Written questions by Hamilton.

What discussions he has had with phone companies on rates charged to the NHS for sending text messages.

The Department does not set or negotiate the rates charged to National Health Service organisations for sending text messages. Telephony and messaging services are procured locally by NHS bodies through established commercial arrangements, including framework agreements. Rates are set by suppliers in accordance with agreed contractual terms and published rate cards, providing a transparent and standardised basis for pricing.

With reference to the report published by Breast Cancer Now, entitled Setting the Bar too High, what assessment his Department has made of the impact of the opportunity cost‑neutrality requirement within NICE’s severity modifier on access to treatments for secondary breast cancer.

The severity modifier was introduced by the National Institute for Health and Care Excellence (NICE) in January 2022 as part of a number of changes intended to make its methods fairer, faster, and more consistent. The severity modifier was designed on the principle of opportunity cost neutrality to ensure that introducing additional weighting for severe conditions did not increase overall National Health Service spending or displace more care than the previous end-of-life modifier.NICE has been monitoring how the severity modifier is being applied and found that it has resulted in a greater proportion of medicines recommended than under NICE’s previous methods. The latest figures indicate 87.0% of decisions taken since the severity modifier was implemented have recommended use of the treatment, compared with 82.5% when the end-of-life modifier was being used. For advanced cancer treatments specifically, 84.8% of decisions have been positive since the introduction of the severity modifier, compared to 69.1% under NICE’s previous methods.

What steps his Department is taking to reduce waiting times for ADHD assessments for children.

The Government has recognised that, nationally in England, demand for assessments for attention deficit hyperactivity disorder (ADHD) has grown significantly in recent years and that people of all ages, including children and young people, are experiencing delays accessing such assessments.NHS England established an ADHD taskforce which brought together those with lived experience with experts from the National Health Service, education, charity, and justice sectors to get a better understanding of the challenges affecting those with ADHD, including in accessing services and support. The final report was published on 6 November 2025, and we are carefully considering its recommendations.The Government’s 10-Year Health Plan for England will make the NHS fit for the future, recognising the need for early intervention and support, including for children and young people, such as those with special educational needs and disabilities (SEND). In 2026, the Government will bring forward a Schools White Paper, which will detail our approach to SEND reform, ensuring joined-up support, including education and healthcare providers working together.In respect of ADHD, the National Institute for Health and Care Excellence’s guideline does not recommend a maximum waiting time for people to receive an assessment for ADHD or a diagnosis, however it sets out best practice on providing a diagnosis.Through the NHS Medium-term planning framework, published 24 October, NHS England has set clear expectations for local integrated care boards and trusts to improve access, experience, and outcomes for autism and ADHD services over the next three years, focusing on improving quality and productivity.The Secretary of State announced on 4th December 2025 the launch of an Independent Review into Prevalence and Support for Mental Health Conditions, ADHD and Autism. This independent review will inform our approach to enabling people with ADHD and autistic people to have the right support in place to enable them to live well in their communities.

If he will review the November 2025 decrease to the Agenda for Change mileage payments for community staff.

As set out in NHS Terms and Conditions of Service (TCS) Handbook, which is ratified by the NHS Staff Council, mileage reimbursement rates are reviewed twice a year in April and November.The outcome of the November 2025 review resulted in a reduction of reimbursement rates due to sustained decreases in fuel prices for the 12-month period ending in October 2025. Reimbursement rates will drop to 56 pence per mile up to 3,500 miles claimed before dropping to 21 pence per mile thereafter. The revised rates will apply to mileage incurred from 1 January 2026.These changes apply to all staff directly employed under Agenda for Change terms and conditions and Resident Doctors. There are no specific rates for community staff.The NHS Staff Council, which is responsible for maintaining the NHS TCS, is currently negotiating a new mechanism that will determine a fair reimbursement rate for miles incurred by these staff. Further updates on their work will be made in due course.

What assessment he has made of the merits of opportunities to (a) enable earlier diagnosis of Type 1 diabetes and (b) reduce incidences of diabetic ketoacidosis; and what actions are being taken by (i) his Department and (ii) NHS England to support (A) research and (B) improved clinical practice in these areas.

The early diagnosis of type 1 diabetes is important to reducing incidences of diabetic ketoacidosis. NHS England is working with experts and relevant stakeholder organisations to monitor the outcomes of the current research on the early detection of type 1 diabetes. To support integrated care boards, NHS England has convened experts and stakeholder organisations to consider emerging evidence and articulate what a pathway of care could look like given advancements in this field.

What recent steps NHS England has taken to help identify (a) children and (b) adults at risk of pre‑symptomatic Type 1 diabetes; and what assessment has been made of (i) the uptake and (ii) effectiveness of those services.

The National Institute for Healthcare Research is funding the EarLy Surveillance for Autoimmune diabetes (ELSA) study into the feasibility of screening for type 1 diabetes in children aged three to 13 years old. The ELSA study has tested over 24,000 people and is being run through schools, general practice surgeries, as well as through online recruitment.The UK National Screening Committee advises the National Health Service on screening programmes and, in 2019, concluded that more research and evidence for the benefits of screening for autoimmune type 1 diabetes was required.

What role mayoral authorities will play in the delivery of Neighbourhood Health Plans.

The wide range of local government responsibilities relevant to health and wellbeing, including social care, public health, and beyond, are central to our vision for Neighbourhood Health. Neighbourhood Health will move care out of hospitals and into communities, with more personalised, proactive, and integrated services starting from where and how people live their lives. This will involve building stronger links to wider local government services such as housing, family hubs, and programmes such as Pride in Place, as well as links with wider civil society including the voluntary, community, and social enterprise (VCSE) sector.We are working closely with the Local Government Association to develop a national framework setting out how the National Health Service, local authorities, and partners should work together under the leadership of health and wellbeing boards to develop and implement local neighbourhood health plans.NHS, local authority, and VCSE services will be co-located in neighbourhood health centres, bringing together a wide range of services to holistically meet the needs of local populations.Neighbourhood teams and services should be designed to reflect the needs of people in their local areas, with licence to tailor the approach to local needs and with an expectation of crossing organisational boundaries.

When NICE plans to review (a) guideline NG17 for Type 1 diabetes in adults and (b) guideline NG18 for Diabetes (type 1 and type 2) in children and young people; and what the timelines are for the next updates.

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for translating evidence into authoritative evidence-based guidance for the health and care system on best practice, in order to drive improved outcomes for patients.NICE currently has no plans to update guidelines NG17 and NG18. NICE takes a proactive approach to surveillance, monitoring for changes in the evidence base that may impact on its recommendations. Topics for new or updated guidance are considered through the NICE prioritisation process. Decisions as to whether NICE will create new, or update existing, guidance are overseen by an integrated, cross-organisational prioritisation board, chaired by NICE’s Chief Medical Officer.

What the role of mayoral authorities will be within Regional Health Innovation Zones.

Collaboration between health systems and local government, including mayoral authorities, is fundamental to the design and delivery of the Regional Health Innovation Zones, as set out in the 10-Year Health Plan and the Life Sciences Sector Plan. The Government is committed to ensuring that local government leaders feel a sense of shared ownership in these plans.The policy is currently in development. It is being designed with flexibility at its core, to ensure it accommodates the diversity of local government structures across the country. The relevant policy teams are already beginning to engage with regional leaders, in health systems and local government, to codesign the approach and to provide more clarity to regions.

What assessment he has made of the potential impact of the 10 Year Health Plan on the roles of mayoral authorities in delivering health and social care services.

As set out in the 10-Year Health Plan, the Government is committed to making mayors, or their representatives, members of integrated care boards (ICBs), harnessing the opportunities of joined-up strategic planning between ICBs and strategic authorities, and supporting delivery of a “health in all policies” approach. Subject to the passage of the English Devolution and Community Empowerment Bill, mayors will be supported by a new health improvement and health inequalities duty, which empowers and supports strategic authorities to exercise their functions in ways that improve health and reduce health inequalities between people living in their area.

How many and what proportion of people initially coded with (a) pre‑diabetes and (b) type 2 diabetes who were later found to have early or established type 1 diabetes in the most recent period for which data is available; and what steps his Department is taking with NHS England to help improve diagnostic accuracy in England.

Data is not collected centrally on the numbers or proportions of people initially coded with pre-diabetes or type 2 diabetes who were later found to have type 1 diabetes. The change of patient diagnosis would be reflected by a change of diagnosis code in clinical systems. However, the way that data extraction works for national audits means that it is not possible to track these types of changes.Published data on diabetes registrations by GP practice can be found in the quarterly National Diabetes Audit (NDA) data release. This also contains data on care process and treatment target attainment as well as the number of new diagnoses by calendar year.The latest quarterly report is available at the following link:https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-audit/core-q4-24-25/national-diabetes-audit-nda-2024-25-quarterly-report-for-england-integrated-care-board-icb-primary-care-network-pcn-and-gp-practiceThe NDA supports improvements in diagnosis by assessing whether people with diabetes are receiving the recommended diagnostic checks and to identify variations and shortfalls in care delivery against National Institute for Health and Care Excellence guidelines.

Pursuant to the Answer of 11 September 2025 to Question 74995 on Covid: Vaccination, for what reason (a) spousal household contacts aged under 75 years of immunosuppressed individuals and (b) other household contacts of immunosuppressed individuals are not eligible for the NHS covid-19 autumn booster programme during the autumn and winter of 2025/26.

The Government is committed to protecting those most vulnerable to COVID-19 through vaccination, as guided by the independent Joint Committee on Vaccination and Immunisation (JCVI). The primary aim of the national COVID-19 vaccination programme remains the prevention of severe illness, involving hospitalisation and/or death, arising from COVID-19.The JCVI’s advice for autumn 2024 noted that in the era of high population immunity to COVID-19, and with all cases due to highly transmissible Omicron sub-variants, any protection offered by the vaccine against the transmission of infection from one person to another was expected to be extremely limited. On this basis, the JCVI did not advise offering vaccination to any household contacts. The Government accepted the JCVI’s advice for autumn 2024, with both the advice and the Government’s response available at the following link:https://www.gov.uk/government/news/government-accepts-advice-on-2024-autumn-covid-vaccine-programmeHousehold contacts were therefore not offered vaccination in the autumn 2024 campaign. On 13 November 2024, the JCVI published advice on the COVID-19 vaccination programme covering vaccination in 2025 and spring 2026. In line with its advice for the autumn 2024 campaign, the JCVI did not advise COVID-19 vaccination for household contacts. This advice is available at the following link:https://www.gov.uk/government/publications/covid-19-vaccination-in-2025-and-spring-2026-jcvi-advice/jcvi-statement-on-covid-19-vaccination-in-2025-and-spring-2026#:~:text=the%20JCVI%20webpage.-,Advice%20on%20vaccination%20in%20spring%202025,care%20home%20for%20older%20adults(opens in a new tab)The Government accepted the JCVI’s advice on eligibility for the spring and autumn 2025 COVID-19 vaccination programme. The Government is considering the advice for spring 2026 carefully, and will respond in due course.

What steps he is taking to ensure that bereaved parents have equal access to specialist psychological support following (a) pregnancy and (b) baby loss.

Experiencing pregnancy or baby loss can be extremely difficult and traumatic. We are determined to make sure all bereaved parents, regardless of where they live, have access to specialist psychological support.As of June 2025, Maternal Mental Health Services are now available in all areas of England. These services provide specialist psychological support for women with moderate/severe or complex mental health difficulties arising from birth trauma or baby loss.All trusts in England are also signed up to the National Bereavement Care Pathway. This pathway is designed to improve the quality and consistency of bereavement care for parents and families experiencing pregnancy or baby loss.We also recognise the importance of maternity bereavement services being available at all times. Seven day a week bereavement services are in the process of being set up in every area in England to support women and families who experience pregnancy loss or neonatal death.

What plans his Department has to include dementia specialist nurses in the Neighbourhood Health Service model; and what steps he is taking to ensure access to dementia specialist nurses in every community.

The Neighbourhood Health Service will bring together teams of professionals closer to people’s homes to work together to provide comprehensive care in the community. We expect neighbourhood teams and services to be designed in a way that reflects the specific needs of local populations, and so they could include dementia specialist nurses. While we will be clear on the outcomes we expect, we will give significant licence to tailor the approach to local need. While the focus on personalised, coordinated care will be consistent, services may look different in rural communities, coastal towns, or deprived inner cities.Provision of dementia health care services is the responsibility of local integrated care boards (ICBs). We would expect ICBs to commission services, which may include dementia specialist nurses/admiral nurses, based on local population needs, taking account of the National Institute for Health and Care Excellence’s (NICE) guidelines. NICE recommends providing people living with dementia with a single named health or social care professional who is responsible for coordinating their care.Under the 10-year plan, those living with dementia will benefit from improved care planning and better services.  We will deliver the first ever Modern Service Framework for Frailty and Dementia to deliver rapid and significant improvements in quality of care and productivity. This will be informed by phase one of the independent commission into adult social care, expected in 2026.

Pursuant to the Answer of 28 June 2025 to Question 61726, if he will publish: (a) the data source for the reported 8.9% increase in doctors working in clinical oncology between 2021 and 2023, (b) the number and percentage increase in consultant clinical oncologists over that same period and (c) the number of consultant clinical ncologists per capita by Integrated Care System or NHS Trust area, including identification of the five areas with the lowest consultant-to-population ratios.

NHS England publishes monthly data on the number of staff employed by National Health Service trusts and integrated care boards (ICBs) in England, which is available at the following link:https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statisticsIt should be noted that the change in doctors working in the specialty of clinical oncology is between February 2024 and February 2025, the latest period for which data is available.As of February 2025, there were over 1,800 full time equivalent doctors working in the speciality of clinical oncology in NHS trusts and other core organisations in England. This is almost 150, or 8.9%, more than in 2024.The change in the total number of full-time equivalent (FTE) doctors working in the specialty of clinical oncology employed by NHS trusts and ICBs in England between 31 December 2020 and 31 December 2023 was 14.1%; the change over the same period in consultant clinical oncologists was 12.2%. The following table shows the number of FTE consultant clinical oncologists employed by NHS trusts or ICBs per million population by ICB area for February 2025:ICBConsultant Clinical Oncologists – FTE, February 2025ONS Projected Population, June 2025Consultant Oncologists (per 1,000,000 population)Mid and South Essex-1,232,502-Shropshire, Telford and Wrekin-533,260-Humber and North Yorkshire1.11,744,8240.6South West London5.81,557,6243.7Frimley3.0791,2373.8West Yorkshire23.22,497,9269.3Coventry and Warwickshire9.61,016,3669.4Bath and North East Somerset, Swindon and Wiltshire9.7980,2509.9Staffordshire and Stoke-on-Trent11.81,167,87310.1Somerset6.0590,92810.2Bedfordshire, Luton and Milton Keynes11.11,060,96310.5Black Country13.91,249,11911.1Sussex20.51,768,73611.6Northamptonshire9.5817,75711.6North East London25.62,147,22311.9Lancashire and South Cumbria21.31,779,69412.0North Central London18.01,485,97512.1Cheshire and Merseyside36.42,620,67813.9Lincolnshire11.2795,66714.1North East and North Cumbria46.03,070,74115.0Norfolk and Waveney17.51,071,92316.3Derby and Derbyshire17.91,091,15016.4Herefordshire and Worcestershire13.6815,03016.7Suffolk and North East Essex17.81,028,29817.3Greater Manchester52.23,008,58917.4Cornwall and the Isles of Scilly10.7596,10817.9Gloucestershire12.4671,29618.5Nottingham and Nottinghamshire24.41,198,87820.4Hampshire and Isle of Wight39.31,893,63520.8Leicester, Leicestershire and Rutland25.31,184,05021.4Kent and Medway42.01,932,16221.8Buckinghamshire, Oxfordshire and Berkshire West42.31,870,24822.6South East London42.11,861,34522.6North West London52.92,222,78423.8Dorset19.7802,63224.6South Yorkshire36.01,432,34925.1Surrey Heartlands28.01,085,72425.7Birmingham and Solihull36.51,407,05326.0Hertfordshire and West Essex44.01,540,31028.6Cambridgeshire and Peterborough27.8964,04128.8Devon37.41,268,83229.5Bristol, North Somerset and South Gloucestershire33.51,037,50032.3England957.158,893,27716.3Source: NHS EnglandNotes:This data should be viewed with an understanding of the structure of delivery of system wide cancer services, where delivery of some specialist services will be concentrated in specific ICB areas.Consultant oncologist data is taken from NHS England published dataICB populations are taken from Office for National Statistics sub national population projections for mid-2025, which are available at the following link: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationprojections/datasets/populationprojectionsforsubintegratedcareboardsbyfiveyearagegroupsandsexengland

Whether his Department has made an assessment of the (a) ethical, (b) legal, and (c) safeguarding implications of UK residents entering commercial surrogacy arrangements overseas; and whether the Government plans to review the legal framework in such cases.

The Department has no plans to review the legal framework for international surrogacy arrangements.The Government supports surrogacy as a part of assisted conception options, to help people who have difficulty starting their own family.The Government recognises that international surrogacy is a complex area, and the Foreign Commonwealth and Development Office has published guidance for British nationals seeking international surrogacy arrangements.

Whether the National Cancer Plan will include targets to improve timely diagnosis of (a) myeloma and (b) other blood cancers.

It is a priority for the Government to support the National Health Service to diagnose cancer, including blood cancers such as myeloma, as well as other unstageable cancers, as early and quickly as possible, and to treat it faster, in order to improve outcomes.To tackle late diagnoses of blood cancers, the NHS is implementing non-specific symptom pathways for patients who present with symptoms such as weight loss and fatigue, which do not clearly align to a tumour type. Blood cancers are one of the most common cancer types diagnosed through these pathways.We will get the NHS diagnosing blood cancer earlier and treating it faster, and we will support the NHS to increase capacity to meet the demand for diagnostic services through investment, including for magnetic resonance imaging and computed tomography scanners.The National Cancer Plan will include further details on how we will improve outcomes for cancer patients, including 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.

What steps his Department is taking to ensure that NHS staff who are assaulted at work do not face (a) loss of pay, (b) punitive attendance management processes and (c) risk of dismissal while recovering from injuries sustained in the course of their duties.

NHS trusts are independent employers that have their own policies and procedures for managing staff sickness absence. Sickness absence policies and procedures should be fair, reasonable and comply with existing employment legislation. For all NHS staff, including those on the Agenda for Change (AfC) contract and medical contracts, the NHS Terms and Conditions of Service Handbook provides entitlement of up to 6 months full and six months half occupational sick pay when staff are too ill to work. The Handbook also states that when calculating an employee’s sick pay entitlement, absence caused by injuries attributable to NHS employment will be disregarded and should not count toward sickness absence totals.Where NHS staff are off work due to a work-related injury or illness, they may be eligible for NHS injury allowance. Injury allowance tops up pay to 85% of an individual’s earnings for up to 12 months when on reduced pay or half pay.To address variance in how NHS organisations manage sickness absence attendance, NHS England is currently working to develop a ‘Supporting Attendance’ Human Resources policy framework. Further information is available at the following link: https://www.england.nhs.uk/future-of-human-resources-and-organisational-development/nhs-people-policy-frameworks/

What steps his Department is taking to increase the number of clinical oncologists in regions with the lowest consultant-to-population ratios.

We’re building our cancer workforce. As of February 2025, there are over 1,800 full time equivalent doctors working in the speciality of clinical oncology in National Health Service trusts and other core organisations in England. This is almost 150, or 8.9%, more than last year.We will publish a new workforce plan to ensure the NHS has the right people in the right places to deliver the care patients need, transforming the health service and making it fit for the future.

What plans his Department has to include the (a) diagnosis, (b) treatment and (c) research of urinary tract infections in the (i) 10-year Health Plan and (ii) Women’s Health Strategy.

The 10-Year Health Plan will set out how we tackle the inequities that lead to poor health. This will include how we will improve access to and the experience of care for conditions such as chronic urinary tract infections (UTIs). More tests and scans delivered in the community, better joint working between services, and greater use of apps and wearable technology will all support people to manage their conditions, including chronic UTIs, closer to home.Recurrent UTIs are more prevalent in women. This Government is committed to prioritising women’s health as we build a National Health Service fit for the future, and our focus is on turning the commitments in the Women's Health Strategy into tangible actions to improve health for women.