Written questions by Mierlo.

What assessment he has made of the potential merits of commissioning of the use of Visualase for Inoperable brain tumours on the NHS.

The decision to commission new services sits with integrated care boards (ICBs), overseen by NHS England. For proposed new treatments which require additional investment, NHS England carries out a relative prioritisation process to determine which services will be routinely commissioned.NHS England and the National Institution for Clinical Excellence have conducted literature reviews on the effectiveness of MRI-guided laser interstitial thermal therapy (MRgLITT), which includes Visualase, to treat different conditions relating to inoperable brain tumours. Studies have shown very low certainty of treatment success, and it was not possible to draw reliable conclusions about the clinical effectiveness, safety or cost effectiveness of MRgLITT compared with continued medical therapy.However, the Government is invested in driving new lifesaving and life-improving research, supporting those diagnosed and living with brain tumours. The Department, NHS England, and the National Institute for Health Care and Research (NIHR) are taking several steps to help improve outcomes for brain tumour patients to ensure the most promising research opportunities are made available to adult and child patients.Furthermore, we will publish a new National Cancer Plan, which will include further details on how we will improve outcomes for cancer patients, including improvement treatment options for cancer patients.

If he will direct NHS England to update the guidance on gluten-free food prescriptions in the document entitled Prescribing Gluten-Free Foods in Primary Care: Guidance for Clinical Commissioning Groups, published on 28 November 2018.

NHS England currently has no plans to update the guidance. NHS England’s guidance on prescribing gluten-free foods in primary care was developed in 2018 to communicate to the then clinical commissioning groups (CCGs). The guidance stated that CCGs may further restrict the prescribing of gluten-free foods by selecting bread and mixes only, or that they may choose to end the prescribing of such foods altogether, having considered whether it is appropriate for their population, taking account of their legal duties to advance equality and have regard of reducing health inequalities.Decisions about the commissioning and funding of local health services are now the responsibility of local integrated care boards (ICBs), rather than the CCGs. NHS England’s guidance should be taken into account when ICBs formulate local policies, and prescribers are expected to reflect local policies in their prescribing practice. The guidance does not remove the clinical discretion of prescribers in accordance with their professional duties.The national prescribing position in England remains that gluten free bread and mixes can be provided to coeliac patients on a National Health Service prescription, and a wide range of these items continue to be listed in part XV of the Drug Tariff. This means that prescribers can issue NHS prescriptions, based on a shared decision between a prescriber and a patient, while also being mindful of local and national guidance.

What steps he is taking to (a) ensure the interoperability of NHS IT systems and (b) reduce duplication across NHS IT systems.

Regulations will be introduced shortly to Parliament to commence section 95 of the Health and Care Act 2022 and establish the process for preparing and publishing information standards, which will be mandatory for public and private health and adult social care providers. In addition, the Data (Use and Access) Bill, which is currently before Parliament, will make information standards mandatory for IT suppliers in the health and care system and will provide support for ensuring compliance. Information standards define a common set of requirements that must be followed when health and adult social care information is used, processed, and shared. Mandatory information standards can be set to provide for interoperability between IT systems, allowing for information to be shared easily, in real time, between organisations that use different systems, to improve outcomes for patients, and the productivity of the National Health Service. To achieve the vision of a digitised NHS by March 2026, the current patchwork of digitisation across the system must be remedied, to reduce duplication and ensure that the NHS is better able to harness the power of data and technology. Through the NHS Federated Data Platform (FDP), we have been supporting trusts and integrated care boards to access the information they already hold in a single, secure place. The NHS FDP is software that sits across existing systems, making it possible to connect them, and thereby reducing duplication and improving efficiency. Through the Frontline Digitisation programme, we are supporting levelling up integrated care systems (ICS) and trusts to a baseline level of digital capability, as defined in our Minimum Digital Foundation. The What Good Looks Like guidance sets a common vision for good digital practice to empower frontline leaders to accelerate digital transformation in their organisations and reduce duplication. The NHS App provides the digital front door for citizens to access whichever national or locally commissioned services will best meet their needs. Each ICS can use these channels to support the delivery of their own digital transformation programmes. We also provide services that can be utilised by health and care organisations through their own system solutions, for example NHS.UK website’s syndicated content or the NHS App notification and messaging service. By enabling others to use our channels and services, we reduce duplication of investment and effort, and create efficiencies across the system.

What steps he is taking to ensure patients have access to (a) oestrogen and (b) testosterone HRT implants in the context of supply difficulties from the US.

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.

With reference to the meeting between PANS PANDAS and his Department on 19 November 2024, what recent assessment he has made of the adequacy of funding for research into that condition.

We are supportive of the progress made by PANS PANDAS UK and the PANS PANDAS Steering Group to undertake a national surveillance study, develop a clinical guideline, and produce guidance for professionals, children, young people, and families.Funding for research into rare diseases such as pediatric acute-onset neuropsychiatric syndrome and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections is available through the National Institute for Health and Care Research, and researchers in this area are encouraged to come forward with proposals that can further our understanding.

What comparative assessment he has made of levels of young people dying from sudden cardiac death in (a) England and (b) other European countries; and what steps he plans to take to reduce levels of sudden cardiac death in young people.

The treatment and prevention of cardiovascular disease is a priority for the Government. We want people to have the best chance of survival from cardiac arrest, and rapid intervention is central to improving outcomes. NHS England has published a national service specification for inherited cardiac conditions that covers patients who often present as young adults with a previously undiagnosed cardiac disease or from families requiring a follow up due to a death from this cause.  Further information on the national service specification for inherited cardiac conditions is available at the following link:https://www.england.nhs.uk/wp-content/uploads/2017/11/cardiology-inherited-cardiac-conditions.pdfThe service specification describes the service model and guidance that should be followed to support the diagnosis and treatment of patients or family members. It also includes the requirement for specialised inherited cardiac conditions services to investigate suspected cases. NHS England is currently reviewing this service specification in line with the national service specification methods review process. NHS England is working with a broad range of stakeholders as part of this review, including National Health Service clinical experts, the Association of Inherited Cardiac Conditions, Cardiomyopathy UK, Heart Valve Voice, and the British Heart Foundation.The consensus at present is to focus on the rapid identification and care of people who are likely to be at risk of sudden cardiac death and automated external defibrillator use for people who suffer a cardiac arrest.

If he will have discussions with (a) Duchenne UK and (b) other patient advocacy groups on steps to increase access to the givinostat early access programme.

The Department has not had any discussions with ITF Pharma UK about the resources or guidance available to National Health Service trusts participating in the early access programme (EAP) for givinostat.Department officials have had discussions with colleagues in NHS England about the guidance and resources that are available to NHS trusts. NHS England has published guidance for integrated care systems (ICS) on free of charge medicine schemes, such as EAPs, including providing advice on potential financial, administrative, and clinical risks. The guidance aims to support the NHS to drive value from medicines and ensure consistent and equitable access to medicines across England. ICSs should follow the recommendations to determine whether to implement any free of charge scheme, including assessing suitability and any risks in the short, medium, and long term. The guidance is available at the following link:https://www.england.nhs.uk/long-read/free-of-charge-foc-medicines-schemes-national-policy-recommendations-for-local-systems/Under the EAP, givinostat is free to both patients taking part in it, and to the NHS, but NHS trusts must still cover the cost of administering it to patients. While there are no current plans to hold discussions with Duchenne UK on steps to increase access, ministers in the Department are keen to engage with a broad range of stakeholders. Participation in the programme is decided at an individual NHS trust level.

Whether he has had discussions with (a) NHS England and (b) ITF Pharma UK on the (i) resources and (ii) guidance available to NHS Trusts that participate in the early access programme for givinostat.

The Department has not had any discussions with ITF Pharma UK about the resources or guidance available to National Health Service trusts participating in the early access programme (EAP) for givinostat.Department officials have had discussions with colleagues in NHS England about the guidance and resources that are available to NHS trusts. NHS England has published guidance for integrated care systems (ICS) on free of charge medicine schemes, such as EAPs, including providing advice on potential financial, administrative, and clinical risks. The guidance aims to support the NHS to drive value from medicines and ensure consistent and equitable access to medicines across England. ICSs should follow the recommendations to determine whether to implement any free of charge scheme, including assessing suitability and any risks in the short, medium, and long term. The guidance is available at the following link:https://www.england.nhs.uk/long-read/free-of-charge-foc-medicines-schemes-national-policy-recommendations-for-local-systems/Under the EAP, givinostat is free to both patients taking part in it, and to the NHS, but NHS trusts must still cover the cost of administering it to patients. While there are no current plans to hold discussions with Duchenne UK on steps to increase access, ministers in the Department are keen to engage with a broad range of stakeholders. Participation in the programme is decided at an individual NHS trust level.

What steps his Department is taking to ensure all eligible NHS Trusts participate in the Early Access Programme for givinostat.

Under the Early Access Programme (EAP), givinostat is free to both patients taking part in it, and to the National Health Service, but NHS trusts must still cover the cost of administering it to patients. The Department and NHS England do not have any initiatives to encourage participation in compassionate use schemes such as the EAP for givinostat and participation is decided at an individual NHS trust level.NHS England has published guidance for integrated care systems (ICSs) on free of charge medicines schemes such as EAPs, including providing advice on potential financial, administrative, and clinical risks. The guidance aims to support the NHS to drive value from medicines and ensure consistent and equitable access to medicines across England. ICSs should follow the recommendations to determine whether to implement any free of charge scheme, including assessing suitability and any risks in the short, medium, and long term. The guidance is available at the following link:https://www.england.nhs.uk/long-read/free-of-charge-foc-medicines-schemes-national-policy-recommendations-for-local-systems/

What recent assessment he has made of the adequacy of the provision of ambulance services by South Central Ambulance Service in Henley and Thame constituency.

No specific assessment has been made for the Henley and Thame area, however we recognise that ambulance response times have been below the high standards that patients should expect in recent years. The latest National Health Service data for January shows that ambulance response times performance for the South Central Ambulance NHS Trust, which provides services to the Henley and Thame, are not meeting the NHS Constitution standards.The Government is committed to returning the NHS to these standards. The NHS 2025/26 priorities and operational planning guidance included improving ambulance response times as one of four national priorities to improve patient outcomes. An urgent and emergency care improvement plan to further support improvements in services will be published shortly.

Whether he plans to retain the 66.7% national dementia diagnosis rate target for the 2025-26 financial year.

The Government and NHS England remain committed to recovering the dementia diagnosis rate to the national ambition of 66.7% The new approach to planning guidance will improve the operating model, giving local leaders the freedom and autonomy they need to provide the best services to their local community, including for those with dementia. Planning guidance is not a catalogue of everything the National Health Service does, and the absence of a target does not mean it has been deprioritised. Lord Darzi’s independent review showed that a timely diagnosis is vital to ensure that a person with dementia can access the advice, information, care and support that can help them to live well and remain independent for as long as possible. The review also highlighted that there were too many targets set for the NHS which made it hard for local systems to prioritise their actions or be held properly accountable.We are therefore reducing the number of national priorities from 32 last year to 18 this year. This will allow local NHS leaders to make the best choices to meet the needs of their local population.

What assessment he has made of adequacy of the diagnostic capacity of memory clinics in Oxfordshire.

Cutting waiting lists, including for diagnostic tests, is a key priority for the Government. We are committed to transforming diagnostic services, and will support the National Health Service to increase diagnostic capacity to meet the demand for diagnostic services through investment in new capacity, including magnetic resonance imaging and computed tomography scanners.Our Elective Reform Plan, published in January 2025, builds on the investments already made with an ambitious vision for the future of diagnostic testing. This will include more straight-to-test pathways, increasing and expanding Community Diagnostic Centres (CDCs), and better use of technology.With 170 CDCs due to be up and running by the end of March 2025, CDCs can take on more of the growing diagnostic demand within elective care. We will also deliver additional CDC capacity in 2025/26 by expanding a number of existing CDCs and building up to five new ones.In Oxfordshire, we are currently working with the local population, including patients, carers, Age UK, and clinicians in primary care, mental health services, and acute hospital services, to develop a new strategy, Living Well with Dementia, to be implemented from April 2025. Within this work we are seeking to increase the rate of diagnosis by streamlining the referral processes into diagnostic and memory clinics, as well as the alignment with the other services that might be needed.

If he will take steps to (a) increase diagnostic capacity at memory clinics, (b) prepare primary care, (c) increase numbers of specialists capable of prescribing new medicines, (d) adopt new diagnostic technology including blood biomarkers, (e) ensure adequate CT scanning capacity and (f) raise awareness among patients of new medications for Alzheimer's Disease.

The Government is committed to transforming diagnostic services and will support the National Health Service to increase diagnostic capacity to meet the demand for diagnostic services through investment in new capacity, including magnetic resonance imaging and computed tomography scanners.Our Elective Reform Plan, published in January 2025, builds on the investments already made with an ambitious vision for the future of diagnostic testing. This will include more straight-to-test pathways, increasing and expanding Community Diagnostic Centres (CDCs), and better use of technology. With 170 CDCs due to be up and running by the end of March 2025, CDCs can take on more of the growing diagnostic demand within elective care. We will also deliver additional CDC capacity in 2025/26 by expanding a number of existing CDCs and building up to five new ones.Alongside Alzheimer’s Research UK, the Alzheimer’s Society, Gates Ventures, and the People’s Postcode Lottery, the National Institute for Health Research is funding the Blood Biomarker Challenge, which seeks to produce the clinical and economic data that could make the case for the use of a blood test in the NHS to support the diagnosis of dementia.New disease modifying drugs for Alzheimer’s disease are in development. NHS England is working closely with system partners to ensure that arrangements are in place to support the adoption of any new licensed and National Institute for Health and Care Excellence-recommended treatments as soon as possible.

Pursuant to the Answer of 22 January 2025 to Question 24596 on Caesarean Sections, what steps he is taking with NHS England to ensure that women are not unnecessarily discouraged from having elective caesarean sections.

NHS England’s three-year delivery plan for maternity and neonatal services recognises the importance of listening to women and families. It aims to ensure that women have clear choices, supported by unbiased information and evidence-based guidelines, and that all women are offered personalised care and support plans.Personalised care and support plans take account of physical health, mental health, social complexities, and choices. Personalised care includes open, honest, and ongoing dialogue between a woman, her midwife, and other clinicians, to understand the care she wants.If a woman would prefer a caesarean for non-medical reasons, they can ask their midwife or doctor, who will explain the overall benefits and risks of a caesarean to the woman and their baby compared with a vaginal birth. If, after discussing all the risks and hearing about all the support on offer, a woman feels that a vaginal birth is not an acceptable option, they should be offered a planned caesarean.

If he will make an assessment of the potential merits of expediting a NICE appraisal for Givinostat.

The National Institute for Health and Care Excellence (NICE) works with companies on timelines for its evaluations of new medicines, and aims, wherever possible, to issue guidance close to the point of licensing to support rapid access for National Health Service patients to clinically and cost-effective medicines. The NICE’s timeline for its evaluation of givinostat was rescheduled at the request of the company, to facilitate a suitably comprehensive and robust submission. The NICE’s Appraisal Committee is due to meet to consider its recommendations on givinostat in May 2025.

What steps the Government if taking to reach an agreement to end collective action by GPs.

The Government has accepted and implemented the independent pay review body recommendation of a 6% uplift in general practitioner (GP) pay, and has committed to hiring an extra 1,000 GPs.We have announced a proposed £889 million uplift for GPs in 2025/26 and set out the proposed areas of reform. This is the largest uplift to GP funding since the beginning of the five-year framework and means that we are reversing the recent trend with a rising share of total National Health Service resources going to GPs.The Department and NHS England started consultation with the General Practitioners Committee in England, of the British Medical Association, on the 2025/26 GP Contract on 19 December 2024, and will consider all proposed policy changes. An announcement will be made before April 2025.

When he plans to respond to the letter of 6 November 2024 from the Hon. Member for Henley and Thame on a constituent's concern over confectionary VAT added to his product designed to be a healthier option.

We have received the Hon. Member’s correspondence of 6 November 2024, and responded on 23 January 2025, with the reference PO-1545237.

If he will have discussions with (a) Eisai Co., Ltd and Biogen Inc. and (b) Eli Lilly and Company on the production of disease-modifying treatments for Alzheimer's disease in the UK.

The Government deeply values its relationships with life science companies and is committed to getting treatments to National Health Service patients through our 10 Year Plan for the NHS. This will include a plan for procurement, giving a clearer route to getting products into the NHS, coupled with reformed incentive structures to drive innovation and faster regulatory approval for new technology and medicines. The Government engages regularly with companies on the production of disease-modifying treatments for Alzheimer's disease in the United Kingdom, such as those developed by Eisai, Biogen, and Eli Lilly, and where appropriate, ministers may be involved in this engagement.

What the uptake rate was of the RSV vaccine by pregnant people in each of the last three years; and if he will make an assessment of the potential implications for his policies of trends in the uptake rate of the RSV vaccine by pregnant people in that time.

The respiratory syncytial virus (RSV) antenatal maternal vaccination programme for infant protection began in England on 1 September 2024. The first uptake data will be published on 30 January 2025.The UK Health Security Agency (UKHSA) undertakes evaluations of national immunisation programmes, and will be evaluating the impact and effectiveness of the RSV maternal vaccination programme for infant protection once sufficient data is available. Immunisation programme effectiveness against hospital admissions is typically assessed using the test-negative case-control method.To raise awareness of the potential vaccination benefits and increase awareness of the programmes amongst health professionals, parents, carers, and the wider public, the UKHSA provides a comprehensive suite of public facing resources and assets. This includes information leaflets in multiple languages and accessible formats, like easy read, British Sign Language, and braille. The UKHSA also provides comprehensive clinical guidance, including e-learning programmes and training for healthcare professionals.

Pursuant to the Answer of 24 October to Question 9576 on Methylphenidate: Shortages, if he will make an assessment of the adequacy of the supply of methylphenidate for ADHD since October 2024.

The Department continues to work hard with industry and NHS England to help resolve the supply issues with some attention deficit hyperactivity disorder (ADHD) medicines, which are affecting the United Kingdom and other countries around the world. As a result of intensive work, some issues have been resolved. All strengths of lisdexamfetamine, atomoxetine capsules, atomoxetine oral solution, and guanfacine prolonged-release tablets are now available.However, whilst the supply of methylphenidate prolonged-release tablets has improved since October 2024, issues persist. We are continuing to work to resolve these remaining issues by engaging with all suppliers of methylphenidate prolonged-release tablets to assess the challenges faced and their actions to address them. We are also directing suppliers to secure additional stocks, expedite deliveries where possible, and review plans to further build capacity to support continued growth in demand for the short and long-term. The Department is also working with new suppliers of methylphenidate prolonged-release tablets to improve supply and resiliency for the UK market.We are supporting an ADHD taskforce that NHS England has established to examine ADHD service provision. The taskforce will bring together expertise from across a broad range of sectors, including the National Health Service, education, and justice, to help provide a joined-up approach in response to concerns around rising demand. In collaboration with NHS England’s national ADHD data improvement plan, we plan to combine modelling for future growth forecasts, which will be shared with industry to improve demand forecasting for ADHD medicines.