Written questions by Mierlo.

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 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 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 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.

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.

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 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 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.

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 discussions he has had with the National Institute for Health and Care Excellence on securing long term access to cerliponase alfa.

Officials in the Department have had a number of discussions with colleagues in the National Institute for Health and Care Excellence (NICE) about the ongoing appraisal of cerliponase alfa (Brineura) for the treatment of neuronal ceroid lipofuscinosis type 2 (CLN2). The Government understands the devastating impact of this condition on those affected, and how important the availability of effective new treatments is to patients and their families.An agreement has now been reached between NHS England and the manufacturer of Brineura, BioMarin, that secures continued access for patients who have already started treatment with Brineura or who begin treatment before the end of this year.NICE is, at present, unable to recommend Brineura for routine National Health Service funding for new patients in its draft guidance published in August. This decision comes after commercial negotiations between NHS England and BioMarin failed to secure a price for the treatment that properly reflects the limited evidence of its long-term effectiveness.I recognise how disappointing this will be to all those affected, but I would like to underline that NICE has not yet concluded its appraisal. Stakeholders, including patient groups and the company, have had an opportunity to appeal the final draft guidance. If no appeal goes ahead, NICE expects to publish its final recommendations on cerliponase alfa in October.

Pursuant to the Answer of 7 March 2025 to Question 35541 and and the Answer of 12 May to Question 50770 on Hormone Replacement Therapy, (a) what progress has been made and (b) what further steps are being taken to ensure a continued supply of HRT implants for patients.

The Department is continuing to work closely with the Medicines and Healthcare products Regulatory Agency (MHRA) to ensure safe access to oestrogen and testosterone hormone replacement therapy (HRT) implants, which are not licensed in the United Kingdom.The MHRA has been working closely with the current importers of the product and is also looking to encourage other applications for a licensed medicinal product. The MHRA is currently assured that there are over 13 months of product in the UK based on currently available stocks and usage rates.As oestrogen and testosterone HRT implants are not licensed in the UK, we are encouraging applications to supply products through the licensed medicines route.The Department is working closely with the MHRA to ensure safe access to these products. The Department have also reached out to specialist importers, who can source unlicensed medicines, to find alternative sources of both HRT implants for UK patients. The Department will continue to work closely with the MHRA and the National Health Service to ensure that suitable alternatives are available for patients.

Pursuant to the Answer of 15 July to Question 66814 on Health Services: Oxfordshire, what steps he is taking to ensure that Oxford University Hospitals NHS Foundation Trust is able to recruit and retain midwives in the context of efficiency savings.

The Government is committed to ensuring the National Health Service can both recruit and retain staff. We recently announced the Graduate Guarantee for nurses and midwives, which will ensure that there are enough positions available for every newly qualified midwife in England, and includes £8 million to support the temporary conversion of vacant maternity support worker posts to band 5 registered midwifery roles.Additionally, NHS England is undertaking targeted retention programme for midwives, led by the Chief Nursing Officer. This includes: a midwifery and nursing retention self-assessment tool; mentoring schemes; strengthened advice and support on pensions and flexible retirement options; and the publication of menopause policies and guidance. NHS England has also invested in unit-based leads in every trust who focus on retention and provide pastoral support to midwives. This initiative, alongside investment in workforce capacity, has seen a reduction in vacancy, leaver and turnover rates.

When he plans to respond to the letter of 10 July 2025 from the hon. Member for Henley and Thame on maternity services.

The letter has been passed to Baroness Amos as chair of the independent investigation into National Health Service maternity and neonatal care, and she will respond directly in due course.