Written questions by Morgan.

Whether future NHS planning guidance will require ICBs to provide specialist rehabilitation and care for patients with spinal cord injury.

Spinal cord injury services in England are commissioned against the national service specification, which is published by NHS England, and is available at the following link:https://www.england.nhs.uk/wp-content/uploads/2019/04/service-spec-spinal-cord-injury-services-all-ages.pdfThe specification sets out the mandated standards all commissioned providers are required to meet for patients. The specification provides detailed information on the pathway of care for spinal cord injury patients, including coordination with interdependent services.All providers are required to submit outcome data to the specialised services quality dashboard, with data available at the following link:https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww.england.nhs.uk%2Fwp-content%2Fuploads%2F2023%2F06%2Fspecialised-services-quality-dashboards-metrics-metadata-2025-2026-v24.0.xlsx&wdOrigin=BROWSELINKThis data enables the monitoring of quality of care, including clinical outcomes, equitability of access and structure, and process measures. The data is linked to the national spinal cord injury registry, which provides audit data.The specific content of future National Health Service planning guidance will be determined and published in due course, but progress has been made on improving spinal cord injury services following the 2016 review through, for example, the development of the Getting It Right First Time (GIRFT) Programme for spinal services, which is driving service improvements and better care for patients with spinal cord injuries. GIRFT has worked with NHS trusts to showcase examples of best practice which other services can then learn from.More recently, in October 2025, the National Institute for Health and Care Excellence published new guidance on rehabilitation for chronic neurological disorders, which includes rehabilitation for spinal cord injury.

Whether his Department has made an estimate of the proportion of requests for specialist care which will be refused due to the requirement for GPs to use the Advice and Guidance system from 1 April 2026.

The purpose of Advice and Guidance (A&G) is not to refuse care but to ensure patients are seen in the right place, first time.Where the outcome of A&G is that care management in primary or community settings is in the patient’s best interests, it is expected that patients will receive timelier care, benefiting from earlier specialist input. In these cases, the general practitioner may still subsequently refer their patient again at any point if they have concerns.Management data shows between April 2025 and November 2025, there were 2,210,443 processed A&G requests where a specialist has returned the advice, and 1,095,172, or 45.7% of total requests, have been diverted, where the outcome of A&G is that a referral is not required.

How his Department will ensure that low-volume, high-cost services such as spinal cord injury are not deprioritised by individual ICBs facing competing local financial pressures.

Plans to delegate suitable specialised services were first set out in the Roadmap for Integrating Specialised Services within Integrated Care Systems and have been developed in close collaboration with NHS England’s regional teams, integrated care boards (ICBs), specialised services provider clinicians, and patient groups. The Roadmap for Integrating Specialised Services within Integrated Care Systems is available at the following link:https://www.england.nhs.uk/wp-content/uploads/2022/05/PAR1440-specialised-commissioning-roadmap-addendum-may-2022.pdfThey represent the outcome of a thorough assessment of ICB readiness, and a comprehensive analysis of services to determine their suitability and readiness for more integrated commissioning.The latest NHS England commissioning update, published on 2 March 2026, sets out the role that seven offices for pan-ICB commissioning (OPICs) will play in supporting ICBs across each National Health Service region to efficiently and effectively commission these services, including commissioning at scale, where appropriate, to improve patient outcomes. The NHS England commissioning update is available at the following link:https://www.england.nhs.uk/long-read/direct-commissioning-update/OPICs will ensure that all ICBs across a region have equal access to the critical mass of expert commissioning knowledge and the capability necessary for the effective and efficient commissioning of these important and complex areas of service provision like spinal cord injury. They will become centres of commissioning excellence, playing a vital role in facilitating multi-ICB collaboration and decision making, ensuring strong patient and public involvement in the design and delivery of services, and building strong relationships with wider health and care system partners.

When he plans to respond to Questions 113872, 113873, 113874 and 113875 of 13 February 2026.

I refer the hon. Member to the answer I gave on 29 April 2026 to Question 113872.

When he plans to respond to Questions 113248, 113249 and 113250, tabled on 12 February 2026.

I refer the hon. Member to the answer I gave on 23 March 2026 to Question 113248.

What steps his Department has taken to address regional disparities in accessing spinal cord injury services.

People with spinal cord injuries in North Shropshire receive specialist care through the Midland Centre for Spinal Injuries (MCSI) at the Robert Jones and Agnes Hunt Orthopaedic Hospital, one of 11 nationally designated spinal injury centres providing lifelong multidisciplinary support in the United Kingdom. MCSI provides multidisciplinary rehabilitation and lifelong follow up care for spinal cord injury patients.Nationally, spinal cord injury services form part of prescribed specialised services, with NHS England maintaining national service standards, specifications, and clinical policies. From 2025, elements of specialised commissioning were delegated to integrated care boards to support more integrated pathways, while overall accountability remains with NHS England.In March 2025, NHS England published the Spinal Services Clinical Network Specification, which establishes expectations for spinal clinical networks to standardise pathways and reduce variation, with the aim of improving access to care for patients.The Getting It Right First Time (GIRFT) Programme for spinal services is also driving service improvements and better care for patients with spinal cord injuries. GIRFT has worked with National Health Service trusts to showcase examples of best practice which other services can then learn from, thereby aiming to reduce regional variation in the quality of care patients with spinal cord injuries receive.

What assessment he has made of the potential clinical impact of (a) current waiting times and (b) levels of coordination in spinal cord injury care.

People with spinal cord injuries in North Shropshire receive specialist care through the Midland Centre for Spinal Injuries (MCSI) at the Robert Jones and Agnes Hunt Orthopaedic Hospital, one of 11 nationally designated spinal injury centres providing lifelong multidisciplinary support in the United Kingdom. MCSI provides multidisciplinary rehabilitation and lifelong follow up care for spinal cord injury patients.Nationally, spinal cord injury services form part of prescribed specialised services, with NHS England maintaining national service standards, specifications, and clinical policies. From 2025, elements of specialised commissioning were delegated to integrated care boards to support more integrated pathways, while overall accountability remains with NHS England.In March 2025, NHS England published the Spinal Services Clinical Network Specification, which establishes expectations for spinal clinical networks to standardise pathways and reduce variation, with the aim of improving access to care for patients.The Getting It Right First Time (GIRFT) Programme for spinal services is also driving service improvements and better care for patients with spinal cord injuries. GIRFT has worked with National Health Service trusts to showcase examples of best practice which other services can then learn from, thereby aiming to reduce regional variation in the quality of care patients with spinal cord injuries receive.

What assessment he has made of the adequacy of the level of support available to people with spinal cord injury in a) North Shropshire and b) England.

People with spinal cord injuries in North Shropshire receive specialist care through the Midland Centre for Spinal Injuries (MCSI) at the Robert Jones and Agnes Hunt Orthopaedic Hospital, one of 11 nationally designated spinal injury centres providing lifelong multidisciplinary support in the United Kingdom. MCSI provides multidisciplinary rehabilitation and lifelong follow up care for spinal cord injury patients.Nationally, spinal cord injury services form part of prescribed specialised services, with NHS England maintaining national service standards, specifications, and clinical policies. From 2025, elements of specialised commissioning were delegated to integrated care boards to support more integrated pathways, while overall accountability remains with NHS England.In March 2025, NHS England published the Spinal Services Clinical Network Specification, which establishes expectations for spinal clinical networks to standardise pathways and reduce variation, with the aim of improving access to care for patients.The Getting It Right First Time (GIRFT) Programme for spinal services is also driving service improvements and better care for patients with spinal cord injuries. GIRFT has worked with National Health Service trusts to showcase examples of best practice which other services can then learn from, thereby aiming to reduce regional variation in the quality of care patients with spinal cord injuries receive.

What assessment he has made of the adequacy of satellite navigation systems used in ambulances in England.

Ambulance vehicles have satellite navigation systems that assist crews to identify the location of the emergency. These are updated regularly to ensure the information within them remains current, and in response to feedback from operational crews and managers who are trained on these systems and have excellent understanding of the areas they serve.

How much his Department has spent on external consultants for the ongoing reorganisation of the NHS since 2024.

It has not proved possible to respond to the hon. Member in the time available before Prorogation.

What steps his Department is taking to ensure that NICE Guidance to prevent irreversible sight loss is being met for patients with wet age-related macular degeneration.

The National Institute for Health and Care Excellence (NICE) has issued technology appraisal guidance recommending several medicines for use in the treatment of wet age-related macular generation. The National Health Service in England is legally required to fund medicines in line with NICE’s recommendations, normally within three months of the publication of final guidance.NICE has also published a clinical guideline that provides comprehensive guidance on best practice in the management of patients with this condition, which is available at the following link:https://www.nice.org.uk/guidance/ng82NICE clinical guidelines are not mandatory, but NHS commissioners are expected to take them fully into account in ensuring that local services meet the needs of their populations.

What steps he is taking to ensure complex ophthalmology care is provided in a timely fashion.

We have committed to ensuring that 92% of all patients wait no longer than 18 weeks from Referral to Treatment (RTT) by March 2029. Since the Government came into office, the waiting list for routine appointments, operations, and procedures in England has now been cut by 374,083, and RTT performance has improved by 2.6%. This is despite 33.3 million referrals onto the waiting list.In ophthalmology, the national waiting list stands at 602,163 pathways, with 69.8% of those having waited 18 weeks or less. This marks a 3.7% improvement in RTT performance since the Government came into office.We are committed to expanding the number of surgical hubs, which provide dedicated and protected elective capacity to drive improvement in six specialities, including ophthalmology. We are reducing missed appointments through enhanced two-way communication between hospitals and patients, supported by artificial intelligence prediction tools. We are also expanding the use of remote monitoring and patient-initiated follow up, where appropriate, to offer patients more flexibility over their care.Improved IT connectivity between primary and secondary eye care services and the development of single points of access has also shown its ability to improve the referral and triage of patients and support more care being delivered in the community.

How many assaults on staff in NHS A&E departments have been recorded each year since 2019.

The 2025 NHS staff survey showed that 14.47% of staff experienced at least one incidence of violence in the last 12 months from patients and/or service users, their relatives, or other members of the public, compared to 14.38% in 2024, 13.88% in 2023, 14.82% in 2022, 14.57% in 2021, 14.90% in 2020, and 15.08% in 2019. Data taken from the NHS Staff Survey cannot, however, be used to identity whether an incident has occurred in a particular department.

Whether any of NHS England's responsibilities or functions have been fully transferred to the Department of Health and Social Care since the announcement of NHS England abolition in March 2025.

The Government intends to abolish NHS England by April 2027. NHS England responsibilities and functions will not be transferred into the restructured Department until the passage of the legislation is complete, subject to the will of Parliament. Work is progressing at pace to develop the design and operating model for the new integrated organisation, to plan for the smooth transfer of people, functions, and responsibilities.

Whether his Department has made an assessment of the potential impact of the NHS England voluntary redundancy scheme on its ability to deliver its functions.

The NHS England voluntary redundancy scheme was launched in December 2025, with staff able to submit applications. Following closure of the window for applications, there has been a considered and risk-based approvals process to determine whether applications can be approved or not, and if approved, at what point it is appropriate for the individual to exit the organisation and the post to become redundant.Considerations included the impact on business-critical activities and functions, the impact on staff remaining in the organisation, and the likelihood that similar skills would be needed in the future. Local panels were held at the directorate and regional level to consider applications, and there was a national moderation and approval process for the entirety of the scheme. In many cases, exit dates were agreed into 2026/27 to ensure that redesign and mitigations could be put in place ahead of departure.As part of planning for 2026/27, NHS England is undertaking a planning process to ensure that the resources at its disposal are focussed on our key priorities and statutory duties, taking into account staff exits ahead of the financial year, and at quarterly intervals during the year. This process is taking place at an organisational level, as well as within each directorate and region.

How many NHS England employees there (a) are and (b) were on 13 March 2025; and what estimate he has made of the number of NHS England employees there will be following the first round of the voluntary redundancy scheme.

It has not proved possible to respond to the hon. Member in the time available before Prorogation.

How many NHS England employees have opted to take the voluntary redundancy scheme commencing in April 2026.

NHS England’s voluntary redundancy scheme opened on 1 December and closed for applications on 16 December. NHS England has approved 3,671 employees to leave under voluntary redundancy prior to March 2027. Currently, 25% of the 1,106 employees identified to leave on 31 March 2026 have confirmed their desire to withdraw from the scheme. Employees can withdraw at any time up to signing their final severance agreement.

How many NHS England employees have resigned, transferred or otherwise terminated their employment at NHS England since the announcement of its abolition.

Since the announcement of NHS England’s abolition, 827 employees have left NHS England’s employment.

What steps he is taking to help ensure the safety of Community First Responders.

Community First Responders (CFRs) are volunteers trained by ambulance services to attend certain types of emergency calls in the communities where they live or work. Decisions on operational arrangements, including safety measures and equipment for CFRs, are determined locally by ambulance trusts.As a complementary resource, CFRs are dispatched only to those calls that appropriately fall within the clinical scope of practice for a volunteer CFR role and assessment of this takes both the safety of the volunteer and patient into account.My Rt Hon. Friend, the Secretary of State for Health and Social Care, may, by regulations, make provisions for courses of training for driving vehicles at high speed. It is generally taken that those responding to incidents using blue lights and sirens are trained to an appropriate standard that is recognised by the despatching National Health Service ambulance service. The decision to authorise interested CFR and/or co-responder schemes to use blue lights and sirens and claim exemptions is for local determination by NHS ambulance services.The CFR scheme is designed so volunteers are typically located close to incidents requiring a response, meaning driving under emergency conditions would typically confer relatively little benefit compared with travelling at normal road speed. Any potential benefits must also be weighed against the increased risks to the public associated with using exemptions to road traffic regulations.

If he will make an assessment of the potential safety benefits of providing warning lights for vehicles used by Community First Responders.

Community First Responders (CFRs) are volunteers trained by ambulance services to attend certain types of emergency calls in the communities where they live or work. Decisions on operational arrangements, including safety measures and equipment for CFRs, are determined locally by ambulance trusts.As a complementary resource, CFRs are dispatched only to those calls that appropriately fall within the clinical scope of practice for a volunteer CFR role and assessment of this takes both the safety of the volunteer and patient into account.My Rt Hon. Friend, the Secretary of State for Health and Social Care, may, by regulations, make provisions for courses of training for driving vehicles at high speed. It is generally taken that those responding to incidents using blue lights and sirens are trained to an appropriate standard that is recognised by the despatching National Health Service ambulance service. The decision to authorise interested CFR and/or co-responder schemes to use blue lights and sirens and claim exemptions is for local determination by NHS ambulance services.The CFR scheme is designed so volunteers are typically located close to incidents requiring a response, meaning driving under emergency conditions would typically confer relatively little benefit compared with travelling at normal road speed. Any potential benefits must also be weighed against the increased risks to the public associated with using exemptions to road traffic regulations.