Written questions by Cooper.

What steps he is taking to monitor the rise in cases in the more spreadable variant of mpox now detected in the UK.

There are two distinct types of the mpox virus: clade I and clade II. The previous significant outbreak in the United Kingdom in 2022 was from clade II. Clade I is currently classified as a high consequence infectious disease. The risk to the UK population remains low. We expect to see the occasional imported case of Clade Ib mpox in the UK.The UK Health Security Agency (UKHSA) continues to closely monitor mpox epidemiology and has well established surveillance systems to monitor the spread of mpox. This is supported by a robust contact tracing process that helps us to effectively contain any imported cases found in the UK.The latest information about UK cases of mpox is available at the following link:https://www.gov.uk/government/news/ukhsa-detects-first-case-of-clade-ib-mpoxA full summary of the measures UKHSA is taking is summarised in the technical briefing, which is available at the following link:https://assets.publishing.service.gov.uk/media/66e83b367f20ecc7ec3aa1db/mpox-technical-briefing-9.pdfThis briefing will be reviewed and updated as more is understood about the disease.UKHSA is engaged with international partners, including the World Health Organisation, European, US and Africa Centres for Disease Control and Prevention, ensuring we receive updates about international cases in a timely fashion.

By what procedure central government funding is allocated to institutions providing hospice care.

Palliative care services are included in the list of services an integrated care board (ICB) must commission. This promotes a more consistent national approach and supports commissioners in prioritising palliative and end of life care. To support ICBs in this duty, NHS England has published statutory guidance and service specifications.Most hospices are charitable, independent organisations which receive some statutory funding for providing NHS services. The amount of funding each charitable hospice receives varies both within and between ICB areas. This will vary depending on the demand in that ICB area, but will also be dependent on the totality and type of palliative and end of life care provision from both NHS and non-NHS services, including charitable hospices, within each ICB area.From 2007/8 until 2023/24, children and young people’s hospices received funding via the Children’s Hospice Grant. While 2023/24 marked the final year of the Children’s Hospice Grant in its previous format, in 2024/25, NHS England provided £25 million of funding for children and young people’s hospices, maintaining the level of funding from 2023/24. For the first time, this funding was distributed to hospices by ICBs, on behalf of NHS England, rather than being centrally administered as before. Since 2022/23, individual allocations of this funding have been determined using a prevalence-based model, enabling allocations to reflect local population need.

What estimate he has made of the percentage of (a) doctors and (b) anaesthetists preparing to leave the profession; and what steps he is taking to improve retention.

The Government is committed to tackling the workforce crisis across the National Health Service. This will be achieved through better workforce planning, which will address the recruitment and retention challenges facing the NHS.NHS England continues to lead on a range of initiatives to boost retention, with a strong focus on improving organisational culture, supporting staff wellbeing, and promoting flexible working opportunities. It is continually reviewing the effectiveness of these, and their impact on the workforce.No specific estimate of the future numbers of doctors and anaesthetists preparing to leave the profession has been made. The General Medical Council publishes annual information on the total number of doctors leaving their register of licenced professionals. This shows that in 2022, 11,319 doctors left the licenced register, the equivalent to 4% of the register. No information is available for anaesthetists specifically.

What assessment he has made of the potential impact of anaesthetic workforce shortages on the NHS’s ability to tackle the elective backlog.

Tackling waiting lists is a key part of our Health Mission. We have committed to getting back to the NHS Constitutional standard that at least 92% of patients wait no longer than 18 weeks from Referral to Treatment within our first term. As a first step to achieving this, we will deliver 2 million additional appointments, scans, and operations, or the equivalent to 40,000 per week.Whilst no formal assessment has been made of the specific potential impact of anaesthetic workforce shortages on the National Health Service’s ability to tackle the backlog, the Government will ensure the NHS has the right people, in the right places, with the right skills, to deliver the care patients need.

Whether he plans to increase the number of medical speciality training places (a) in total and (b) in anaesthesia.

NHS staff have been overworked for years, with staff being burnt out and demoralised.We are committed to training the staff we need, including anaesthetists, to ensure patients are cared for by the right professional, when and where they need it.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.There is no quick fix, but through the NHS Long Term Workforce Plan we will build a health service fit for the future.

What steps his Department is taking to help increase the number of anaesthetists.

NHS staff have been overworked for years, with staff being burnt out and demoralised.We are committed to training the staff we need, including anaesthetists, to ensure patients are cared for by the right professional, when and where they need it.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.There is no quick fix, but through the NHS Long Term Workforce Plan we will build a health service fit for the future.

With reference to Lord Darzi's Independent investigation of the NHS in England, published on 12 September 2024, what steps his Department is taking to support integrated care boards to increase capital expenditure in the primary care estate.

The Government is committed to delivering a National Health Service that is fit for the future, which means we require world class NHS infrastructure across the entire NHS estate. Beyond hospitals, we know we need the right infrastructure in the right place to deliver on our commitments of creating a true Neighbourhood Health Service and ensuring that patients receive the care they deserve.At the Autumn Budget, we established a dedicated capital fund of £102 million to deliver approximately 200 upgrades to general practice surgeries across England, supporting improved use of existing buildings and space, boosting productivity, and enabling delivery of more appointments. This funding represents a first step in delivering the additional capital the primary care sector needs. It responds directly to issues highlighted by Lord Darzi’s independent review of the NHS and is the first dedicated national capital fund for primary care since 2020.The Department and NHS England are working with integrated care boards to prioritise high-impact projects where investment can unlock significant productivity gains and additional usable space from existing buildings. Capital budgets for 2026/27 onwards will be considered through Phase 2 of the Spending Review process, concluding in Spring 2025.

If he will make an assessment of the potential impact of the provision of advice on plant-based diets by clinicians in primary care settings on (a) achieving the aim in the NHS Long Term Plan of supporting patients to adopt improved healthy behaviours and (b) the cost of health care.

The Scientific Advisory Committee on Nutrition (SACN) discussed the topic of plant-based diets at its horizon scan meetings in 2022 and 2024. The SACN concluded it is an important topic and will continue to grow in interest, particularly from a sustainability viewpoint. The SACN agreed to keep the topic on its watching brief. Meeting papers are available on the SACN’s website, at the following link:https://www.gov.uk/government/groups/scientific-advisory-committee-on-nutrition#sacn-meetingsGovernment advice on a healthy, balanced diet is encapsulated in the United Kingdom’s national food model, the Eatwell Guide. The Eatwell Guide depicts a diet that is based on fruit, vegetables, and higher fibre starchy carbohydrates. It divides the foods and drinks we consume into five main groups and illustrates that both animal products and plant-based products can be part of a healthy balanced diet. Further information on the Eatwell Guide is available at the following link:https://www.gov.uk/government/publications/the-eatwell-guideThese Eatwell Guide nutrition principles underpin the Government Buying Standards for Food and Catering Services (GBSF). Hospitals, the Government, and their agencies are required to apply the GBSF, with other public sector settings also encouraged to follow. Further information on the GBSF is available at the following link:https://www.gov.uk/government/publications/sustainable-procurement-the-gbs-for-food-and-catering-servicesAdherence to the Eatwell Guide has been shown to significantly improve both health and environmental outcomes, as per the 2020 Scheelbeek et al. study, with appreciably lower environmental impact than the current UK diet, as noted in 2016 by the Carbon Trust. Further information on the Scheelbeek et al. study and the Carbon Trust’s analysis is available, respectively, at the following two links:https://bmjopen.bmj.com/content/10/8/e037554https://www.carbontrust.com/our-work-and-impact/guides-reports-and-tools/the-eatwell-guide-a-more-sustainable-dietGiven that most people in the UK do not currently follow a diet in line with Government’s dietary recommendations, moving the population to dietary intakes in line with the Eatwell Guide remains the priority.The Government recognises the valuable contribution that plant-based foods and drinks can make to people’s diets, alongside the contribution that fish and animal-based foods and drinks can make. Health care professionals in primary care settings are expected to provide a wide range of advice and support to patients that is based around their clinical needs. This advice should be based on robust clinical evidence and should allow patients freedom of choice over the way their care is planned and delivered, which includes individual dietary requirements and preferences where appropriate.

If he will make an assessment of the potential merits of developing a National GP Retention Strategy backed by ring-fenced funding.

The Government has committed to increasing the number of general practitioners (GPs), and this includes doing more to address GP retention and the reasons why GPs leave the profession. The 10-Year Health Plan, which will be published in spring 2025, will set out a long-term vision to train and retain the staff the National Health Service needs to be fit for the future. The plan will be shaped by responses from the public, NHS staff, and experts to the biggest national conversation about the future of the NHS since its birth, launched by the Department and NHS England in October.

With reference to paragraph 2.71 of the Autumn Budget 2024, published on 30 October, what support his Department plans to give to GP practices unable to access the fund for GP surgery upgrades.

There is no additional national funding for those not prioritised by their local systems to access the capital fund of £102m for GP upgrades allocated in the 2024 Autumn Budget.This capital fund is in addition to annual capital allocations to Integrated Care Boards (ICBs). Since 2022/23, the Department includes a substantial proportion of primary care business as usual estates and GP IT capital in ICB capital funding envelopes. This allows ICBs to take a more cohesive approach to capital investment decisions across all organisations within that system. In addition, ICBs are responsible for commissioning - planning, securing, and monitoring – GP services within their health systems through delegated responsibility from NHS England.

Whether he plans to provide additional funding to (a) community musculoskeletal services and (b) physiotherapy.

The Government recognises the importance of improving health for the 20 million people in the United Kingdom who live with a musculoskeletal condition. This forms a key part of the Government’s mission to build a National Health Service fit for the future.Financial allocations will be confirmed through NHS Planning Guidance. In the meantime, we are working with NHS England and other stakeholders to explore options to increase access to, and improve support for, those living with arthritis and musculoskeletal conditions.We will publish a 10-Year Health Plan for the NHS in the spring which will focus on increasing productivity and ensuring that every pound of taxpayer money is spent wisely, by reforming how healthcare is delivered.

Whether he plans to provide additional support for people with (a) arthritis and (b) musculoskeletal conditions.

Services for those with musculoskeletal (MSK) conditions, including arthritis, are commissioned locally by integrated care boards (ICBs). The Department expects MSK services and fragility fracture to be fully incorporated into integrated care system planning and decision-making.At a national level, NHS England is working to improve the diagnosis, treatment, and care of patients with MSK conditions, such as arthritis, and increase support for patients with arthritis through its Getting It Right First Time rheumatology programme. In January 2023, NHS England also published an improvement framework to reduce community MSK waits while delivering the best outcomes and experience. This supports integrated care systems to improve timely access to commissioned MSK triage and therapy services.To support health and care professionals in the early diagnosis and management of rheumatoid arthritis and osteoarthritis, and in the provision of services for people living with arthritis, the National Institute for Health and Care Excellence has published expert guidance for rheumatoid arthritis and osteoarthritis, with further information on the two available, respectively, at the following two links:https://www.nice.org.uk/guidance/ng100https://www.nice.org.uk/guidance/ng226The Department funds research into MSK conditions, including arthritis, through the National Institute for Health and Care Research (NIHR). Through the NIHR, the Department spent approximately £26.3 million on MSK research in 2023/24 and £79.2 million since 2019/20. Six NIHR Biomedical Research Centres have MSK conditions as a research theme. In particular, the Leeds Biomedical Research Centre aims to improve treatment for osteoarthritis. The NIHR, in collaboration with Versus Arthritis, also funds a dedicated UK Musculoskeletal Translational Research Collaboration, aligning investment in MSK translational research, and creating a United Kingdom-wide ambition and focus to drive cutting edge research and improve outcomes for patients.

If he will make an assessment of the potential merits of requiring NHS Trusts to amalgamate patient data across primary care.

My Rt Hon. Friend, the Secretary of State for Health and Social Care has announced the intention for there to be a single patient record, including primary care and hospital data, so professionals have the data they need when treating patients and are able to make better informed decisions and deliver more preventative health and care.We are in the early stages of engaging with the public and stakeholders to understand their views about the use of health and care data. We will use the findings to form the basis of any future plans regarding a single patient record.

What assessment he has made of the impact of surgical hubs on waiting times for (a) trauma and (b) orthopaedic treatment.

No formal assessment has been made on the impact of surgical hubs on waiting times for trauma and orthopaedic treatment.Surgical hubs enable trusts to increase resilience for elective procedures and minimise cancellations during periods of high pressure. This can reduce uncertainty for patients around last-minute cancellations, maximise the use of available capacity, and helps to reduce waiting times. In the Budget, we committed additional funding to set up new surgical hubs to help with our commitment to get the waiting lists down.

With reference to paragraph 2.71 of the Autumn Budget 2024, published on 30 October, how many new surgical hubs will focus solely on orthopaedic procedures.

The Department, in collaboration with NHS England, will outline details of the funding allocation for surgical hubs at the earliest opportunity. This will include the number of hubs to be established, and their specialty focus. Each hub will be developed based on the needs of patients and the current waiting list pressures in the areas that they cover.

If he will include enforcement measures in the Tobacco and Vapes Bill to prevent the sale of tobacco products on the internet to those under age.

Selling tobacco to someone underage, whether in person or online, is a serious criminal offence which carries a fine of up to £2,500 on conviction in a magistrates’ court. It is the responsibility of all retailers including those online to ensure their customers are over the age of sale. The Tobacco and Vapes Bill, introduced to Parliament on 5 November 2024, is the biggest public health intervention in a generation, and takes significant action to strengthen enforcement to ensure that current and new sales regulations are successfully implemented.The Bill introduces a new £200 fixed penalty notice in England and Wales, which will enable Trading Standards Officers to act ‘on the spot’ to clamp down on rogue retailers selling tobacco, vapes or nicotine products to people underage, whether in-person or online. The Bill also provides powers in England, Wales, and Northern Ireland to introduce a licensing scheme for the retail sale of these products. Once the scheme is introduced, it will be a criminal offence to sell these products, either in person or online, without a licence. Licensing offences will carry significant financial penalties, and those who commit sales offences could face licence revocation, enabling Trading Standards to further clamp down on rogue retailers. The details of the licensing scheme including licence conditions will be subject to consultation ahead of introduction.Alongside the Bill, the Government is exploring how we can further tackle online underage sales. The Department for Science, Innovation and Technology is creating a framework of standards and governance, namely the UK digital identity and attributes trust framework, underpinned by legislation, to enable the widespread use of trusted digital identity services. This framework provides a potential opportunity for companies providing age verification services to be certified, to prove they are delivering age assurance solutions that meet Government standards.

What steps he is taking to help increase the uptake of NHS stop smoking services amongst underage smokers.

On 5 November 2024, the Government introduced the Tobacco and Vapes Bill, which stands to be the most significant public health intervention in a generation. It will create the first smoke-free generation, as children turning 15 years old this year or younger can never legally be sold tobacco, whilst those who currently legally smoke are able to continue doing so. The bill sits alongside wider support across the health service to assist smokers in quitting for good.We remain committed to helping existing smokers to quit with effective support, which is three times as effective as making an unassisted quit attempt. The National Institute for Health and Care Excellence recommends nicotine replacement therapy for young people aged 12 years old and over, and if prescribed, that behavioural support is also provided. Local authority funding has been boosted with an additional £70 million in 2024/25 to build capacity and demand for local stop smoking support.

What steps he is taking to support the (a) mental health and (b) wellbeing of nursing staff.

It is important that National Health Service staff are able to work in a supportive and compassionate environment that prioritises their health and wellbeing. NHS England has a wide-ranging package of mental health and wellbeing support for all staff, including nurses, which includes access to counselling services, a self-check wellbeing tool, free access to a range of wellbeing apps, and a health and wellbeing guardian role to provide board level scrutiny within NHS organisations. NHS England is also leading work with partner organisations to strengthen occupational health and wellbeing services for NHS staff.

What assessment he has made of the potential impact of increases in levels of demand for patient care on the capacity of the nursing workforce.

We are committed to training the staff we need to ensure that patients are cared for by the right professional, when and where they need it. The Long Term Workforce Plan, which included assessments of nursing demand and supply, will be reviewed following the recommendations of 10-Year Health Plan.

Whether his Department has made an assessment of the potential merits of introducing auto-enrolment for the Healthy Start scheme.

The Healthy Start scheme is kept under review. There have been no discussions with my Rt Hon. Friend, Secretary of State for Work and Pensions on introducing auto-enrolment for Healthy Start.The Healthy Start scheme was introduced in 2006 to encourage a healthy diet for pregnant women, babies, and young children under four years old, from very low-income households. It can be used to buy, or put towards the cost of, fruit, vegetables, pulses, milk, and infant formula. Healthy Start beneficiaries have access to free Healthy Start Vitamins for pregnant women and children aged under four years old. Healthy Start now supports over 355,000 beneficiaries. This figure is higher than the previous paper voucher scheme.The NHS Business Services Authority operates the Healthy Start scheme on behalf of the Department. All applicants to the Healthy Start scheme, where they meet the eligibility criteria, must accept the terms and conditions of the prepaid card at the point of application. As the prepaid card is a financial product and cannot be issued without the applicant accepting these terms, the NHS Business Services Authority is not able to automatically provide eligible families with a prepaid card. However, we remain open to all viable routes to improve uptake.