To date 236 organisations from across the National Health Service in England have signed up to the campaign and made their five pledges on behalf of all of their members of staff. This includes 86% of acute, 68% of community and 54% of mental health providers and 50% of ambulance trusts plus a range of other health related organisations at frontline regional and national level*.

Individuals everywhere are also able to sign up to the campaign and make their own pledges online. Currently we have around 250 individuals who have done this so far from a wide variety of organisation types. The campaign has focused in its first year on engaging organisations and in its second year will focus on individual involvement.

Organisations who have joined the Sign up to Safety community commit to turning their five pledges into a personalised Safety Improvement Plan. These plans are derived from working with their staff on what matters to them and sets out their ambition and focus for the next three years for how their staff will take action to support the NHS shared goal of halving avoidable harm and saving lives.

*Percentage figures derive from publicly available numbers from 2013, accessible on the NHS Confederation’s website.

The Government has put in place a number of measures to support National Health Service orgnisations to respond positively to the Berwick Report ‘Improving the Safety of Patients in England’’ including greater transparency, openness and candour; ensuring safe staffing levels; creating a culture of learning and development with the establishment of 15 Patient Safety Collaboratives; and making patient safety a primary goal with a new ambition to halve avoidable harm and save 6,000 lives over the next three years, underpinned by the Sign up to Safety campaign.

The Department commissioned Frontier Economics to investigate the costs of unsafe care in the National Health Service. The final report, Exploring the cost of unsafe care in the NHS suggests that the costs of preventable, adverse events is likely to be more than £1 billion per year, but could be up to £2.5 billion annually. The report, which was published on 16 October, is available at:

http://www.frontier-economics.com/publications/exploring-the-costs-of-unsafe-care-in-the-nhs/

The Sign up to Safety campaign launched in June is now working with healthcare organisations to make the NHS one of the safest healthcare systems in the world and contribute to the goal to halve avoidable harm and save 6,000 lives over the next three years.

It is difficult to disaggregate direct cash releasing savings from this evidence which must take into account the upfront costs of investing in safer care.

We know that staff who feel engaged and valued in an open and supportive working environment deliver better care and support for patients, and this theme was reiterated in the initial Government response to the Francis report. In particular there are a number of academic studies which show a clear link between staff survey results and the quality of NHS services.

Patient and staff feedback, including a suite of patient experience surveys and the annual NHS staff survey, is now the responsibility of NHS England. A number of elements of its programme of work have been informed by the evidence that demonstrates the links between staff experience and the performance of health care

providers. In particular, NHS England is committed to implementing the Friends and Family Test for both patients and staff. The information they gather from patient and staff feedback as described above will allow NHS England to continue to assess the link between patient experience and staff satisfaction.

Listening and acting on patient feedback from patients is a fundamental part of improving the care that the national health service provides. A key benefit of the Friends and Family Test is that it enables providers to see feedback in real-time and act on it to improve services. Furthermore, patients can compare providers and commissioners and the public can hold services to account.

The impact assessment published by the Department in November 2012 estimated that the average annual costs for implementation of the Friends and Family Test in acute inpatients and accident and emergency, the first services in which it was implemented, would be approximately £5 million. However, actual implementation costs will vary from provider to provider and cost data is not being collected centrally.

A copy of the impact assessment has been placed in the Library and is available at:

www.gov.uk/government/uploads/system/uploads/attachment_data/file/128461/DH-5169-Friends-and-Family-Test.pdf.pdf

Dr Poulter: The provision of NHS primary medical services under the violent patients' scheme was, up to 1 April 2013, the responsibility of primary care trusts (PCTs). The data requested are not routinely collected but it is possible to provide information from data, provided by PCTs, on recorded expenditure on such schemes.

As at December 2012, 117 out of 151 PCTs operated a violent patients' scheme. A list of those PCTs with arrangements for providing primary medical services to violent patients is in the following list. From 1 April 2013, the provision of primary medical services in England became the responsibility of NHS England.

PCTs with a violent patients' scheme prior to 1 April 2013

PCT name

Ashton, Leigh and Wigan PCT

Barking and Dagenham PCT

Barnet PCT

Barnsley PCT

Bassetlaw PCT

Bath and North East Somerset

PCT (PMS only)

Berkshire East PCT

Berkshire West PCT

Bexley NHS Care Trust PCT

Birmingham East and North PCT

Blackburn with Darwen Teaching Care Trust Plus PCT

Blackpool PCT

Bournemouth and Poole Teaching PCT

Bradford and Airedale Teaching PCT

Brent Teaching PCT

Brighton and Hove City Teaching PCT

Bristol PCT

Bromley PCT

Buckinghamshire PCT

Bury PCT

Central and Eastern Cheshire PCT

Central Lancashire PCT

City and Hackney Teaching PCT

Cornwall and Isles of Scilly PCT

County Durham PCT

Cumbria Teaching PCT

Derby City PCT

Derbyshire County PCT

Devon PCT

Doncaster PCT

Dudley PCT

East Lancashire Teaching PCT

East Sussex Downs and Weald PCT

Eastern and Coastal Kent PCT

Gateshead PCT

Great Yarmouth and Waveney PCT

Greenwich Teaching PCT

Hammersmith and Fulham PCT

Hampshire PCT

Haringey Teaching PCT

Harrow PCT

Hartlepool PCT

Hastings and Rother PCT

Herefordshire PCT

Hertfordshire PCT

Heywood, Middleton and Rochdale PCT

Isle of Wight NHS PCT

Islington PCT

Kensington and Chelsea PCT

Kingston PCT

Kirklees PCT

Knowsley PCT

Lambeth PCT

Leeds PCT

Leicester City PCT

Leicestershire County and Rutland PCT

Lincolnshire Teaching PCT

Liverpool PCT

Manchester PCT

Medway PCT

Mid Essex PCT

Milton Keynes PCT

Newham PCT

Norfolk PCT

North East Essex PCT

North East Lincolnshire Care Trust Plus PCT

North Lancashire Teaching PCT

North Lincolnshire PCT

North Somerset PCT

North Staffordshire PCT

North Yorkshire and York PCT

Northamptonshire Teaching PCT

Northumberland Care PCT

Nottingham City PCT

Nottinghamshire County Teaching PCT

Oldham PCT

Oxfordshire PCT

Peterborough PCT

Plymouth Teaching PCT

Portsmouth City Teaching PCT

Redcar and Cleveland PCT

Richmond and Twickenham PCT

Salford PCT

Sandwell PCT

Sefton PCT

Sheffield PCT

Shropshire County PCT

Solihull PCT

Somerset PCT

South Birmingham PCT

South Staffordshire PCT

South Tyneside PCT

Southampton City PCT

Southwark PCT

Stoke on Trent PCT

Suffolk PCT

Sunderland Teaching PCT

Surrey PCT

Sutton and Merton PCT

Swindon PCT

Tameside and Glossop PCT

Telford and Wrekin PCT

Torbay PCT

Tower Hamlets PCT

Trafford PCT

Walsall Teaching PCT

Waltham Forest PCT

Warrington PCT

Warwickshire PCT

West Essex PCT

West Kent PCT

West Sussex PCT

Westminster PCT

Wiltshire PCT

Wirral PCT

Wolverhampton City PCT

Worcestershire PCT

NHS England is committed to putting patients and their carers at the centre of everything it does. Patients, their relatives and carers, as well as patient groups, voluntary organisations and other representatives, have been heavily involved in helping to design and make decisions on key policy areas within NHS England to date. This will continue and strengthen as NHS England takes on its full responsibilities.

NHS England will develop a strategy to ensure that patients, are included in strategic decision-making, in partnership with voluntary organisations and other key partners, later this year.

Healthwatch is the new, independent, consumer champion for health and social care. Local Healthwatch organisations will give citizens and communities a stronger voice to influence and challenge how health and social care services are delivered. As a member of the health and wellbeing board, Local Healthwatch will ensure that what matters to local people is at the heart of the local decision-making processes. Local Healthwatch will gather views and experiences from local people on their health and care services and present this evidence to commissioners and providers of local services.

Healthwatch England, using evidence from local Healthwatches and other sources, will provide advice to the Secretary of State for Health, NHS England, Monitor, the Care Quality Commission and English local authorities.

Getting feedback from patients and using it to improve services is an important responsibility of all organisations providing NHS services. From 1 April 2013, the Friends and Family Test is now allowing all patients using acute inpatient and accident and emergency services to rate the care they received. Results will allow hospitals to be more responsive, patients to compare services and commissioners and the public to hold services to account.

All existing national health service trusts will remain obliged, under section 242 of the NHS Act 2006, to involve patients and the public in the planning of service provision, the development and consideration of proposals for changes in the way those services are provided, and decisions affecting the operation of those services.

The Health and Social Care Act 2012 will require clinical commissioning groups (CCGs) to involve patients and public in all aspects of the commissioning of health services from 1 April 2013. CCGs have to set out how they will involve people in their planning, and then evidence the impact of that involvement in their annual reports. CCG boards will also have at least two lay members sitting on the board, to secure strong patient and public voice in their decision making.

The NHS Commissioning Board will shortly issue statutory guidance for CCGs on how they can promote the involvement of patients in decisions about their care and treatment, and ensure patients and the public are involved in the planning, development and delivery of health services.

The Department does not hold information about the treatment of non-EEA overseas private patients centrally. The Department expects that data about the treatment of privately-funded patients, including those from non-EEA states, would be held locally by individual health care providers.

We understand from the chairman of Monitor that they do not collect information about the collection of fees owing to NHS foundation trusts from non-EEA overseas private patients, as this is an operational matter for the individual trusts concerned.

To manage the National Cancer Patient Experience Survey 2011-12, the Department paid Quality Health, the Survey Provider, £398,090.58 (including VAT).

The Care Quality Commission (CQC) is responsible for overseeing the national patient experience surveys programme, which comprises surveys of in-patient, out-patient, accident and emergency, maternity and mental health patient experience. The CQC provided the following information.

The CQC estimate that its own cost for providing national statistics for the year to 31 August 2012 is £1,882,000, but the total cost of each of these surveys is not quantifiable. This is due to the way in which patient experience surveys are commissioned. The national patient experience surveys programme operates a devolved model, whereby the CQC's role is limited to developing, designing and testing the surveys, and collating, analysing and publishing the results.

Individual national health service provider organisations are responsible for commissioning and funding these surveys. Some organisations choose to administer the surveys themselves, while others procure services from a group of five contractors approved by the CQC for running these surveys on behalf of the NHS.

Approved contractors may offer a variety of additional services (for example, increasing the sample size, adding extra questions, presenting the findings or developing action plans), the costs of which vary between each contractor. In addition, contractors may also offer discount packages for more than one survey or where groups of trusts use the same contractor. CQC is not party to these contracts and is not therefore able to state the total cost of each survey.

In 2011-12, the latest 12-month period for which firm data are available, there were 6,580 in-patient hospital episodes for injuries caused by dog attacks. No information is available centrally on the number of cases treated in accident and emergency clinics, hospital outpatient clinics or primary care, or information on the costs of treating injuries from dog attacks.

The information requested is not held centrally.

Under the current dental contractual arrangements, introduced on 1 April 2006, patients do not have to be registered with a national health service dentist to receive NHS care.

The care of patients in the modern health service is by multidisciplinary clinical teams with strong innovative, senior clinical leadership. Good teams are the safest way to care for patients; ensuring that care is continuous cannot be the responsibility of just one member of the team.

It is the responsibility of individual national health service trusts to assess the effects the directive is having on patients and staff in their trust. However, the Government recognises the difficulties caused by the working time directive. The review by Sir John Temple reported on the directive's impact on doctors' training.

In response to this review and the Collins' report ‘Foundation for Excellence’, Medical Education England are implementing a programme—Better Training, Better Care—to improve the quality of training and improved patient outcomes, safety and experience.

Sir John Temple also reported that the requirements of the junior doctors' contract and the directive differ and that this reduces flexibility. As a result the NHS Employers organisation was commissioned to make recommendations for reappraising the contract. The report's recommendations are being considering carefully.

Car parking policies are not set nationally. National health service organisations have the autonomy to make decisions locally on the provision of car parking to patients, visitors and staff.

Patients whose health care needs require frequent or extended access to hospitals have a fundamental right to fair and appropriate car parking concessions and we expect hospital trusts to deliver them.

The Department issued guidance and directions to national health service bodies in December 2009 on the cost of telephone calls, which prohibit the use of telephone numbers that charge the patient more than the equivalent cost of calling a geographical number to contact the NHS. It is currently the responsibility of primary care trusts to ensure that local practices are compliant with the directions and guidance.

The Department published further guidance as clarification on 23 February 2012, setting out the roles and responsibilities of the Department, primary care trusts, and NHS bodies, with relation to the guidance.

Anyone may approach a general practitioner (GP) practice and apply to join its list of national health service patients, normally by attending the practice premises. Under the terms of their contracts, GP practices have a measure of discretion in accepting or refusing applications to join their patient lists.

A GP practice cannot turn down an applicant oh the grounds of race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition. Other than that, GP practices can turn down an application if the primary care trust (PCT) has agreed that they can close their list to new patients, that an applicant lives outside the practice's boundary area or if they have other reasonable grounds.

In applying to become a patient of a GP practice there is no formal requirement to prove identity or immigration status. However, there are practical reasons why a practice might need to be assured that someone is who they say they are. Consequently, it can help the process if a patient offers relevant documents. Many asylum seekers offer to show their Immigration Service issued ‘Application Registration Card’ (ARC) or official documents that confirm their status.

One of the factors which determine the level of funding GP practices receive under their NHS contractual arrangements is the number of registered patients on their lists. Their global sum payments in respect of patients who are from overseas will not differ from that of other patients. For General Medical Services practices the average payment per weighed patient is £64.67 in 2012-13.

Currently, the local PCT is responsible for establishing and maintaining an accurate list of NHS patients for the practices in its area. From April 2013, this responsibility for the whole of England will transfer to the NHS Commissioning Board.

NHS GPs and hospitals have a duty to identify and charge all visitors that are chargeable for NHS hospital treatment, including those registered with, or referred by a GP. Entitlement to free NHS hospital treatment is based on ordinary residence in the United Kingdom or exemption from charges under regulations. The Department strongly recommends that NHS hospitals use baseline questioning and pre-attendance forms to indicate ordinary residence or exemption from charges and most have an overseas visitors manager to oversee this process.

In recognition that the current rules are generous but also complex and therefore inconsistently applied by NHS staff. The Department has been undertaking a thorough review of charging overseas visitors for NHS care. This included how to establish more effective screening processes across the NHS to identify all of those who should be charged, so that charges are levied appropriately. The initial phase of the review has concluded and its findings are being considered.

The Department has not made nor would be able to make any estimates of the number of overseas visitors or illegal immigrants in this country who may register with GP practices in each of the next three financial years.

The average cost of national health service primary care in England for 2011-12 was £394 per patient.

This figure was calculated by adding together the net costs spent on NHS primary medical care of £8,397 million, NHS dental care of £2,222 million, NHS pharmaceutical services including primary care drugs of £9,827 million and NHS eye care services of £491 million.

The sum of £20,937 million was then divided by the population for England, which was 53,107,200 in mid-2011 according to the Office for National Statistics.

It is not possible to provide the average cost for an adult patient, as it is not possible to disaggregate centrally the individual elements of primary care resources that have been consumed by adults and those consumed by children.