Written questions by Mierlo.

What criteria he plans to use to evaluate the respiratory syncytial virus immunisation method to protect infants in the June 2025 review.

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.

What steps he is taking to help increase the uptake rate of the RSV vaccine during pregnancy.

The maternal respiratory syncytial virus (RSV) vaccination programme launched on 1 September 2024, and is being delivered by general practices and commissioned maternity services. NHS England has been working with systems, stakeholders, and partners to increase awareness and uptake of the RSV vaccine amongst pregnant women.A system letter setting out the role of providers in advising pregnant women of their eligibility for vaccination was sent from the Chief Midwifery Officer for England, the National Clinical Director for Maternity, and the Chief Delivery Officer and National Director for Vaccination and Screening in August 2024.NHS England has held webinars for health professionals on vaccination in pregnancy and with the midwifery and nursing teams delivering the RSV vaccine, to provide information on eligibility, outreach, and how to administer the vaccine before the programme started. Resources and information have been shared with maternity leads since the programme began, to increase awareness of the vaccine and ensure more women are booking their vaccination for when they become eligible at 28 weeks. Commissioned maternity services are also encouraged to have vaccination discussions with pregnant women early in pregnancy.A range of communication materials have been produced by NHS England and the UK Health Security Agency, who are working with stakeholders, including parenting clubs, to disseminate information on vaccination in pregnancy through their channels.RSV vaccination event data from all commissioned providers is made available to NHS England regional commissioning teams and their partner integrated care boards in a timely way. NHS operational vaccination data is being monitored closely at a local and national level, and is being used to drive further development of the programme.

If he will make an assessment of the adequacy of access to (a) ultrasound and (b) other scans during pregnancy in Henley and Thame constituency.

Antenatal care can start as soon as a woman knows she is pregnant. This can be done by contacting a midwife or general practitioner, or by referring herself direct to a maternity service. There will be two ultrasound scans at 11 to 14 weeks and at 18 to 21 weeks, followed by any further scans recommended by the relevant healthcare professionals.Further details can be found on the NHS.UK website, at the following link:https://www.nhs.uk/pregnancy/your-pregnancy-care/your-antenatal-appointments/The Government is continuing to work with NHS England as it delivers its three-year maternity and neonatal plan to ensure that women receive timely care.

What steps he is taking to ensure that pregnant women are informed of their rights to an elective C-section.

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 their physical health, mental health, social complexities, and choices. Personalised care includes an open and honest ongoing dialogue between a woman, her midwife, and other clinicians, to understand the care that is wanted.NHS England’s website includes information about asking for a caesarean.

If he will make an assessment of the adequacy of (a) the funding provided through and (b) other aspects of general practitioner core contracts.

We have announced a proposed £889 million uplift for general practices (GPs) in 2025/26, and set out the proposed areas of contract reform which will help us to deliver on our commitments. This is the largest uplift to GP funding in years, reversing the recent trend, with a rising share of total National Health Service resources going to GPs.GPs receive funding through a range of income streams in return for providing services specified in the GP Contract. Global sum, which is the funding allocated for providing core services, makes up 50 to 60% of practice income. The global sum allocation formula, also known as the Carr-Hill formula, is designed to ensure that resources are directed to practices based on an estimate of their patient workload and unavoidable practice costs.  The rest of the income is made of the Quality and Outcomes Framework, premises payments, directed enhanced services, and additional services, for instance vaccine and immunisation services.Practices are able to provide additional services by opting in, and will receive payment for these services separately to global sum payments. As commissioners of primary care, integrated care boards are responsible for commissioning additional services locally, which are not agreed nationally and can vary in scope and funding to fit local needs.

If he will make an assessment of the potential merits of Integrated Care Boards taking steps to help general practitioners set up new practices.

Integrated care boards (ICBs) have a delegated responsibility for planning and commissioning healthcare services to meet the reasonable needs of the people for whom they are responsible. ICBs should evaluate the needs of the populations for which they are responsible, including for general practice services, and plan service provision as required.ICBs’ annual commissioning plans for general practice (GP) services will consider requirements for new GP practices, for example, in response to population growth, planned contract expiry and management of unplanned closures, as well as the additional local services they wish to commission. The commissioner must decide on the contracting route for new core general practice services and select providers that will deliver the best quality and outcomes. Commissioners sometimes provide additional funding to new practices while they are growing their list sizes to enable them to recover their fixed costs, as most of the funding GP providers receive is related to the number and type of patients they have on their registered list and growing list size may take time.At the Autumn Budget 2024, we established a dedicated capital fund of £102 million for the next financial year to deliver around 200 upgrades to GP surgeries across England, which will support improved use of existing buildings and space, boosting productivity and enabling delivery of more appointments. This funding represents a first step in delivering the additional capital the primary care sector needs.

What steps he is taking to help prevent the illegal sale of ADHD medication for recreational use.

The illegal sale and supply of human medicines is recognised as a significant challenge for regulators across the world. Medicines purchased from websites that are illegally trading can be harmful to health, as the products received are generally unlicensed in the United Kingdom. They can contain too little, too much, or incorrect active ingredients. The global trade is substantial, with offences often taking place beyond the geographical reach of UK legislation.The Criminal Enforcement Unit (CEU) within the Medicines and Healthcare products Regulatory Agency (MHRA) works with law enforcement partners and others to tackle the illegal trade, and to prevent products from entering the UK. Where offences are identified in the UK, the CEU can investigate and, where appropriate, bring those involved to justice. In parallel with enforcement action, the MHRA also operates the #FakeMeds campaign, offering safety advice and providing practical tools to help the public stay safe when buying medicines online.

If he will make it his policy to extend Start for Life and Family Hub funding to include Oxfordshire.

The Prime Minister’s Plan for Change outlined that there will be investment to continue to build up the Family Hubs and Start for Life programme. In 2025/26, this investment will fund the 75 local authorities in England with high levels of deprivation that are part of the existing programme.Family Hubs funding is the responsibility of the Department for Education, with Start for Life funding sitting with the Department of Health and Social Care. Due to the challenging fiscal context, we have had to make difficult decisions for 2025/26, and only those areas currently in the scheme will receive funding. We will continue to evaluate the programme and assess evidence to support wider rollout in future financial years.

Whether he has made an assessment of the adequacy of NICE methodology in appraising innovative medicines for licensed for Alzheimer's Disease.

The National Institute for Health and Care Excellence (NICE) is responsible for the methods and processes it uses to develop recommendations on whether new medicines represent a clinically and cost-effective use of National Health Service resources. The NICE develops those methods and processes independently and in consultation with stakeholders.The NICE keeps its methods and processes under review to ensure that they are fit for purpose and are appropriate to emerging new treatments, and has a Health Technology Assessment (HTA) Lab that enables the NICE to develop creative solutions to complex problems in HTA. The HTA Lab produced a report in November 2023 on issues and challenges in the evaluation of disease-modifying dementia treatments. The report concluded that the NICE’s current approach and methods are considered appropriate for evaluating these treatments.The NICE has recently consulted on its draft guidance on the use of two new disease-modifying treatments for the treatment of Alzheimer’s disease. The NICE’s guidance says that the benefits of these treatments are too small to justify the significant cost to the NHS. These are very difficult decisions to make, and it is right that they are taken independently on the basis of the available evidence of costs and benefits.

How many patients were in receipt of Givinostat through the Early Access Programme on 10 December 2024; and if he will make an assessment of the potential barriers to accessing the Early Access Programme by patients.

The information on how many patients were in receipt of givinostat through the Early Access Programme (EAP) on 10 December 2024 is not held centrally, as the scheme was set up by the manufacturer.We have made no assessment of access to the EAP for givinostat, which must be through one of the 23 NorthStar Centres in the United Kingdom. However, participation in the EAP is decided at an individual National Health Service trust level, and a North Star Centre will not be able to provide givinostat if its local trust has not approved participation. Under the EAP, givinostat is free to both patients taking part in it and to the NHS, but the NHS trusts must still cover the cost of administering it to patients. Only Duchenne muscular dystrophy clinicians can make requests for givinostat for their patients. Decisions are made on a case-by-case basis for individual named patients aligned to the eligibility criteria.

What steps he is taking to support NHS Trusts to speed up access to innovative therapies before MHRA approval through Early Access Programmes.

NHS England has issued national policy guidelines on free of charge schemes, which are available at the following link:https://www.england.nhs.uk/long-read/free-of-charge-foc-medicines-schemes-national-policy-recommendations-for-local-systems/The only free of charge schemes supported by the Medicines and Healthcare products Regulatory Agency and NHS England are those through the Early Access to Medicines Scheme. Other, company led early access programmes operate under the unlicensed medicines scheme, but these are not approved by the Medicines and Healthcare products Regulatory Agency, nor supported by NHS England nationally. Participation in such programmes is decided at an individual National Health Service trust level, in the form of an agreement between the trust and a pharmaceutical company.

With reference to the New Hospital Programme review, when the (a) options and (b) recommendations for the Royal Berkshire Hospital, Reading will be published; and when he plans to announce which hospitals will be prioritised.

The new hospital scheme for the Royal Berkshire NHS Foundation Trust at the Royal Berkshire Hospital is in the scope of the review into the New Hospital Programme.We are finalising the outcome of the review so we can be honest and upfront with everyone on when we expect the new hospitals to be delivered.My Rt Hon. Friend, the Secretary of State for Health and Social Care will set out further details on the outcome of the review, which will include a new and realistic delivery schedule for the programme, at the earliest opportunity.

What steps he is taking to increase the uptake of (a) digital innovation and (b) patient data systems within the NHS.

NHS England is working closely with National Institute for Health and Care Excellence, the Medicines and Healthcare products Regulatory Agency and the Accelerated Access Collaborative to improve the process for uptake of innovative digital health technologies in the National Health Service. This includes working with healthcare professionals and other key stakeholders to understand what matters to them.The Federated Data Platform (FDP) is being rolled out to all trusts and integrated care systems which wish to use it, to bring together data in different local systems, to allow better co-ordination of care to patients. All trusts and integrated care boards (ICBs) are being asked to provide plans for how they will maximise the benefits of the NHS FDP for their patients in the next two years.The Shared Care Record programme set the target that by the end of September 2021, ICBs across the country would have a basic shared record in place. As of March 2022, all 42 ICBs in England have at least a basic shared care record.My Rt. Hon. Friend, the Secretary of State for Health and Social Care, has announced the intention for there to be a single patient record that both empowers patients by giving them access to their records and gives professionals access to the information they need to make the best-informed decisions when delivering care and treatment. We have begun engaging with the public to help shape our plans, including what information they would want to see included in a single record.

Whether he has made an assessment of the adequacy of (a) patient knowledge of the training physicians associates receive and (b) information available in general practice for patients on physician associates.

On 20 November 2024, the Government announced that it is establishing an independent review of the physician associate and anaesthesia associate professions. It will consider the safety of the roles, and their contribution to multidisciplinary healthcare teams. The review will report in spring 2025.The introduction of regulation by the General Medical Council (GMC) will provide a standardised framework of governance and assurance for the clinical practice of Physician Associates (PAs) and make it easier for employers, patients, and the public to understand the relationship between these roles and that of doctors.As set out in the National Institute for Health and Care Excellence’s guidelines, all healthcare professionals directly involved in a patient's care should introduce themselves and explain their role to the patient. The GMC has published interim standards for PAs in advance of regulation, which make it clear that professionals should always introduce their role to patients, and set out their responsibilities in the team. In primary care, NHS England has produced patient-facing materials that have been shared widely with general practices to support patient awareness and understanding of the PA role.

If he will review the (a) incentives and (b) funding for physician associates.

There is no current plan to review the funding for Physician Associates’ (PAs) training or pay. The Government has commissioned an independent review on the PA and Anaesthesia Associate professions. This review will consider the safety of the roles, and their contribution to multidisciplinary teams.

If he will make an assessment of the potential merits of testing newborn babies for spinal muscular atrophy.

Work is already underway to assess the potential merits of testing newborn babies for spinal muscular atrophy (SMA).This is following the UK National Screening Committee’s two-fold recommendation in 2023, to simultaneously develop a new cost-effectiveness screening modelling study for the United Kingdom’s screening context, and to start scoping work for an in-service evaluation of newborn screening for SMA in real world National Health Services in the UK.

Whether he plans to take steps to help support people with Coeliac disease with the cost of food; and if he will make an assessment of the potential merits of widening access to gluten free products on prescription.

We recognise the pressures people are facing with the rising cost of living. Our extensive arrangements to help people afford National Health Service prescription charges mean that almost 89% of prescription items in England are already provided free of charge. For those who are not exempt from charges, pre-payment certificates can be used to cap costs at just over £2 a week for regular prescriptions.The national prescribing position in England remains that gluten free bread and mixes can be provided to all coeliac patients on an NHS 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 the individual preferences of their patients, while also being mindful of which product best suits the patient’s dietary needs.

What assessment he has made of the potential implications for his Department’s policies of the recommendation from the French health authority that the RSV vaccine should be provided to (a) 75-80 and (b) over 80 year olds.

The Joint Committee on Vaccination and Immunisation (JCVI) is the United Kingdom’s expert committee that advises the government on immunisation programmes.In line with JCVI advice, the respiratory syncytial virus (RSV) vaccination programme for adults turning 75 years old began on 1 September 2024 in England alongside a one-off catch-up programme to rapidly vaccinate all those already aged between 75 and 79 years old. The JCVI considered that there was less certainty about how well the vaccine works in people aged 80 years old and older, as there were not enough people of this age in the clinical trials to be able to see if the vaccines are protective in this age band.Whilst the JCVI notes what takes place in other countries, its advice is specific to the UK. The JCVI continues to keep evidence under review, including data from clinical trials and real world evidence emerging from immunisation programmes in different countries.The JCVI recently discussed the RSV programme at their committee meeting on 2nd October 2024. The minutes from this meeting are publicly available at the following link: https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation

When he plans to publish real world evidence on the effectiveness of the respiratory syncytial virus vaccine in the 75-80 cohort; how much such evidence has been collected; and whether such evidence from other countries has been taken into account in consideration of extending eligibility for that vaccine.

The UK Health Security Agency is working on vaccine effectiveness analysis within the 75 to 80-year-old age group for this winter season 2024 to 2025. We are collating data on respitatory syncytial virus (RSV) hospitalisations in England and general practice consultations in a sentinel network.Data is required from across the entire RSV season to give an accurate estimate of effectiveness. Analyses are therefore likely to take place around the end of the winter season 2024-2025. Publication is expected to follow in due course.Evidence of effectiveness in all age groups in all countries where data has been made available is being used to inform eligibility considerations. Emerging real-world evidence will be reviewed by the Joint Committee on Vaccination & Immunisation as part of its considerations for a potential extension to the older adults RSV immunisation programme, currently aimed at people aged between 75 and 80 years old, to include people over 80 years old and risk groups.

What progress he has made on dementia care in his plans for social care workforce reform; and if he will make an assessment of the potential merits of making dementia training mandatory for adult social care workers as a part of that reform.

Providers must provide sufficient numbers of suitably qualified, competent, skilled, and experienced staff to meet the needs of the people using the service. Staff must receive the support, training, professional development, supervision, and appraisals that are necessary for them to carry out their role.We now have a national career framework for adult social car, the Care Workforce Pathway, which is linked to a number of existing competency frameworks, including the dementia training standards framework.The Department has also launched a new Level 2 Adult Social Care Certificate qualification which links to the outcomes in the Care Workforce Pathway. This contains the baseline knowledge required to provide quality care, and will make sure that those who are starting out their careers have an informed awareness of dementia.