Written questions by Cooper.

What estimate he has made of the number of dietitians required to adequately support obesity, diabetes and malnutrition services in community healthcare settings in England.

The 10 Year Workforce Plan will ensure that the National Health Service has the right people in the right places, with the right skills to care for patients, when they need it. We are working through how the 10 Year Workforce Plan will articulate the changes for different professional groups. The plan will be published in spring 2026.As of January 2026, there are 5,624 full time equivalent (FTE) dietitians in NHS trusts and other core organisations in England. This is 220 (4.1%) more than last year, 1,040 (22.7%) than 2021, and 2,321 (70.3%) more than in 2010.

Which professional groups are currently included in NHS clinical pathways for patients prescribed weight loss medications; and what guidance his Department has issued on clinical oversight for those pathways.

Weight loss medicines are available through National Health Service specialist weight management services and, from June 2025 tirzepatide, brand name Mounjaro, is being made available in primary care through a phased approach. In specialist services, patients receive wraparound care from a multidisciplinary team providing nutritional, psychological, and medical support, tailored to individual need. In primary care, clinical oversight is provided by general practitioners and other prescribing healthcare professionals, with behavioural support delivered through locally commissioned services or via the national Healthier You: NHS Behavioural Support for Obesity Prescribing service. NHS England does not routinely hold information on the specific professional groups included in local clinical pathways. National guidance to support prescribing and clinical oversight includes: the National Institute for Health and Care Excellence (NICE) Technology Appraisal 1026 Tirzepatide for managing overweight and obesity;NICE’s Practical guide to using medicines to manage overweight and obesity; andNHS England’s interim commissioning guidance. Integrated care boards are responsible for ensuring robust clinical governance of these pathways.

What steps he is taking to improve the (a) completeness and (b) quality of data collected on waiting times to access adult community eating disorder services.

Adult eating disorders are covered by the overall adult waiting time metrics developed through the Clinically Led Review of Standards. Work to implement adult community mental health time-based metrics therefore also applies to adult community eating disorder services. To improve completeness and quality of data submitted to the Mental Health Services Dataset (MHSDS), the Adult Mental Health team has developed SNOMED CT clinical coding guidance and national reference sets to support accurate recording of assessments, interventions, medications, and waiting time clock stops. Online training modules have been published to support providers with MHSDS submissions, with further pathway-specific modules and clinical descriptor guidance in development, alongside planned educational sessions for 2026/27. The national Data Collections Service provides proactive one-to-one data quality support to providers, and an experimental access and waiting times dashboard is available on NHS Futures. In addition, NHS England publishes data quality information on all MHSDS submissions and contacts providers monthly to address identified issues. Together, these measures are intended to strengthen the completeness and accuracy of waiting time data for adult community eating disorder services.

Whether he plans to commission national training to support the workforce delivering Children and Young People’s Eating Disorder Services.

NHS England already has comprehensive eating disorder training in place for staff across mental and physical health services, including those delivering Children and Young People’s Eating Disorder Services (CYP ED). This covers both awareness-raising and specialist up-skilling, with e-learning and simulation training available to doctors, general practitioners and primary care clinicians, nurses across all four branches, acute hospital staff, dietitians, and pharmacy teams. Following the 2017 Ombudsman report Ignoring the Alarms, NHS England worked with Beat and the Royal College of Psychiatrists to strengthen training on the safe medical management of eating disorders, which remains available. More recently, NHS England has commissioned further specialist training to support the CYP ED workforce, including the Royal College of Psychiatrists’ Eating Disorders Credential, family-based therapies, cognitive behavioural therapy for eating disorders, and training on Avoidant/Restrictive Food Intake Disorder. Together, this national programme of training ensures that the workforce is better equipped to identify risk early and provide safe, effective, evidence-based care for children and young people wherever they present.

What steps his Department is taking to ensure equitable access to multidisciplinary rehabilitation services for people with functional neurological disorder across Integrated Care Boards (a) in general and (b) for people under 18.

The National Institute for Care Excellence’s (NICE) guideline on rehabilitation for chronic neurological disorders, including acquired brain injury, was published in October 2025 and with the code NG252, includes functional neurological disorder within its scope. The guideline, which covers rehabilitation in all settings for children, young people, and adults with a chronic neurological disorder, neurological impairment, or disabling neurological symptoms, recommends a holistic, multidisciplinary approach to rehabilitation. The guideline emphasises the need for personalised care plans that address physical, cognitive, and psychological needs.We expect integrated care boards to take NICE guidelines fully into account when designing and commissioning services to meet the needs of their local populations. NICE guidelines represent authoritative, evidence-based recommendations on best practice, including clinical and cost-effectiveness considerations. This approach ensures consistency, quality, and equity in service provision across the National Health Service. The guideline is available at the following link:https://www.nice.org.uk/guidance/ng252

Whether he has made an assessment of the potential merits of extending eligibility for covid-19 vaccinations to groups not included in the vaccination programme.

The Government is committed to protecting those most vulnerable to COVID-19 through vaccination, as guided by the independent Joint Committee on Vaccination and Immunisation (JCVI). The primary aim of the national COVID-19 vaccination programme remains the prevention of serious illness (hospitalisations and deaths) arising from COVID-19. Population immunity to COVID-19 has been increasing due to a combination of naturally acquired immunity following recovery from infection and vaccine-derived immunity. COVID-19 is now a relatively mild disease for most people, though it can still be unpleasant, with rates of hospitalisation and death from COVID-19 having reduced significantly since COVID-19 first emerged.The focus of the JCVI advised programme has therefore moved towards targeted vaccination of the two groups who continue to be at higher risk of serious disease, including mortality. These are the oldest adults and individuals who are immunosuppressed.On 13 November 2024, JCVI published advice on who should be offered vaccination in autumn 2025. On 26 June 2025, the Government accepted the JCVI’s advice that in autumn 2025, a COVID-19 vaccination should be offered to the following groups:adults aged 75 years and over;residents in care homes for older adults;individuals aged 6 months and over who are immunosuppressed (as defined in the ‘immunosuppression’ sections of tables 3 or 4 in the COVID-19 chapter of the UK Health Security Agency Green Book).The Government has no plans to change eligibility for autumn 2025. It has accepted the JCVI advice for this campaign in full. As for all vaccines, the JCVI keeps the evidence under regular review.

When he expects NICE to publish the updated fertility guidance.

The National Institute for Health and Care Excellence (NICE), the independent body responsible for translating evidence into authoritative guidance for the health and care system on best practice, is currently updating its guidance on the assessment and treatment of fertility problems. NICE’s consultation on its draft guidance will run from 10 September 2025 to 21 October 2025, and final guidance is expected to be published in March 2026.

What assessment he has made of the potential impact of hydrotherapy services on people with learning disabilities.

NHS England advises that there is not a strong evidence base for the benefits of hydrotherapy for people with learning disabilities. As part of their duties under the Care Act 2014, local authorities are expected to ensure high quality services that put the wellbeing of people who draw on care at the centre of decisions and ensure positive outcomes. It is the role of local authorities to facilitate the personalisation of care and support services and encourage a variety of services for their population, such as community support options.As set out in NHS England’s Planning Guidance, integrated care boards (ICBs) are expected to work with local system colleagues to ensure that there is high quality and accessible community infrastructure in place for people with a learning disability and autistic people. The guidance is available at the following link:https://www.england.nhs.uk/publication/2025-26-priorities-and-operational-planning-guidance/ICBs are expected to assign an executive lead role for learning disability and autism to support planning to meet the needs of people with a learning disability and autistic people.

What steps her Department is taking to work with manufacturers of Concerta XL to (a) resolve the ongoing supply shortages and (b) prevent disruption for patients reliant on this medication.

The Department can confirm that the supply disruptions affecting various strengths of Concerta XL, generic name methylphenidate, tablets have now been fully resolved. We continue to support the NHS England’s attention deficit hyperactivity disorder (ADHD) taskforce, which brings together expertise from the National Health Service, education, and justice sectors to coordinate a system-wide response to rising demand. In collaboration with NHS England’s national ADHD data improvement plan, we are developing future growth forecasts to support improved demand planning. These forecasts will be shared with industry to help ensure a more responsive and sustainable supply of ADHD medicines. We continue to work closely with the supplier of Concerta XL tablets to help ensure a stable and increased supply for the United Kingdom’s market. To further strengthen supply chain resilience, we are also engaging with new suppliers to expand the UK supplier base for generic bioequivalents of Concerta XL. This approach will help improve the availability and reduce the risk of future shortages for patients across the UK. The Department also maintains and regularly updates a list of currently available and unavailable ADHD products on the Specialist Pharmacy Service website. This resource supports prescribers and dispensers in making informed decisions with patients. The list is available at the following link: www.sps.nhs.uk/articles/prescribing-available-medicines-to-treat-adhd

What his planned timeline is for the restoration of a (a) normal and (b) stable supply of Concerta XL; and what contingency measures his Department is putting in place until then.

The Department can confirm that the supply disruptions affecting various strengths of Concerta XL, generic name methylphenidate, tablets have now been fully resolved. We continue to support the NHS England’s attention deficit hyperactivity disorder (ADHD) taskforce, which brings together expertise from the National Health Service, education, and justice sectors to coordinate a system-wide response to rising demand. In collaboration with NHS England’s national ADHD data improvement plan, we are developing future growth forecasts to support improved demand planning. These forecasts will be shared with industry to help ensure a more responsive and sustainable supply of ADHD medicines. We continue to work closely with the supplier of Concerta XL tablets to help ensure a stable and increased supply for the United Kingdom’s market. To further strengthen supply chain resilience, we are also engaging with new suppliers to expand the UK supplier base for generic bioequivalents of Concerta XL. This approach will help improve the availability and reduce the risk of future shortages for patients across the UK. The Department also maintains and regularly updates a list of currently available and unavailable ADHD products on the Specialist Pharmacy Service website. This resource supports prescribers and dispensers in making informed decisions with patients. The list is available at the following link: www.sps.nhs.uk/articles/prescribing-available-medicines-to-treat-adhd

Whether his Department has made an assessment of the potential merits of commissioning a formal review into the historical handling of (a) thalidomide and (b) the long-term support provided to people affected by thalidomide.

The Thalidomide Health Grant exists to meet the health and wellbeing needs, present and future, of thalidomide survivors living in England.In 2023, the Department put in place a new four-year grant agreement with the Thalidomide Trust, to administer the grant of approximately £40 million over four years. The agreement was made in recognition of the complex and highly specialised needs of people affected by thalidomide in England, particularly as they approach old age. The funding helps beneficiaries to maintain control over their own health, enabling them to personalise the way their health and care needs are met, maintain independence, and minimise any further deterioration in their health.To understand how well the current grant agreement operates, the Department has commissioned an independent evaluation of the Thalidomide Health Grant through the National Institute for Health and Care Research. The evaluation began in October 2024 and aims to understand the health and care needs of people affected by thalidomide, particularly as they age, what funded resources produce the most tangible benefits to this group, how best to distribute financial support to them, and the extent to which their needs are met by the current grant.This independent, external research will help us to ensure that the Government supports the needs of people affected by thalidomide as they age. Funding beyond the current grant agreement will be subject to the outcome of future spending reviews.

Whether his Department has considered (a) alternative and (b) long-term funding models for supporting people affected by thalidomide after the current health grant period has ended.

The Thalidomide Health Grant exists to meet the health and wellbeing needs, present and future, of thalidomide survivors living in England.In 2023, the Department put in place a new four-year grant agreement with the Thalidomide Trust, to administer the grant of approximately £40 million over four years. The agreement was made in recognition of the complex and highly specialised needs of people affected by thalidomide in England, particularly as they approach old age. The funding helps beneficiaries to maintain control over their own health, enabling them to personalise the way their health and care needs are met, maintain independence, and minimise any further deterioration in their health.To understand how well the current grant agreement operates, the Department has commissioned an independent evaluation of the Thalidomide Health Grant through the National Institute for Health and Care Research. The evaluation began in October 2024 and aims to understand the health and care needs of people affected by thalidomide, particularly as they age, what funded resources produce the most tangible benefits to this group, how best to distribute financial support to them, and the extent to which their needs are met by the current grant.This independent, external research will help us to ensure that the Government supports the needs of people affected by thalidomide as they age. Funding beyond the current grant agreement will be subject to the outcome of future spending reviews.

What assessment his Department has made of the adequacy of the Thalidomide Health Grant in meeting the health and care needs of survivors as they age.

The Thalidomide Health Grant exists to meet the health and wellbeing needs, present and future, of thalidomide survivors living in England.In 2023, the Department put in place a new four-year grant agreement with the Thalidomide Trust, to administer the grant of approximately £40 million over four years. The agreement was made in recognition of the complex and highly specialised needs of people affected by thalidomide in England, particularly as they approach old age. The funding helps beneficiaries to maintain control over their own health, enabling them to personalise the way their health and care needs are met, maintain independence, and minimise any further deterioration in their health.To understand how well the current grant agreement operates, the Department has commissioned an independent evaluation of the Thalidomide Health Grant through the National Institute for Health and Care Research. The evaluation began in October 2024 and aims to understand the health and care needs of people affected by thalidomide, particularly as they age, what funded resources produce the most tangible benefits to this group, how best to distribute financial support to them, and the extent to which their needs are met by the current grant.This independent, external research will help us to ensure that the Government supports the needs of people affected by thalidomide as they age. Funding beyond the current grant agreement will be subject to the outcome of future spending reviews.

What assessment his Department has made of the potential merits of waiving fees charged by GP surgeries for (a) medical evidence letters, (b) certificates and (c) reports that are required by HM Passport Office to show that a patient has a disability that prevents them from attending a passport interview.

There are some medical evidence letters, certificates, or reports that general practices (GPs) may charge for, and others that they must not charge patients for. The legislation that sets this out is the General Medical Services and Personal Medical Services Regulations, which form the basis of the GP Contract with the National Health Service. There is no statutory limit to the level of such fees, as this is outside of core NHS work.The Professional Fees Committee of the British Medical Association suggests guideline fees for such services, to help doctors set their own professional fees.We are continuing to work across Government to cut red tape and improve ways of working, including work to improve the patient experience, such as removing the need to request unnecessary medical evidence where possible.

What assessment he has made of the adequacy of levels of compliance with the Mental Health Investment Standard by ICBs in each of the last four years.

The following table shows the number of integrated care boards (ICBs), formerly clinical commissioning groups (CCGs), meeting the Mental Health Investment Standard, meaning that their investment in mental health services increased in line with their overall increase in funding for the year, from 2020/21 to 2024/25:YearNumber of CCGs/ICBs meeting the Mental Health Investment Standard2020/21135 out of 135 CCGs2021/22106 out of 106 CCGs2022/2341 out of 42 ICBs2023/2442 out of 42 ICBs2024/25Information not yet availableSource: NHS Mental Health Dashboard, NHS EnglandNote: between 2020/21 and 2021/22 there was a methodology change in how ICB/CCG base allocation was calculated. The calculation of the Mental Health Investment Standard does not include spend on learning disabilities, autism, dementia, and specialised commissioning.

What steps his Department is taking to help safeguard young people from (a) drug and (b) alcohol addiction.

The most effective and sustainable approach to safeguarding children and young people from drug and alcohol harm is by giving them the best start in life, and by keeping them safe, well, and happy. Our mission-based approach will ensure that every child has the best start in life and that we create the healthiest generation of children ever.Statutory guidance on relationships, sex, and health education requires all primary and secondary schools to ensure that pupils know the key facts and risks associated with alcohol and drug use, as well as how to manage influences and pressure, and keep themselves healthy and safe. The Department has worked with the Personal, Social, Health and Economic Education Association to develop lesson plans on alcohol and drugs and has commissioned an update of the resources to be published later this year.The Government also has an alcohol and drug information and advice service called Talk to FRANK, which aims to reduce alcohol and drug use and its harms by providing awareness to young people, parents, and concerned others. Further information is available on the Talk to FRANK website, which is available at the following link:https://www.talktofrank.com/Children and families affected by parental alcohol and/or drug use can experience adverse health, social, and economic outcomes, which can continue for generations without effective interventions to break the cycle. The Department is continuing to invest in improvements to local alcohol and drug treatment services to ensure that those in need can access high quality help and support.In addition to the Public Health Grant, local authorities have had a further £267 million from the Department this year to improve the quality and capacity of treatment. This is alongside the additional investment of £105 million made available by the Department of Health and Social Care, the Department for Work and Pensions, and the Ministry of Housing, Communities, and Local Government to improve treatment pathways and recovery, housing, and employment outcomes for people affected by alcohol and drug use.

What discussions he has had with NHS England on the potential merits of conducting cross-conditional testing in the NHS when assessing for a neurodivergent condition to determine the potential co-occurrence of (a) autism and (b) ADHD to help (i) increase early diagnosis rates and (b) improve outcomes.

It is the responsibility of the integrated care boards (ICBs) across England to make available appropriate provision to meet the health and care needs of their local population, including autism and attention deficit hyperactivity disorder (ADHD) 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 children, young people, and adults referred to an autism assessment service. The framework notes that autism should not be assessed without also considering the possibility of differential or co-occurring diagnoses.In respect of ADHD, we are supportive of a cross-sector taskforce that NHS England has established to look at ADHD service provision and support across sectors, and their impact on patient experience. The taskforce is bringing together expertise from across a broad range of sectors, including the NHS, education, and justice, to better understand the challenges affecting people with ADHD, including timely access to services and support. The ADHD taskforce will also work closely with the Department for Education’s neurodivergence task and finish group.

What assessment he has made of the potential merits of introducing a national water fluoridation strategy.

Water fluoridation is an effective population measure that reduces tooth decay. It should be used to complement other effective methods of increasing fluoride use, as set out in the statement by the UK Chief Medical Officers, which is available at the following link:https://www.gov.uk/government/publications/water-fluoridation-statement-from-the-uk-chief-medical-officers/statement-on-water-fluoridation-from-the-uk-chief-medical-officers.On 7 March 2025, we confirmed plans, following public consultation, to expand provision of water fluoridation in the north east of England. The outcome report is available at the following link:https://www.gov.uk/government/consultations/community-water-fluoridation-expansion-in-the-north-east-of-englandThere are no current plans for a national water fluoridation strategy. Any decisions on the future expansion of water fluoridation will be based on oral health needs, funding, and will be subject to public consultation.

What (a) financial and (b) other steps his Department is taking to increase access to NHS dentistry in (i) Mid Cheshire constituency, (ii) Cheshire and (iii) England.

The Government plans to tackle the challenges for patients trying to access National Health Service dental care with a rescue plan to provide 700,000 more urgent dental appointments and recruit new dentists to the areas that need them most. To rebuild dentistry in the long term, we will reform the dental contract with the sector, with a shift to focus on prevention and the retention of NHS dentists.The responsibility for commissioning primary care services, including NHS dentistry, to meet the needs of the local population has been delegated to the integrated care boards (ICBs) across England. For the Cheshire constituency, this is the NHS Cheshire and Merseyside ICB.

What steps his Department is taking to tackle health inequalities in (a) Mid Cheshire constituency, (b) Cheshire and (c) England.

The United Kingdom faces significant health inequalities, with life expectancy varying widely across and within communities. The Government is committed to building a fairer Britain by tackling the structural inequalities that contribute to poor health, particularly for disadvantaged groups.Existing initiatives to reduce inequalities in relation to health services in England include NHS England’s Core20PLUS5, which focuses on improving the five clinical areas at most need of accelerated improvement in the poorest 20% of the population, along with other underserved population groups identified at a local level, including groups that share protected characteristics, and socially excluded groups such as people experiencing homelessness.The Office of Health Improvement and Disparities’ North West Regional Team provides system leadership for population health and for reducing health inequalities across the North West. Mid Cheshire local authorities, the Cheshire West and Chester Council and the Cheshire East Council, received a combined total of £36.9 million in Public Health Grant funding for 2024/25. This provides services such as stop smoking, drug and alcohol treatment, health visiting and school nursing, sexual health, and NHS Health Checks, among others, all of which contribute to addressing health inequalities.Across Cheshire and Merseyside, partners are working together as part of the All Together Fairer collaborative to improve health equity and the social determinants of health, through measurable actions for each place, to create a fairer, more equitable society.