Written questions by Beales.

Whether his Department plans to publish a modern service framework for respiratory health.

Modern service frameworks will define an aspirational, long-term outcome goal for a major condition and then identify the best evidenced interventions and the support for delivery. Early priorities will include cardiovascular disease, severe mental illness, and the first ever service framework for frailty and dementia.The Government will consider other long-term conditions for future waves of modern service frameworks, including respiratory conditions. The criteria for determining other conditions for future modern service frameworks will be based on where there is potential for rapid and significant improvements in quality of care and productivity.

Whether the NICE guidance on abiraterone produced in 2021 was based on abiraterone's cost in generic form.

The National Institute for Health and Care Excellence’s (NICE) published guidance on abiraterone for treating newly diagnosed high-risk hormone-sensitive metastatic prostate cancer, which has the reference code TA721, was developed before the patent for abiraterone expired and was therefore based on the cost of the branded medicine.NICE is now re-evaluating abiraterone, both the originator and the generics, for the treatment of newly diagnosed high-risk hormone-sensitive metastatic prostate cancer and currently expects to publish the final guidance on 19 November 2025. The progress of this guidance can be followed at the following link:https://www.nice.org.uk/guidance/indevelopment/gid-ta11730

What estimate his Department has made of the number of men in England with newly diagnosed high-risk, non-metastatic prostate cancer who would be eligible for abiraterone under the eligibility criteria used in (a) Scotland and (b) Wales.

NHS England estimates that the number of eligible patients in England is between 7,500 and 9,500 per year. This is based on the same eligibility criteria as are used in Scotland and Wales. NHS England has not completed any specific work to estimate the potential impact of prescribing abiraterone in England using the eligibility criteria used in Scotland and Wales on the number of premature deaths from high-risk, non-metastatic prostate cancer. However, the policy was ranked as the top priority for routine commissioning at the Clinical Priorities Advisory Group Prioritisation Meeting in 2024/25, based upon the clinical benefit, which included evidence that demonstrated statistically significantly fewer deaths with abiraterone and androgen deprivation therapy versus androgen deprivation therapy alone.

If he will make an estimate of the (a) cost per patient, (b) number of eligible patients, (c) net cost, (d) incremental quality-adjusted life years gained and (e) incremental cost-effectiveness ratio of extending abiraterone access to high-risk, non-metastatic prostate cancer patients in England.

NHS England is unable to provide information related to the cost per patient as disclosure of this information could be used to identify the discounted price that we have agreed and would prejudice the commercial interests of both NHS England and the supplier.The number of patients eligible for abiraterone for the treatment of high-risk, non-metastatic prostate cancer is between 7,500 and 9,500 per year.The total net cost of the policy, including the drug cost, to NHS England is estimated to be approximately £49.36 million over five years.NHS England has not calculated the incremental quality-adjusted life years gained or the incremental cost-effectiveness ratio because NHS England uses a relative prioritisation process for policy propositions that require funding in line with the published NHS England Specialised Commissioning Service Development Policy, which is available at the following link:https://www.england.nhs.uk/wp-content/uploads/2017/09/B0026_NHS-England-Specialised-Commissioning-Service-Development-Policy.pdf

What information his Department holds on the estimate made by (a) NHS England, (b) NHS Wales and (c) NHS Scotland of the incremental cost-effectiveness ratio for abiraterone in high-risk, non-metastatic prostate cancer.

NHS England has not calculated the incremental cost-effectiveness ratio for any policy proposition because NHS England uses a relative prioritisation process for policy propositions that require funding in line with the published NHS England Specialised Commissioning Service Development Policy, a copy of which is attached.

Whether NHS England has approved any drugs with a higher incremental cost-effectiveness ratio than abiraterone for high-risk, non-metastatic prostate cancer in the last five years.

NHS England has not calculated the incremental cost-effectiveness ratio for any policy proposition because NHS England uses a relative prioritisation process for policy propositions that require funding in line with the published NHS England Specialised Commissioning Service Development Policy, a copy of which is attached.

If he will make an estimate of the potential impact of prescribing abiraterone in England using the eligibility criteria used in (a) Scotland and (b) Wales on the number of premature deaths from high-risk, non-metastatic prostate cancer.

NHS England estimates that the number of eligible patients in England is between 7,500 and 9,500 per year. This is based on the same eligibility criteria as are used in Scotland and Wales. NHS England has not completed any specific work to estimate the potential impact of prescribing abiraterone in England using the eligibility criteria used in Scotland and Wales on the number of premature deaths from high-risk, non-metastatic prostate cancer. However, the policy was ranked as the top priority for routine commissioning at the Clinical Priorities Advisory Group Prioritisation Meeting in 2024/25, based upon the clinical benefit, which included evidence that demonstrated statistically significantly fewer deaths with abiraterone and androgen deprivation therapy versus androgen deprivation therapy alone.

For what reason NHS England has not approved abiraterone for use in high-risk, non-metastatic prostate cancer.

Abiraterone is licensed by the Medicines and Healthcare products Regulatory Agency for use in the treatment of high-risk hormone-sensitive metastatic prostate cancer. The National Institute for Health and Care Excellence (NICE) has published final draft guidance on 30 October and has been able to recommend abiraterone (originator and generics) for treating newly diagnosed high-risk hormone-sensitive metastatic prostate cancer. NICE reviewed its guidance to determine whether to recommend abiraterone for use in this indication following the patent expiry for the medicine.Abiraterone is not licensed for use in the treatment of high-risk, non-metastatic hormone-sensitive prostate cancer, and as such, it has not been evaluated by NICE through its technology appraisal programme. NICE makes recommendations for the National Health Service in England on the vast majority of new medicines and significant licence indications for existing medicines but does not evaluate medicines that are used outside their marketing authorisations, also known as “off-label”.Funding decisions for off-label medicines are the responsibility of NHS commissioners who are required to make decisions on the basis of the available evidence. For cancer medicines, NHS England is the responsible commissioner and has an established mechanism to make funding decisions on medicines that are not evaluated by NICE through its clinical prioritisation process. NHS England considered abiraterone as an off-label treatment for hormone-sensitive, non-metastatic prostate cancer through its clinical policy development process in 2024/25. Through this process, NHS England confirmed that there was sufficient supporting evidence to support the routine commissioning of abiraterone in this indication and it was ranked as the top priority for routine commissioning.However, NHS England has not been able to identify the necessary recurrent funding to support the commissioning of abiraterone, or any other treatments within the prioritisation round. This position in being kept under review and will be progressed as soon as recurrent funding is identified.This position takes into account the need to ensure the affordability of introducing any new routine commissioning policies, alongside maintaining existing services for patients, and meeting their legal requirement to fund all NICE approved drugs. Abiraterone for the treatment of high-risk, hormone sensitive, non-metastatic prostate cancer remains the top priority for routine commissioning.

How the full roll-out of the non-specific symptom pathways is being measured; and how their development has included the less survivable cancers.

Since 2019, NHS England and cancer alliances have been developing non-specific symptom (NSS) pathways for patients who present with vague and non-site-specific symptoms which do not clearly align to a tumour type. Full roll out of NSS pathways has been achieved with 115 live NSS pathways across England. This is particularly relevant to less survivable cancers which are often diagnosed at a later stage due to their non-specific symptoms.Trusts and providers are working to achieve the Faster Diagnosis Standard (FDS), which ensures patients are diagnosed or have cancer ruled out within 28 days of being urgently referred. NSS pathways should support patients until they are diagnosed and referred onward or their symptoms resolve, aligning with the FDS, and providers of NSS pathways should ensure patient administration systems can capture and report the NSS referral and any subsequent diagnosis.Additionally, best practiced timed pathways to support the FDS are being developed for all suspected cancer pathways, including NSS pathways.

What assessment his Department has made of the potential merits of minimally invasive therapies for the less survivable cancers.

Ongoing research is exploring the potential of minimally invasive cancer therapies for less survivable cancers. This includes non-invasive liver cancer treatments that use ultrasound technology to destroy tumours without surgery, scalpels, or radiation, with minimal damage to surrounding organs.The adoption of new treatments, including minimally invasive cancer treatments for less survivable cancers, into the National Health Service in England is generally the result of National Institution of Clinical Excellence (NICE) guidance and/or commissioner decisions.The NHS has launched a new £2 million programme which is funding 300 general practices to identify pancreatic cancer early by screening high-risk patients over 60 years old with new diabetes diagnoses and unexplained weight loss for urgent testing.Both NHS England and the integrated care boards are required to put in place access for any treatment that carries a positive recommendation from the Technology Appraisal programme, operated by NICE. Agreements on timelines and funding for making therapies available on the NHS can vary, with implementation supported by the service readiness assessment and the development of additional capacity where necessary.

Whether there is a facility for the NHS to approve treatments without external payment for assessment by the National Institute for Health and Care Excellence.

The National Institute for Health and Care Excellence (NICE) charges companies for the development of its technology appraisal and highly specialised technologies recommendations on medicines and other health technologies. Where a company does not participate in the NICE appraisal process, the default National Health Service position will be to not routinely commission the intervention for the stated indication. This is to avoid a potential pathway for circumventing the NICE process. In some cases, such as where there is no single company that markets the medicine or technology under evaluation, NICE evaluations can be funded from other sources, such as from NICE’s core Government funding or NHS England.

Whether the Clinical Priorities Advisory Group has a budget to approve new treatments.

The Clinical Priorities Advisory Group is an advisory committee that makes recommendations on the relative priority of treatments to be commissioned subject to the available discretionary investment. It is not a decision-making body and does not allocate funds or have a budget for approving new treatments. Further information is available at the following link:https://www.england.nhs.uk/commissioning/cpag/

Pursuant to the Answer of 9 July 2025 to Question 64681 on Prostate Cancer: Hormone Treatments, for what reason recurrent headroom in revenue budgets is considered a barrier to implementing the abiraterone acetate plus prednisone/prednisolone treatment.

Reimbursement of abiraterone across all indications is managed at a national level by NHS England who must ensure the affordability of introducing any new routine commissioning policies, alongside maintaining existing services for patients and meeting their legal requirement to fund all National Institute for Health and Care Excellence (NICE) recommended medicines.Abiraterone has not been licensed for the treatment of high-risk, hormone sensitive, non-metastatic prostate cancer, and has not been assessed by NICE in this indication. NHS England therefore enabled a clinically-led review of the treatment in this indication determining it to be the highest priority for routine commissioning, and intends to commission the treatment for eligible patients as soon as recurrent funding is identified.

If he will take steps to include policies on replacing older radiotherapy machines in the national cancer plan.

The National Cancer Plan will cover the entirety of the cancer pathway, from referral and diagnosis to treatment and ongoing care. Radiotherapy plays a crucial role in the care of many cancer patients, and we remain committed to continuing support for radiotherapy in the future.In October 2024, as part of a broader investment across the health sector, the Government announced that £70 million would be spent on new radiotherapy machines to improve cancer treatment. We expect that trusts will be fully using new machines by the end of June 2026.The plan will include further details on how we will improve outcomes for cancer patients, as well as speeding up diagnosis and treatment, ensuring patients have access to the latest treatments and technology, and ultimately drive up this country’s cancer survival rates.

If he will make an assessment of the potential merits of establishing a national radiotherapy advisory group.

The Government recognises radiotherapy as a crucial part of cancer treatment, which is why we have invested £70 million in 28 new radiotherapy machines to ensure the most advanced radiotherapy treatment is available to patients when they need it.There are no current plans to establish a national radiotherapy advisory group, however, the Government regularly engages with key stakeholders, including the All Party Parliamentary Group on Radiotherapy.

Pursuant to the Answer of 15 July 2025 to Question 64682 on Prostate Cancer: Hormone Treatments, if his Department will publish the Equality and Health Inequalities Impact Assessment for abiraterone acetate plus prednisone for hormone-sensitive non-metastatic prostate cancer.

The Equality and Health Inequalities Impact Assessment for abiraterone acetate plus prednisone for hormone-sensitive non-metastatic prostate cancer can be found in the attached document.

What assessment he has made of adequacy of the (a) support available to ambulance staff who attend traumatic callouts and (b) suicide prevention training provided to ambulance staff.

The mental health of all National Health Service staff is taken seriously, including ambulance staff as responders to emergency incidents. Ambulance trusts and the Association of Ambulance Trust Chief Executives have worked closely with NHS England to ensure there is a good range of health and wellbeing support for staff. This includes an ambulance sector specific suicide prevention pathway to provide immediate support 24 hours a day, seven days a week for staff experiencing suicidal ideation. At a national level, ambulance trust employees have access to the SHOUT helpline for crisis support, alongside the Practitioner Health service for more complex mental health wellbeing support, including trauma and addiction.

What assessment he has made of the potential impact of innovation in the beer and pub sector with the (a) development and (b) availability of (i) no and (ii) low alcohol products on the aims of the NHS 10 Year Plan.

In Fit for the Future: 10 Year Health Plan for England, the Government has committed to tackling harmful levels of alcohol consumption through exploring options to standardise which products can describe themselves as alcohol free. One of the first steps will be to explore raising the upper alcohol limit for drinks labelled as alcohol-free to 0.5% alcohol by volume (ABV) from 0.05% ABV, aligning with international standards. At the same time, we will explore measures to regulate access to no- and low-alcohol (NoLo) products in line with other alcoholic beverages, including prohibiting sales to individuals under the age of 18 years old.Alongside the plan, a large multi-year National Institute for Health and Care Research study is underway to examine the public health impacts of NoLo products, and we look forward to the findings the study being available in the coming year.

With reference to the randomised control trial study report entitled Cost utility analysis of adding abiraterone acetate plus prednisone/prednisolone to long term hormone therapy in newly diagnosed advanced prostate cancer in England: Lifetime decision model based on STAMPEDE trial data, published in June 2022, what assessment he has made of the potential implications for his policies of the findings of that study on the cost utility of adding abiraterone acetate plus prednisone/prednisolone to long term hormone therapy in men with newly diagnosed high risk non metastatic prostate cancer.

NHS England considered abiraterone as an off-label treatment for hormone sensitive, non-metastatic prostate cancer through its clinical policy development process in 2024/25. Through this process, NHS England confirmed that there was sufficient supporting evidence to support the routine commissioning of abiraterone in this indication, and it was ranked in the highest priority level. However, at this point in time, it has not been possible to identify the necessary recurrent headroom in revenue budgets to support the funding of any treatments under consideration. This position is being kept under review.NHS England examined papers from the STAMPEDE trial, including Cost utility analysis of adding abiraterone acetate plus prednisone/prednisolone to long term hormone therapy in newly diagnosed advanced prostate cancer in England: Lifetime decision model based on STAMPEDE trial data, as part of the review of evidence for the policy proposition.

What assessment he has made of the potential impact of NHS England’s decision not to commission abiraterone acetate plus prednisone/prednisolone for men with high risk non metastatic prostate cancer on health equity for Black men.

NHS England develops an Equality and Health Inequalities Impact Assessment (EHIA) for policy propositions included in its Policy Work Programme. The EHIA for abiraterone acetate plus prednisone for hormone sensitive non-metastatic prostate cancer noted that incidence rates for prostate cancer are higher in the black ethnic group, compared with the white ethnic group, in males in England. Commissioning decisions for abiraterone acetate plus prednisone/prednisolone apply equally to all individuals with high risk non metastatic prostate cancer regardless of race or ethnicity.Incidence rates for prostate cancer are higher in the black ethnic group, compared with the white ethnic group, in males in England. To address this inequality, the Government has invested £16 million in the £42 million United Kingdom-wide TRANSFORM trial, led by Prostate Cancer UK, which aims to identify new ways of detecting prostate cancer at an earlier stage, including in men without symptoms. The trial will ensure that at least 10% of participants are Black men, reflecting their higher risk and the importance of ensuring new tests are effective across all groups.