Written questions by Egan.

What assessment he has made of the potential merits of the use and funding of technology enabled care in the NHS and other care settings.

Awaiting answer.

What steps are being taken to prevent abuse of social care staff, including threatening unemployment, wage theft, and abuse of overtime.

The Department works closely with regulators, local authorities, other departments, and enforcement bodies to share concerns and intelligence about illegal or unethical practices in adult social care.The Government is creating the Fair Work Agency (FWA) to simplify the labour market enforcement system and build an economy based on fair competition and fair reward for hard work. It will bring enforcement functions of three existing bodies together, into one place, so employment rights are enforced more effectively and efficiently.The FWA will be responsible for enforcing domestic agency rules, the national minimum wage, licensing standards for gangmasters, and acting against serious labour exploitation.The FWA will be implemented in phases following Royal Assent of the Employment Rights Bill, with the FWA being established in April 2026.

What assessment his Department has made of the effectiveness of the NHS prescription exemption-checking system.

While the Department has not undertaken a formal evaluation of the National Health Service prescription exemption‑checking system, it has put in place arrangements to balance timely access to medicines with proportionate protection of public funds.The Prescription Exemption Checking Service, delivered by the NHS Business Services Authority on behalf of the Department and NHS England, operates retrospectively by checking a random sample of prescriptions where an exemption has been claimed, using data held by the NHS Business Services Authority and the Department for Work and Pensions. These checks typically take approximately three months to complete. Where entitlement cannot be confirmed, a staged enquiry process allows individuals to clarify or evidence their eligibility before any penalty is applied.Alongside this, Real Time Exemption Checking enables exemption status to be verified at the point of dispensing and is now used by approximately 95% of community pharmacies in England. Where an exemption is confirmed in real time, the prescription is automatically flagged as exempt and no retrospective penalty charge can be issued, reducing incorrect charges and follow‑up correspondence. Taken together, these arrangements are intended to ensure exemption checking is fair, proportionate, and effective in protecting NHS resources.

Whether (a) NHS England and (b) his Department has considered introducing a national (i) prescribing indicator and (ii) thematic audit on (A) long-term and (B) high-potency topical corticosteroid use.

Neither NHS England nor the Department have considered introducing a national prescribing indicator and thematic audit on long-term and high-potency topical corticosteroid use.Auditing of general practice (GP) prescribing data is usually undertaken by practice pharmacists or medicines optimisation teams locally. GPs, pharmacists, or a suitably qualified healthcare professional are expected to carry out a regular Structured Medication Review (SMR) of a patient’s medication. SMRs are an evidence-based and comprehensive review of a patient’s medication, taking into consideration all aspects of their health.

Which national body has responsibility for routinely auditing prescribing data to identify GP repeat-prescribing of topical corticosteroids that is (a) long-term and (b) high-potency.

The NHS Business Services Authority collects and publishes prescribing data for primary care in England. NHS England and the Department do not routinely audit data to identify general practice repeat-prescribing of topical corticosteroids that is long-term and high-potency. Responsibility for reviewing repeat prescribing practices sits with individual practices and their commissioners, who are expected to ensure prescribing is safe, appropriate, and in line with relevant clinical guidance.

What guidance has been issued to clinicians on recording suspected Topical Steroid Withdrawal in patient medical records, including GP records, where a formal diagnosis has not been made.

No specific guidance has been issued on recording suspected topical steroid withdrawal in patient medical records, including to general practitioners. The Medicines and Healthcare products Regulatory Agency has issued guidance documents on topical steroid withdrawal, which are available at the following two links:https://www.gov.uk/drug-safety-update/topical-corticosteroids-information-on-the-risk-of-topical-steroid-withdrawal-reactionshttps://www.gov.uk/drug-safety-update/topical-steroids-introduction-of-new-labelling-and-a-reminder-of-the-possibility-of-severe-side-effects-including-topical-steroid-withdrawal-reactionsThe National Institute for Health and Care Excellence has also published guidance, which is available at the following link:https://cks.nice.org.uk/topics/corticosteroids-topical-skin-nose-eyes/management/topical-skin-treatment/

Whether NHS England has assessed the potential merits of a dedicated referral and support pathway for patients experiencing Topical Steroid Withdrawal, distinct from standard eczema care.

There has been no national assessment of need for a dedicated referral and support pathway for topical steroid withdrawal (TSW). Care for patients presenting with TSW is provided through services commissioned by individual integrated care boards. The Elective Reform Plan, published January 2025, outlines actions that will help ensure care is delivered in the right place. This includes expanding the use of Advice and Guidance, a clinical collaboration tool that supports timely specialist input and helps patients receive care in the right setting, including for dermatology care.

What data (a) his Department and (b) NHS England holds on the proportion of prescribers and pharmacists who have received training on the risks of Topical Steroid Withdrawal.

The Department and NHS England do not hold data on the proportion of prescribers and pharmacists who have received training on the risks of topical steroid withdrawal. Initial education and training and continued professional develop is wide ranging, including dermatology. Clinicians would be expected to provide advice and counselling to patients in-line with guidance issued by the Medicines and Healthcare products Regulatory Agency on the safe use of topical steroids and topical steroid withdrawal.

What assessment his Department has made of the adequacy of Yellow Card reporting for capturing cases of Topical Steroid Withdrawal.

The Medicines and Healthcare products Regulatory Agency (MHRA) is an executive agency of the Department, with responsibility for ensuring medicines meet appropriate standards of safety, quality, and efficacy.In 2021, the MHRA published a Public Assessment Report (PAR), reviewing the available evidence for topical steroid withdrawal (TSW) reactions, which can be found at the following link:https://www.gov.uk/government/publications/topical-steroid-withdrawal-reactions-a-review-of-the-evidenceTo inform this report, a comprehensive review of the available evidence was undertaken. This included an assessment of data from Yellow Card reports to identify suspected spontaneous cases of TSW reactions associated with topical corticosteroids on the Yellow Card database, as well as information from the published literature and other medicines regulators. The review considered whether regulatory action was required to minimise the risk of these events.The PAR resulted in two Drug Safety Updates in 2021 and 2024 which aimed to raise awareness on the risk of TSW reactions and introduce new labelling. Both updates are available, respectively, at the following two links:https://www.gov.uk/drug-safety-update/topical-corticosteroids-information-on-the-risk-of-topical-steroid-withdrawal-reactionshttps://www.gov.uk/drug-safety-update/topical-steroids-introduction-of-new-labelling-and-a-reminder-of-the-possibility-of-severe-side-effects-including-topical-steroid-withdrawal-reactionsThe MHRA uses the Medical Dictionary for Regulatory Activities (MedDRA) to code suspected adverse drug reactions reported by patients and healthcare professionals via the Yellow Card scheme. MedDRA is an international, clinically validated medical terminology used by regulatory authorities and the biopharmaceutical industry throughout the entire regulatory process, from pre-marketing to post-marketing safety monitoring. MedDRA is updated twice annually, and new terms can be proposed by any MedDRA users. Following the publication of the PAR, the term “Topical steroid withdrawal reaction” was added to MedDRA as a lower level term in version 24.1 and made available to users of the Yellow Card website in February 2022 as part of routine updates. This helps to ensure that more reports pertaining to TSW reactions are appropriately captured. The MHRA continues to closely monitor Yellow Card reports submitted for suspected TSW reactions.The MHRA continues to engage with the British Association of Dermatologist who have also released a statement, which is available at the following link:https://cdn.bad.org.uk/uploads/2024/02/22095550/Topical-Steroid-Withdrawal-Joint-Statement.pdf

Whether his Department plans to mandate (a) training and (b) continuing professional development for prescribers and pharmacists on recognising and managing Topical Steroid Withdrawal.

Regulated healthcare professionals need to meet the standards of proficiency, conduct, and performance set by the relevant professional regulator, which are independent of the Government. It is the responsibility of individual employers to ensure their staff have appropriate access to ongoing training and professional development to provide safe and effective care.

Whether the upcoming integration of NHS England into the Department will affect the operation of Directed Enhanced Services or Structured Medication Reviews in relation to long-term topical steroid use.

Work is progressing at pace to develop the design and operating model for the new integrated organisation, and to plan for the smooth transfer of people, functions, and responsibilities. It is only right that with such significant reform, we commit to carefully assessing and understanding the potential impacts, as is due process. These ongoing assessments will inform our programme as appropriate. At this stage, we do not anticipate any impacts on Structured Medication Reviews relating to long-term topical steroid use, nor on the operation of Directed Enhanced Services.

If he will publish guidance clarifying which organisation is responsible for ensuring that prescribers act on updated patient-safety information on topical corticosteroids.

The health and care professional regulators are responsible for the regulation of health and care professionals across the United Kingdom. Regulators require all registrants to work within their scope of practice by only practising in areas where they have appropriate knowledge, skills, and experience. This also applies to prescribing. The General Medical Council, the Nursing and Midwifery Council, the Health and Care Professions Council, and the General Pharmaceutical Council each publish guidance on prescribing for their registrants, which includes signposting to the Medicines and Healthcare products Regulatory Agency which monitors the safety of medicines. Regulators can take action through fitness to practise processes where professionals on the register fail to uphold professional standards or practise outside of relevant guidance, posing a risk to patient safety.

What steps he is taking to ensure that Integrated Care Boards monitor implementation of MHRA safety alerts on Topical Steroid Withdrawal across GP practices and community pharmacies.

NHS England is not aware that the Medicines and Healthcare products Regulatory Agency (MHRA) has issued a National Patient Safety Alert on topical steroid withdrawal (TSW). NHS England's Patient safety team issued this National Patient Safety Alert in 2020, and it is available at the following link: https://www.england.nhs.uk/2020/08/steroid-emergency-card-to-support-early-recognition-and-treatment-of-adrenal-crisis-in-adults/ The safety alert mentions topical steroids, although they are not the focus of the alert. These alerts are a contractual requirement as set out in clause 33.8 of the NHS Standard Contract and so integrated care boards are expected to include consideration of these as part of their wider commissioning responsibilities. The Care Quality Commission Regulation 12: Safe care and treatment' in Guidance on 12(2)(b) states that “Providers must comply with relevant Patient Safety Alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System”. Further information is available at the following link: https://www.cqc.org.uk/guidance-regulation/providers/regulations-service-providers-and-managers/health-social-care-act/regulation-12#:~:text=Guidance%20on%2012(2)(b) Additionally, general practitioners are included, with further information is available at the following link: https://www.cqc.org.uk/guidance-providers/gps/gp-mythbusters/gp-mythbuster-91-patient-safety-alertsIn 2021, the MHRA published a Public Assessment Report (PAR), reviewing the available evidence for TSW reactions. This PAR is available at the following link:https://www.gov.uk/government/publications/topical-steroid-withdrawal-reactions-a-review-of-the-evidenceThe PAR resulted in two Drug Safety Updates in 2021 and 2024 which aimed to raise awareness on the risk of TSW reactions and introduce new labelling. Both updates are available, respectively, at the following two links:https://www.gov.uk/drug-safety-update/topical-corticosteroids-information-on-the-risk-of-topical-steroid-withdrawal-reactionshttps://www.gov.uk/drug-safety-update/topical-steroids-introduction-of-new-labelling-and-a-reminder-of-the-possibility-of-severe-side-effects-including-topical-steroid-withdrawal-reactions

What assessment his Department has made of the potential impact of staff undertaking additional work in private hospitals on NHS workforce capacity.

The Department has made no assessment of the impact of National Health Service staff undertaking additional work in private hospitals on NHS workforce capacity.

What steps his Department is taking to improve recruitment and retention of general practitioners in Bristol North East.

Since October 2024 we have funded primary care networks with an additional £160 million to recruit recently qualified general practitioners (GPs) through the Additional Roles Reimbursement Scheme (ARRS). In the Bristol, North Somerset and South Gloucestershire Integrated Care Board (ICB) 44 GPs have been recruited via the scheme since October 2024.Within the 2025/26 GP Contract, a number of changes have been confirmed to increase the flexibility of ARRS and allow primary care networks to respond better to local workforce needs. This includes GPs and practice nurses included in the main ARRS funding pot, an uplift of the maximum reimbursable rate for GPs in the scheme, and no caps on the number of GPs that can be employed through the scheme.We are investing an additional £1.1 billion into GPs to reinforce the front door of the National Health Service, bringing total spend on the GP Contract to £13.4 billion in 2025/26. This is the biggest cash increase in over a decade and will facilitate the recruitment of GPs. The 8.9% boost to the GP Contract in 2025/26 is greater than the 5.8% growth to the NHS budget as a whole.The Bristol, North Somerset and South Gloucestershire ICB also has a successful GP and Nurse fellowship scheme to support retention of staff.

What steps his Department is taking to reduce waiting times for ear, nose, and throat (ENT) specialist appointments.

Cutting elective care waiting times, including for ear, nose, and throat services (ENT), is a key priority for the Government. Between July 2024 and June 2025, we delivered 5.2 million additional appointments, compared to the previous year, more than double our pledge of two million. The latest data from August 2025 shows the ENT waiting list, currently at 627,206, has reduced by 31,000, or 4.7%, since the start of July 2024. ENT is identified as a priority in the Elective Reform Plan. Specific actions to reform ENT include expanding non-surgical community-based ENT services, maximising pharmacy first approaches, and developing one-stop clinical models to support patients needing ear care and patients with rhinitis. We are also focussing on reducing unwarranted variation in surgical pathways, supporting nationwide adoption of high-flow operating lists, and promoting greater ENT and paediatric ENT access at surgical hubs.Surgical hubs focus on driving improvement in six high volume specialties, including ENT. There are currently 124 elective surgical hubs that are operational across England. Additionally, as outlined in the Elective Reform Plan, we will continue to promote greater ENT access at surgical hubs and greater partnership working with the independent sector to deliver more non-urgent care, free at the point of use.

Pursuant to the Answer of 1 September 2025 to Question 69695, what are the timescales for improving access to palliative care at home for children nearing the end of life; and what assessment he has made of the (a) provision and (b) commissioning of such services in Bristol.

The Department and NHS England are currently working at pace to develop plans on how best to improve the access, quality, and sustainability of all-age palliative care and end of life care in line with the 10-Year Health Plan. I will be able to say more about our timelines for that work in the near future.We will closely monitor the shift towards the strategic commissioning of palliative and end of life care services to ensure that services reduce variation in access and quality, although some variation may be appropriate to reflect both innovation and the needs of local populations.Children’s palliative care services are included in the list of services an integrated care board (ICB) must commission. To support ICBs in this duty, NHS England has published statutory guidance and a service specification for children and young people.  The statutory guidance states that ICBs, including the NHS Bristol, North Somerset and South Gloucestershire ICB, must work to ensure that there is sufficient provision of palliative care and end of life care services to meet the needs of their local populations.We are providing £26 million of revenue funding for children and young people’s hospices for 2025/26. Jessie May Children’s Hospice in Bristol has received £182,000 from this funding. We are also committing £80 million for children’s and young people’s hospices over the next three financial years, giving them stability to plan ahead and focus on what matters most, caring for their patients.

What steps his Department is taking to ensure that children nearing the end of life can access palliative care at home.

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. ICBs are responsible for the commissioning of palliative and end of life care services, to meet the needs of their local populations.To support ICBs in this duty, NHS England has published statutory guidance and service specifications.  The statutory guidance requires ICBs to work to ensure that there is sufficient provision of palliative and end of life care services to meet the needs of their local populations.We are supporting the hospice sector with a £100 million capital funding boost for eligible adult and children’s hospices in England to ensure they have the best physical environment for care. This funding will also help to develop and better outreach services to support people in their own homes when needed.Additionally, we are providing £26 million of revenue funding to support children and young people’s hospices for 2025/26. This is a continuation of the funding which until recently was known as the children and young people’s hospice grant.I have tasked officials to look at how to improve the access, quality, and sustainability of all- age palliative and end of life care, including services provided at, or closer to, home, in line with the 10-Year Health Plan. It is our intention to work together with stakeholders to ensure that everyone has access to the care they need, in the right place, at the right time, at the end of life.

What recent assessment his Department has made of the adequacy of the (a) availability and (b) eligibility requirements for NHS hernia operations.

No specific assessment has been made of the adequacy of the availability of hernia operations. Integrated care boards are responsible for commissioning services, considering the needs of their local population and national guidance, such as that from the National Institute for Health and Care Excellence.There are several types of hernia and therefore decisions about the eligibility to treat will be based on guidelines and clinical judgement appropriate to the individual circumstances.