Written questions by Khan.

Whether he plans to review the medical model of autism support in favour of strength-based, neuro-affirmative approaches.

The Government is committed to creating a more inclusive society where autistic people are supported to thrive. We value the unique strengths and skills that autistic people can bring to education, employment, and communities, and there is relevant work on inclusion ongoing in multiple Government departments.For the National Health Service, our focus is to make sure the NHS is providing the right support to the right people at the right time. For people with suspected or diagnosed autism, the optimal approach is often to identify and meet needs early in life, and support and empower individuals, which need not always be reliant on a clinical diagnosis. The 10-Year Health Plan sets out the core principle of early intervention and support, without the need for diagnosis, including for children and young people.It is the responsibility of integrated care boards to make available appropriate provision to meet the health and care needs of their local population, including autism assessments and support, in line with relevant National Institute for Health and Care Excellence (NICE) guidelines. The NICE guidelines on autism cover the different ways that health and care professionals can provide support for autistic people and aim to improve access and engagement with interventions and services.

Whether she has made an assessment of the potential impact of (a) intersectionality and (b) cultural perceptions on the underdiagnosis of autism in women and girls.

The Department and NHS England continue to look at relevant evidence and national data sources so that we can identify and try to mitigate health inequalities.Analyses of the NHS Health and Care of People with Learning Disabilities data, which provides information on differences in healthcare between people with a learning disability and/or autism and those without, published by NHS England, supports evidence from the literature that rates of diagnoses are often lower, and below expected prevalence, in certain ethnic communities. We also know from the research literature that attitudes, beliefs, and stigma about neurodevelopmental differences likely play a significant role.

What steps she is taking to reduce waiting times for autism (a) diagnosis and (b) support for (i) adults and (ii) children.

The Government has recognised that, nationally, the demand for assessments for autism has grown significantly in recent years and that people are experiencing severe delays for accessing such assessments. The Government’s 10-Year Health Plan will make the National Health Service fit for the future, and it recognises the need for early intervention and support, without the need for diagnosis.It is the responsibility of integrated care boards (ICBs) to make available appropriate provision to meet the health and care needs of their local population, including provision of autism services, in line with relevant National Institute for Health and Care Excellence guidelines.On 5 April 2023, NHS England published a national framework and operational guidance to help ICBs and the NHS deliver improved outcomes for people referred to an autism assessment service. The guidance also sets out what support should be available before an assessment and following a recent diagnosis of autism. Since publication, NHS England has been supporting systems and services to identify where there are challenges for implementation and how they might overcome these.The Government is supporting inclusive environments and earlier intervention for children with special educational needs and disabilities (SEND) through the Early Language Support for Every Child and the Partnerships for Inclusion of Neurodiversity in Schools programmes. In addition, through local commissioning, the Government will ensure that neighbourhood health services work in partnership with family hubs, schools, nurseries, and colleges to offer timely and joined-up support to children, young people, and their families, including for those with SEND.

What steps he is taking with Cabinet colleagues to use the NHS 10 Year Health Plan to adapt housing policy to better support the needs of (a) disabled and (b) older people.

We recognise how important the right housing arrangements are in supporting people to live independently, and the need to support disabled and older people to live behind their own front door wherever possible.We are working across Government to tackle the wider determinants of health, including poor housing and fuel poverty, providing advice on the health impacts for the new Fuel Poverty Strategy, and supporting the Ministry of Housing, Communities and Local Government with the implementation of Awaab’s Law and the Decent Homes Standard in the social housing sector.In the 10-Year Health Plan, we have committed to moving towards a Neighbourhood Health Service, with more care delivered locally to create healthier communities, spot problems earlier, and support people to stay healthier and maintain their independence for longer. Over the next three years, we will roll out the neighbourhood health approach to the groups most failed by the current system, improving people’s quality of life and easing pressures on both hospitals and the adult social care system.We have provided an additional £172 million across this and the last financial year to uplift the Disabled Facilities Grant, which could provide approximately 15,600 home adaptations to give older and disabled people more independence in their homes.

What steps her Department is taking to help reduce the gender diagnosis gap for autism.

We recognise that diagnosis rates of autism are lower in women and girls and lower than the best evidence on prevalence. This may reflect differences in how autism presents in males and females, which may make autism more difficult to identify in women and girls.Autism assessments should be undertaken by appropriately skilled clinicians who consider a number of factors before coming to a clinical decision. Integrated care boards and health professionals should have due regard to National Institute for Health and Care Excellence (NICE) guidelines when commissioning and providing health care services, including autism assessment services. The NICE guideline Autism spectrum disorder in under 19s: recognition, referral and diagnosis sets out considerations for clinicians when assessing for autism, including highlighting that autism may be under-diagnosed in women and girls.NHS England has also rolled out training across mental health services with 5,000 trainers having been trained as part of the National Autism Trainer Programme, and this training covers autism presentation in women and girls. These trainers will cascade their training to teams across mental health services.

What steps he is taking to ensure that autism-related mental health needs are recognised and supported before reaching clinical thresholds.

The 10-Year Health Plan sets out the core principle of early intervention and support, without the need for diagnosis, including for children and young people. In the autumn, the Government will bring forward a schools white paper, which will detail the Government’s approach to reforming the special educational needs and disabilities (SEND) system, ensuring joined-up support, and including education and healthcare providers working together.NHS England has also rolled out additional training across mental health services. 5,000 trainers have been trained as part of the National Autism Trainer Programme, and this training covers autism presentation in women and girls. These trainers will cascade their training to teams across mental health services.Through the 10-Year Health Plan, we will continue to roll out mental health support teams in schools and colleges, to reach full national coverage by 2029/30. We will also ensure that support for children and young people’s mental health is embedded in new Young Futures Hubs, alongside a wellbeing offer, to ensure there is no ‘wrong front door’ for young people with mental health needs, including those who are autistic, seeking help.The Government is transforming mental health services through 24 hour a day, seven day a week neighbourhood mental health centres to support our ambition to shift care from hospitals to communities. People will get better direct access to mental health support and advice 24 hours a day, seven days a week through the NHS App, without needing a general practice appointment.

What steps she is taking to reduce waiting times for autism (a) diagnosis and (b) support for (i) adults and (ii) children in Manchester Rusholme constituency.

The Government has recognised that, nationally, demand for assessments for autism has grown significantly in recent years, and that people are experiencing severe delays for accessing such assessments. The Government’s 10-Year Health Plan will make the National Health Service fit for the future, including early intervention and support without the need for diagnosis.It is the responsibility of integrated care boards (ICBs) to make available appropriate provision to meet the health and care needs of their local population, including provision of autism services, in line with relevant National Institute for Health and Care Excellence guidelines.On 5 April 2023, NHS England published a national framework and operational guidance to help ICBs and the National Health Service to deliver improved outcomes for people referred to an autism assessment service. The guidance also sets out what support should be available before an assessment and following a recent diagnosis of autism. Since publication, NHS England has been supporting systems and services to identify where there are challenges for implementation and how they might overcome these.The Government is also supporting inclusive environments and earlier intervention for children through the Early Language Support for Every Child and the Partnerships for Inclusion of Neurodiversity in Schools programmes.The NHS Greater Manchester ICB, shaped by engagement with over 15,000 people, has developed a new model of care to improve the outcomes of children and young people with neurodiverse needs. The model supports:- local neurodevelopmental hubs to provide a single point of access for help, each with specialist teams to provide tailored support for individuals and families;- triage and prioritisation, where children who are most vulnerable and in need of support are seen first; and- standardising core services across Greater Manchester to reduce regional inequalities.The NHS Greater Manchester ICB has also prioritised alignment with the adoption of the GM Children and Young People and Adult Autism Standards for all commissioned services, with further information available at the following link:https://autismgm.org.uk/resources/gm-autism-post-diagnosis-standards/

What steps he is taking to help ensure adult (a) diagnostic and (b) post-diagnostic pathways for autism are (i) available and (ii) accessible in Manchester.

The Government has recognised that, nationally, demand for assessments for autism has grown significantly in recent years, and that people are experiencing severe delays for accessing such assessments. The Government’s 10-Year Health Plan will make the National Health Service fit for the future, including early intervention and support without the need for diagnosis.It is the responsibility of integrated care boards (ICBs) to make available appropriate provision to meet the health and care needs of their local population, including provision of autism services, in line with relevant National Institute for Health and Care Excellence guidelines.On 5 April 2023, NHS England published a national framework and operational guidance to help ICBs and the National Health Service to deliver improved outcomes for people referred to an autism assessment service. The guidance also sets out what support should be available before an assessment and following a recent diagnosis of autism. Since publication, NHS England has been supporting systems and services to identify where there are challenges for implementation and how they might overcome these.The Government is also supporting inclusive environments and earlier intervention for children through the Early Language Support for Every Child and the Partnerships for Inclusion of Neurodiversity in Schools programmes.The NHS Greater Manchester ICB, shaped by engagement with over 15,000 people, has developed a new model of care to improve the outcomes of children and young people with neurodiverse needs. The model supports:- local neurodevelopmental hubs to provide a single point of access for help, each with specialist teams to provide tailored support for individuals and families;- triage and prioritisation, where children who are most vulnerable and in need of support are seen first; and- standardising core services across Greater Manchester to reduce regional inequalities.The NHS Greater Manchester ICB has also prioritised alignment with the adoption of the GM Children and Young People and Adult Autism Standards for all commissioned services, with further information available at the following link:https://autismgm.org.uk/resources/gm-autism-post-diagnosis-standards/

Whether she has made an assessment of the potential merits of reviewing national guidance for autism diagnosis to reflect differences in how males and females (a) experience and (b) present neurodivergence.

The National Institute for Health and Care Excellence (NICE) guideline, Autism spectrum disorder in under 19s: recognition, referral and diagnosis, sets out considerations for clinicians when assessing for autism, including highlighting that this condition may be under-recognised in women and girls. The guidelines are available at the following links:https://www.nice.org.uk/guidance/cg142https://www.nice.org.uk/guidance/cg128NICE has committed to updating these guidelines; however, this work has not yet been scheduled into NICE’s work programme. NHS England published a national framework and operational guidance for autism assessment services in April 2023.

What steps she is taking to incorporate research on (a) masking and (b) internalised behaviours into (i) autism diagnostic pathways and (ii) training for healthcare professionals.

Integrated care boards (ICBs) and health professionals should have due regard to National Institute for Health and Care Excellence (NICE) guidelines when commissioning and providing health care services, including autism assessment services. NICE guidelines are developed by experts based on a thorough assessment of the available evidence and through extensive engagement with stakeholders. In June 2024, NICE’s prioritisation board decided to prioritise updating the current NICE guidelines on autism assessment and diagnosis, namely Autism spectrum disorder in adults: diagnosis and management, and Autism spectrum disorder in under 19s: recognition, referral and diagnosis. Both guidelines are available, respectively, at the following two links:https://www.nice.org.uk/guidance/cg142https://www.nice.org.uk/guidance/cg128Although NICE has committed to updating these guidelines, this work has not yet been scheduled into NICE’s work programme.Under the Health and Care Act 2022, providers registered with the Care Quality Commission are required to ensure their staff receive specific training on learning disability and autism, appropriate to their role. To support this, we have been rolling out the Oliver McGowan Mandatory Training on Learning Disability and Autism to the health and adult social care workforce. The first part of this training has now been completed by over three million people. Staff with responsibility for providing care, support, or healthcare, including social care and other professionals with a high degree of autonomy, are expected to complete Tier 2 of Oliver’s Training, which includes content on avoiding diagnostic overshadowing. Oliver's Training has been developed with reference to the Core Capabilities Frameworks on Learning Disability and Autism, co-produced alongside people with a learning disability and autistic people, and based on learning from the independently evaluated trials of the training in 2021. A long-term evaluation is now underway.In addition, 5,000 trainers have been trained as part of the National Autism Trainer Programme, which covers autism presentation in women and girls. These trainers will cascade their training to teams across mental health services. NHS England has also published guidance on meeting the needs of autistic adults in mental health services, which makes specific references to the possible role of masking.

What assessment he has made of the potential impact of family hubs playing on (a) neighbourhood health and (b) the delivery of integrated community-based health services.

The 10-Year Health Plan outlined proposals for a new Neighbourhood Health Service, which embodies our preventative principle, that care should happen as locally as it can. Neighbourhood health services will build on, and will coordinate with Best Start Family Hubs and Start for Life services to continue to integrate children’s services, National Health Services, and public health.The Neighbourhood Health Service will mean that millions of patients are treated and cared for closer to their home by new teams of health professionals, providing easier, more convenient access to a full range of healthcare services on people’s doorsteps.The impact of Family Hubs and Start for Life services will take time to be realised. The current Family Hubs and Start for Life programme is subject to two national, independent evaluations to understand its implementation and impact.

What recent assessment he has made of the adequacy of the number of practising (a) dentists and (b) dental (i) hygienists, (ii) therapists and (iii) nurses.

We are determined to rebuild National Health Service dentistry and deliver a dentistry service fit for the future.No recent assessment has been made. The 10-Year Health Plan has set out a new service model for the NHS. The 10 Year Workforce Plan will assess what this means for the workforce, and will ensure we have the right people, in the right places, with the right skills to care for patients when they need it.We are regularly engaging with the sector on a range of issues, including workforce recruitment and retention. For instance, the Department has held two roundtables in the last month with dentists, dental nurses, dental therapists and dental hygienists sharing their views on the changes we are making to NHS dentistry.

What steps he is taking to ensure that the needs and wellbeing of (a) infants, (b) children and (c) young people are central to the priorities in the NHS 10-Year Plan.

The Government is committed to raising the healthiest generation of children ever and the 10-Year Health Plan is central to achieving this ambition. The three strategic shifts in the Plan set out how we are prioritising them.Hospital to community will mean parents and children will have better access to care and treatment in their local areas, meaning less time taken out of school to make appointments and fewer hospital visits.Analogue to digital will see delivery of My Children function on the NHS App. This will enable parents to have access to their child/children’s complete medical history. It will also enable parents to book appointments for their children and be signposted through artificial intelligence to advice for urgent and non-urgent medical questions.Sickness to prevention will see a greater emphasis on ensuring children develop and maintain healthy habits throughout their childhood and into adulthood. Children turning 16 years old or younger this year will never legally be sold tobacco, and we intend to strengthen the existing ban on smoking in public places to reduce the harms of passive smoking to children. All children will see less junk food advertising and will be given healthy nutritious food in schools.

What steps he is taking to identify (a) undiagnosed patients with chronic obstructive pulmonary disease (COPD), and (b) COPD patients who are managed in primary care that should have their management escalated to specialist care in Greater Manchester ICB.

Respiratory disease, including chronic obstructive pulmonary disease (COPD) is a clinical priority and the National Health Service is investing in the provision of more and better rehabilitation services for respiratory patients. This has the objective of improving outcomes for people with COPD through early diagnosis including via spirometry tests, and through increased access to treatments.The NHS RightCare COPD pathway has been rolled out nationally and defines the optimal service for people with COPD. Furthermore, the National Respiratory Audit Programme aims to improve quality of care, services, and clinical outcomes for patients with asthma and COPD, by collecting and providing data on a range of indicators and pulmonary rehabilitation activity.A national programme of work is underway to support systems with improving access to Pulmonary Rehabilitation for the eligible population; increase capacity of provision to reduce waiting lists; and improve the quality and consistency of rehabilitation programmes through accreditation. Pulmonary rehabilitation is effective for people with COPD, improving exercise capacity or increased quality of life in 90% of patients who complete a programme.Within NHS Greater Manchester, action being taken to address COPD includes:- improving equity of access to diagnostic spirometry and fractional exhaled nitric oxide, particularly for disadvantaged population groups;- increasing capacity and reducing waiting times for pulmonary rehabilitation services;- increasing vaccination uptake and focusing on secondary prevention of pneumonia;- running smoking cessation services; and- introducing a respiratory standard to improve quality in general practice in managing COPD.This standard utilises a tool to identify patients with COPD who are at the highest risk and asks practices to do an enhanced review and management of these patients to help manage their COPD better.Data on the average time to diagnosis of COPD following patient contact with their general practitioner (GP) is not available. COPD diagnosis typically involves a spirometry test, and data related to such tests may be available at the level of individual GP practices and secondary care providers but is not yet routinely collected in national datasets or in Greater Manchester Integrated Care Board. Furthermore, the test is also used in the diagnosis of other respiratory conditions, not just COPD.

What the average time is for a patient to receive a diagnosis of chronic obstructive pulmonary disease (COPD) following initial contact with their GP for respiratory illness symptoms in (a) Greater Manchester ICB and (b) England in weeks.

Respiratory disease, including chronic obstructive pulmonary disease (COPD) is a clinical priority and the National Health Service is investing in the provision of more and better rehabilitation services for respiratory patients. This has the objective of improving outcomes for people with COPD through early diagnosis including via spirometry tests, and through increased access to treatments.The NHS RightCare COPD pathway has been rolled out nationally and defines the optimal service for people with COPD. Furthermore, the National Respiratory Audit Programme aims to improve quality of care, services, and clinical outcomes for patients with asthma and COPD, by collecting and providing data on a range of indicators and pulmonary rehabilitation activity.A national programme of work is underway to support systems with improving access to Pulmonary Rehabilitation for the eligible population; increase capacity of provision to reduce waiting lists; and improve the quality and consistency of rehabilitation programmes through accreditation. Pulmonary rehabilitation is effective for people with COPD, improving exercise capacity or increased quality of life in 90% of patients who complete a programme.Within NHS Greater Manchester, action being taken to address COPD includes:- improving equity of access to diagnostic spirometry and fractional exhaled nitric oxide, particularly for disadvantaged population groups;- increasing capacity and reducing waiting times for pulmonary rehabilitation services;- increasing vaccination uptake and focusing on secondary prevention of pneumonia;- running smoking cessation services; and- introducing a respiratory standard to improve quality in general practice in managing COPD.This standard utilises a tool to identify patients with COPD who are at the highest risk and asks practices to do an enhanced review and management of these patients to help manage their COPD better.Data on the average time to diagnosis of COPD following patient contact with their general practitioner (GP) is not available. COPD diagnosis typically involves a spirometry test, and data related to such tests may be available at the level of individual GP practices and secondary care providers but is not yet routinely collected in national datasets or in Greater Manchester Integrated Care Board. Furthermore, the test is also used in the diagnosis of other respiratory conditions, not just COPD.

Whether he plans to introduce a national framework mandating GP acceptance of ADHD diagnoses from Right to Choose providers.

There are no current plans to introduce a national framework mandating general practice (GP) acceptance of attention deficit hyperactivity disorder (ADHD) diagnoses from Right to Choose providers.Shared care within the National Health Service refers to an arrangement whereby a specialist doctor formally transfers responsibility for all or some aspects of their patient’s care, such as the prescription of medication, over to the patient’s GP.The General Medical Council (GMC) has issued guidance on prescribing and managing medicines, which helps GPs decide whether to accept shared care responsibilities. The GMC has made it clear that GPs cannot be compelled to enter into a shared care agreement. GPs may decline such requests on clinical or capacity grounds.If a shared care arrangement cannot be put in place after the treatment has been initiated, the responsibility for continued prescribing falls upon the specialist clinician. This applies to both NHS and private medical care.

Whether he has made an assessment of the potential merits of increasing funding for ADHD services.

The ongoing Spending Review, which will be announced at my Rt. Hon. Friend, the Chancellor of the Exchequer’s Budget on 11 June, will set budgets for all areas of health.

What steps he plans to take to reduce waiting times for ADHD diagnoses.

It is the responsibility of the integrated care boards (ICBs) in England to make appropriate provision to meet the health and care needs of their local population, including attention deficit hyperactivity disorder (ADHD) assessments, in line with relevant National Institute for Health and Care Excellence guidelines.NHS England has established an ADHD taskforce which is working to bring together those with lived experience with experts from the National Health Service, education, charity, and justice sectors to get a better understanding of the challenges affecting those with ADHD, including timely and equitable access to services and support, with the report expected in the summer.For the first time, NHS England will publish management information on ADHD prevalence and waits at a national level on 29 May 2025, as part of its ADHD data improvement plan, and will soon release technical guidance to ICBs to improve the recording of ADHD data, with a view to improving the quality of ADHD waits data. NHS England has also captured examples from ICBs who are trialling innovative ways of delivering ADHD services, and is using this information to support systems to tackle ADHD waiting lists and to provide support to address people’s needs.

What assessment his Department has made of the potential implications for his policies of the report entitled The ADHD crisis in the UK – A Call to Action by ADHD360, published in January 2025.

The Department is aware of the report, and officials will consider its findings, alongside wider evidence, in future policy development.NHS England has established an attention deficit hyperactivity disorder (ADHD) taskforce which is working to bring together those with lived experience with experts from the National Health Service, education, charity and justice sectors to get a better understanding of the challenges affecting those with ADHD, including timely and equitable access to services and support, with the report expected in the summer.For the first time, NHS England will publish management information on ADHD prevalence and waits at a national level on 29 May 2025 as part of its ADHD data improvement plan; it will soon release technical guidance to integrated care boards (ICBs) to improve recording of ADHD data, with a view to improving the quality of ADHD waits data. NHS England has also captured examples from ICBs who are trialling innovative ways of delivering ADHD services and is using this information to support systems to tackle ADHD waiting lists and provide support to address people’s needs.

What steps his Department is taking to ensure NHS Trusts meet digital capability targets.

NHS England has supported over 160 trusts with digital transformation, which includes the implementation of Electronic Patient Records. Currently, we have achieved a 91% rollout of Electronic Patient Records, with work underway to provide tailored support to the remaining 19 trusts that do not yet have an Electronic Patient Record.The Digital Maturity Assessment was also successfully completed in May 2024, with a 100% response rate from secondary care organisations and integrated care systems. This assessment provides a baseline and a holistic view of digital maturity across National Health Service trusts in England. The assessment will be run yearly to track progress and identify areas for improvement.