Written questions by Brandreth.

What steps his Department is taking to improve coordination between NHS services and local government in providing aftercare and community support for elderly and frail people following discharge from hospital.

The Department continues to work with the systems facing the greatest challenges to embed best practice in discharge processes, improve patient flow, and ensure timely follow‑up and community support for those most at risk of complications.For people who need further care after discharge, a multi-disciplinary care transfer hub in each area brings together National Health Service, local authority, social care, housing, and other professionals to ensure timely discharge and suitable ongoing care and support.As part of the Better Care Fund framework for 2025/26, the NHS and local authorities in every area are encouraged to work together to review the capacity needed to support hospital discharge for people with more complex needs. This includes ensuring there is sufficient capacity to rehabilitation and recovery services to support a timely and effective discharge, or to support avoidable admissions. It is for local systems to determine the right mix of services for their population.In 2026/27, the Better Care Fund will continue to focus on those services that are essential for integrated health and social care, such as hospital discharge, intermediate care, rehabilitation, and reablement.

What mechanisms are in place to ensure that patients discharged from hospital receive appropriate aftercare and follow‑up, particularly older patients at higher risk of complications; and whether his Department plans to improve coordination of post‑discharge support.

The Department continues to work with the systems facing the greatest challenges to embed best practice in discharge processes, improve patient flow, and ensure timely follow‑up and community support for those most at risk of complications.For people who need further care after discharge, a multi-disciplinary care transfer hub in each area brings together National Health Service, local authority, social care, housing, and other professionals to ensure timely discharge and suitable ongoing care and support.As part of the Better Care Fund framework for 2025/26, the NHS and local authorities in every area are encouraged to work together to review the capacity needed to support hospital discharge for people with more complex needs. This includes ensuring there is sufficient capacity to rehabilitation and recovery services to support a timely and effective discharge, or to support avoidable admissions. It is for local systems to determine the right mix of services for their population.In 2026/27, the Better Care Fund will continue to focus on those services that are essential for integrated health and social care, such as hospital discharge, intermediate care, rehabilitation, and reablement.

What actions he is taking to reduce the length of time older people spend on trolleys in Accident and Emergency departments, including cases where patients wait many hours or days; and what assessment he has made of the impact of such waits on dignity, safety and health outcomes.

The Government recognises that urgent and emergency care performance has fallen short in recent years and is taking action to improve services for patients. We are committed to restoring accident and emergency waiting times to the National Health Service constitutional standard and to reducing long waits that can result in patients receiving care in inappropriate settings. To support this, we are investing £450 million to expand same-day and urgent care services and to improve hospital flow, with a focus on addressing the longest waits and improving patient experience.As committed to in the Urgent and Emergency Care plan, we will publish data on the prevalence of corridor care for the first time. NHS England has been working with trusts since 2024 to put in place, new reporting arrangements to drive improvement. The data quality is currently being reviewed, and we expect to publish the information shortly.Where corridor care cannot be avoided, we have published updated guidance to support trusts to deliver it safely, ensuring dignity and privacy is maintained to reduce impacts on patients and staff.Our Urgent and Emergency Care Plan for 2025/26 sets out clear actions to deliver improvements, reducing the proportion of patients waiting more than 12 hours for admission or discharge to less than 10% of the time. This includes expanding urgent community care, such as urgent community response, neighbourhood multidisciplinary teams, and virtual wards, to reduce avoidable emergency department attendances and hospital admissions. We have asked NHS trusts to focus on eliminating discharge delays of more than 48 hours caused by issues within the hospital, and to work with local authorities on eliminating the longest delays. The NHS Medium-Term Planning Framework sets out a year-on-year trajectory to improve performance towards the constitutional standard, reduce long waits, and improve safety and efficiency in emergency departments.We have also introduced new clinical operational standards for the first 72 hours of care to support better hospital flow. These set minimum expectations for timely review, availability of advice, and coordinated care when multiple specialist teams are involved, to improve patient care and flow through the hospital.

What steps his Department is taking to ensure that older patients are not discharged from hospital prematurely due to bed pressures; and what measures are in place to safeguard patient safety during the discharge process.

The Government is committed to ensuring that all patients are discharged from hospital appropriately with the right care and support in place. Clinicians in every speciality use a set of criteria and clinical judgement to determine when a patient is medically fit for discharge, and where people need further care after discharge, multi-disciplinary care transfer hubs bring together the National Health Service, local authorities, social care, housing, and other professionals to make arrangements for safe and timely discharge.

What steps he is taking to improve integration between hospitals, GP practices and district nursing services to streamline care for older patients and prevent long delays in accessing medical assessment for potentially serious conditions such as infection or deep vein thrombosis.

The 10-Year Health Plan sets out how we will fundamentally transform the National Health Service, through shifting resources from hospital to community, with a focus on population health. We know that reform cannot be achieved by simply shifting care to other parts of the health and care system working as they are now, and that more integrated working between primary and secondary care will be vital.We are improving access to the front door of the NHS, for example by increasing capacity in general practice. More timely access to primary care and better proactive care for long term conditions will reduce demand into urgent and emergency care and reduce pressure in hospitals, freeing them up to providing faster and productive care for those who most need it, including older patients.One example of the left-shift in practice is the pan-Sussex community project. Here patients with suspected deep vein thrombosis are seen in the community under the care of their general practitioner, leading to a substantial reduction in the number of patients needing to visit their local acute hospital.We are also committed to reducing long waits and improving patient experience in urgent and emergency care. The NHS Medium Term Planning Framework sets out a clear trajectory to improve performance year-on-year toward the constitutional standard. This will be supported by investment in staff, digital triage, and community urgent care.

Whether his Department plans to create a pathway for NHS (a) diagnosis and (b) care for (i) hypermobile Ehlers-Danlos syndrome and (ii) hypermobility spectrum disorders.

Integrated care boards (ICBs) have a statutory responsibility to commission services which meet the needs of their local population, including for those with hypermobile Ehlers-Danlos syndrome (EDS) and hypermobility spectrum disorders. It is the responsibility of ICBs, working with clinicians, service users, and patient groups, to develop services and care pathways that meet patients’ needs.The 10-Year Health Plan for England will improve services for people with EDS and other long-term conditions by shifting care to the community with neighbourhood teams, expanding access to physiotherapy and rehabilitation, and using digital innovation to help patients self-manage and receive more integrated, personalised care. This approach aims to provide more proactive and accessible support by bringing services closer to home and making it easier for patients to access the help they need.

What training is provided to healthcare professionals to (a) identify and (b) help tackle the causes of mental distress.

Individual health care providers are responsible for ensuring that their staff have the knowledge, skills, and competence to meet the specific needs of the communities they serve. To support this, NHS England offers a wide range of training opportunities designed to help mental health professionals identify and address the possible causes of mental distress.These programmes cover a variety of settings, from early intervention and preventative psychological therapies services, such as Mental Health Support Teams in schools and colleges and Talking Therapies for adults, to crisis services for individuals with severe mental health conditions who may be at risk of harming themselves or others. In addition, NHS England provides training for staff working in physical health, accident, and urgent care centres, ensuring they are equipped to support individuals presenting with mental distress across demographics.

What assessment he has made of the potential implications for his policies of the recommendations of the Centre for Social Justice's report entitled Change the Prescription, published in January 2025.

We recognise that for some people, treatment through medication may not be the best option, which is why we are continuing to expand access to alternative forms of treatment through NHS Talking Therapies and Individual Placement and Support schemes. This demonstrates our commitment to addressing the root causes of mental health issues and to providing support for people to contribute to the economy by remaining in or returning to work.As part of our mission to build a National Health Service that is fit for the future and that is there when people need it, we are recruiting 8,500 mental health workers across child and adult mental health services to help ease pressure on busy services.We continue to work with NHS England to consider options to deliver this commitment, alongside publishing a refreshed workforce plan to deliver the transformed health service we will build over the next decade. There are a wide range of factors that will affect this future growth of the NHS mental health workforce, and we will provide an update in due course.

What steps his Department is taking to ensure that variations in local NHS (a) capacity and (b) resourcing of (i) Early Access Programmes and (ii) the availability of tofersen support the reduction of health inequalities.

The Medicines and Healthcare products Regulatory Agency has received the application for tofersen and is currently reviewing it rapidly for quality, safety, and efficacy, for use in the United Kingdom.The National Institute for Health and Care Excellence (NICE) is the independent body responsible for developing authoritative, evidence-based recommendations for the National Health Service on whether new medicines represent a clinically and cost-effective use of resources. The NICE has selected tofersen for treating amyotrophic lateral sclerosis caused by SOD1 gene mutations as a topic for guidance development through its Highly Specialised Technology (HST) programme. The HST programme appraises medicines for the treatment of very rare, and often very severe diseases, and evaluates whether they can be considered a clinically and cost-effective use of NHS resources.Companies may put in place Early Access Programmes (EAPs) to allow early access to new medicines that do not yet have a marketing authorisation. Participation in EAPs is decided at an individual NHS trust level, and under these programmes, the cost of the drug is free to both the patients taking part in it, and to the NHS, although NHS trusts must still cover the administration costs and provide clinical resources to deliver the EAP.

Whether his Department has considered allowing medical students in their second foundation year to apply for positions that are ring-fenced for physician associates.

No such consideration has been made. The role of physician associates (PAs) is to work with and support doctors, not to replace them. To become employed as a PA, candidates will need to have completed a recognised PA qualification.Regulation of PAs by the General Medical Council (GMC) began at the end of 2024. To join the register, PAs must meet the GMC’s requirements and pass both parts of the Physician Associate National Examination.

What recent assessment he has made of the adequacy of the (a) career and (b) job search support provisions available to junior doctors.

There has been no recent assessment. Under the UK Foundation Programme curriculum, foundation doctors should receive career guidance and advice from educational supervisors, along with the opportunity to explore potential careers.A variety of other tools and support are available to support resident doctors with their career development and job searches. This includes an e-learning for healthcare course on career planning, and guidance on training pathways and career opportunities for doctors on the NHS Health Careers website, which is available at the following link:https://www.healthcareers.nhs.uk/explore-roles/doctors

Whether he has considered reformulating unfilled training posts to enable them to be given to medical students in their second foundation year who have prior experience in the relevant department.

There has been no such consideration. Foundation training and medical speciality training involve different responsibilities, expectations, and levels of experience. The two-year foundation programme acts as a bridge between medical school and specialty training. The programme provides trainees with the defined practical skills, competencies, and sound knowledge of how to manage acutely ill patients that prepares them for entry into specialty training.

What steps his Department is taking to help junior doctors find employment in the NHS after they have completed training.

Decisions about recruitment are matters for individual National Health Service employers. NHS trusts manage their recruitment at a local level, ensuring they have the right number of staff in place, with the right skill mix, to deliver safe and effective care.We will ensure that the number of medical specialty training places meets the demands of the NHS in the future. NHS England will work with stakeholders to ensure that any growth is sustainable and focused in the service areas where need is greatest.To reform the NHS and make it fit for the future, we have launched a 10-Year Health Plan as part of Government’s five long-term missions. Ensuring we have the right people, in the right places, with the right skills will be central to this vision. We will publish a refreshed workforce plan to deliver the transformed health service we will build over the next decade, and treat patients on time again.The Government committed to recruiting over 1,000 recently qualified general practitioners (GPs) through an £82 million boost to the Additional Roles Reimbursement Scheme (ARRS) over 2024/25, as part of an initiative to secure the future pipeline of GPs, with over 1,000 doctors otherwise likely to graduate into unemployment in 2024/25. Data on the number of recently qualified GPs for which primary care networks are claiming reimbursement via the ARRS was published by NHS England on 7 April, and showed that since 1 October 2024, 1,503 GPs were recruited through the scheme.Newly qualified GPs employed under the ARRS will continue to receive support under the scheme in the coming year as part of the 2025/26 contract. A number of changes have been confirmed to increase the flexibility of the ARRS. This includes GPs and practice nurses being included in the main ARRS funding pot, an uplift to the maximum reimbursable rate for GPs in the scheme, and no caps on the number of GPs that can be employed through the scheme.

What proportion of eligible families are receiving Healthy Start in Chester South and Eddisbury constituency.

The NHS Business Services Authority (NHSBSA) operates the Healthy Start scheme on behalf of the Department. Monthly figures for the number of people on the digital Healthy Start scheme are published on the NHS Healthy Start website, which is available at the following link:https://www.healthystart.nhs.uk/healthcare-professionals/The NHSBSA does not hold data on the number of families receiving Healthy Start. The Chester South and Eddisbury constituencies are included within the local authority areas of Chester West and Chester, within NHSBSA data reporting. The total number of people on the scheme for Chester South and Eddisbury in March 2025 was 1,729.The NHSBSA does not currently hold data on the number of people who are eligible for the scheme. An issue was identified with the source data that is used to calculate uptake of the NHS Healthy Start scheme. The NHSBSA has therefore removed data for the number of people eligible for the scheme and the uptake percentage from January 2023 onwards.The issue has only affected the data on the number of people eligible for the scheme. It has not prevented anyone from joining the scheme or continuing to access the scheme if they were eligible.

What steps his Department is taking to (a) support people with Sjogrens to work and (b) implement a multi-disciplinary care system.

Appropriate work is generally good for health and wellbeing, so we want everyone to get work and get on in work, whoever they are and wherever they live. Disabled people and people with health conditions such as Sjogren’s syndrome are a diverse group, so access to the right work and health support, in the right place, at the right time, is key.The Department of Health and Social Care and the Department for Work and Pensions are committed to supporting disabled people and people with health conditions, including people with Sjogren’s, and have range of support available so individuals can stay in work and get back into work, including those that join up employment and health systems.Measures include joining up health and employment support around the individual through Employment Advisors in NHS Talking Therapies and Individual Placement and Support in Primary Care, as well as support from Work Coaches and Disability Employment Advisers in Jobcentres and Access to Work grants.It is also recognised that employers play an important role in addressing health and disability. To build on this, the joint Department for Work and Pensions and Department of Health and Social Care’s Work and Health Directorate is facilitating Keep Britain Working, an independent review of the role of the United Kingdom’s employers in reducing health-related inactivity, and to promote healthy and inclusive workplaces. The lead reviewer, Sir Charlie Mayfield, is expected to bring forward recommendations in Autumn 2025.Most patients with Sjogren’s syndrome will be cared for in primary and secondary care services. A small number of people with complex disease will be cared for in specialised rheumatology services. The national service specifications for specialised rheumatology services define the standards of care expected from organisations commissioned by NHS England to provide specialised rheumatology services for either adults or children. These specifications set the national minimum standards for the diagnosis, treatment, and outcomes for people with Sjogren’s syndrome, and include the requirement for a multi-disciplinary team. People with Sjogren’s will be given the support to manage their condition and signposted to employment advice if required.

What steps his Department is taking to support specialist neuromuscular clinics that wish to take part in the Givinostat Early Access Programme.

The Government welcomes the Early Access Programme (EAP) that the company has put in place to provide early access for patients to givinostat. Access to the EAP must be through one of the 23 NorthStar Centres in the United Kingdom. However, participation in the EAP is decided at an individual National Health Service trust level and a NorthStar Centre will not be able to provide givinostat, if its local trust has not approved participation. Under the EAP, givinostat is free to both patients taking part in it and to the NHS, but the NHS trusts must still cover the cost of administering it to patients.