt an important measure, and we welcome Government steps in this regard. Individuals should take responsibility for their food consumption and make …

Gov response: The Government agrees with the need for policy coherence and for strong leadership on food- related issues. Food supply is one of the UK’s 13 Critical National Infrastructure sectors. Defra and the Food Standards Agency …

Accepted

#41 — Under-investment in NHS capital impedes productivity and compromises modern healthcare environment standards.

Public Accounts Committee

Recommendation: In written evidence, the NHS Confederation also highlighted to us that the NHS was suffering because of the under-investment in capital. It said this was hampering productivity and efficiency at a time when record numbers of adults were unable to …

Gov response: 8.1 The government agrees with the Committee’s recommendation. Recommendation implemented 8.2 The government recognises the importance of capital investment in the NHS and the role it plays in an effective and productive healthcare system. The …

Not Addressed

#5 — Introduce a system-wide and Government-wide commitment to trauma-informed practice in Northern Ireland.

Northern Ireland Affairs Committee

Recommendation: There is a correlation between paramilitary activity, deprivation, mental health issues and trauma. We therefore support the trauma-informed and public health approach of the Tackling Paramilitarism Programme. The Government must collaborate with the Executive to introduce forthwith a system-wide and …

Gov response: The EPPOC promotes the adoption of a trauma-informed approach across all systems, organisations, policies and services in Northern Ireland. A report on Implementing trauma informed approaches in NI, which was funded by the Programme and …

Accepted