Written questions by Mierlo.

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.

What assessment he has made of the adequacy of (a) funding and (b) the availability of trained staff for GP practices to perform blood tests for children.

Overall, ensuring adequate general practice (GP) provision is the responsibility of the integrated care boards (ICBs).GPs are independent businesses, providing primary care services, based on a National Health Service GP Contract, to their local populations. Most commonly, GPs are run by GP partners who, alongside other GPs and healthcare staff, are responsible for running their own practice. This allows them to have relative autonomy in deciding how to provide contracted services, and provides opportunities for innovation.Local enhanced services, such as blood tests, are negotiated and agreed locally, and are commissioned by ICBs to fit the needs of the local population. GPs can choose whether or not they would like to participate in providing these services. These services can vary in scope and funding across the country.

What assessment he has made of the adequacy of the availability of phlebotomy services to perform blood tests for children in (a) Oxfordshire and (b) nationally.

The Government is committed to putting patients first. This means making sure that patients are seen on time and ensuring that patients have the best possible experience during their care.Community diagnostic centres (CDCs) offer local populations a wide range of diagnostic tests closer to home as well as greater choice on where and how they are undertaken. This reduces the need for hospital visits, reduces pressure on hospitals, and speeds up diagnosis. CDCs are expected to offer their services to children and young people where it is safe and appropriate to do so. The Oxfordshire, Oxford CDC in Cowley delivers a range of diagnostic services, including phlebotomy services.Phlebotomy services are also provided by general practices (GPs). Where services are provided by GP, they are commissioned locally by integrated care boards (ICBs), based on local population need, and are funded as part of their annual funding allocations.In Oxfordshire, the Buckinghamshire, Oxfordshire and Berkshire West ICB has commissioned GPs to deliver phlebotomy services for all ages, including children. Services must be led by suitably trained professionals.Guidance communicated to GPs from the Berks, Bucks and Oxon Local Medical Committee, the body representing all NHS GPs practising in the Buckinghamshire, Oxfordshire, and Berkshire area, is that GPs should not perform blood tests for patients under 12 years old and instead that these should be performed by specialist paediatric trained staff. Where GPs have clinical staff with the training, competence, and experience to perform blood tests on patients under 12 years old, these services may be available. However, at practices that do not have these staff, they will instead refer the child to alternative providers, such as in a children’s hospital clinic.

What steps he is taking to encourage Hormone Replacement Therapy implant manufacturers to apply for UK licenses.

The Medicines and Healthcare products Regulatory Agency (MHRA) and the Department have kept ministers informed of the ongoing issues in the manufacturing of unlicenced products used as medicines for hormone replacement therapy (HRT) implants.Regular discussions with the importer of the unlicenced medicines have been held, and the Medicines Supply team in the Department are actively looking at both licenced and other sources, to ensure an ongoing supply of appropriate products.The MHRA welcomes these applications and has processes in place to review applications for HRT implants, as soon as they are received.

What steps he is taking to ensure access to licenced Hormone Replacement Therapy implants for women.

There are currently no licensed United Kingdom suppliers of oestrogen and testosterone hormone replacement therapy (HRT) implants in the UK, and companies are free to decide what they market.The Department is working closely with the Medicines and Healthcare products Regulatory Agency to ensure safe access to these products. As part of this, we have also reached out to specialist importers who can source unlicensed medicines in order to find HRT implants for UK patients.

What discussions he has had with the Medicines and Healthcare products Regulatory Agency on encouraging manufacturers to apply for UK licenses for Hormone Replacement Therapy implants.

The Medicines and Healthcare products Regulatory Agency (MHRA) and the Department have kept ministers informed of the ongoing issues in the manufacturing of unlicenced products used as medicines for hormone replacement therapy (HRT) implants. Regular discussions have been held with the importer of the unlicenced medicines, and the Medicines Supply team in the Department are actively looking at licenced alternatives to ensure ongoing supply.A medicine can only become licensed if an application is made for such a licence, usually by the manufacturer, and the MHRA is only able to grant a marketing authorisation after the supporting data has been assessed to demonstrate its quality, safety, and efficacy for the conditions it is intended to treat, and to confirm that it has an acceptable balance of risk and benefit. In our role as the medicines regulator, we are not in a position to solicit for new product licence applications.However, the MHRA welcomes marketing authorisation applications for HRT implants and has processes in place to review applications as soon as they are received. In addition, manufacturers can seek scientific advice on their product from the MHRA at any stage of development.

If he will make an assessment of the potential merits of expanding the criteria for medical exemption certificates to include everyone with a (a) disability and (b) chronic illness.

The Department has no plans to expand the criteria for medical exemption certificates.Individuals with qualifying medical conditions or with a continuing physical disability which prevents them from leaving their residence without the help of another person are entitled to apply for a medical exemption certificate.People may also be exempt from prescription charges depending on their age, whether they are in qualifying full-time education, whether they are pregnant or have recently given birth, or whether they are in receipt of certain benefits or a war pension.People who do not qualify for an exemption and who need many prescription items could save money with a prescription prepayment certificate, which allows people to claim as many prescriptions as they need for a set cost. People on a low income can seek help under the NHS Low Income Scheme.

What discussions he has had with the Secretary of State for Work and Pensions on the potential merits of expanding eligibility for free prescriptions to include everyone in receipt of Universal Credit.

No discussions have been held between my Rt Hon. Friend, the Secretary of State for Health and Social Care and my Rt Hon. Friend, the Secretary of State for Work and Pensions on expanding eligibility to all claimants in receipt of Universal Credit. The Department keeps the earnings thresholds for free prescriptions under review on an annual basis.Approximately 89% of prescription items dispensed in community pharmacy in England are free of charge, and for the first time in three years prescription charges have been frozen, meaning around 40% of the population will save money on their prescriptions.

If he will make it his policy to review the adequacy of the earnings criteria for free prescriptions.

No discussions have been held between my Rt Hon. Friend, the Secretary of State for Health and Social Care and my Rt Hon. Friend, the Secretary of State for Work and Pensions on expanding eligibility to all claimants in receipt of Universal Credit. The Department keeps the earnings thresholds for free prescriptions under review on an annual basis.Approximately 89% of prescription items dispensed in community pharmacy in England are free of charge, and for the first time in three years prescription charges have been frozen, meaning around 40% of the population will save money on their prescriptions.

What steps he is taking to increase the proportion of Alzheimer's disease specialists compared to other G7 countries.

The provision of dementia health care services is the responsibility of local integrated care boards (ICBs). We expect ICBs to commission services based on local population needs, taking account of National Institute for Health and Care Excellence guidelines.We want all health and care staff to have received appropriate training to provide high quality care to people with dementia. Employers in the health system are responsible for ensuring that their staff are trained to the required standards to deliver appropriate care for patients. The required training needs are set out in the Dementia Training Standards Framework, which is available through Skills For Health at the following link:https://www.skillsforhealth.org.uk/wp-content/uploads/2021/01/Dementia-Core-Skills-Education-and-Training-Framework.pdf

What steps he is taking to help support UK-based research into new forms of treatment for dementia.

The Department delivers dementia research via the National Institute for Health and Care Research (NIHR). Government funders are investing in dementia research across all areas, from causes, diagnosis and prevention to treatment, care and support, including for carers.The NIHR is investing almost £50 million to the UK Dementia Trials Network, which will deliver a coordinated network of early phase dementia trial sites. This will be complemented by the £20 million Dementia Clinical Trials Accelerator, designed to position the United Kingdom as the destination of choice for late phase clinical trials in dementia and neurodegenerative diseases.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 based on 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 amount of research funding a particular area can be awarded, and the type of research which can be funded.The Government’s Dame Barbara Windsor Dementia Goals programme, with almost £150 million expected to be allocated to, or aligned with it, aims to speed up the development of new treatments for dementia by accelerating innovations in biomarkers, clinical trials and implementation. Some of this will be delivered through the Neurodegeneration Initiative which the programme is establishing, which will be a globally unique, not-for-profit, industry led public-private partnership that will work together across government, industry, academia, the National Health Service and third sector to deliver its objectives, including UK research organisations.So far, the programme has invested £13 million into a range of biomarker innovation projects, many of which are being delivered by UK small and medium enterprises and UK research organisations.

If he will make an assessment of the potential merits of using (a) PET scans, (b) cerebrospinal fluid testing and (c) other bio-marker led tests to confirm Alzheimer's disease.

The Department delivers dementia research through the National Institute for Health and Care Research (NIHR). The NIHR funds a range of research into dementia, for example investing almost £11 million to develop new digital approaches for the early detection and diagnosis of dementia.The Government’s Dame Barbara Windsor Dementia Goals programme has already invested £13 million into a range of biomarker innovation projects which include biomarker technologies, ranging from an artificial intelligence tool designed to improve the accuracy of blood tests for dementia, to using retinal scans to detect early-onset dementia decades before symptoms. Some of these innovations could support improved diagnosis in the future, if validated for clinical use.

What steps he is taking to return the dementia diagnosis rate to its target level.

To support recovery of the dementia diagnosis rates, we have developed a memory service dashboard to support commissioners and providers with appropriate data and enable targeted support where needed.We have funded an evidence-based improvement project to fund two trusts in each region, totalling 14 sites, to pilot the Diagnosing Advanced Dementia Mandate protocol. Learning is currently being shared and promoted with regional and local partners following an impact assessment of the pilots.The Office for Health Improvement and Disparities’ Dementia Intelligence Network has developed a tool for local systems to enable investigation into local variation in diagnosis and take informed action to enhance diagnosis rates.We have also published the D100: Assessment Tool Pathway programme, which brings together multiple resources into a single, consolidated tool. The tool continues the work of the Dementia Care Pathway, covering all elements of the Well Pathway, including Diagnosing Well.The D100: Pathway Assessment Tool launched in April 2025 and is available at the following link:https://www.rcpsych.ac.uk/improving-care/nccmh/service-design-and-development/dementia-100-pathway-assessment-tool

If he will make an assessment of the potential impact of the time taken by integrated care boards to add new National Institute for Health and Care Excellence-recommended medicines to their formularies on the ability of NHS patients to access new treatments.

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 based on an assessment of their costs and benefits. The NHS in England is legally required to fund medicines recommended in a NICE technology appraisal, usually within three months of final guidance.The NICE has published guidance on the adoption of medicines in local formularies which states that once a NICE technology appraisal recommends a medicine, it must be included in a local formulary within three months, providing it is clinically appropriate and relevant to the services provided by the organisation, or within 30 days for Early Access to Medicines Scheme medicines.As part of the commitments made in the 2024 voluntary scheme for branded medicines pricing, access and growth (2024 VPAG), NHS England agreed to the development of a local formulary national minimum dataset within the first half of the 2024 VPAG, to increase visibility of local variation in the implementation of NICE guidance, identify where variation in local formularies may be creating barriers to access, and to confirm to NHS England when a NICE recommended treatment has been placed on a local formulary.NHS England also agreed to use the dataset to inform a report, which will be published no less frequently than annually, identifying unwarranted variation between national guidance and local formularies.

What criteria his Department has used to determine which integrated care boards should merge.

NHS England has asked the integrated care boards (ICBs) to act primarily as strategic commissioners of health and care services, and to reduce the duplication of responsibilities within their structure, with the expectation of achieving a 50% cost reduction in their running cost allowance. NHS England provided additional guidance to ICBs, National Health Service trusts, and NHS foundation trusts on 1 April 2025, where ICBs were tasked with developing plans by the end of May setting out how they will manage their resources to deliver across their priorities. This letter can be found at the following link:https://www.england.nhs.uk/long-read/working-together-in-2025-26-to-lay-the-foundations-for-reform/Details of how ICBs will work together to share functions and agree clustering arrangements to deliver services and meet local needs may emerge following the publication the plans.Ministers and the Department will work with the new transformation team at the top of NHS England, led by Sir Jim Mackey, to ensure ICBs continue to fulfil their future functions effectively, within the running costs cap, and unlock the benefit of working at scale to deliver better care for patients.

What information has been provided to him on the reason for the delay on publication of the National Institute for Health and Care Research research brief that will inform the UK National Screening Committee’s in-service evaluation of newborn screening for Spinal Muscular Atrophy.

My Rt Hon. Friend, the Secretary of State for Health and Social Care has been kept informed of the plans being developed for the in-service evaluation of newborn screening for spinal muscular atrophy, including the National Institute for Health and Care Research’s brief. The Department is working with NHS England on the deliverability of the in-service evaluation. The roll out and timeline will be confirmed after the conclusion of the 2025 Spending Review.

Pursuant to the Answer of 7 March 2025 to Question 35541 on Hormone Replacement Therapy, what discussions he has had with the Medicines and Healthcare products Regulatory Agency on the adequacy of the process for applying for UK licenses for HRT implant manufacturers.

The processes of the Medicines and Healthcare products Regulatory Agency (MHRA) are now performing within the expected timelines, and are meeting company commitments. Guidance has been updated on 3 April 2024 to aid the rapid approval of medicines, ensuring that quality, safety, and efficacy assessments are completed.The assessment of hormone replacement therapy products falls within these overall processes, and we are working closely with Department’s medicines supply to ensure the early flagging of issues, so they can be resolved by either companies or the MHRA.

Pursuant to the Answer of 7 March 2025 to Question 35541 on Hormone Replacement Therapy, what discussions he has had with the Medicines and Healthcare products Regulatory Agency on encouraging manufacturers to apply for a UK license for HRT implants.

Oestrogen and testosterone hormone replacement therapy (HRT) implants are not licenced in the United Kingdom. The Department is working closely with the Medicines and Healthcare products Regulatory Agency (MHRA) to ensure safe access to these products. We have also reached out to specialist importers who can source unlicensed medicines in order to find alternative sources of both HRT implants for UK patients. We will continue to work closely with the MHRA, and the National Health Service to ensure suitable alternatives are available for patients.The MHRA has held regular discussions with the importer of the unlicenced medicine and the Department is actively looking at this to ensure ongoing supply from this and other sources. Stakeholder groups, including the Patient Safety Commissioner and the British Menopause Society, have also been kept actively informed.

Pursuant to the Answer of 7 March 2025 to Question 35541 on Hormone Replacement Therapy, what discussions he has had with the Medicines and Healthcare products Regulatory Agency on the adequacy of the number of (a) manufacturers that produce and (b) importers of HRT implants.

Oestrogen and testosterone hormone replacement therapy (HRT) implants are not licenced in the United Kingdom. The Department is working closely with the Medicines and Healthcare products Regulatory Agency (MHRA) to ensure safe access to these products. We have also reached out to specialist importers who can source unlicensed medicines in order to find alternative sources of both HRT implants for UK patients. We will continue to work closely with the MHRA, and the National Health Service to ensure suitable alternatives are available for patients.The MHRA has held regular discussions with the importer of the unlicenced medicine and the Department is actively looking at this to ensure ongoing supply from this and other sources. Stakeholder groups, including the Patient Safety Commissioner and the British Menopause Society, have also been kept actively informed.

What information the UK National Screening Committee has provided on the (a) format, (b) scale and (c) duration of the upcoming in-service evaluation of newborn screening for Spinal Muscular Atrophy in the NHS.

The UK National Screening Committee (UK NSC) is working with the spinal muscular atrophy (SMA) partnership board to scope out the potential shape of the in-service evaluation into SMA. The partnership board includes clinicians, academics, patient representatives, the National Institute for Health and Research (NIHR), NHS England, and the UK NSC. The final decision on the exact format, scale, and duration will be determined following a successful NIHR tendering process. The timescale for the implementation of the SMA in-service evaluation will not be confirmed until after the 2025 Spending Review.The UK NSC is aware that screening for SMA and severe combined immunodeficiency uses the same test, and as such there may be saving opportunities through economies of scale, if the two conditions are determined to be suitable for a screening programme. This is still under consideration by the committee.