Written questions by Khan.

What steps his Department is taking to improve the affordability of prescriptions for people with asthma in Birmingham Perry Barr constituency.

No assessment has been made of the potential impact of prescription charges on the health outcomes of people with asthma. However, the National Institute for Health and Care Excellence, the British Thoracic Society, and the Scottish Intercollegiate Guideline Network published a new collaborative guideline for asthma in November 2024. The guideline covers diagnosing, monitoring, and managing asthma in adults, young people, and children. It aims to improve the accuracy of diagnosis, help people to control their asthma, and reduce the risk of asthma attacks. The recommendations offer the opportunity to simplify diagnostic processes and improve the treatment of people with asthma, and NHS England is working with specialist groups and partners to encourage a joined-up approach to implementation. Through its national respiratory programme and focused work on children and young people with asthma, NHS England is already supporting systems to improve outcomes for people with asthma.While there are no plans to amend the criteria for eligibility for free prescriptions, approximately 89% of prescription items are dispensed free of charge in the community in England, and there are a wide range of exemptions from prescription charges already in place for which those with asthma may be eligible. Eligibility depends on the patient’s age, whether they are in qualifying full-time education, whether they are pregnant or have recently given birth, or whether they are in receipt of certain benefits or a war pension.People on low incomes can apply for help with their health costs through the NHS Low Income Scheme. Prescription prepayment certificates (PPCs) are also available. PPCs allow people to claim as many prescriptions as they need for a set cost, with three month and 12-month certificates available, and PPCs can be paid for in instalments.

Pursuant to the Answer of 3 July 2025 to Question 62444 on Asthma: Medical Equipment, what recent discussions his Department has had with pharmaceutical companies on encouraging them to become marketing authorisation holders for dosage counters in emergency inhalers.

The Medicines and Healthcare products Regulatory Agency (MHRA) has not approached any pharmaceutical company to encourage them to become a marketing authorisation holder (MAH) for short-acting beta agonist (SABA) pressurised metered-dose inhalers (pMDIs) with integrated dose counters. As the United Kingdom’s independent regulator for medicines and medical devices, the MHRA does not have the remit to proactively approach pharmaceutical companies with requests to become MAHs for specific products.However, the MHRA provides scientific and regulatory advice to support any pharmaceutical company that wishes to develop and seek authorisation for SABA pMDIs that incorporate integrated dose counters. Through scientific advice meetings and regulatory interactions, the MHRA can offer support on the design, development, and licensing requirements for these products.

How many and what proportion of (a) all people with and (b) children with asthma have a personalised asthma action plan in Birmingham Perry Barr constituency.

The National Institute for Health and Care Excellence (NICE), the British Thoracic Society (BTS), and the Scottish Intercollegiate Guidelines Network (SIGN) published the guideline Asthma: diagnosis, monitoring and chronic asthma management in November 2024, which covers diagnosing, monitoring, and managing asthma in adults, young people, and children. The guideline emphasises the importance of personalised asthma action plans (PAAPs) for effective asthma management. The Department and NHS England welcome the updated guideline and have been engaging with health system partners to support its implementation across the country, including the use of PAAPs. NHS England’s National bundle of care for children and young people with asthma aims to support integrated care systems to deliver high quality asthma care and has resources available to support the use of PAAPs in children and young people. NHS England has also been working jointly with the Health Innovation Networks to form a national respiratory partnership to improve asthma outcomes, including through implementation of the collaborative NICE, BTS, and SIGN asthma guideline. The Quality and Outcomes Framework (QOF) incentivises use of PAAPs through indicator AST007, which measures the percentage of patients with asthma on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control, a recording of the number of exacerbations, an assessment of inhaler technique, and a written personalised action plan. The latest QOF data shows that for England, the percentage of asthma patients on the register receiving this care has increased from 52.5% in 2021/22 to 64.6% in 2023/24. According to the QOF data for the end of 2023/24, general practices in the Perry Barr constituency had 5,437 patients on the asthma register. Of these, 4,253 had received an asthma review in the previous 12 months, and 3,361, or 61.8% of patients on the register, had a written personalised asthma plan. Data for this indicator is not broken down by age, and determining these numbers for children would require contacting individual general practices, as they are the data controllers for this patient information. Further information on the QOF asthma indicators are available on pages 41 to 46 of NHS England’s 2025/26 QOF guidance, which is available at the following link: https://www.england.nhs.uk/wp-content/uploads/2025/03/quality-outcomes-framework-guidance-for-2025-26.pdf

What steps his Department is taking to provide people with asthma with Personalised Asthma Action Plans.

The National Institute for Health and Care Excellence (NICE), the British Thoracic Society (BTS), and the Scottish Intercollegiate Guidelines Network (SIGN) published the guideline Asthma: diagnosis, monitoring and chronic asthma management in November 2024, which covers diagnosing, monitoring, and managing asthma in adults, young people, and children. The guideline emphasises the importance of personalised asthma action plans (PAAPs) for effective asthma management. The Department and NHS England welcome the updated guideline and have been engaging with health system partners to support its implementation across the country, including the use of PAAPs. NHS England’s National bundle of care for children and young people with asthma aims to support integrated care systems to deliver high quality asthma care and has resources available to support the use of PAAPs in children and young people. NHS England has also been working jointly with the Health Innovation Networks to form a national respiratory partnership to improve asthma outcomes, including through implementation of the collaborative NICE, BTS, and SIGN asthma guideline. The Quality and Outcomes Framework (QOF) incentivises use of PAAPs through indicator AST007, which measures the percentage of patients with asthma on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control, a recording of the number of exacerbations, an assessment of inhaler technique, and a written personalised action plan. The latest QOF data shows that for England, the percentage of asthma patients on the register receiving this care has increased from 52.5% in 2021/22 to 64.6% in 2023/24. According to the QOF data for the end of 2023/24, general practices in the Perry Barr constituency had 5,437 patients on the asthma register. Of these, 4,253 had received an asthma review in the previous 12 months, and 3,361, or 61.8% of patients on the register, had a written personalised asthma plan. Data for this indicator is not broken down by age, and determining these numbers for children would require contacting individual general practices, as they are the data controllers for this patient information. Further information on the QOF asthma indicators are available on pages 41 to 46 of NHS England’s 2025/26 QOF guidance, which is available at the following link: https://www.england.nhs.uk/wp-content/uploads/2025/03/quality-outcomes-framework-guidance-for-2025-26.pdf

Pursuant to the Answer of 3 July 2025 to Question 62444 on Asthma: Medical Equipment, how many pharmaceutical companies are registered as marketing authorisation holders for dosage counters in emergency inhalers.

The Medicines and Healthcare products Regulatory Agency understands the term “emergency asthma inhalers” in this context to refer to inhalers containing short-acting beta agonist, such as salbutamol and terbutaline, licensed for the rapid relief of symptoms during acute asthma attacks or bronchospasm, as well as for the prevention of exercise-induced bronchospasm.There are typically two types of inhalers used, pressurised metered dose inhalers (pMDI), often described as an ‘aerosol’ or ‘spray’ inhaler, and dry powder inhalers (DPI). Pressurised metered dose inhalers may be used more commonly in the United Kingdom.All the currently licensed DPIs containing salbutamol or terbutaline include dose counters or dose indicators. There are four registered marketing authorisation holders in total.None of the currently licensed pMDIs containing salbutamol for this emergency indication include dose counters or dose indicators. There are currently no licensed pMDIs containing terbutaline.

Pursuant to the Answer of 1 July 2025 to Question 62448 on Asthma: Medical Equipment, how many patients with asthma receive their inhaler prescriptions (a) free of charge and (b) at the current prescription charge in the latest period for which data is available.

Whilst the NHS Business Services Authority collects data for the number of specific prescription items dispensed in England, it is not possible to determine the indication for which a medicine was prescribed. Given inhalers can be used to treat medical conditions other than asthma, for example chronic obstructive pulmonary disease, we are unable to determine how many were dispensed for the treatment of asthma. From February to April 2025, dispensers in the community in England issued inhalation products to approximately 3,751,000 unique patients who did not pay a charge at the point of dispensing. This total includes items where no charge was collected due to a patient holding a valid pre-payment certificate. Furthermore, from February to April 2025, dispensers in the community in England issued inhalation products to approximately 492,000 unique patients who did pay a charge at the point of dispensing. Figures are approximate, as a unique patient cannot always be identified from a paper prescription.

Pursuant to the Answer of 3 July 2025 to Question 62444 on Asthma: Medical Equipment, what steps his Department is taking to encourage an increase in the number of market authorisation holders for dosage counters for emergency inhalers.

The Medicines and Healthcare products Regulatory Agency (MHRA) has not taken steps to increase the number of marketing authorisation holders for short-acting beta agonist pressurised metered-dose inhalers with integrated dose counters. As the United Kingdom’s independent regulator for medicines and medical devices, the MHRA promotes patient safety and supports improvements in product design but does not have the remit to direct or influence the commercial decisions of pharmaceutical companies. The MHRA can provide scientific and regulatory advice to support potential new entrants to the market, but cannot compel or incentivise companies to apply for marketing authorisation for specific products.

How many asthma attacks that resulted in hospital admissions occurred in schools that (a) had emergency inhalers and (b) did not have emergency inhalers installed on their grounds.

The information requested is not held centrally.

How many asthma patients receiving their inhaler prescriptions (a) free of charge and (b) at the current prescription charge have been admitted to hospitals with life-threatening asthma attacks in the latest period for which data is available.

The Government and its arm’s-length bodies, including the NHS Business Services Authority, do not collect this information.

How many and what proportion of schools (a) had and (b) did not have emergency inhalers installed on their grounds in the latest period for which data is available.

The department does not hold data on emergency inhalers in schools.Under section 100 of the Children and Families Act 2014, maintained schools, academies and pupil referral units must make arrangements for supporting pupils with medical conditions. Schools are responsible for deciding how best to fulfil this duty. They are permitted to buy salbutamol inhalers, without a prescription, for use in emergencies, but there is no requirement to do so.

Pursuant to the Answer of 2 July 2025 to Question 62446 on Schools: Asthma, what steps his Department is taking to increase the (a) purchase of and (b) storage for emergency inhalers in schools.

The department does not hold data on emergency inhalers in schools.Under section 100 of the Children and Families Act 2014, maintained schools, academies and pupil referral units must make arrangements for supporting pupils with medical conditions. Schools are responsible for deciding how best to fulfil this duty. They are permitted to buy salbutamol inhalers, without a prescription, for use in emergencies, but there is no requirement to do so.

Whether her Department has made an assessment of the potential merits of reforming the eligibility criteria for the Social Fund Funeral Expenses Payment in line with the Scottish Government’s Funeral Support Payment.

The eligibility criteria for a Social Fund Funeral Expenses Payment are designed to ensure the scheme is fair for taxpayers, while supporting the most vulnerable with these costs. We continue to keep the Funeral Expenses Payment scheme under review to ensure it remains effective and sustainable within current budgetary constraints. This includes the eligibility criteria, application process, customer experience, processing times and administrative costs.

Whether her Department has made an assessment of the potential impact of simplifying the eligibility criteria for the Funeral Expenses Payment on (a) application processing times and (b) the administrative costs of processing applications.

The eligibility criteria for a Social Fund Funeral Expenses Payment are designed to ensure the scheme is fair for taxpayers, while supporting the most vulnerable with these costs. We continue to keep the Funeral Expenses Payment scheme under review to ensure it remains effective and sustainable within current budgetary constraints. This includes the eligibility criteria, application process, customer experience, processing times and administrative costs.

Whether her Department plans to assess the adequacy of the clarity of the application process for the Social Fund Funeral Expenses Payment for bereaved applicants.

The eligibility criteria for a Social Fund Funeral Expenses Payment are designed to ensure the scheme is fair for taxpayers, while supporting the most vulnerable with these costs. We continue to keep the Funeral Expenses Payment scheme under review to ensure it remains effective and sustainable within current budgetary constraints. This includes the eligibility criteria, application process, customer experience, processing times and administrative costs.

Whether his Department has made an assessment of the potential benefits of requiring schools to hold emergency asthma inhalers.

Schools are permitted to buy salbutamol inhalers, without a prescription, for use in emergencies. An emergency salbutamol inhaler should only be used by children who have either been diagnosed with asthma and prescribed an inhaler, or who have been prescribed an inhaler as reliever medication and who have written parental consent for use of the emergency inhaler.Schools are not required to hold an inhaler. If they choose to keep an emergency inhaler, they should establish a policy or protocol for its use based on published guidance available here: https://www.gov.uk/government/publications/emergency-asthma-inhalers-for-use-in-schools.

Whether his Department has made an assessment of the potential merits of mandating the installation of dosage counters in all NHS-provided emergency asthma inhalers.

The Medicines and Healthcare products Regulatory Agency (MHRA) understands the term “emergency asthma inhalers” in this context to refer to reliever inhalers containing short-acting beta agonist (SABA) licensed for the rapid relief of symptoms during acute asthma attacks or bronchospasm, as well as for the prevention of exercise-induced bronchospasm. The MHRA is aware of ongoing safety concerns associated with the absence of integrated dose counters on SABA pressurised metered dose inhalers (pMDIs), particularly the risk that patients may unknowingly use inhalers that are empty or near empty during an asthma attack.The MHRA has assessed the potential merits of mandating the inclusion of dose counters on SABA pMDIs. As part of this review, the MHRA has actively engaged with external national healthcare stakeholders and pharmaceutical industry to explore the feasibility of the integration. While the safety case for improved dose visibility is recognised, it is equally important to consider the potential impact of the product design change on supply resilience. The United Kingdom market for SABA pMDIs is currently limited to a small number of market authorisation holders and introducing a regulatory requirement without fully considering implementation timelines, material and personnel resources, and manufacturing capabilities could risk destabilising the supply of these critical medicines.Rather than mandating dose counters on SABA pMDIs, the MHRA is currently pursuing a more flexible, proportionate approach to strongly recommend the inclusion of dose counters. This strategy seeks to improve patient safety outcomes while avoiding the risk of unintended supply disruption. The MHRA remains committed to working closely with industry and other stakeholders to ensure that any changes are introduced within a robust and pragmatic framework and timeline that safeguards patient access to essential respiratory medicines.

Whether his Department has made an assessment of the potential merits of making all NHS-provided emergency asthma inhalers free of charge.

There are no current plans to review the list of medical conditions that entitle someone to apply for a medical exemption certificate.Approximately 89% of prescription items are dispensed free of charge in the community in England, and there are a wide range of exemptions from prescription charges already in place for which those with asthma may be eligible.Eligibility depends on the patient’s age, whether they are in qualifying full-time education, whether they are pregnant or have recently given birth, or whether they are in receipt of certain benefits or a war pension.People on low incomes can apply for help with their health costs through the NHS Low Income Scheme. Prescription prepayment certificates (PPCs) are also available. PPCs allow people to claim as many prescriptions as they need for a set cost, with three month and 12-month certificates available, and PPCs can be paid for in instalments.

What steps his Department is taking to help support people with asthma in Birmingham Perry Barr constituency.

The Birmingham and Solihull Integrated Care System (BSol ICS) is working to enhance asthma care, which includes access to diagnostics in the community, across the city and the borough. Improved rates of diagnosis will allow early intervention and prevention, supporting patients to manage their condition more effectively at home or in the community, and preventing emergency hospital admissions.In primary care, adults, children, and young people can access support from their general practice (GP) for diagnosis and ongoing management of the condition, treatment of mild exacerbations, and asthma annual reviews to optimise treatment and prevent exacerbations.Adults, children, and young people have access to outpatient reviews by community respiratory specialist nurses through GP referrals to the Birmingham Community Healthcare NHS Foundation Trust. These reviews are for patients requiring specialist support, where their condition is not severe enough to require secondary care.In December 2024, the BSol ICS’s Community Care Collaborative launched a Respiratory Same Day Emergency Care Service at Washwood Health and Wellbeing Centre. The service is in particular responding to the issue that 40% of those admitted to Birmingham Heartlands Hospital have respiratory illness. The service is for patients aged 17 years old and over from any part of Birmingham and Solihull who have chronic respiratory conditions, including chronic obstructive pulmonary disease, asthma, pneumonia, respiratory failure, bronchiectasis, and interstitial lung disease. Patients who access the service are then either discharged, followed-up with a GP, admitted to a virtual ward, also known as hospital at home, or referred to a community respiratory service.For children and young people, the Birmingham Women’s and Children’s NHS Foundation Trust’s Department of Respiratory Medicine and Cystic Fibrosis treats children and young people aged between zero and 18 years old with asthma, including 40 to 50 with difficult asthma, who are receiving specialised treatments.The BSol ICS has also established a Paediatric Asthma Network which has been leading a number of workstreams focused on improving asthma education, training, post-asthma attack management, and the creation of a novel risk stratification tool to identify children with high risk of asthma attacks. The BSol ICB has also provided funding to support the creation of new asthma clinics, specialist asthma nurses, and asthma-friendly school initiatives. 75% of children who had a second review at these clinics showed significant improvement in their asthma control test, suggesting improved disease control. 100% of children who attended the clinics had a reduction in asthma-related hospital accident and emergency department visits over the subsequent six months.

Whether his Department has made an assessment of the potential benefits of amending the Human Medicines (Amendment) (No. 2) Regulations 2014 to require (a) colleges, (b) nurseries, and (c) universities to hold emergency asthma inhalers.

There are no plans to amend these regulations to require colleges and universities to hold emergency inhalers. These are not controlled environments like schools, which require parents to inform them if their children need an inhaler. Colleges and universities typically have much larger enrolment numbers than schools, with their students having greater freedom of movement than schools. Colleges and universities also have students of adult age who are responsible, as adults, for ensuring both have and properly use their inhalers.Emergency inhalers in schools are a back-up and not a substitution for a child having their own inhaler to hand. The emergency inhaler is for use in the event a child’s inhaler is empty, broken or unavailable.By virtue of the wording of the School Standards and Framework Act 1998, the Human Medicines (Amendment) (No. 2) Regulations 2014 also apply to maintained nursery schools, namely state-funded early years settings, controlled and funded by the local authority. Evidence has not been presented that suggests it is necessary to extend the regulations to all non-state-run nurseries in England. Parents of children with asthma attending nursery should ensure that their child, or the nursery, has the child’s inhaler available.

Whether his Department monitors the involvement of UK-Israeli dual nationals serving in the Israel Defense Forces.

The UK recognises the right of British dual nationals to serve in the legitimately recognised armed forces of the country of their other nationality. We do not track the number of dual nationals that choose to take up this right. The Secretary of State for Defence has not discussed the issue of UK-Israeli dual nationals serving in the Israel Defense Forces with the Secretary of State for the Home Department.