Delivering core NHS and care services during the pandemic and beyond Contents

3Waiting times and managing the backlog of appointments

23.At the start of the pandemic, NHS England & Improvement and the Government rightly prioritised the treatment of individuals showing COVID-19 symptoms and focused their efforts on supporting the extra pressure put on hospitals—ensuring that everybody who needed coronavirus emergency care was able to get it.34 However, with many local NHS services having had to suspend, cancel or otherwise alter the delivery of their services and treatments, there has now been a substantial increase in the number of missed, delayed and cancelled appointments across essential non-COVID related services. This has increased waiting times, the backlog of appointments and pent-up demand for core healthcare services. As a result, Dr Charlotte Augst (Chief Executive, National Voices) told us “avoidable harm is now very clearly happening”. It is right that the restoration of non-COVID related services is now being prioritised: the NHS cannot act exclusively as a “COVID-only” service.

24.During our inquiry, we were told that there has been:

25.Although reductions in the use of health services are likely to have been caused by a combination of factors, throughout our inquiry Presidents of Royal Colleges, senior NHSE/I leaders and others have expressed concern that patients are not accessing NHS services as they fear that in doing so they will be putting themselves at greater risk of catching COVID-19.53

Reduction in elective surgery, mental health services cancer services and dental treatments

26.While the delivery of all health and care services have been significantly reduced during the pandemic. This has particularly been the case for elective surgery, mental health services, cancer treatments and dental treatments.

Elective surgery

27.During the pandemic, elective surgery has been mostly postponed with resources being reallocated to other areas in order to help tackle COVID-19. The Royal College of Surgeons of England told us of their concern that patients that do not receive the surgery that they require in a timely fashion will “suffer from worsening symptoms, deterioration in their condition, greater disability and (in some cases) a significant risk of death”.54

28.The suspension of surgeries has led to many patients living in distress and feeling abandoned. Rob Martinez, an NHS patient who has been unable to receive joint replacement surgery, told us:

The last I heard from [my local hospital] was in March, when they phoned me with the bad news that my operation was being cancelled. I have been told there is zero chance of my first knee replacement being done this year. I was pretty shocked at that, considering that I had an operation date of 15 April this year.

I have ongoing pain in my knees. I have difficulty climbing stairs at home, and anywhere else. I have pain when walking and sleeping. I basically have pain all the time. No medication that I have been on has helped me at all.

I am frustrated and anxious. My family and social life have been affected as well. It is having an impact on my mental health. It is the not knowing. It is as though my whole life is on hold. I am just getting worse, to be honest. I would like to get my life back again. That is what I want.

There is obviously a massive backlog, let alone the backlog that we had before the pandemic. I had already experienced a massive delay, and it is now going to be far worse. It was absolutely devastating the day it got cancelled.55

29.Commenting on Rob Martinez’s experience, Professor Derek Alderson (President, the Royal College of Surgeons of England) told us “What he [Rob Martinez] describes is not atypical, and that is the real sadness”.56 Professor Alderson told us of his concern about the growing backlog for surgery:

The consequence for some patients is the risk of dying if they do not get their new heart valve, or, for a person who has cancer, that it advances in stage so that their chances of being cured are substantially reduced by delay. That is a real issue for us […] We now have a large backlog of patients in that category when you look across the totality of surgery.57

30.During our inquiry we heard that:

31.On 16 June 2020, Professor Alderson emphasised to us the strain that NHS Trusts are facing in managing the backlog of elective surgery. He told us:

We believe that at the moment anyway, and for the foreseeable future, the capacity within our NHS resource alone is insufficient for us to be able to get surgery started again and maintain a sustainable and resilient service as we move into the winter.62

Recent findings from the Royal College of Surgeons of England’s survey of 1,692 surgeons further highlighted a reduction in the pace at which elective surgeries can be resumed. The survey showed that 32.77% of surgeons stated that they are unable to resume elective surgery.63

32.Some Trusts have been able to create “COVID-light hubs” to help better manage the backlog of elective surgery. These hubs are typically characterised by repeat testing of NHS staff and patients, enhanced cleaning and separate pathways to allow surgery to continue safely. Professor Alderson told us that COVID-light sites are “ideal” for patients who require elective surgery64—noting in that context that it “is absolutely essential to regain public confidence that we are able to test our staff regularly”.65 However, the Royal College of Surgeons of England’s survey showed that one quarter (26.2%) of surgeons surveyed said that they are unable to access a COVID-light hub for their patients.66

33.Professor Alderson also told us that dealing with the backlog would need to be a long-term project for the NHS:

Dealing with the backlog is not something that is achievable simply in weeks. We have stopped for 12 weeks, but we cannot catch up in 12 weeks. That, to my mind, is completely unrealistic. It will certainly be many months. It may take us a few years to catch up, and we have to be able to sustain that effort. We need a programme for the recovery of surgery and the sustainability of surgery, and we are probably looking at four or five years to have a resilient system and take things forward in the best possible way.67

This was reiterated to us by Chris Hopson (Chief Executive, NHS Providers), who estimated that this would take “many months, more likely years, to get through”.68

Mental health services

34.Since the start of the pandemic there has been significant disruption to referral routes (such as schools, primary care and A&E departments) for mental health services. There has also been a notable decrease in referral rates to, and a reduction in, patient use of mental health services.69

35.Throughout our inquiry, we have heard of the disruption caused to mental health services across the country and the impact it has had on patients. Notable evidence we have received includes:

36.The leading mental health charity Mind noted that with “vital mental health services being scaled back and people being unable to get support, [this] is likely to have led to people becoming more unwell and more likely to reach crisis point.”74 Rethink Mental Illness has said that “a common theme” from their recent work has shown that mental health services have “been completely withdrawn in the wake of coronavirus.”75

37.The Royal College of Psychiatrists has also highlighted the effect of the reduction in child and adolescent mental health services:

Our members in the front line are reporting significant reductions in patient referrals—especially in child and adolescent services. Those who fail to get the help they need now, will inevitably become more seriously ill. This is particularly concerning for deadly mental health conditions such as eating disorders, which have a higher mortality rate than many cancers. The College is also monitoring early signs that child and adolescent suicide rates may have risen since the lock-down began.76

Chris Hopson (Chief Executive, NHS Providers) explained that there is likely to be an increase in demand for mental services particularly for those who have suffered “economic, social and loss of life consequences of COVID-19”.77

38.On 14 May 2020, Richard Murray (Chief Executive, The King’s Fund) told us of the importance of prioritising the restoration of mental health services. Mr Murray said:

[Mental health services were] not a key priority for the health service and the Government, and that is reflected in deep difficulties in staffing across both adult and children’s mental health services. We need to think very carefully about how these services come back together again, so that they do not get pushed into just dealing with emergencies, and we can invest in some of the community services.78

39.Throughout the course of the pandemic, various changes have occurred to the provision of mental health services. For example, the reduction in face-to-face contact has been accompanied by the establishment of an all-age 24–7 emergency phone line (and other forms of digital treatment) and there have also been attempts to move the provision of emergency mental health care away from hospital emergency departments.79 There has also been a further recruitment of at least 750 mental health support team therapists80 and an increase in support offered by specialist perinatal mental health services.81

40.Nonetheless, more needs to be done to ensure mental health services are delivering at the pace and to the standard required to effectively meet patient demand. Chris Hopson (Chief Executive, NHS Providers) stressed the importance in preparing the NHS for future demand for mental health services, telling us:

We have already begun to see […] that COVID-19 is going to generate significant amounts of extra mental health demand. We need to be ready for that. We cannot wait until next year to build the capacity to meet that demand.82

41.On 30 June 2020, address the provision of mental health services and managing the backlog, Sir Simon Stevens told us:

The honest answer is that there is a big unknown as to how much of an additional burden of mental ill-health there will be coming out of the last four months. There is some evidence that there will be higher rates of mental distress. […] we believe there will be increased mental health demand, but the precise size and shape of it is yet to be determined and seen.83

42.On CAMHS, Sir Simon told us that there is an “unknown around how much the mental health needs of young people can be met through, for example, schools-based programmes as against referrals to the specialist CAMHS service”.84 Sir Simon added that, despite recent innovation in the delivery of mental health services, “we clearly have a long way to go”.85

43.Chris Hopson also told us that a key problem with mental health services has been “the inability of funding to actually reach the front lines of mental health”.86 Mr Hopson explained:

At the moment, nobody is talking about money because, effectively, the Government are saying, “Look, whatever the NHS needs, we will ensure gets funded.” But when you are talking about the kind of expansion of mental health service that we are going to need, over probably the medium term, one of the important questions that our trusts are beginning to ask is, “Okay, we are going to need to fund this beyond the end of COVID-19. How is the funding for that going to work?”87

44.Sir Simon emphasised his commitment to financial support for mental health services to us and said that “Mental health services grew faster than the NHS overall last year, and that the mental health investment standard was exceeded by £200 million or thereabouts.”88 In further correspondence to us, on 21 August 2020, Sir Simon wrote:

We understand the government intends to make decisions in the autumn spending review about the need for any future waiting list ‘catch up’ and any resulting need for permanent additions to NHS capacity, and the funding consequences arising from that.89

Cancer services

45.Cancer referrals, screening, diagnosis and treatment have all been affected by the pandemic. During our inquiry, we have heard about the backlog of appointments, a decrease in referral rates and a reduction in the overall use of cancer services. Some notable concerns raised with us, include the following:

46.The Royal College of Radiologists and the Society and College of Radiographers, in a joint submission to our inquiry, stated that the pandemic has resulted in “a significant decline in patients presenting to primary care with signs and symptoms of cancer”.97 NHS Providers has said that Trusts are “deeply concerned” at the “marked drop in demand for key services” including cancer diagnostics. Trusts are also receiving fewer referrals from general practice for conditions such as suspected cancer.98

47.We are aware that cancer services and treatments have been suspended or otherwise altered due to capacity restrictions, reallocation of resources and in order to manage risk to patients (particularly those who are immunocompromised and therefore at a greater risk of catching and then being unable to recover from coronavirus (and other infections)).99 We have also heard that “cancer hubs” and COVID-light facilities have been introduced to support cancer patients but that they have met limited success.100

48.Richard Murray (Chief Executive, The King’s Fund) highlighted the critical importance of referral rates for cancer services returning to pre-COVID levels:

The key to avoiding a spike in cancer mortalities later in the year, next year and the year after is how quickly those referrals pick up again. They definitely declined for a bit, but in most cases of cancer a clinical delay of a couple of weeks is probably not going to be that severe. What matters now is how quickly they go back up again […] as long as referrals pick up again, at least diagnosing them, we may manage to avoid the worst of a big surge in cancer deaths.101

49.On 17 March 2020, we asked Sir Simon Stevens if cancer operations and routine care for cancer patients would still go ahead despite the disruption caused by the pandemic. Sir Simon confidently responded with “yes”.102 On 30 June 2020, we therefore questioned NHSE/I leaders on why cancer services have been so severely disrupted during the pandemic despite the assurance given to us at that earlier session. In contrast to much of the written and oral evidence provided to our inquiry, Amanda Pritchard (Chief Operating Officer, NHSE/I) told us “our ability across the NHS to maintain the treatment part of cancer care has been strong throughout the pandemic”.103 Professor Steve Powis (National Medical Director, NHSE/I) added “we did not stand down cancer services at all during the peak of the pandemic” although he acknowledged that there was disruption to the delivery of cancer services “for a variety of reasons”.104 Sir Simon Stevens explained that the reduction in the delivery of cancer services was due to “routine invitations being largely paused by screening providers at the end of March [2020]”105 and that “there has been a big reduction in the flow of patients through those diagnostic services”.106

50.On 21 August 2020, Sir Simon wrote to us to explain the steps NHSE/I would be taking to ensure the backlog would be effectively managed. Sir Simon wrote that NHSE/I had proposed several “very challenging ‘stretch’ objectives”.107 These objectives will aim to ensure that the restoration of core healthcare services happens at pace although, as Sir Simon noted, these objectives will “need to flex depending on local circumstances and any Covid/winter upturn in emergency hospitalisation”.108

51.Recognising the need to restore cancer services as quickly as possible, Sir Simon said that the delivery of cancer services would have to be done in “new ways”,109 while Professor Powis noted that “imaginative and innovative thinking”110 will be required. Professor Powis added, “We cannot go back to exactly where we were prior to COVID. We have to do things in a new way.”111 A letter issued by NHSE/I to Chief Executives of all NHS trusts and foundation trusts, CCG Accountable Offices, GP practices and primary care networks and others on 31 July 2020, contained a clear instruction to “restore full operation of all cancer services” and broad plans to “manage the immediate growth in people requiring cancer diagnosis and/or treatment returning”.112

Dental services in England

52.Dentistry services in England have been severely disrupted by the pandemic. On 25 March 2020, in a joint-letter from Sara Hurley (Chief Dental Officer for England) and Matt Neligan (Director of Primary Care and System Transformation), dental practices in England were instructed to suspend all routine, non-urgent dental care. At the same time, NHS regions were instructed to set up local Urgent Dental Care systems in order to carry out emergency dental treatment for patients.113 Although the restoration of dental practices in England began from 8 June 2020,114 concerns have been raised about the backlog of appointments for routine dental care which has, in part, been worsened by financial difficulties some dental practices have faced during the pandemic.

Dentistry and the impact of the pandemic

53.During the course of our inquiry, concerns have been raised about the quality of dental care on offer, particularly at the start of the pandemic, and the impact of pandemic on the population’s oral health. For example, the Association of Dentists Groups (ADG) reported that patients have been remotely prescribed with antibiotics for their dental problems but have returned with pain or further swelling as the cause of their dental problem has not been properly addressed. The ADG has described this as contributing to an “overhang of oral healthcare”.115 The British Dental Association (BDA) has also said that the limited availability of dental services during the start of the pandemic has led to “a very substantial burden of untreated dental disease and an overall worsening of the nation’s oral health as the UK emerges from the peak of the pandemic”.116 The BDA has argued that:

There will be a backlog of patients requiring oral surgery that will have been in (sometime intolerable pain from toothache and infection) and with potentially life-threatening infection who will require treatment amidst a growing backlog.

54.In their joint-letter of 28 May 2020, Sara Hurley and Matt Neligan, NHSE/I set out its proposals for the restoration of dental practices in England in a COVID-secure way. Dental practices were asked to commence opening for all face-to-face care and adhere to further COVID-related safety measures.117

Financial challenges

55.We have also heard that some dental practices have incurred significant financial costs during the pandemic and have subsequently struggled to re-open. This is because practices are unable to conduct the level of service that they had been able to provide prior to the pandemic but are still incurring substantial overhead costs and other expenses. The BDA have described this as a “dire situation” with private dental practices, in particular, being “left with little or no income in this period, while a range of fixed business costs remain in place.”118 Mick Armstrong (Chair, British Dental Association) warned us that the effect of the pandemic on general practice, NHS and private, “has been devastating and is probably existential”.119 This was, in part, illustrated by a survey conducted by the BDA of 2,860 owners of dental practices in April 2020. Results from the survey showed that:

56.In early June 2020, a further BDA survey of more than 2,000 of its members, indicated that only 8% of dental practices would be financially viable to open from 8 June 2020. That figure was based on expected patient numbers and estimated costs.121 As discussed in Chapter 4, access to and the cost of PPE has remained a particular issue for dentistry because dental treatments typically involve aerosol generating procedures which are considered to be an infection risk and therefore require all dental staff to wear particular types of PPE.122 Further to this, Mick Armstrong told us:

Where [dental practices] may have seen 15 patients a day, they will now see five. The only thing I can say is that they have the ability to pass on those increased costs to patients. Whether that makes dentistry unaffordable is an entirely separate matter.123

On 30 June 2020, we were told by Amanda Pritchard (Chief Operating Officer, NHSE/I) that NHSE/I are working with the BDA to support NHS dentists in accessing PPE.124

Leadership from NHSE/I

57.Some of the submissions to our inquiry have expressed concern about the priority given by NHSE/I to supporting dental services in England throughout the pandemic.125 On 14 May 2020, Nigel Edwards (Chief Executive, Nuffield Trust) highlighted his concerns relating to the attention on and support for dentistry services during the pandemic:

[Dentistry] has not received a lot of attention, but it is a real problem because virtually everything that is done in dentistry generates an infection risk, and we have not given dentists a good answer about how on earth they will run their businesses in a safe way in the future.

We are going to have a very major problem of long-term dental morbidity as a consequence unless we can find an answer to that. There is a limit to what hospitals can do on that, but at the moment we are unclear about how to safely run a general dental practice.126

58.On 16 June 2020, Mick Armstrong (Chair, British Dental Association) told us that, in his view, the dental sector has been treated as a “Cinderella service” and as a result there had been a failure in accounting for dentistry services in key strategies such as the NHS Long Term Plan.127 Mr Armstrong explained:

The profession is ready, willing and very able to deliver whatever you want us to deliver, but we need that plan and we need clear lines of communication and influence. If we ask for something, we expect to be heard.128

Mr Armstrong suggested that leadership from NHSE/I had not always been effective because there is a “disconnect” between dental practices and NHSE/I leaders.129

Response from NHSE/I

59.In oral evidence to us on 30 June 2020, Amanda Pritchard (Chief Operating Officer, NHSE/I) reiterated NHSE/I’s commitment to support dental practices and staff in England. Ms Pritchard said:

Dentistry is a hugely important service. We are very much aware that the whole of the dental sector has, as has the rest of the NHS, stepped up through the COVID-19 crisis despite considerable pressures on their services. Our particular responsibility is to NHS dental practitioners.130

60.However, Amanda Pritchard acknowledged that “in common with the rest of the NHS, there are real constraints around the productivity that dental services are able to operate.”131 Consequently, NHSE/I are focussing on “balancing safety and patient needs” in order to “absolutely support dentists making some local judgments about what the right balance is to make sure they are able to operate safely.”132

61.Ms Pritchard also acknowledged the financial challenges facing dental practices and outlined the support that NHSE/I is offering:

What we have done is maintain a roll-over contract model from last year, so that there is stability and a reliable source of income that is separated from the amount of activity that is being done at the moment.133

Waiting times and managing the backlog: conclusion

62.The pandemic has placed an unprecedented burden on the delivery of core NHS and care services. This has resulted in the delay, suspension or cancellation of services which in turn has inevitably led to a significant increase in waiting times, the backlog of appointments and pent-up demand for medical treatments. We are concerned that this has, in part, been created as a result of many individuals being too scared to access the medical treatment they require because they are uncertain as to whether NHS services are safe to use.

63.We recognise the commitment of policy makers and the NHS leadership to restoring core NHS services and the ongoing efforts to manage the backlog. We are also grateful for the hard work of all staff and the use of innovative methods to support core NHS services during the pandemic, including: the creation of cancer hubs, Urgent Dental Centres and COVID-light facilities. We are concerned, however, that despite such innovations many core health services have been unable to continue or have continued with very limited capacity. In March 2020, Sir Simon Stevens issued an instruction that cancer services should not be stopped, but it is clear that this instruction was not always adhered to.

64.During our session on 30 June 2020, Sir Simon Stevens told us that he “expects” waiting times for and referrals to core health services to “go up quite significantly over the second half of the year.”134 We also heard from Sir Simon,135 Amanda Pritchard136 and Professor Steve Powis137 of the importance of restoring core services for patients. It nevertheless remains unclear to us what practical steps the Government and NHSE/I are taking and are planning to take to reduce waiting times, meet the backlog of appointments and prepare the NHS for addressing pent-up demand. The absence of a public plan to address these issues may be contributing to the inability of local trusts to inform patients when they can expect to receive a long-awaited medical procedure. Nevertheless, we do also recognise the significant difficulty in planning ahead when the risk of a second spike remains unclear.

65.We recommend that the Department of Health & Social Care and NHSE/I provide an update on what steps they have, individually and collectively, taken and are planning to take to quantify and address the overall impact of the pandemic on waiting times, the backlog of appointments and pent-up, and as yet unknown and unmet patient demand for all health services, specifically across cancer treatments, mental health services, dentistry services, GP services and elective surgery. We also ask the Department and NHSE/I to provide a comprehensive update on what steps are being taken and what steps will be taken in the future to manage the overall level of demand across health services. We request this information by the end of October 2020.

66.We also recommend that NHSE/I provides us with a more broader update on what positive innovations or changes have taken place in the NHS during the pandemic, and how it seeks to ensure all the positive changes that have occurred are captured and potentially implemented across the entire NHS. We expect this information by the end of 2020.

67.We further conclude that the delivery of dental services in England has been significantly hindered by the pandemic. This has been largely due to the need to protect both patients and staff from COVID-19 which has, in turn, presented financial challenges to both NHS and private dental practices. We welcome NHSE/I’s continued efforts to support the restoration of dentistry services in England.

68.We are concerned that there does not appear to be a plan for the restoration of dental services in England. We recommend that Sara Hurley (Chief Dental Officer for England) sets out her assessment of the challenges facing dentistry services in England, and clarifies what steps will be taken to ensure dentistry services are able to continue to be restored to meet patient demand in the safest possible way whilst also remaining financially sustainable.


36 NHS Confederation, Public reassurance needed over slow road to recovery for the NHS, 10 June 2020 [webpage]

39 Q179. See also: NHS Providers (DEL0318).

44 Janine Aldridge (Public Affairs Officer at The Royal College of Pathologists) (DEL0034) and (DEL0211); and Ms Janine Aldridge (Public Affairs Officer at The Royal College of Pathologists’ Cytopathology Sub-Committee ) (DEL0213).

47 Ms Penny Whitehead (Head of Policy and Research at British Dental Association) (DEL0252)

48 NHS Digital, Appointments in General Practice - April 2020, 28 May 2020 [webpage]

49 Q75 and Q137

50 Dr Katherine Henderson (President at Royal College of Emergency Medicine) (DEL0081) and Mr Theo Chiles (Policy Research Manager at The Royal College of Emergency Medicine) (DEL0288)

51 Mr Richard Phillips (Director, Healthcare Policy at Association of British HealthTech Industries) (DEL0119) and Dr Samual Dick (Policy Manager - Health and Care Systems at British Heart Foundation) (DEL0240)

52 Royal College of Surgeons of England and Royal College of Emergency Medicine (DEL0308)

53 See, for example: Q1; Q20; Q54; Q70; Q87; Mr Shueb Ansar (Public Affairs Officer at HealthWatch England) (DEL0070); Rory Murray (Public Affairs Manager at Royal College of Physicians) (DEL0160); Mr Paul Alexander (Policy Manager at The Royal College of Radiologists and collaborator at The Society and College of Radiographers) (DEL0030); Dr Katherine Henderson (President at Royal College of Emergency Medicine) (DEL0081); The Royal College of Pathologists Janine Aldridge (Public Affairs Officer at The Royal College of Pathologists) (DEL0211); Caitlin Plunkett-Reilly (Public Affairs and Campaigns Lead at Royal College of Paediatrics and Child Health) (DEL0237) and Response from Rt Hon Hancock MP, Secretary of State for Health and Social Care, to Rt Hon Jeremy Hunt MP, Chair of the Health and Social Care Committee, 6 August 2020 [letter].

54 Tamora Langley (Head of Policy Media and Public Affairs at Royal College of Surgeons of England) (DEL0258)

58 Tamora Langley (Head of Policy Media and Public Affairs at Royal College of Surgeons of England) (DEL0258). See also: Committee of Public Accounts, NHS waiting times for elective and cancer treatment, HC 1750, 12 June 2019 [report].

63 Royal College of Surgeons of England and Royal College of Emergency Medicine (DEL0308)

66 Royal College of Surgeons of England and Royal College of Emergency Medicine (DEL0308)

68 Q184. See also: Royal College of Surgeons of Edinburgh (DEL0344)

69 Q47; Rhea Newman (Senior Parliamentary Officer at Mind) (DEL0066) and (DEL0165); Mr Alex Kennedy (Head of Campaigns and Public Affairs at Rethink Mental Illness) (DEL0077); Rethink Mental Illness Jonathan Moore (Head of Social Policy at Rethink Mental Illness) (DEL0194) and Andy Bell (Deputy Chief Executive at Centre for Mental Health) (DEL0130)

70 Rhea Newman (Senior Parliamentary Officer at Mind) (DEL0066) and (DEL0165)

71 Mr Alex Kennedy (Head of Campaigns and Public Affairs at Rethink Mental Illness) (DEL0077; Rethink Mental Illness Jonathan Moore (Head of Social Policy at Rethink Mental Illness) (DEL0194); National Voices (DEL0266) and National Voices (DEL0329)

73 Rhea Newman (Senior Parliamentary Officer at Mind) (DEL0066) and (DEL0165)

74 Rhea Newman (Senior Parliamentary Officer at Mind) (DEL0066) and (DEL0165)

75 Mr Alex Kennedy (Head of Campaigns and Public Affairs at Rethink Mental Illness) (DEL0077) and Rethink Mental Illness Jonathan Moore (Head of Social Policy at Rethink Mental Illness) (DEL0194)

76 Mr Jonathan Blay (Public Affairs Manager at Royal College of Psychiatrists) (DEL0038) and (DEL0139)

77 Q74. See also: British Medical Association, The impact of COVID-19 on mental health in England; Supporting services to go beyond parity of esteem, 19 May 2020 [report] and Eve De Marchi (BACP at BACP and BPC at BPC) (DEL0331).

79 Qq47–51; Rhea Newman (Senior Parliamentary Officer at Mind) (DEL0066) and (DEL0165); Charlotte Watson (Policy and Parliamentary Officer at YoungMinds) (DEL0096); Mr Alex Kennedy (Head of Campaigns and Public Affairs at Rethink Mental Illness) (DEL0077); Rethink Mental Illness Jonathan Moore (Head of Social Policy at Rethink Mental Illness) (DEL0194); and Mr Jonathan Blay (Public Affairs Manager at Royal College of Psychiatrists) (DEL0038) and (Public Affairs Manager at Royal College of Psychiatrists) (DEL0139)

81 Q10; Q13; Q15 and Q207

87 Q89. See also: Centre for Mental Health, A spending review for wellbeing, July 2020 [briefing], Centre for Mental Health, Our Place: Local authorities and the public’s mental health, August 2020 [report] and NHS Confederation, Mental health services and COVID-19: preparing for the rising tide, August 2020 [report]

90 Mr Michael Cousins (Public Affairs Officer at Cancer Research UK) (DEL0063). See also: Mr Shueb Ansar (Public Affairs Officer at HealthWatch England) (DEL0070)

91 UCL Partners, Deaths in people with cancer could rise by at least 20%, 29 April 2020 [blogpost]

93 Royal College of Surgeons of England and Royal College of Emergency Medicine (DEL0308)

94 Janine Aldridge (Public Affairs Officer at The Royal College of Pathologists) (DEL0034) and (DEL0211); and Ms Janine Aldridge (Public Affairs Officer at The Royal College of Pathologists Cytopathology Sub-Committee ) (DEL0213)

95 Mr Paul Alexander (Policy Manager at The Royal College of Radiologists and collaborator at The Society and College of Radiographers) (DEL0030) and Mr Paul Alexander (Policy & Academic Research Manager at The Royal College of Radiologists, Colleague collaborator at The Society and College of Radiographers and Colleague collaborator at The Institute of Physics and Engineering in Medicine ) (DEL0121)

96 Q161. See also: National Voices (DEL0329); Mr Shueb Ansar (Public Affairs Officer at HealthWatch England) (DEL0070); Mr Andy McGuinness (Senior Public Affairs Officer at Macmillan Cancer Support) (DEL0079) and (DEL0238); and Mr Michael Cousins (Public Affairs Officer at Cancer Research UK) (DEL0063)

97 Mr Paul Alexander (Policy Manager at The Royal College of Radiologists and collaborator at The Society and College of Radiographers) (DEL0030) and Mr Paul Alexander (Policy & Academic Research Manager at The Royal College of Radiologists, Colleague collaborator at The Society and College of Radiographers and Colleague collaborator at The Institute of Physics and Engineering in Medicine ) (DEL0121)

98 Ms Susan Bahl (Head of Policy and Public Affairs at NHS Providers) (DEL0137) and NHS Providers (DEL0318)

100 Qq125–126; Q184; Mrs Katie Begg (Secretariat at Blood Cancer Alliance) (DEL0039); Tamora Langley (Head of Policy Media and Public Affairs at Royal College of Surgeons of England) (DEL0258); Noah Froud (Secretariat at Less Survivable Cancers Taskforce) (DEL0050); Mr Peter De Rosa (Policy and Intelligence Team at Pancreatic Cancer UK) (DEL0058); Mr Michael Cousins (Public Affairs Officer at Cancer Research UK) (DEL0063); and National Voices (DEL0266) and (DEL0329).

102 Q149, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36. See also: Qq180–182.

108 Ibid.

113 Letter Sara Hurley, Chief Dental Officer for England, and Matt Neligan, Director of Primary Care and System Transformation at NHSE/I, to general dental practices and community dental services, from 25 March 2020 [letter]. Urgent Dental Care “hubs” have been designed to provide emergency dental treatment for patients with urgent needs, such as cracked teeth, gum infections and facial swelling.

115 Lewis Robinson (Policy and Public Affairs Advisor at Association of Dental Groups) (DEL0276)

116 Ms Penny Whitehead (Head of Policy and Research at British Dental Association) (DEL0252)

118 Ms Penny Whitehead (Head of Policy and Research at British Dental Association) (DEL0252)

120 Ms Penny Whitehead (Head of Policy and Research at British Dental Association) (DEL0252)

122 Dr Martin Skipper (Head of Policy at LDC Confederation) (DEL0248); Ms Penny Whitehead (Head of Policy and Research at British Dental Association) (DEL0252); and Lewis Robinson (Policy and Public Affairs Advisor at Association of Dental Groups) (DEL0276).

125 See, for example: Qq152–154; Dr Martin Skipper (Head of Policy at LDC Confederation) (DEL0248); Ms Penny Whitehead (Head of Policy and Research at British Dental Association) (DEL0252); and Lewis Robinson (Policy and Public Affairs Advisor at Association of Dental Groups) (DEL0276).




Published: 1 October 2020