Written questions by Mierlo.

What assessment he has made of the potential impact of activity management plans on patient waiting times for elective surgery.

Integrated care boards have existing contractual powers to manage activity by providers, which were enhanced in 2025/26 with central support for setting and managing activity. The NHS Standard Contract includes the ability to set Indicative Action Plans (IAPs) to help providers and commissioners plan demand, capacity, and expenditure. While not binding, if activity exceeds the agreed plan, and therefore the funding agreed, an Activity Management Plan (AMP) can be agreed to bring activity back in line.The provision and use of IAPs and AMPs is designed to deliver the activity levels required to achieve the goal of at least 65% of patients waiting no longer than 18 weeks for treatment by March 2026 whilst also living within financial budgets set for 2025/26.Any planning assumptions based on waiting times need to support commissioners’ overall duties to the populations they serve and our waiting time targets, including our commitment to return to the 18 week standard. AMPs allow commissioners and providers to work together to manage elective activity within agreed performance and financial targets, all whilst working towards improving patient waiting times overall.

What estimate he has made of the number of patients whose treatment has been delayed as a result of restrictions placed on private providers delivering NHS services.

Reducing waiting lists is a key part of the Government’s Health Mission, and we are committed to putting patients first by ensuring that they are seen on time and that they have the best possible experience of care. Since the Government came into office, the waiting list for routine appointments, operations, and procedures in England has now been cut by 312,369. This is despite 30.1 million referrals onto the waiting list.Integrated care boards have existing contractual powers to manage activity by providers, which were enhanced in 2025/26 with central support for setting and managing activity. Commissioners’ use of these powers support systems to live within their means and deploy better financial discipline than previous years where systems have overspent. As these powers are exercised by local systems, no national assessment has been made.We expect use of activity management provisions by local systems to support efforts achieving the goal of at least 65% of patients waiting no longer than 18 weeks for treatment by March 2026 whilst living within financial budgets set for 2025/26.All trusts are expected to have their own safeguards to ensure that patients waiting for planned care are triaged, and that appointments take place according to clinical priority and the length of time patients have waited, avoiding risk of serious complications.

If he will bring forward legislative proposals to introduce protections for (a) whistleblowing patients and (b) patient safety advocates.

There are no plans to bring forward legislation to strengthen protections for patients who raise concerns and patient safety advocates.National Health Service patients should not experience negative consequences if they raise concerns. The NHS Constitution pledges that patient complaints will not adversely impact future treatment. Patients can raise concerns or provide feedback through channels such as the NHS complaints process, Patient Advice and Liaison Service, and the Friends and Family Test, and can also share experiences of care with the Care Quality Commission. Independent advice and support are available for them from the Independent Complaints Advocacy Service.Through implementation of the Government’s 10-Year Health Plan, we will reform the NHS complaints process and strengthen the patient voice by setting clear standards for the quality of responses to complaints and ensure the NHS listens carefully and compassionately, taking forward learnings to ensure high quality care.Patient safety advocates in the NHS may include Patient Safety Specialists and Freedom to Speak Up Guardians who as workers in the NHS are protected by the Public Interest Disclosure Act 1998 (PIDA). They may also include Patient Safety Partners (PSPs) who are usually lay people and include patients, carers, or members of the public who work with NHS organisations to improve patient safety by contributing directly to governance, decision making, and safety improvement activity. As lay people, PSPs are not covered by PIDA.

If he will make an assessment of effectiveness of Maternity and Neonatal Voices Partnerships (MNVP), including Oxfordshire MNVP in representing the experience of mothers and families.

Maternity and Neonatal Voices Partnerships (MNVPs) ensure that the voices of service users are central to decision-making within maternity and neonatal services. An MNVP listens to the experiences of women and families, and brings together service users, staff, and other stakeholders to plan, review, and improve maternity and neonatal care. The ambitions and objectives for MNVPs are outlined in the Three-year delivery plan for maternity and neonatal services, which is available at the following link:https://www.england.nhs.uk/long-read/three-year-delivery-plan-for-maternity-and-neonatal-services/Integrated care board (ICBs) have a responsibility to ensure that MNVPs are delivering on the commitments set out in NHS England’s national guidance, which is available at the following link:https://www.england.nhs.uk/publication/maternity-and-neonatal-voices-partnership-guidance/A memorandum of understanding is in place for the Oxfordshire MNVP to oversee an agreed workplan, which is supported by the financial investment made by the ICB.The ICB has appropriate governance mechanisms in place to ensure oversight of Oxfordshire MNVP activities.

What discussions has he had to help conclude the dialogue between NHS England and the manufacturer of givinostat as part of the NICE appraisal.

The Department has had no such discussions. NHS England is responsible for any commercial discussions with companies whose products are undergoing a National Institute for Health and Care Excellence evaluation.Following discussions in November 2025, NHS England invited the manufacturer, ITF Pharma UK and Ireland, to submit a written proposal to progress a potential commercial agreement in December, with a range of ideas being offered by NHS England that could form the basis of a deal.NHS England is still awaiting a proposal from the company and has continued to press ITF Pharma on the need to make progress as patients and campaigners deserve certainty on the next steps regarding access to this treatment.

What support for training and resources his Department is providing to integrated care boards to help implement the NHS England Maternal Care Bundle, published on 6 January 2026.

Maternity care remains a top priority for NHS Providers, as demonstrated in the planning guidance.Maternity services in England are commissioned by integrated care boards (ICBs), and maternity funding, which formed part of the System Development Funding in 2024/25, has been transferred to ICB core allocations for 2025/26. This is to allow local leaders more flexibility to serve the needs of their population.The Maternity Care Bundle codifies best practice standards and therefore the implementation of the Maternity Care Bundle will be absorbed through ICB core allocations.

Whether he is taking steps to ensure that all patients with suspected leukaemia symptoms can access a full blood count test within 48 hours, as recommended by the NICE NG12 guidelines.

The Department is determined to take all the necessary steps to improve early diagnosis for all cancers, including blood cancers such as leukaemia.To accomplish this, the National Health Service 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.The National Institute for Health and Care Excellence (NICE) has a guideline on suspected cancer called ‘recognition and referral’ which aim to support the identification of children, young people and adults with symptoms that could be caused by cancer’. The guideline provides guidance on appropriate investigations in primary care, and the selection of people to refer for a specialist opinion. The guideline recommends that people with specific symptoms should be offered a very urgent full blood count to assess for leukaemia. Local NHS organisations are expected to take NICE guidelines fully into account in ensuring that their services meet the needs of their local populations. The NHS is held to account to deliver guidelines, which include all NICE directions, at local and regional level. The National Cancer Plan for England will cover the entirety of the cancer pathway, from referral and diagnosis to treatment and ongoing care, as well as prevention. The plan will seek to improve every aspect of cancer care to better the experience and outcomes for all patient groups, including leukaemia patients.

What steps he is taking to support the development of gene therapy treatments for rare genetic diseases such as tyrosinemia and Gaucher disease.

The Government is committed to improving the lives of those living with rare diseases, such as tyrosinemia and Gaucher disease. Through the UK Rare Diseases Framework, the Government supports access to specialist care, treatment, and drugs as a priority. This has included NHS England developing a strategic approach to commissioning advanced therapy medicinal products (ATMPs) to facilitate rapid access to National Institute for Health and Care Excellence approved therapies. We recognise the transformative potential of gene therapies and other advanced therapy medicinal products (ATMPs) for rare diseases and have stood up an advanced therapies co-ordination group spanning public sector partners. This group aims to create a joined-up ecosystem that will support the development, regulation, and delivery of ATMPs in the United Kingdom. We continue to invest in ATMPs through initiatives such as the Cell and Gene Therapy Catapult. With £17.9 million of new funding via the National Institute of Health and Care Research (NIHR), the Advanced Therapy Treatment Centres is driving forward work to enhance the UK’s environment for ATMP clinical trials and to progress research within the National Health Service to ensure patients can get safe access to these innovative therapies. NIHR’s ‘Be Part of Research’ allows individuals to find and take part in current research. There are currently a number of studies on tyrosinemia and Gaucher disease where researchers are actively looking for participants. Further information on NIHR’s ‘Be Part of Research’ is available at the following link: https://bepartofresearch.nihr.ac.uk/ This includes a clinical trial assessing the safety of a gene therapy for those with peripheral manifestations of Gaucher disease, with further information available at the following link: https://bepartofresearch.nihr.ac.uk/trial-details/trial-detail?trialId=55560&location=&distance=

What assessment he has made of the adequacy of the time taken by NICE to assess Givinostat.

The National Institute for Health and Care Excellence (NICE) aims wherever possible to publish recommendations on new medicines close to the point of licensing. NICE’s appraisal of givinostat has been more complex and has required additional work to ensure that it is able to make a recommendation on its use for the NHS. The timeline was extended following discussions with the company in order to facilitate a suitably comprehensive and robust submission and to incorporate a four-week targeted call for evidence from stakeholders. This call was to address specific areas where additional evidence was required to support the NICE appraisal committee to make a fully informed decision. NICE’s Appraisal Committee met to consider its recommendations on 23 October 2025. Stakeholders in the appraisal will be kept informed of the outcome and the next steps for the appraisal of givinostat as it progresses.

What steps he is taking to help ensure that diagnostic imaging in the NHS is reported within 4 weeks.

Ensuring patients receive their diagnostic test results quickly is a priority for the Government. NHS England’s guidance, published in August 2023, sets out that imaging reports must be provided within four weeks, or 28 days, of image acquisition. All National Health Service providers and imaging networks are expected to meet this standard. The guidance is available at the following link:https://www.england.nhs.uk/long-read/diagnostic-imaging-reporting-turnaround-times/Achieving this relies on good digital connectivity, IT infrastructure, home working solutions, and approved insourcing models established across imaging departments and networks. That is why the Government is investing in digital diagnostic transformation through NHS England’s Diagnostics Digital Capability Programme, which ensures that networks have a core set of digital capabilities to improve the quality, safety, and productivity of care.The 2025 Spending Review settlement commits to a major transformation of care delivery, moving from analogue to digital systems, hospital to community-based care, and from treatment to prevention. To support this, the NHS productivity plan is backed by a nearly 50% increase to NHS technology and digital transformation spend in 2025/26, totalling up to £10 billion by 2028/29.NHS England has also formed 22 imaging networks across the country to improve the quality, safety, and productivity of care, and to accelerate test reporting through digital investment.The Elective Reform Plan, published on 6 January 2025, sets out a whole system approach to hitting the 18-week referral to treatment target by the end of this Parliament including transforming and expanding diagnostic services to reduce waits for test results.

What steps his Department is taking to ensure that the National Maternity Taskforce includes balanced representation between (a) professional bodies and (b) families with lived experience of maternity services.

The National Maternity and Neonatal Taskforce, chaired by my Rt Hon. Friend, the Secretary of State for Health and Social Care, will be made of up a breadth of expertise. This will include people who bring clinical and international perspectives, those who can speak to the inequalities within maternal health, workforce representatives, and families with lived experience.We are currently engaging with families, including service user representatives, as well as other individuals and organisations in the maternity and neonatal sector, on the make-up of the taskforce and its terms of reference, and we will carefully consider their feedback.My Rt Hon. Friend, the Secretary of State for Health and Social Care is committed to ensuring the voices of women and families are at the heart of improving maternity and neonatal care.

Pursuant to the answer of 5 November 2025 provided to question 86540, how many new radiotherapy treatment machines will be provided to a) Oxford University Hospitals NHS Foundation Trust (b) Royal Berkshire Hospital NHS Foundation Trust.

As part of the Government’s £70 million investment in new radiotherapy treatment machines, the Royal Berkshire Hospital NHS Foundation Trust will receive one LINAC radiotherapy machine to replace an existing machine. The Oxford University Hospitals Trust will not receive any new radiotherapy machines from this investment. Responsibility for investing in new radiotherapy machines remains with local systems.NHS Trusts which have radiotherapy treatment machines were invited to apply last year to replace a machine, with funding coming from the £70m investment. Machine allocation was based on various criteria such as the age of the machine being replaced, the proportion of older machines in use within the trust, and the trust’s performance on radiotherapy.

Pursuant to the answer of 8 October 2025 provided to question 76507, (i) how many NICE Technology Appraisal approved therapies are not being provided in contravention of obligations by a) Oxford University Hospitals NHS Foundation Trust b) Royal Berkshire Hospital NHS Foundation Trust, and c) Buckinghamshire Healthcare NHS Trust and (ii) what the names of these therapies are.

The information requested is not held centrally.

What assessment he has made of the potential impact of the recent FDA advisory committee discussion on the risks and benefits of HRT, on (a) product labelling and (b) patient information; and whether the MHRA plans to conduct a similar review in the UK.

The Medicines and Healthcare Products Regulatory Agency (MHRA) is an executive agency of the Department which regulates medicine, medical devices, and blood components for transfusion in the United Kingdom, with responsibility for ensuring that medicines meet appropriate standards of safety, quality, and efficacy.Patient safety is our top priority. The MHRA keeps the safety and effectiveness of all medicines under continuous review, drawing on the latest scientific and clinical evidence. Hormone replacement therapy (HRT) is an important treatment that helps many women manage menopause symptoms. We continually review emerging data on HRT to ensure that information and guidance in the UK reflects the latest evidence. The MHRA is currently reviewing the available evidence on HRT risks and considering whether updates to the product information are warranted for certain HRT products. This review remains ongoing, and we are currently determining the appropriate next steps based on the evidence. Women should not make any changes to their treatment plan without first speaking to their general practitioner or healthcare professional, who can provide advice tailored to their individual circumstances.

What assessment he has made of levels of inequality of access to hormone replacement therapy and menopause care by (a) deprivation, (b) ethnicity and (c) geography.

We know that more needs to be done to address the barriers to accessing menopause care experienced by women, and that some groups of women experience these even more acutely. The Government is committed to prioritising women’s health as we reform the National Health Service, and women’s equality will be at the heart of our missions, our 10-Year Health Plan, and the renewal of the Women’s Health Strategy.In October 2024, the NHS published a healthcare inequalities report into NHS primary care hormone replacement therapy prescribing to treat menopause symptoms. This report provides insights by age, deprivation, region, integrated care system (ICS), primary care network, local authority, electoral ward, and Core20, as well as specific medication level analysts. ICS’s and local authorities should use this information to inform policies, planning, commissioning, and promotion of services.From 2026 onwards, local authorities will be asked to include menopause in the NHS Health Check which will support up to five million eligible women across England to access high quality information on the menopause, including advice on managing symptoms and where to seek support when they need it the most. To improve access and engagement with the NHS Health Check, a new NHS Health Check Online service is in development, which people can use at home, at a time convenient to them. The new online service is now being piloted in multiple local authorities.

If he will (a) provide an official NHS definition of dyscalculia and (b) whether he has made an assessment of the potential merits of including dyscalculia in NHS A-Z conditions.

The International Classification of Diseases (ICD) is used to classify diseases and other health conditions and is set by the World Health Organisation. ICD-11 classifies dyscalculia as a developmental learning disorder with impairment in mathematics. We want all children who struggle with maths or any other subject to be able to receive the appropriate support so they can succeed in their education. The Special Educational Needs and Disabilities Code of Practice is clear that meeting the needs of a child or young person with Special Educational Needs and Disability does not require a diagnostic label or test.NHS England advises that the NHS.UK website is not intended to cover every condition, treatment, or service the National Health Service provides. If something is not currently covered, it does not mean the NHS does not recognise it. The key factors considered include:public demand, for insurance search engine activity;suitability for a national audience;prevalence of the condition or symptom;whether other trusted organisations, for instance charities, are better placed to provide this information; andNHS England’s ability to clinically assure and maintain the content over time.NHS England appreciates the importance of providing information for conditions like dyscalculia and will continue to review and assess requests to ensure the NHS.UK website best serves the needs of the public.

When he plans to respond to the letter from the hon. Member for Henley and Thames of 10 October 2025 on Suicide Bereavement Support Services.

We replied to the Hon. Member’s correspondence on 13 November 2025.

What steps he is taking to reduce reliance on (a) voluntary and (b) charitable organisations to deliver core mental health services for older people; and what steps his Department plans to take to provide sustainable statutory funding to fill service gaps covered by the voluntary sector.

The Government values the huge contribution that voluntary and charitable organisations play in supporting older people with their mental health. The 10-Year Health Plan sets out ambitious plans to transform mental health services to improve access and treatment, and to promote good mental health and wellbeing for the nation. This includes improving assertive outreach, investing in mental health emergency departments and neighbourhood mental health centres, and increasing access to talking therapies and evidence-based digital interventions. Spending on mental health support is forecast to increase by £688 million in cash terms this financial year. Details of future funding arrangements, including integrated care board allocations over the next three years, will be set out across revenue finance and contracting guidance, capital guidance, and published allocations in due course.

What steps he is taking to ensure that the goals for to older people's mental health services in the 10-Year Plan for the NHS are met in relation to (a) prevention, (b) early intervention, (c) access to community-based support and (d) in general.

The 10-Year Health Plan sets out ambitious plans to transform mental health services, including for older people, to improve access and treatment, and to promote good mental health and wellbeing for the nation. This includes improving early intervention and assertive outreach, investing in mental health emergency departments and neighbourhood mental health centres, and increasing access to talking therapies and evidence-based digital interventions.The recently published Medium Term Planning Framework sets targets for integrated care boards to expand coverage of mental health support teams in schools and colleges, expand NHS Talking Therapies and Individual Placement Support schemes, and eliminate inappropriate out-of-area placements by 2029.We are also committed to working beyond the health system to create an environment that promotes good mental health, prevents people from developing mental health problems, and improves the lives of people living with a mental health problem.

What recent assessment he has made of the efficacy of the implementation by Local Authorities of the Food Standards Agency's Food Hygiene Rating Scheme process from investigation to action.

The Food Hygiene Rating Scheme is operated by the Food Standards Agency (FSA) in partnership with local authorities across England, Wales, and Northern Ireland.The FSA monitors the operation of the Food Hygiene Ratings Scheme by local authorities to provide assurance as far as practical that it is operated consistently within and between authorities. Any issues identified are addressed with the relevant local authorities to ensure the scheme is delivered in line with the required standards. The FSA coordinates a regular national consistency exercise with local authorities to assess the consistent application of scoring at food hygiene inspections as required by the Food Law Code of Practice.