Written questions by Mierlo.

What steps he is taking to ensure that cancer patients in Oxfordshire have timely access to radiotherapy services.

The Department remains committed to ensuring that all patients have access to timely diagnosis and treatments, including those in Oxfordshire.We have invested £70 million of central funding into new radiotherapy treatment machines to replace older, less efficient machines. These new machines are currently being rolled out to trusts throughout the country. These newer machines will reduce treatment times, boost productivity, and allow more patients to be seen over the same period.The National Cancer Plan, which we will publish in the new year, will include further details on how we will improve outcomes for cancer patients, as well as speeding up diagnosis and treatment. It will ensure patients, including those in Oxfordshire, have timely access to the latest treatments and technology.

Pursuant to the Answer of 17 October 2025 to Question 77387 on Hormone Replacement Therapy, what steps he is taking to support women receiving treatment with Testo-100 HRT implants following (a) the recent recall of current stock by the distributor and (b) the current lack of alternative supplies of HRT implants.

The Department continues to work closely with the Medicines and Healthcare products Regulatory Agency (MHRA) and can confirm that we have engaged with specialist importers to understand if they can source this product, but unfortunately, they have not been able to. We have also approached a supplier which has a product that is licensed in the United States but are yet to receive a response.In the longer term, the MHRA is working with the importer Smartway, in an expedited fashion, to encourage full United Kingdom Marketing Authorisations for these products in 2026, which if successful, should bring about a safer and more stable supply.

Pursuant to the Answer of 3 July 2025 to Question 63715 on ADHD taskforce, when he expects the final report of the independent ADHD taskforce to be published.

The independent attention deficit hyperactivity disorder taskforce is expected to publish its final report in the coming weeks, and the Government will carefully consider its recommendations.

How many patients accessed specialist weight management services operated by private providers through the Right to Choose pathway in the latest period for which data is available; and if he will make an assessment of the adequacy of funding provided to integrated care boards to support access to these services.

Patients have a legal right to choose where they go for their first appointment when referred to consultant-led care as an outpatient. Patients can choose a clinically appropriate provider who holds a contract for the provision of National Health Services. This includes independent sector providers who hold contracts with integrated care boards (ICBs) across the country to deliver services for the NHS.The Department does not hold data on whether patients were either offered a choice, or requested a choice, by provider or speciality pathway.ICBs are responsible for arranging the provision of health services within their area, in line with local population need and taking account of relevant guidance. This includes specialist weight management services, which are commissioned and funded by ICBs. NHS England has provided additional funding for ICBs to develop their obesity care pathways to support the roll out of some obesity medicines that have previously only been available in specialist weight management services.

What steps he is taking to ensure that women with polycystic ovary syndrome receive (a) timely and (b) equitable access to fertility assessment and treatment under NHS pathways.

Funding decisions for health services in England are made by integrated care boards (ICBs) and are based on the clinical needs of their population. We expect ICBs to commission fertility services in line with National Institute for Health and Care Excellence (NICE) guidelines ensuring equal access to fertility treatment across England.The NICE fertility guideline includes information on what advice and treatment should be offered to women with ovulation disorders, including polycystic ovary syndrome.NICE is currently reviewing the fertility guidelines and will consider whether the current recommendations for access to National Health Service funded treatment are still appropriate. A consultation on revised guidelines was published on 10 September.NICE is the independent body responsible for translating evidence into authoritative evidence-based guidance for the health and care system on best practice. NICE has been asked to develop a clinical guideline on the assessment and management of polycystic ovary syndrome and is now planning its development. The guideline will cover the assessment and treatment of infertility for people with suspected or confirmed polycystic ovary syndrome, including in vitro fertilisation and in vitro maturation.The Government recognises that fertility treatment across the NHS in England is subject to variation in access. Work continues between the Department and NHS England to better understand the offer around NHS-funded fertility services. This work will take time to develop, however the Department is keen to ensure there will be stakeholder engagement during this process beginning in the new year.

What guidance his Department provides to ICBs to ensure that patients are informed of local IVF eligibility criteria at the point of referral to fertility services.

Funding decisions for health services in England are made by integrated care boards (ICBs), and we expect ICBs to commission fertility services in line with National Institute for Health and Care Excellence (NICE) guidelines. No guidance has been provided by the Department to the ICBs regarding the information provided to patients at the point of referral to fertility services.As part of the Women’s Health Strategy for England, we published data showing how many in vitro fertilisation cycles are funded by the NHS in each area of England, to promote more transparency about what services commissioners are offering. This data is reviewed and updated periodically and was last updated on 11 September 2025. Further information is available at the following link:https://www.gov.uk/government/publications/nhs-funded-ivf-in-england/nhs-funded-in-vitro-fertilisation-ivf-in-england

What recent data his Department holds on the number of NHS-funded IVF cycles provided in each Integrated Care Board area.

Funding decisions for health services in England are made by integrated care boards (ICBs), and we expect ICBs to commission fertility services in line with National Institute for Health and Care Excellence (NICE) guidelines. No guidance has been provided by the Department to the ICBs regarding the information provided to patients at the point of referral to fertility services.As part of the Women’s Health Strategy for England, we published data showing how many in vitro fertilisation cycles are funded by the NHS in each area of England, to promote more transparency about what services commissioners are offering. This data is reviewed and updated periodically and was last updated on 11 September 2025. Further information is available at the following link:https://www.gov.uk/government/publications/nhs-funded-ivf-in-england/nhs-funded-in-vitro-fertilisation-ivf-in-england

What assessment he has made of the potential impact of IVF age limits on women who delay starting families for (a) educational, (b) career and (c) financial reasons.

The Government recognises that fertility treatment across the National Health Service in England is subject to variation in access. Work continues between the Department and NHS England to better understand the offer around NHS-funded fertility services. This work will take time to develop, and the Department is keen to ensure there will be stakeholder engagement during this process, beginning in the new year.Funding decisions for health services in England are made by integrated care boards (ICBs) and are based on the clinical needs of their population. We expect ICBs to commission fertility services in line with National Institute for Health and Care Excellence (NICE) guidelines, ensuring equal access to fertility treatment across England.NICE develops its guidelines independent of the Government, based on the best available clinical evidence. The age limits recommended by NICE are informed by the chance of a live birth following in vitro fertilisation treatment falling with rising female age.NICE is currently reviewing the fertility guidelines and will consider whether the current recommendations for access to NHS-funded treatment are still appropriate. A consultation on revised guidelines was published on 10 September.

What assessment she has made of the adequacy of national funding allocations to Integrated Care Boards to support the delivery of levels of IVF treatment recommended by NICE.

No assessment has been made. Funding decisions for health services in England are made by integrated care boards (ICBs) and are based on the clinical needs of their population. We expect ICBs to commission fertility services in line with National Institute for Health and Care Excellence guidelines, ensuring equal access to fertility treatment across England.

What steps he is taking to ensure that Integrated Care Boards implement National Institute for Health and Care Excellence guidance on access to NHS-funded IVF treatment.

The Government recognises that fertility treatment across the National Health Service in England is subject to variation in access. Work continues between the Department and NHS England to better understand the offer around NHS-funded fertility services. This work will take time to develop, and the Department is keen to ensure there will be stakeholder engagement during this process, beginning in the new year.Funding decisions for health services in England are made by integrated care boards (ICBs) and are based on the clinical needs of their population. We expect ICBs to commission fertility services in line with National Institute for Health and Care Excellence (NICE) guidelines, ensuring equal access to fertility treatment across England.NICE develops its guidelines independent of the Government, based on the best available clinical evidence. The age limits recommended by NICE are informed by the chance of a live birth following in vitro fertilisation treatment falling with rising female age.NICE is currently reviewing the fertility guidelines and will consider whether the current recommendations for access to NHS-funded treatment are still appropriate. A consultation on revised guidelines was published on 10 September.

What recent discussions he has had with NHS England on Innovative Medicines funding for givinostat.

Department officials have regular discussions with NHS England on a number of topics, including funding for innovative medicines.The National Institute for Health and Care Excellence (NICE) makes recommendations for the National Health Service on whether new licensed medicines should be routinely funded by the NHS independently, based on an assessment of their costs and benefits. The NHS in England is legally required to fund medicines recommended by NICE, normally within three months of the publication of final guidance.NICE is currently evaluating givinostat for the treatment of Duchenne muscular dystrophy and, following a call for evidence, its Appraisal Committee will meet to consider its recommendations on 23 October 2025. NICE currently expects to publish final guidance in January 2026.If recommended by NICE in draft guidance, my Rt Hon. Friend, the Secretary of State for Health and Social Care, has been clear that NHS England should aim to work with the pharmaceutical company, Italfarmaco, to provide early interim funding for givinostat through the Innovative Medicines Fund, which has made available £340 million of ringfenced funding for the NHS to fund early access to medicines. This could potentially speed up access to givinostat by up to five months.To avoid the possibility of creating a way to circumvent the appraisal process, NHS England is unable to fund givinostat prior to the publication of draft NICE guidance that recommends the treatment.

What steps he is taking to ensure medicine shortages do not impact clinicians' ability to prescribe medicines that are best suited to the patient.

The resilience of UK supply chains is a key priority, and we are continually learning and seeking to improve the way we work to both manage and help prevent supply issues and avoid shortages. In August, the Government published a policy paper, ‘Managing a robust and resilient supply of medicines’, which outlines the steps the Department and NHS England are taking to enhance resilience in our supply chains. As part of that work, we continue to engage with industry, the Medicines and Healthcare products Regulatory Agency, and other colleagues across the supply chain as we progress work to co-design and deliver these actions. While we cannot always prevent supply issues from occurring, we have a range of well-established processes and tools to manage them when they arise and mitigate risks to patients. These include close and regular engagement with suppliers, use of alternative strengths or forms of a medicine to allow patients to remain on the same product, expediting regulatory procedures, sourcing unlicensed imports from abroad, adding products to the restricted exports and hoarding list, use of Serious Shortage Protocols (SSPs), and issuing National Health Service communications to provide management advice and information on the issue to healthcare professionals including pharmacists, so they can advise and support their patients.

What steps he is taking to decrease the level of the impact of medicine shortages on patients.

The resilience of UK supply chains is a key priority, and we are continually learning and seeking to improve the way we work to both manage and help prevent supply issues and avoid shortages. In August, the Government published a policy paper, ‘Managing a robust and resilient supply of medicines’, which outlines the steps the Department and NHS England are taking to enhance resilience in our supply chains. As part of that work, we continue to engage with industry, the Medicines and Healthcare products Regulatory Agency, and other colleagues across the supply chain as we progress work to co-design and deliver these actions. While we cannot always prevent supply issues from occurring, we have a range of well-established processes and tools to manage them when they arise and mitigate risks to patients. These include close and regular engagement with suppliers, use of alternative strengths or forms of a medicine to allow patients to remain on the same product, expediting regulatory procedures, sourcing unlicensed imports from abroad, adding products to the restricted exports and hoarding list, use of Serious Shortage Protocols (SSPs), and issuing National Health Service communications to provide management advice and information on the issue to healthcare professionals including pharmacists, so they can advise and support their patients.

What steps his Department is taking to support NHS patient transport for (a) elderly people and (b) other patients.

Non-Emergency Patient Transport Services (NEPTS) are designed to provide transport for patients who have particular clinical or mobility needs that necessitate such support, which may include elderly or vulnerable patients. The eligibility criteria for NEPTS have been set nationally by NHS England, and the details are available at the following link: https://www.england.nhs.uk/wp-content/uploads/2022/05/B1244-nepts-eligibility-criteria.pdf The Healthcare Travel Cost Scheme (HTCS) is available for eligible patients and provides financial support to facilitate journeys to and from National Health Service funded secondary care. Details on the eligibility for HTCS is available at the following link:https://www.nhs.uk/nhs-services/help-with-health-costs/healthcare-travel-costs-scheme-htcs/.Local integrated care boards (ICBs) hold responsibility for the implementation of patient transport services at a local level, including monitoring and improving against performance targets. ICBs are best placed to work and consult with their local stakeholders, health and care organisations, and local authorities to decide how to best meet and deliver for the needs of their local population. NHS England is funding and co-ordinating a range of Patient Transport Pathfinder projects to explore more effective approaches to supporting patients with their NHS travel needs.

If he will make an assessment of the potential impact of NHS tariff thresholds on pharmacies' ability to source medicines.

Evaluations by the National Institute for Health and Care Excellence (NICE) ensure that spend on new medicines represents a clinically and cost-effective use of National Health Service resources.NICE thresholds should not have any impact on pharmacies’ ability to source medicines. Community pharmacies source the drugs they need to dispense against NHS prescriptions and will be reimbursed according to the prices and arrangements set out in the Drug Tariff. The United Kingdom has well established ways of managing the cost of medicines, ensuring pharmacies are appropriately reimbursed and clear processes in place to protect against risks to supply.

What assessment he has made of the effectiveness of the fortnightly notification provided to medicine suppliers regarding medicine shortages.

NHS England’s medicines frameworks contain a contractual ask that requires all suppliers to update NHS England on their ability to supply their products to National Health Service hospitals. This information is requested fortnightly and the responses are the basis by which NHS England’s medicines supply chain team assess current or potential upcoming medicines shortages. This is a process designed to ensure the continuity of medicines supply for NHS hospitals and the information is not shared openly, but rather is only shared with specific relevant suppliers, who may be able to assist with the proposed mitigation plan. A compilation of the mitigations is shared with all NHS hospitals and regional pharmacy procurement leads in order to support the implementation of the agreed actions locally.

If he will make an assessment of the adequacy of his Department's processes for (a) forecasting, (b) alerting and (c) responding to medicine shortages.

Medicine supply chains are complex, global and highly regulated and there are a number of reasons why supply can be disrupted – many of which are not specific to the United Kingdom and are outside of government control. This includes manufacturing difficulties, access to raw materials, sudden demand spikes or distribution issues, and regulatory issues.The resilience of UK supply chains is a key priority, and we are continually learning and seeking to improve the way we work to both manage and help prevent supply issues and avoid shortages. In August, the government published a policy paper, ‘Managing a robust and resilient supply of medicines’, which provides transparency of the supply chains we rely on, the actions we take to protect patients from medicines shortages when they occur, and the steps the Department and NHS England are taking to enhance resilience in our supply chains. As part of that work, we continue to engage with industry, the Medicines and Healthcare products Regulatory Agency, and other colleagues across the supply chain as we progress work to co-design and deliver these actions.

What discussions he has had with his international counterparts on (a) the suitability of country-level forecasts of supply needs for medicines up to three years in advance and (b) the steps needed to reduce medicine shortages from unexpected rises in demand including for (i) Attention Deficit Hyperactivity Disorder and (ii) hormone replacement therapy.

Given the inherent global nature of medical supply chains, international collaboration is key to strengthening supply resilience. The United Kingdom is committed to working with international partners to enhance the resilience and security of medical supply chains. We regularly engage with international partners, bilaterally and multilaterally, to exchange information on approaches to strengthen medical supply chains including approaches to manage and reduce shortages. The Department and the Medicines and Healthcare products Regulatory Agency (MHRA) both participate in the Drug Shortages Global Regulatory Working Group, an international forum of medicine regulatory authorities from the UK alongside Australia, Canada, Japan, the United States and the European Medicines Agency, with the World Health Organisation as an observer. Information is shared about shortages of medicines with a global impact, including medicines used for Attention Deficit Hyperactivity Disorder (ADHD), and actions are taken to prevent, monitor and mitigate their impact. While we cannot always prevent supply issues from occurring, we have a range of well-established processes and tools to manage them when they arise and mitigate risks to patients. We continue to work closely with suppliers and other stakeholders such as the National Health Service and MHRA to maintain supply of medicines used for ADHD and Hormone Replacement Treatment (HRT) across the UK during any shortages. This includes working to expedite resupply dates of the disrupted products to resolve issues as soon as possible and engaging with new suppliers of medicines to increase supply capacity and resilience, to help fill supply gaps and prevent future shortages. As a result of intensive work, the supply issues affecting medicines used for ADHD and HRT are now largely resolved.

What steps is he taking to reduce the level of medicine access inequalities in England; and what discussions he has had with his counterparts in the devolved Administrations on this matter.

The National Institute for Health and Care Excellence (NICE) is the independent body that develops authoritative, evidence-based guidance on whether new medicines should be routinely funded by the National Health Service in England based on an evaluation of clinical and cost effectiveness. The NHS in England is legally required to fund medicines recommended by NICE, normally within three months of the publication of final guidance, which supports consistent access for NHS patients wherever in England they live.Fit for the future: 10 Year Health Plan for England, published on 3 July 2025, describes the creation of a single national formulary (SNF) for medicines to supersede the current process by which each local area decides which medicines, in addition to those recommended by NICE, are available to its patients. A SNF is expected to supersede these local processes with a formulary oversight board responsible for sequencing products included in the SNF based on clinical and cost effectiveness, supported by NICE. The intention is to drive rapid and equitable adoption of the most clinically and cost-effective medicines.Work will now begin on design and delivery planning, and we will work collaboratively with key stakeholders including NICE and industry on the plans.The devolved administrations are responsible for the arrangements that they put in place to make decisions on access to medicines for NHS patients, however, this Department’s officials engage and meet with them regularly in a spirit of collaboration and mutual learning. At the political level, health ministers from the four nations also meet quarterly.

What recent assessment he has made of the robustness of protections for patient advocates' (a) personal care interactions with NHS services and (b) their advocacy for patients.

For people who find it difficult to understand their care or find it hard to speak up, ‘Someone to speak up for you advocates’ are available to act as a spokesperson for them. They can help with a wide range of support needs, including understanding the care and support process, helping with decisions and standing up for a patient’s rights. People can access this support through their local council.Advocacy support is also available for anyone who wants to make a complaint about the National Health Service. Local authorities have a legal obligation to provide an Independent Complaints Advocacy Service to support people who are making or thinking about making a complaint. An NHS complaints advocate can provide support at any stage of the complaints process. The Government is providing approximately £15 million of grant funding to local authorities this year towards this service.