Written questions by Egan.

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 assessment her Department has made of the potential impact of affordable and accessible public transport on supporting older people to (a) remain in and (b) return to employment.

While employment policy sits primarily with the Department for Work and Pensions, the Department for Transport considers the impacts of transport affordability and accessibility through its policy development and funding decisions. This includes supporting lower fares, service provision and improvements to the accessibility of the transport network. The Government is supporting affordability by extending the £3 bus fare cap in England to March 2027, freezing regulated rail fares until March 2027, and providing over £700 million to local authorities in 2025/26 through the Local Authority Bus Grant to help maintain and improve bus services.Alongside this, the Department is investing in accessibility through programmes such as Access for All and is developing an Accessible Travel Charter to help improve the end‑to‑end journey experience. These measures support older people and others with accessibility needs to travel with greater confidence, helping them to access and sustain employment where they choose to do so.

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/

What steps her Department is taking to assist UK citizens whose children have been rendered stateless as a result of incorrect advice regarding dual nationality provided by foreign authorities; and if she will review guidance and support available to families affected.

As responsibility for nationality rests with the Home Office, this has been transferred to the Secretary of State for the Home Department for a substantive response.Where a child is not a British citizen at birth, UK law provides a number of statutory routes which allow children to be registered as British citizens where the relevant legal criteria are met, including in circumstances where the child would otherwise be stateless. British nationality law allows dual nationality, but it is for other states to set and apply their own nationality laws.

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 steps his Department is taking to help ensure that the cost of legal representation and court proceedings does not prevent individuals from accessing justice; and whether he has made an assessment of the adequacy of legal aid eligibility thresholds in meeting that objective.

The Government is committed to the provision of legal aid, recognising the vital role that it plays in underpinning genuine access to justice.We are considering our approach to eligibility across legal aid, including carefully assessing the impact of the recommendations made by the Independent Review of the Criminal Courts This Government inherited a legal system in crisis, and we are taking steps to invest in legal aid.We are providing additional funding of up to £34 million a year for criminal legal aid advocates alongside our commitment to match fund a number of criminal barrister pupillages. This is in addition to the investment of £92 million in the solicitor fee schemes.Alongside this, we have also announced an uplift to immigration and housing legal aid fees. This amounts to a significant investment of £20 million a year once fully implemented – the first major increase since 1996.Furthermore, we are delivering the largest expansion of civil legal aid in a decade, enabling bereaved families to access non-means tested legal aid at all inquests where a public authority is an interested person.Beyond legal aid, this Government is also providing over £6 million of grant funding in 2025-2026 to support access to legal support services for people with social welfare problems. We have also announced nearly £20 million of multi-year funding to extend existing grant programmes to September 2026 and providing a new grant from October 2026 to March 2029.

Whether she has made an assessment of the potential impact of Child Benefit rules on children in shared care arrangements.

The current system places Child Benefit in the hands of one parent or guardian and gives that person responsibility for allocating it between capital and day to day costs. This ensures that the family with priority of entitlement for a child is provided with a suitable level of support for any particular child at any one time. It is vital especially for parents and families on lower incomes that enough support is directed to them to lift the child out of poverty or to keep the child out of poverty. We recognise that where families share responsibility for a child there may be issues around the availability of support. However, payment of support to the person with priority of entitlement for a child is seen as the most appropriate way to deal with the majority of families with children.

Media and Sport, what steps her Department is taking with Ofcom and the Advertising Standards Authority to help reduce children’s exposure to gambling advertising across broadcast, online and social media platforms.

The government recognises that children’s exposure to gambling advertising is a serious issue. We continue to work with a wide range of stakeholders, including Ofcom and the Advertising Standards Authority, to further strengthen protections. We have also redoubled efforts to work cross-government and with tech platforms to address illegal gambling advertising, which poses the most immediate risk for children and young people.

What the average processing time is for the allocation of a civil servant’s death‑in‑service widow and widower's pension after the submission of a valid claim form; and what steps are being taken to improve timescales for finalising payments.

The Cabinet Office awarded the contract to administer the Civil Service Pension Scheme to Capita in November 2023 under the previous government. The issues and delays facing a number of civil servants and pension scheme members in receiving their pension quotes are unacceptable. I want to reassure you that this Government has taken firm action to help put things right as soon as possible. We have agreed a clear recovery plan with Capita, which includes specific milestones and accountability targets for delivery. For priority cases, we have deployed additional resources and improved communication to ensure members receive the support they deserve. While the immediate focus remains on stabilising the service through this intensive recovery plan, we are committed to ensuring all staff, both former and serving, receive the quality of service and support they deserve. Existing Key Performance Indicators (KPIs) have been enhanced and strengthened to deliver improved performance and higher penalties for failure, including financial penalties. These have already applied in respect to Capita's performance with recent issues and delays in administering the Civil Service Pension Scheme. We recognise the significant pressure on surviving spouses. Upon receipt of a valid, fully completed claim form from the spouse, the Service Level Agreement (SLA) for paying the lump sum is five working days, which is concurrent with the five-day SLA for setting up the spouse’s pension; however, the physical receipt of this first payment will be determined by the timing of the payroll cycle, and as of March 2026, this SLA is being met for new cases. Possible exceptions to these timelines include circumstances where the spouse is not the named beneficiary, necessitating a wait for the Grant of Probate before a lump sum payment can be made, or where data issues requiring employer input prevent benefits from being accurately calculated, thereby extending the settlement period. Furthermore, where benefits include a Defined Contribution (DCU) option, the spouse will be issued the various options within the five-day period and must make a formal decision before any benefits can be paid. The latest position of the Civil Service Pension Recovery Plan Update (2 March 2026) is available at this weblink: https://www.gov.uk/government/publications/civil-service-pension-recovery-plan-updates/civil-service-pension-recovery-plan-update-2-march-2026

Whether she has made an assessment of the effectiveness of multi‑agency information‑sharing protocols between local authorities, schools and health bodies in the EHC needs assessment process.

The special educational needs and disabilities (SEND) code of practice sets out the importance of information sharing across education, health and social care to support effective needs assessments and planning processes.The department is determined to restore confidence in the system of support for children and young people with SEND and ensure they get the chance to achieve and thrive in their education and beyond, as set out in the recently published SEND reform consultation document, available here: https://www.gov.uk/government/consultations/send-reform-putting-children-and-young-people-first.We are committed to co-designing the future needs assessment process with parents, local authorities and experts to make sure we get it right. We continue to monitor and work closely with local authorities that have issues with their education, health and care plan processes. Where there are concerns about a local authority’s capacity to make the required improvements, we help the local authority to identify the problems and put in place an effective recovery plan.

Communities and Local Government, what steps the Government is taking to improve recognition of non-visible disabilities, including stoma use, in the design of public facilities.

I refer the hon. Member to the answer given to Question UIN 70255 which was answered on 4 September 2025. Government policies relating to Building Regulations and how the accessibility and use of buildings is reflected in design are made in accordance with the Public Sector Equality Duty. Changes to the statutory guidance which accompanies the Building Regulations (Approved Document M Volume 2) made in January 2021 make provision for facilities, including Changing Places toilets, in new buildings (or those undergoing major redevelopment) other than dwellings, that fall above a certain size threshold. This aims to make accessibility a mainstream consideration in how public spaces are planned and built.

Commonwealth and Development Affairs, what recent discussions she has had with the Palestinian Authority on the Palestinian Authority Martyrs Fund.

The Palestinian Authority has committed publicly to the principle of non-violence, including a new social security system that will ensure future welfare payments are needs-based and delinked from violent actions.An independent audit has been commissioned to verify the implementation of these and other reform commitments, and we will review the results when it is published.

Food and Rural Affairs, what assessment her Department has made of the potential impact of public toilet facilities on the health and wellbeing of people with stomas.

The Government oversees policy and legislation with respect to the safe management of waste and litter as well as the protection of drains and sewers. This however does not extend to compelling or explicitly encouraging local authorities with regard to types of waste receptacles or their placement. These decisions are for local authorities to make.

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 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.

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.

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.

Communities and Local Government, what steps his Department is taking to reduce delays in the home buying and selling process.

I refer the hon. Member to the answer given to Question UIN 87197 on 7 November 2025.