Written questions by Mierlo.

What steps his Department is taking to identify and tackle systemic causes of avoidable harm in maternity and neonatal services.

While the vast majority of births in England are safe, we know that systemic causes of avoidable harm exist in maternity and neonatal services, and this is not acceptable.This is why my Rt Hon. Friend, the Secretary of State for Health and Social Care, asked Baroness Amos to lead an independent investigation in National Health Service maternity and neonatal care to help us understand the systemic issues behind why so many women, babies, and families experience unacceptable care. The investigation will publish its final report and recommendations in June 2026.The Government is also setting up a National Maternity and Neonatal Taskforce, chaired by my Rt Hon. Friend, the Secretary of State for Health and Social Care. The taskforce will address the recommendations of the investigation by developing a new national action plan to drive improvements across maternity and neonatal care. The taskforce will also hold the system to account for improving outcomes and experiences for women and babies.We are not waiting to take action. We have already recruited over 800 more midwives, we’re investing over £140 million to address critical safety risks on the maternity estate, and we are rolling out guidance to tackle the leading causes of maternal death. We are also rolling out programmes to tackle discrimination and racism and avoidable brain injuries.

Whether his Department plans to publish a response when the final part of the Amos Review has been delivered; and what preparatory work his Department has undertaken to respond to the anticipated recommendations.

The Maternity and Neonatal Taskforce, chaired by my Rt. Hon. Friend, the Secretary of State for Health and Social Care, will be launched imminently. The taskforce will develop a national action plan to address the National Maternity and Neonatal Investigation’s recommendations. The Department has been engaging with bereaved and harmed families and stakeholders on how the taskforce is set up, including the Terms of Reference and membership. It will be made up of a breadth of independent clinical and international expertise including those who can speak to the inequalities within maternal health, as well as family and staff representatives, charities and campaigners. The taskforce will work closely with families in developing the action plan, ensuring their voices are central to this work.Previous reviews and research have provided a clear picture of the challenges facing maternity and neonatal services. The National Maternity and Neonatal Investigation will bring together and prioritise all the existing recommendations, as well as the new evidence they are collecting. The investigation’s interim report details the insights gathered so far but much evidence is still being collected and analysed. Baroness Amos has advised that the investigation will publish its final report and recommendations in June.Alongside this, the Government is taking immediate action to boost accountability and safety as part of the Government’s mission to build a National Health Service fit for the future. This includes measures to hold the system to account, a system to better identify safety concerns, rolling out a programme to all trusts to tackle discrimination and racism, and new best practice standards in maternal mortality.

What consideration the Department has given to Baroness Amos' interim report’s findings regarding the limited progress on recommendations from previous maternity investigations, and how this will influence future review and implementation processes.

The Maternity and Neonatal Taskforce, chaired by my Rt. Hon. Friend, the Secretary of State for Health and Social Care, will be launched imminently. The taskforce will develop a national action plan to address the National Maternity and Neonatal Investigation’s recommendations. The Department has been engaging with bereaved and harmed families and stakeholders on how the taskforce is set up, including the Terms of Reference and membership. It will be made up of a breadth of independent clinical and international expertise including those who can speak to the inequalities within maternal health, as well as family and staff representatives, charities and campaigners. The taskforce will work closely with families in developing the action plan, ensuring their voices are central to this work.Previous reviews and research have provided a clear picture of the challenges facing maternity and neonatal services. The National Maternity and Neonatal Investigation will bring together and prioritise all the existing recommendations, as well as the new evidence they are collecting. The investigation’s interim report details the insights gathered so far but much evidence is still being collected and analysed. Baroness Amos has advised that the investigation will publish its final report and recommendations in June.Alongside this, the Government is taking immediate action to boost accountability and safety as part of the Government’s mission to build a National Health Service fit for the future. This includes measures to hold the system to account, a system to better identify safety concerns, rolling out a programme to all trusts to tackle discrimination and racism, and new best practice standards in maternal mortality.

What assessment he has made of the potential implications for his policies of the cultural and leadership issues referenced in the Baroness Amos' interim report; and whether those findings will inform future approaches to supporting maternity teams.

The Maternity and Neonatal Taskforce, chaired by my Rt. Hon. Friend, the Secretary of State for Health and Social Care, will be launched imminently. The taskforce will develop a national action plan to address the National Maternity and Neonatal Investigation’s recommendations. The Department has been engaging with bereaved and harmed families and stakeholders on how the taskforce is set up, including the Terms of Reference and membership. It will be made up of a breadth of independent clinical and international expertise including those who can speak to the inequalities within maternal health, as well as family and staff representatives, charities and campaigners. The taskforce will work closely with families in developing the action plan, ensuring their voices are central to this work.Previous reviews and research have provided a clear picture of the challenges facing maternity and neonatal services. The National Maternity and Neonatal Investigation will bring together and prioritise all the existing recommendations, as well as the new evidence they are collecting. The investigation’s interim report details the insights gathered so far but much evidence is still being collected and analysed. Baroness Amos has advised that the investigation will publish its final report and recommendations in June.Alongside this, the Government is taking immediate action to boost accountability and safety as part of the Government’s mission to build a National Health Service fit for the future. This includes measures to hold the system to account, a system to better identify safety concerns, rolling out a programme to all trusts to tackle discrimination and racism, and new best practice standards in maternal mortality.

Whether he plans to prioritise the assessment of breakthrough implantable devices in the MHRA Early Access Service.

In July 2025, the Medicines and Healthcare products Regulatory Agency (MHRA) published a statement of policy intent for the development and implementation of an Early Access Service for innovative medical devices. The statement of policy is available at the following link:https://www.gov.uk/government/publications/statement-of-policy-intent-early-access-to-innovative-medical-devices/statement-of-policy-intent-early-access-to-innovative-medical-devices#next-stepsThe service aims to speed up safe access to innovative medical devices for patients, supporting the Government’s Life Sciences Sector Plan. Implementing the Early Access Service will require new systems and processes to be established. The MHRA is currently investing in internal capability and working closely with stakeholders to support the establishment and implementation of the service. Further information on this work, including details of the products that will initially be in scope, will be provided later this year.

Pursuant to the answer on 20 November 2025 to question 90583 on medical treatments, (a) what progress has been made on the establishment of the MHRA Early Access Service and (b) when they expect to formally launch the service.

In July 2025, the Medicines and Healthcare products Regulatory Agency (MHRA) published a statement of policy intent for the development and implementation of an Early Access Service for innovative medical devices. The statement of policy is available at the following link:https://www.gov.uk/government/publications/statement-of-policy-intent-early-access-to-innovative-medical-devices/statement-of-policy-intent-early-access-to-innovative-medical-devices#next-stepsThe service aims to speed up safe access to innovative medical devices for patients, supporting the Government’s Life Sciences Sector Plan. Implementing the Early Access Service will require new systems and processes to be established. The MHRA is currently investing in internal capability and working closely with stakeholders to support the establishment and implementation of the service. Further information on this work, including details of the products that will initially be in scope, will be provided later this year.

What steps are being taken to ensure that screening as part of the in-service evaluation of newborn screening of spinal muscular atrophy is commenced.

The Government recognises the challenges faced by those living with rare diseases and their families and is committed to improving outcomes. This is why the National Health Service is planning a large-scale in-service evaluation (ISE) of screening for spinal muscular atrophy in newborn screening services, starting in January 2027.Over 400,000 babies would be offered screening as part of this ISE. My Rt Hon. Friend, the Secretary of State for Health and Social Care, has asked NHS England to investigate whether it would be appropriate and feasible for the evaluation to be rolled out across the whole of England.Spinal muscular atrophy (SMA) can be a devastating condition, and we recognise that if treatment is given before a baby shows any symptoms, outcomes can be significantly improved. However, any screening programme that would impact approximately 650,000 babies per year in the United Kingdom must be underpinned by high quality robust evidence that demonstrates that screening will do more good than harm. The ISE will will help inform a future UK National Screening Committee recommendation on whether screening for SMA should be added to the NHS Newborn Blood Spot Screening Programme.

What steps are being taken to mitigate disparities in outcomes associated with partial geographical coverage of the in-service evaluation of newborn screening for spinal muscular atrophy.

The Government recognises the challenges faced by those living with rare diseases and their families and is committed to improving outcomes. This is why the National Health Service is planning a large-scale in-service evaluation (ISE) of screening for spinal muscular atrophy in newborn screening services, starting in January 2027.Over 400,000 babies would be offered screening as part of this ISE. My Rt Hon. Friend, the Secretary of State for Health and Social Care, has asked NHS England to investigate whether it would be appropriate and feasible for the evaluation to be rolled out across the whole of England.Spinal muscular atrophy (SMA) can be a devastating condition, and we recognise that if treatment is given before a baby shows any symptoms, outcomes can be significantly improved. However, any screening programme that would impact approximately 650,000 babies per year in the United Kingdom must be underpinned by high quality robust evidence that demonstrates that screening will do more good than harm. The ISE will will help inform a future UK National Screening Committee recommendation on whether screening for SMA should be added to the NHS Newborn Blood Spot Screening Programme.

What assessment has been made of the potential impact that delays in access to newborn screening for spinal muscular atrophy will have on those not part of the upcoming in-service evaluation of screening for the condition.

The Government recognises the challenges faced by those living with rare diseases and their families and is committed to improving outcomes. This is why the National Health Service is planning a large-scale in-service evaluation (ISE) of screening for spinal muscular atrophy in newborn screening services, starting in January 2027.Over 400,000 babies would be offered screening as part of this ISE. My Rt Hon. Friend, the Secretary of State for Health and Social Care, has asked NHS England to investigate whether it would be appropriate and feasible for the evaluation to be rolled out across the whole of England.Spinal muscular atrophy (SMA) can be a devastating condition, and we recognise that if treatment is given before a baby shows any symptoms, outcomes can be significantly improved. However, any screening programme that would impact approximately 650,000 babies per year in the United Kingdom must be underpinned by high quality robust evidence that demonstrates that screening will do more good than harm. The ISE will will help inform a future UK National Screening Committee recommendation on whether screening for SMA should be added to the NHS Newborn Blood Spot Screening Programme.

What steps his Department is taking to ensure that overseas visitor charging regulations are applied uniformly across NHS trusts.

The overseas visitor charging regulations apply to all National Health Service trusts in England. The Department is working closely with NHS England to ensure the NHS (Charges to Overseas Visitors) Regulations 2015 are applied fairly and consistently across all NHS trusts.

Whether his Department plans to ensure that the (a) psychological, (b) social and (b) financial impacts of caring for someone with Alzheimer’s disease are accounted for as part of National Institute for Health and Care Excellence methods for evaluating novel treatments.

In developing its recommendations, the National Institute for Health and Care Excellence (NICE) takes into account all health-related costs and benefits for patients and caregivers, in line with its established methods and processes.In 2022, NICE undertook a detailed review of whether it should broaden the perspective it uses in its economic evaluations, including consideration of wider societal impacts. NICE found that robust methods for quantifying wider societal effects are not yet sufficiently developed, and that evidence on the wider societal benefits of interventions, and of the services that might be displaced, is limited. NICE has also noted that expanding assessments to capture socioeconomic impacts could introduce ethical challenges, such as advantaging interventions for populations with higher workforce participation over those for children, older adults, or people unable to work.Following this review, and after examining both international comparisons, and the significant methodological and ethical challenges involved, NICE’s Board concluded that it should retain its current approach of using a health-sector perspective routinely but with the flexibility to include wider societal benefits when they are especially relevant.

Pursuant to the answer of 19th January to question 105612, to ask what role the Department for Health and Social Care will have in drug price negotiations following the abolishment of NHS England.

The target operating model for the integration of NHS England operations into the Department has yet to be finalised. However, drug-price negotiations will continue uninterrupted up to and beyond April 2027, when NHS England will cease to exist as a separate entity.

Pursuant to to the answers of 5 and 17 October 2025 to Questions 77387 and 86538, what progress he has made on ensuring a reliable supply of testosterone and oestrogen HRT implants.

We are continuing to work closely with the Medicines and Healthcare products Regulatory Agency (MHRA) to ensure safe access to these products. We have reached out to Specialist Importers who can source unlicensed medicines in order to find alternative sources of both oestrogen and testosterone hormone replacement therapy (HRT) implants, which are not licenced in the United Kingdom. We are engaging with companies globally to source supplies of HRT implants for UK patients. We are aware of a Specialist Importer who is able to source unlicensed testosterone implants. The decision to prescribe an unlicensed imported medicine sits with the prescriber. We are also engaging with companies globally to source supplies of HRT implants for UK patients. The MHRA has been working closely with current importers of the product and are also looking to encourage other applications for a licenced medicinal product. As oestrogen and testosterone HRT implants are not licenced in the UK, the MHRA is encouraging applications to supply products through the licenced medicines route.

How much funding was allocated to dementia research by (a) the National Institute for Health and Care Research and (b) UK Research and Innovation in each of the last five years.

Government responsibility for delivering dementia research is shared between the Department of Health and Social Care, with research delivered via the National Institute for Health and Care Research (NIHR), and the Department for Science, Innovation and Technology, with research delivered via UK Research and Innovation (UKRI).The table in the document attached shows the NIHR and UKRI’s spend data for dementia research across the five financial years from 2020/21 to 2024/25Spend for dementia research is calculated retrospectively, with a time lag due to annual reporting cycles, therefore 2024/25 is the most recent year we have data for. The Department does not centrally hold data on dementia research funding from other public bodies, and 2024/25 data from UKRI is still being confirmed.The NIHR welcomes funding applications for research into any aspect of human health and care, including dementia. These applications are subject to peer review and judged in open competition, with awards being made on the basis of the importance of the topic to patients and health and care services, value for money and scientific quality. Welcoming applications on dementia to all NIHR programmes enables maximum flexibility both in terms of the amount of research funding a particular area can be awarded, and the type of research which can be funded.

What assessment he has made of the potential impact of the length of time medical malpractice legal proceedings take to complete on (a) families and (b) staff.

NHS Resolution handles claims for compensation against National Health Service providers of healthcare and has a strategic priority to keep patients and healthcare staff out of litigation to minimise distress. To achieve this, NHS Resolution deploys a range of dispute resolution techniques including mediation, resolution meetings, and early neutral evaluation, and aims to resolve claims promptly and fairly. As a result, the percentage of cases resolving without litigation has continued to increase, reaching 83% of clinical claims in 2024/25. Each case must be, however, considered on its own merits in line with the prevailing law with appropriate investigation into legal liability and the amount of compensation due. Court involvement remains necessary for those who lack capacity and may also be required to determine points of law or where there is conflicting evidence.

What steps his Department is taking to ensure that the 18-week waiting time target can be met.

The Government is committed to returning, by March 2029, to the National Health Service constitutional standard that 92% of patients wait no longer than 18 weeks from referral to consultant-led treatment.In November 2025, performance against the standard was at 61.8%, 2.6% higher than a year earlier. Since the Government came into office, the waiting list for routine appointments, operations, and procedures in England has now been cut by 312,369 despite 30.1 million referrals being added onto the waiting list.As set out in the Elective Reform Plan, we’ve set ambitious targets, and are investing in modernisation, and reforming and simplifying pathways, increasing surgical and diagnostic capacity, and empowering patients with faster and more convenient access to care. We’ve made good progress, through there remains lots more to do.We will empower patients by giving them more choice and control, reform delivery by working more consistently, and in many cases differently, to deliver more elective care, ensure care takes place in the right place, and implement robust and regular oversight of performance with clear expectations.In September last year, we announced a new “online hospital”, through NHS Online, which will help to reduce patient waiting times, delivering the equivalent of up to 8.5 million appointments and assessments in its first three years, four times more than an average trust, while enhancing patient choice and control over their care. The first patients will be able to use the service from 2027.We are investing £6 billion of additional capital over five years for diagnostic, elective, urgent, and emergency capacity in the NHS. This includes £1.65 billion of capital funding in 2025/26 to support both immediate winter capacity and infrastructure transformation, for instance new surgical hubs, community diagnostic centres, and beds to increase capacity for elective and emergency care.

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.

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.

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.