Written questions by Mierlo.

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

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 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.

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

Food and Rural Affairs, whether he plans to amend the Water Environment (Water Framework Directive) (England and Wales) Regulations 2017.

In October 2024 the UK and Welsh Government launched an Independent Commission into the water sector regulatory system, this is the third stage of the Government’s water strategy and is the largest review of the industry since privatisation.The Commission will publish an interim report soon and final report later this summer with recommendations to the Government on how to tackle inherited systemic issues in the water sector. The Water Environment (Water Framework Directive) (England and Wales) and River Basin Management Plans are in scope of the Commission.The UK and Welsh Government will respond to the report and consult on proposals they intend to take forward to fundamentally transform how the nation’s water system operates to tackle pollution and deliver a resilient water supply, turbocharge investment, and speed up the delivery of infrastructure upgrades to clean up the nation’s waterways.The Corry Review into Defra’s regulatory landscape, published in April this year, has identified the Water Environment (Water Framework Directive) (England and Wales) Regulations 2017 along with other regulations as a priority for reform. The review recommends modernising these regulations to ensure they are outcome-focused, proportionate and fit for the future- supporting both nature recovery and sustainable growth. Defra is actively considering implementation of the recommendations from the review.

Food and Rural Affairs, what progress he has made on achieving (a) Good Chemical Status and (b) Good Ecological Status for waterways in Henley and Thame constituency.

The major waterbodies in the Henley & Thames constituency are the Thames (Wallingford to Caversham), Thames (Caversham to Cookham) and the Thame. These waterbodies do not achieve Good Ecological Status due to their Phosphate Status. All the other elements are at Good Status or above. The Environment Act (2021) puts obligations on water companies to reduce their Phosphorous loading from STWs by 80% using a 2020 base. This needs to be achieved by 2038. It is anticipated that once these improvements have been made, most waterbodies will be at or close to Good Status for Phosphate. Any additional reductions to get Phosphate to meet Good Status will need to be done with other sectors, particularly the agricultural sector. The tributaries within the Thame catchment have various reasons for Not Achieving Good Status. During Asset Management Period 8 (which covers 2025-30), 8 Sewage Treatment Works (STW) overflows will be improved to meet Environment Act targets, and a further 7 will have storm overflow investigations, alongside Phosphorus reduction. It is expected that these measures will form part of the pathway to getting the waterbodies to Good Ecological Status.

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.

How many active travel routes in England have used Compulsory Purchase Order powers to facilitate their construction.

The Department for Transport has not made an assessment of the effectiveness of compulsory purchase order powers in progressing active travel schemes and there is currently no centralised record of how many active travel schemes in England have relied on these powers. Local authorities can use their compulsory purchase powers for a wide range of purposes in order to facilitate specific schemes, including active travel routes.

What assessment her Department has made of the effectiveness of Compulsory Purchase Order powers in progressing active travel schemes.

The Department for Transport has not made an assessment of the effectiveness of compulsory purchase order powers in progressing active travel schemes and there is currently no centralised record of how many active travel schemes in England have relied on these powers. Local authorities can use their compulsory purchase powers for a wide range of purposes in order to facilitate specific schemes, including active travel routes.

Food and Rural Affairs, pursuant to the Answer of 27 November 2024 to Question 15607 on Water: Standards and with reference to Henley Swim's announcement entitled Henley Swim stops trading, published on 2 May 2025, what steps he has taken on reopening applications for new bathing water designations.

This Government supports the innovative approaches being taken to trial new charges aiming to make bills fairer and more affordable. All companies plan to trial new charging structures by 2030 and some of them plan to introduce them more widely for additional customers if the trials are successful. Companies can design their charges to provide benefits and incentives in a range of ways. As the water regulator, Ofwat regulates the charging trials by issuing rules that require companies to set fair charges for all customers, and to ensure all trials are consistent with good practice principles. Information on Ministerial meetings are published quarterly on GOV.UK.

Food and Rural Affairs, pursuant to the Answer of 27 November 2024 to Question 15605 on Water: Standards and with reference to Henley Swim's announcement entitled Henley Swim stops trading, published on 2 May 2025, what recent assessment he has made of the economic impact on river-based leisure businesses of sewage in waterways.

This Government supports the innovative approaches being taken to trial new charges aiming to make bills fairer and more affordable. All companies plan to trial new charging structures by 2030 and some of them plan to introduce them more widely for additional customers if the trials are successful. Companies can design their charges to provide benefits and incentives in a range of ways. As the water regulator, Ofwat regulates the charging trials by issuing rules that require companies to set fair charges for all customers, and to ensure all trials are consistent with good practice principles. Information on Ministerial meetings are published quarterly on GOV.UK.

Food and Rural Affairs, what progress Natural England have made on the proposed expansion of the Chilterns Area of Outstanding Beauty; and if he will set out a timeline for a consultation on that expansion.

The Department is aware that Natural England in light of pressure on their budgets have taken the hard decision to stop work on the Chilterns boundary review. It had yet to reach the stage of sharing proposed ‘candidate areas’ publicly and as a result of having to stop the project there is no longer a planned timeline for the public consultation. Natural England are in contact with the affected partners to work through the implications of this decision over the coming weeks. Natural England continues to recognise the value landscape designations bring to people and nature and remain committed to maximising that value over the long term.

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.

Whether she is taking steps with her EU counterparts to help (a) improve the accessibility and (b) increase the use of UK blue parking badges in the EU.

The Department for Transport has ongoing discussions with individual countries regarding continued recognition of the UK Blue Badge across the European Union (EU).

What assessment he has made of the potential merits of launching newborn screening for Spinal Muscular Atrophy alongside the upcoming launch of newborn screening for severe combined immunodeficiency.

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.

What recent discussions he has had with the UK National Screening Committee on timelines for implementing in-service evaluation of newborn screening for spinal muscular atrophy.

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.