Public Services Committee

The session scrutinised how ambulance services have evolved beyond transport to become an integral part of urgent and emergency care, with emphasis on triage, community-based care, and reducing hospital admissions. Key government positions include formal recognition of ambulance services as a core part of the system, ongoing development of neighbourhood delivery under the 10-year plan, and four-year capital planning to provide certainty. Witnesses highlighted ongoing commissioning reforms to reduce regional variation, the establishment of an ambulance commissioning framework, and moves to expand clinical roles (e.g., paramedic prescribing). They also flagged concerns about discharge delays, data integration with social care, and persistent variation in local Commissioning footprint across ICBs. The session endorsed expanding community pathways, improving access to care records, and maintaining time-based targets alongside outcome-based measures. Major-incident preparedness was confirmed as a formal, resourced activity with regular drills. Overall, the evidence demonstrates government commitment to stronger ambulance integration within local care, but ongoing challenges around commissioning consistency, discharge coordination, and data sharing remain priorities for policy improvement.

The session scrutinised urgent and emergency care pressures in the NHS, focusing on ambulance services, ED overcrowding, mental health patients in emergency settings, and the balance between ambulance roles and community care. Witnesses highlighted data gaps, the impact of time-based targets, burnout among emergency clinicians, and the need for better alternative care pathways. Government commitments identified included reform of patient-reported experience and outcome measures within the neighbourhood health framework, and Healthwatch England noted forthcoming national data on corridor care. The discussion underscored calls for clearer roles for paramedics, expanded digital records to aid clinical decisions, and the importance of integrating mental health services and community care to relieve ED bottlenecks.

The session scrutinised escalating ambulance-demand in England, drivers of demand (ageing population, deprivation, mental health, and Covid-era legacies), and the strain on handovers between ambulance services and Emergency Departments. Witnesses highlighted workforce evolution (advanced practitioners, paramedic prescribers), end-of-life care in the community, and the role of mental-health pathways. The committee explored governance, commissioning reforms (local ICBs vs regional/pan-ICB models), data sharing, and digital tools to improve flow. Policy signals include a shift toward neighbourhood care, greater system-navigation opportunities, multi-year funding trajectories, and a push for time to be complemented by outcomes-based measures. There was broad acknowledgement of variation across regions and geographies, with calls for consistency, scalable best practice, and better public comms to reduce unnecessary 999/111 calls.

The Public Services Committee scrutinised the Department of Health and Social Care’s handling of medicines shortages and supply resilience. Evidence highlighted that supply-chain issues declined in the first half of 2025 compared with 2024, with the department stating that overall medicine supply is in a good place, though risks remain from single-source products, cyber/energy threats, and global supply dynamics. The witnesses discussed mandating reporting, information sharing between primary and secondary care, and targeted data collection for winter. The department outlined resilience measures including stockholding for secondary care, diversification of suppliers, domestic manufacturing investment, and partnerships with industry (e.g., Moderna) to bolster capacity and maintain priority access to vaccines. Value-based procurement was described as balancing price with resilience and lifecycle value. The committee probed transparency around a public list of critical medicines, with officials indicating publication is not currently taking place but remains under review. The session also highlighted commitments to provide written information on spending through the Office for Life Sciences and to circulate a detailed letter on innovative-manufacturing funding allocations.

The Public Services Committee scrutinised medicines security with a focus on supply-chain resilience, onshoring versus stockpiling, pricing incentives, and regulatory dynamics. Witnesses from manufacturers, industry bodies, and bioscience associations highlighted that: (a) the root causes of shortages are multifaceted, including manufacturing capacity, demand signaling, regulatory timelines, and price pressure; (b) onshoring and stockpiling are being pursued in vaccines through partnerships (e.g., Moderna’s 10-year plan with a Harwell facility) and government-onboarded stockpiles, but endemic challenges remain for non-vaccine medicines, including VPAG pricing, limited incentives, and a lack of a central demand-forecasting system; (c) reforms requested include mutual recognition of manufacturing with the EU, a formalised generic/biosimilar medicines task group, enhanced horizon-scanning, data-sharing improvements, a centralised critical medicines list, and prioritised funding for MHRA/NICE/JCVI to accelerate clinical trials and approvals; (d) witnesses urged to treat medicines supply as a national-security issue, bolster domestic manufacturing, and maintain robust public investment in life sciences. The session also signposted key political signals: a need for updated pricing/incentive frameworks, a strengthened Life Sciences Sector Plan, and a push for closer-aligned UK–EU manufacturing recognition post-Brexit.

The committee questioned industry bodies about the resilience of the medicines supply chain and potential fragilities, particularly around incentives, funding for community pharmacies, and information flows. Evidence from Session 1 stressed that the UK medicines supply chain is broadly resilient but could be eroded by economic incentives, underfunding of community pharmacies, and limited visibility into stock and shortages outside manufacturer–wholesaler channels. Session 2 focused on hospital and NHS-wide shortages, data systems, ward-level stock visibility, and governance of stock management, with emphasis on the need for stronger collaboration, digitisation of the supply chain, and regional/central leadership to mitigate shortages. Across both sessions, witnesses highlighted barriers to transparency (e.g., barcoding, Falsified Medicines Directive limitations), current procurement incentives that discourage stockholding, and debates about stockpiling versus just-in-time supply. There were no explicit government commitments in the session transcripts; instead witnesses called for concrete actions such as expanding 2D barcoding, improving real-time stock data, better integration across NHS bodies and ICBs, onshore API/manufacturing capacity considerations, and sustained executive leadership to implement digital supply-chain improvements.