Written questions by Mierlo.

Pursuant to the Answer of 27 January to Question 25553 on Methylphenidate Shortages, if he will make an assessment of the adequacy of the current supply of methylphenidate for ADHD.

The Department has worked closely with industry stakeholders, and, following extensive collaborative efforts, previous issues have been resolved and all strengths of lisdexamfetamine, atomoxetine capsules, atomoxetine oral solution, guanfacine prolonged-release tablets and methylphenidate prolonged-release tablets and prolonged-release capsules are now available.We continue to support the NHS England Attention Deficit Hyperactivity Disorder (ADHD) taskforce, which brings together expertise from the National Health Service, education, and justice sectors to coordinate a system-wide response to rising demand. In collaboration with NHS England’s national ADHD data improvement plan, we are developing future growth forecasts to support improved demand planning. These forecasts will be shared with industry to help ensure a more responsive and sustainable supply of ADHD medicines.In parallel, we are also engaging with new suppliers for ADHD medicines to increase supply capacity and resilience.The Department also maintains and regularly updates a list of currently available and unavailable ADHD products on the Specialist Pharmacy Service website. This resource supports prescribers and dispensers in making informed decisions with patients. The list is available at the following link:www.sps.nhs.uk/articles/prescribing-available-medicines-to-treat-adhd

What steps his Department is taking to ensure that NICE appraisals for (a) Duchenne muscular dystrophy and (b) other rare, progressive conditions take into account urgency of access.

The National Institute for Health and Care Excellence (NICE) aims wherever possible to issue guidance on new medicines close to the time of licensing to ensure that patients can benefit from rapid access to clinically and cost-effective new medicines. NICE’s ability to do so is contingent on the company notifying NICE of its launch plans at an early stage and providing a timely evidence submission.The Life Sciences Sector Plan sets out the measures we are taking that will mean that patients are able to access medicines three to six months faster, including improved alignment between decisions from the Medicines and Healthcare products Regulatory Agency and NICE guidance publication.The Life Sciences Sector Plan is available at the following link:https://assets.publishing.service.gov.uk/media/688c90a8e8ba9507fc1b090c/Life_Sciences_Sector_Plan.pdf

What steps his Department is taking to ensure that the impact on carers is included in NICE technology appraisals for rare and progressive diseases.

NICE’s technology appraisal process allows its independent committees to take societal benefits, such as health-related quality-of-life for carers and impact on personal social services, into account. NICE’s methods are set out in its published health technology evaluations manual, which is available at the following link:https://www.nice.org.uk/process/pmg36.Evaluations should consider all health effects for patients, and, when relevant, carers. When presenting health effects for carers, evidence should show when the condition is associated with a substantial effect on carer’s health-related quality of life and how the technology affects carers. This applies for all therapies, including therapies for rare diseases. NICE appraisals specifically consider health-related quality of life, for both patients and carers, rather than quality of life as a whole.

Which NHS Trusts will be involved in the Rapid National Investigation into maternity and neonatal services.

On 14 August 2025, my Rt Hon. Friend, the Secretary of State for Health and Social Care, announced the appointment of Baroness Amos as Chair of the Independent Maternity and Neonatal Investigation, with further information available at the following link:https://www.gov.uk/government/news/baroness-amos-to-spearhead-maternity-and-neonatal-investigation#The investigation will carry out rapid reviews of up to ten trusts with specific issues. The Chair is working closely with families to finalise the terms of reference, including the selection criteria to select the trusts, which will be announced as soon as possible.

How many (a) births and (b) elective c-sections occurred in each NHS trust in England in 2024.

The National Health Service routinely publishes data on maternity activity for NHS hospitals, including data relating to the number of births, the method of onset of labour, delivery methods, and places of delivery. An annual publication for this data, covering the financial year ending March 2024, is available at the following link:https://digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2023-24A monthly breakdown of statistics is also available, at the following link:https://digital.nhs.uk/data-and-information/publications/statistical/maternity-services-monthly-statistics/final-may-2025-provisional-june-2025-official-statistics

What assessment he has made of the potential merits of ensuring that the national review of Maternity Services (a) includes representations from (i) patients and (ii) campaign groups and (b) encourages their active involvement.

On 23 June, my Rt Hon. Friend, the Secretary of State for Health and Social Care announced an independent investigation into National Health Service maternity and neonatal services to understand the systemic issues behind why so many women, babies, and families experience unacceptable care. He has held a series of meetings with harmed and bereaved families from across the country and has committed to ensuring that the voices of women and families are at the heart of improving standards.In addition, on 14 August, the appointment was announced of the Rt Hon. the Baroness Amos as chair of the independent maternity and neonatal investigation. Further information is available at the following link:https://www.gov.uk/government/news/baroness-amos-to-spearhead-maternity-and-neonatal-investigationThe Rt. Hon. the Baroness Amos was selected after feedback from bereaved families who expressed a preference for someone with distance from the NHS. Support will be given by a team of esteemed expert advisors, who will be selected following further engagement with families. The chair is working with families to finalise the terms of reference for the investigation, and these will be published shortly.The Government is also establishing a National Maternity and Neonatal Taskforce, chaired by my Rt Hon. Friend, the Secretary of State for Health and Social Care, and this is to be made up of a panel of experts and family, charity, and staff representatives.The taskforce will use the recommendations from the independent investigation to develop a national plan to drive improvements across maternity and neonatal care. The taskforce will work closely with families in developing the action plan, ensuring their voices are central to this work.

If he will make an assessment of the potential merits of introducing a regulatory body for antenatal education organisations.

As outlined in the 10-Year Health Plan, we are cutting the number of regulatory bodies as they are overwhelming the National Health Service system and taking focus away from the basics of patient care. The changes we are making will improve quality and safety by making it clear where responsibility and accountability sits at all levels of the system, and making it easier for staff, patients, and users to directly feed into the system to improve quality of care. We therefore have no plans currently to introduce a further regulatory body specific to antenatal education organisations.

What steps he has taken to (a) improve access to antenatal care education for women and families and (b) ensure that high-quality (a) information and (b) information on birthing is delivered during antenatal classes.

Maternity services are commissioned by integrated care boards (ICBs), and it is the responsibility of local commissioners to ensure services, including antenatal education, are designed to be accessible and high-quality. As was set out in the 2025/26 National Health Service operational planning and contracting guidance, when taking decisions, ICBs and providers are asked to pay particular attention to challenged and fragile services, including maternity and neonatal services, thereby delivering the key actions of the Three Year Delivery Plan and continuing to address variation in access, experiences, and outcomes. Antenatal care is a key focus of the plan. In addition, NHS England expects ICBs to have due regard to relevant National Institute for Health and Care Excellence (NICE) guidelines. For antenatal care education, NICE guidelines recommend offering antenatal classes to all first-time mothers and their partners, covering a range of topics, including preparing for labour and birth. It also advises that classes should be considered for women in subsequent pregnancies where there may be a benefit.

If he will make an assessment of the potential merits of the inclusion of Oxford University Hospitals Trust in the rapid review of NHS maternity services.

The investigation will carry out rapid reviews of up to ten trusts with specific issues. The process of determining which trusts to review is ongoing, and once decided, they will be announced as soon as possible.

What steps he is taking to support NHS Trusts with (a) additional pharmacist staff salaries, (b) the cost of additional monitoring blood tests and (c) additional service delivery costs when new drug treatments are funded for NHS patients.

The 2025/26 NHS Payment Scheme, published on 4 April 2025, governs transactions between providers and commissioners of secondary healthcare by setting the rules for determining the amount payable for the provision of healthcare services. In short, it defines the basis for fairly reimbursing National Health Service trusts for the work they do. More information on the scheme is available at the following link:https://www.england.nhs.uk/long-read/25-26-nhs-payment-scheme/Prices in the scheme have been updated to reflect the latest NHS pay awards. The 2025/26 prices have been calculated in part by updating 2024/25 pay award prices, published in September 2024. for inflation and efficiency;The scheme includes a published list of 2025/26 prices reflecting the latest pay awards, which are available at the following link:https://www.england.nhs.uk/publication/2025-26-nhs-payment-scheme/This list includes the price paid to NHS trusts for persons who solely require a blood test. High-cost drugs, which can include those that have just received approval, are excluded from prices and are subject to separate agreement on appropriate funding between providers and commissioners.

What assessment he has made of the potential impact of the requirement upon Oxford University Hospitals NHS Foundation Trust to make savings of £99 million this year on the delivery of health services in Oxfordshire.

Like many other trusts, the Oxford University Hospitals NHS Foundation Trust overspent against their own plan in 2024/25, despite receiving significant additional support to deliver that plan. We can no longer accept overspends as standard. It is critical that all National Health Service organisations maximise every penny available to them and deliver the plans that they agree to. All efficiency savings will be used by organisations such as the Oxford University Hospitals NHS Foundation Trust to reinvest in services and deliver on their plans. All systems have agreed breakeven financial plans for 2025/26, requiring £11 billion of efficiencies and other savings, or 7.1% of total allocation. While ambitious, NHS England has provided detailed efficiency and productivity support during 2025/26 planning and will continue to do so through a new finance improvement programme to ensure efficiency and financial plans are met without adversely impacting service delivery or patient care. As of the second month, the trust reports that it is on track to deliver the efficiencies set out in their plan for 2025/26.

What steps his Department is taking to improve access to NHS occupational therapists involved in Disabled Facilities Grants for (a) children and (b) other people.

Occupational therapists play an important role in delivering the Disabled Facilities Grant at a local level by assessing older and disabled people’s needs, recommending home adaptations, and ensuring the suitability of proposed solutions.Decisions about recruitment are matters for individual National Health Service trusts. NHS trusts manage their recruitment at a local level ensuring they have the right number of staff in place and with the right skills mix, to deliver safe and effective care. These staff include Allied Health Professionals such as occupational therapists.The Government is committed to making the NHS the best place to work, to ensure that we retain more of our skilled and dedicated staff. NHS England is leading work nationally through its retention programme to drive a consistent, system-wide approach to staff retention across NHS trusts. This ensures trusts have access to proven retention strategies, data-driven monitoring, and can foster a more stable, engaged, productive, and supported workforce.

Pursuant to the Answer of 30 June 2025 to Question 62450 on Vamorolone, which NHS Trusts have submitted prior approval forms.

The National Health Service trusts which have submitted prior approval forms are as follows:Alder Hey Children's NHS Foundation Trust;Cambridge University Hospitals NHS Foundation Trust;Great Ormond Street Hospital for Children NHS Foundation Trust;Guy's and St Thomas' NHS Foundation Trust;Nottingham University Hospitals NHS Trust;The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust;University Hospital Southampton NHS Foundation Trust;University Hospitals Birmingham NHS Foundation Trust; andUniversity Hospitals Bristol and Weston NHS Foundation Trust.

On what date he expects the final report of the independent ADHD taskforce to be published.

The ADHD taskforce's final report is expected to be published later this year.

How many patients have accessed Vamorolone since it was given NICE approval for Duchenne Muscular Dystrophy; what assessment he has made of the adequacy of availability of Vamorolone to patients with DMD in that period; and whether the NHS had fully implemented the NICE recommendation by the April 2025 deadline.

The National Institute for Health and Care Excellence (NICE) published its technology appraisal, titled Vamorolone for treating Duchenne muscular dystrophy in people 4 years and over, on 16 January 2025. NHS England routinely commissioned vamorolone in line with the guidance, from 16 April 2025.When a patient is started on vamorolone, the prescribing clinician submits an electronic prior approval form, confirming that NICE’s recommendation criteria are met. NICE’s costing report, included in the technology appraisal, suggested that 1,390 people expected to receive vamorolone in 2025/26. The NICE’s technology appraisal is available at the following link:https://www.nice.org.uk/guidance/ta1031/resources/resource-impact-summary-report-15239352925/chapter/Resource-impact-summary-reportThere is only 10 full weeks of data available since routine commissioning commenced in mid-April, and over this period there have been 32 prior approval forms submitted. Whilst submission of a form is not confirmation that treatment has begun, this is used as a proxy indication for the number of patients starting treatment.

Whether he has made an assessment of the adequacy of the provision of 24/7 palliative care in Oxfordshire: and what steps he is taking to extend provision of this service.

We want a society where every person receives high-quality, compassionate care from diagnosis through to the end of life. The Government will shift the focus of healthcare out of the hospital and into the community, to ensure patients and their families receive personalised care in the most appropriate setting. Palliative care and end of life care services will have a big role to play in that shift.Palliative care services are included in the list of services that integrated care boards (ICBs), including the NHS Buckinghamshire, Oxfordshire and West Berkshire ICB, must commission. This promotes a more consistent national approach and supports commissioners in prioritising palliative care and end of life care. To support ICBs in this duty, NHS England has published statutory guidance and service specifications, with further information on both available, respectively, at the following two links:https://www.england.nhs.uk/publication/palliative-and-end-of-life-care-statutory-guidance-for-integrated-care-boards-icbs/https://www.england.nhs.uk/publication/service-specifications-for-palliative-and-end-of-life-care-adults/The statutory guidance makes specific reference to commissioners defining how their services will meet population needs 24/7 and includes a priority action for ensuring that staff, patients, and carers can access the care and advice they need, whatever time of day.Earlier this year, I met with key palliative care and end of life care and hospice stakeholders, in a roundtable format, with a focus on long-term sector sustainability within the context of our forthcoming 10-Year Health Plan.

What assessment he has made of the merits of reforming GP licensing; and whether he will make it his policy to protect GPs from unaffordable costs when a practice fails financially.

Most general practices (GPs) are run by general, unlimited liability partnerships. Limited liability partnerships are currently not permitted as business vehicles for General Medical Services or Personal Medical Services contractors. However, limited companies can be used to manage financial risks in a partnership. GP partnerships may also manage liabilities through indemnities and different forms of insurance. As independent contractors and small business owners, these are decisions for GP partners to make, with legal and accounting advice.We have committed to substantive GP Contract reform within this Parliament following acceptance of the 2025/26 contract by the General Practitioners Committee England. As part of this, we expect to consider a breadth of topics, which may include updates to the partnership model.We are investing an additional £889 million in GPs, to reinforce the front door of the National Health Service and to bring back the family doctor, bringing the total spend on the GP Contract to £13.2billion in 2025/26. This is the biggest increase in over a decade, and means we are reversing the recent trend by allocating a rising share of total NHS resources to GPs.

What criteria his Department has used to determine the allocation of repair funds to the Royal Berkshire Hospital.

The £750 million Estates Safety Fund is part of the overall 2025/26 capital allocation announced by the Chancellor at the Autumn Budget 2024.The £750 million was divided between integrated care systems (ICSs) through indicative funding allocations as part of the NHS Capital Guidance 2025/26. Each system’s indicative allocation represents a proportion of the £750 million based on need, taking into account levels of critical infrastructure risk, incidents and returns to the recent maternity estates survey.Due to the diverse needs of the National Health Service estate, a flexible approach has been taken to ensure national and regional priorities are addressed effectively. ICSs worked with their local systems to identify and prioritise which schemes would be funded at which sites from their provisional allocations to deliver maximum safety benefits. The value of these schemes determined the financial allocations to NHS trusts.

What assessment he has made of the potential merits of reforming GP licensing; and if he will develop plans to protect GPs from costs when practices fail financially.

We have committed to substantive GP contract reform within Parliament following acceptance of the 2025/26 contract by the England general practitioners committee of the British Medical Association. As part of this, we expect to consider a breadth of topics, which may include updates to the partnership model.Practices with a General Medical Services contract are eligible for rent reimbursements, with different terms depending on the ownership or occupation arrangements for the property, as set out in the Premises Costs Directions 2024. The commissioner has discretion to provide further financial assistance if other costs rise exponentially, such as service charges, all budget-dependent.

What steps he is taking to ensure that private providers of physiotherapy services to the NHS (a) provide value for money and (b) do not operate with excessive profit margins.

Throughout its history, the National Health Service has always worked with non-NHS healthcare providers to deliver essential services to patients, especially at times of operational pressures. The overall proportion of health spending on independent sector providers has not increased significantly over recent years. In 2013/14, 6.1% of total health spending, or £6.5 billion, was spent on purchase of healthcare from independent sector providers. In 2023/24, this was 6.8% or £12.4 billion.The Provider Selection Regime is a set of rules for procuring health care services in England, giving decision-makers the flexibility they need to arrange services that best promote the interests of patients, the taxpayer, and the population. As part of the Provider Selection Regime, commissioners need to be transparent in their decision making to ensure that there is proper scrutiny and accountability of decisions made about NHS services.Rates of payment for physiotherapy services are set at a local level. Pursuant to the Government’s public interest test, NHS bodies are not obliged to accept any bids submitted by external suppliers unless they clearly demonstrate value for money and deliver against the aims and objectives of a business cases. It is expected that any outsourced services are delivered in a way that improves quality, ensures greater stability and longer-term investment in the workforce, and delivers better value for money as part of broader commitments on procurement.