Written questions by Morgan.

What assessment he has made of the potential impact of BMI-based restriction on access to joint replacement surgery on health inequalities.

The Department has made no specific assessment of the potential impact of body mass index (BMI) based restrictions on health inequalities.It is the responsibility of individual integrated care boards to determine policies for their local area, including that of the BMI threshold criteria for joint replacement surgery. As with all surgery, BMI should be considered as part of a holistic, personalised perioperative evaluation of the risks versus clinical need for joint replacement surgery of an individual patient. However, BMI should not be considered in isolation and in and of itself should not act as a barrier to surgery.While National Institute for Health and Care Excellence guidelines are not mandatory, they do represent best practice and National Health Service organisations are expected to take them fully into account in ensuring that local services meet the needs of their populations.The NHS and local government provide a range of services to help people living with overweight and obesity to manage their weight, which may include individuals waiting for joint replacement surgery, where they meet other eligibility criteria. These range from multi-component behavioural programmes, such as the NHS Digital Weight Management Programme, to specialist services for those living with severe obesity and associated co-morbidities.

If he will publish the ten advice and guidance referral pathways selected by each integrated care board.

Currently there are no plans to publish a national dataset setting out the specialties selected by National Health Service providers at integrated care board level. This position is being kept under review.

If he will publish the referral network map for specialist centres for placenta accreta spectrum disorder.

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

What assessment he has made of the gap between diagnosed and actual incidence of placenta accreta spectrum disorder.

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

(a) what criteria a hospital must meet to be designated as an accredited specialist centre for placenta accreta spectrum disorder and (b) what assessment process is used to verify compliance with those criteria.

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

What assessment he has made of the causes of the reported 19 per cent increase in postpartum haemorrhage rates among mothers in England.

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

Whether his Department holds guidance on histopathological examination of retained placenta to identify undiagnosed placenta accreta spectrum disorder.

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

What steps he is taking to address regional differences in funding for patients trying to conceive through IVF, in the context of NICE guidelines on offering people under 40 up to three full cycles of IVF.

Funding decisions for health services in England are made by integrated care boards (ICBs) and are based on the clinical needs of their local population.On 31 March, the National Institute for Health and Care Excellence (NICE) published its updated fertility guideline, which recommends that women under 40 years old who meet the clinical eligibility criteria should be offered up to three full cycles of in vitro fertilisation.We expect ICBs to consider and reflect the updated NICE fertility guideline in their commissioning decisions, and we are working with NHS England to support greater consistency in provision.

When he will publish the legal text for the UK-US pharmaceuticals deal.

The full text of the UK-US pharmaceutical agreement is available at the following link:https://www.gov.uk/government/publications/uk-us-arrangement-on-pharmaceutical-trade-and-pricing/arrangement-between-the-united-states-of-america-and-the-united-kingdom-on-pharmaceutical-pricing-html

What steps he is taking with local optometrists to support eye care services within neighbourhood health systems.

The Neighbourhood Health Framework outlines the national minimum aims and objectives of Neighbourhood Health Services. It is important that reforms are locally led, as integrated care boards and local authorities are best placed to design services that make sense for their local populations. Local systems can choose to go further than the minimum aims set out in the framework, including in relation to optometry.

What steps his Department is taking to work with local optometrists to ensure that neighbourhood‑level eye care services are supported.

The Neighbourhood Health Framework outlines the national minimum aims and objectives of Neighbourhood Health Services. It is important that reforms are locally led, as integrated care boards and local authorities are best placed to design services that make sense for their local populations. Local systems can choose to go further than the minimum aims set out in the framework, including in relation to optometry.

What assessment his Department has made of the potential impact of optometrists on neighbourhood‑level health planning; and whether he considered including optometrists as a listed provider in the Neighbourhood Health Framework.

The Neighbourhood Health Framework outlines the national minimum aims and objectives of Neighbourhood Health Services. It is important that reforms are locally led, as integrated care boards and local authorities are best placed to design services that make sense for their local populations. Local systems can choose to go further than the minimum aims set out in the framework, including in relation to optometry.

What criteria were used to determine which providers were included in the Neighbourhood Health Framework.

The Neighbourhood Health Framework is designed to provide clarity and consistency to integrated care boards (ICBs), local authorities, and their partners, in developing and scaling neighbourhood health.The framework outlines the national minimum aims and objectives of neighbourhood health services. It is important that reforms are locally led, as ICBs and local authorities are best placed to design services that make sense for their local populations. Local systems can choose to go further than the minimum aims set out in the framework.General practice, primary care, pharmacies, mental health providers, community health services, social care services, local authorities, and civil society partners are included, to deliver the ambition to shift care from hospital to communities, improve access, and provide proactive, holistic care for people with complex needs.This is not an exhaustive list of all possible providers of neighbourhood health services but illustrates the types of providers with whom we are actively working.No specific criteria were used to determine which providers were included in the framework. The framework does not prevent other providers from being part of neighbourhood health services.

What assessment he has made of the potential impact of the level of volatility in the prices of petrol and diesel on the budgets of hospital trusts and ambulance trusts.

We will be carefully monitoring the impact of the current volatility in fuel prices on the National Health Service, with a view to managing it as part of usual in-year financial management of risk. The impact on fuel prices will be felt by all organisations who rely on fuel for transport, including the indirect potential impact on the cost of deliveries, and direct costs on the NHS fleet which consists of over 20,000 vehicles travelling over 460 million miles every year. The impact is likely to vary, for example as part of the NHS Net Zero travel and transport strategy, a number of ambulance trusts are trialling zero-emission response vehicles.

What assessment he has made of the potential impact of hospital handover delays on the budgets of ambulance trusts.

No specific assessment has been made. The Medium-Term Planning Framework, published in October 2025, recognises handover delays as a system wide responsibility and effective collaboration between ambulance services, acute trusts, integrated care boards, and others is required to reduce ambulance handover times toward the 15-minute standard. NHS England continues to monitor average hospital handover times, sharing data with regions to support focussed discussions and identify improvement actions with those trusts not achieving handovers within 45 minutes.

Whether NHS England has engaged formally with the General Medical Council about the interaction between mandatory pre-referral Advice and Guidance requirements and the professional duty of GPs under General Medical Council guidance to refer patients to specialist care when it is in their best interests to do so; and whether a joint risk assessment or patient safety review has been carried out to ensure GPs are not placed in conflict between their contractual and professional obligations.

In early 2026, we concluded the consultation on the changes to the GP Contract for 2026/27. As part of this process, we expanded the consultation to engage with a wider set of primary care stakeholders, these were the British Medical Association’s General Practitioner’s Committee England, the Royal College of General Practitioners, National Voices, the Institute of General Practice Management, Healthwatch England, the NHS Confederation, and the National Association of Primary Care. The Department has not engaged formally with the General Medical Council (GMC) regarding the interaction between the 2026/27 contractual changes and the professional duties set out in GMC guidance. No formal joint risk assessment or joint patient safety review has been undertaken. However, the Department and NHS England considered the potential risks, benefits, and wider impact of the policy changes as part of standard policy-development processes. The 2026/27 GP Contract embeds the current Advice and Guidance (A&G) enhanced service funding into core practice funding. The contract does not mandate the use of A&G in all circumstances. Instead, practices are expected to use A&G prior to or in place of a planned care referral, where clinically appropriate, and to follow locally agreed referral pathways. This reflects longstanding planned‑care referral practice and does not alter existing legal or professional accountability frameworks for general practitioners (GPs). GPs, and other primary care referrers, remain professionally accountable for making appropriate clinical decisions, including referring patients to specialist care when it is in the patient’s best interests. The use of A&G does not override those responsibilities or place GPs in conflict between contractual and professional obligations. NHS England continues to support clinicians through guidance, pathway design, and local governance arrangements to ensure A&G is used safely, proportionately, and in a way that preserves clear clinical accountability.

What arrangements NHS England has made to ensure that patients retain the statutory right to choose a provider where a mandatory Single Point of Access triage process operates; and what guidance has been issued to Integrated Care Boards on preserving patient choice rights within mandatory Single Point of Access pathways from 1 April 2026.

The policy intention for Advice and Guidance (A&G) and the Elective Single Point of Access (SPoA) model is fully compatible with NHS England’s Patient Choice Guidance, published December 2023. Patients must continue to be offered a choice of provider at the appropriate point in the pathway, and local pathways should be designed to ensure that choice rights operate in practice.The purpose of A&G is to support decision‑making, reduce unnecessary referrals, and deliver more care closer to home. SPoA acts as a single ‘front door’ to support clinical triage to the most appropriate service or outcome, meaning timelier, more joined-up care for patients, without altering patients’ statutory right to choice.NHS England has published system guidance The Elective Single Point of Access: Technical Guidance for 2026/27, which specifies that patients must continue to be offered choice of provider and team at the appropriate point in the pathway when they can make an informed choice. An elective SPoA diagram showing touchpoints of choice is included in the technical guidance annex.

What assessment his Department has made of the potential impact of mandatory pre-referral Advice and Guidance requirements from 1 April 2026 on workload transferred to GP practices, including the workload arising from acting on specialist advice responses, requesting and reviewing diagnostic investigations recommended by specialists, and managing patients while awaiting responses; and whether additional funding has been allocated to reflect that workload transfer.

Advice and Guidance (A&G) is designed to support quicker, clearer clinical decision making, by enabling general practitioners (GPs) and specialists to discuss and agree on the most appropriate next steps for a patient. The 2026/27 GP Contract does not mandate the use of A&G in all circumstances. Instead, practices are expected to use A&G prior to or in place of a planned care referral, where clinically appropriate, and to follow locally agreed referral pathways. In 2025/26 we introduced a £20 payment for GPs for each A&G request, allocating up to a total of £80 million of new funding, which has supported significant increases in A&G. For 2026/27, this funding is being incorporated into the GP Contract to provide a consistent, streamlined approach that recognises the vital role of GPs in delivering A&G. Embedding A&G in the GP Contract recognises it as routine clinical practice, removes annual signups, and provides more predictable funding while supporting consistent patient pathways. We are investing £485 million in GPs in 2026/27, bringing the total spend on the GP Contract to over £13.8 billion. This builds on last year’s £1.1 billion of investment. This uplift represents a 3.6% cash increase, or 1.4% real terms increase, and includes an assumed pay increase of 2.5%. As with previous years, we have asked the independent pay review body for Doctors' and Dentists' Remuneration, for a pay recommendation for 2026/27 for the Government to consider.

If he will make an assessment of the adequacy of the consistency of the mandatory Single Point of Access triage process with NHS England's Jess's Rule guidance; and what safeguards are in place to ensure that a mandatory Single Point of Access triage process does not return to primary care a patient whom a GP has referred in accordance with that guidance.

The Single Point of Access (SPoA) triage process is consistent with Jess’s Rule.Jess’s Rule is an NHS England patient safety initiative for primary care. It is designed for general practitioners (GPs) and supports them to reconsider a patient’s presentation and/or diagnosis where the patient has attended a GP three or more times and symptoms have escalated, or the diagnosis is uncertain.Jess’s Rule can be used to support a GP’s decision on an appropriate referral within the SPoA model. SPoA will provide a more efficient approach to triaging patients, with all appropriate requests and referrals, excluding urgent suspect cancer, flowing through a single ‘front door’. SPoA supports clinical triage to the most appropriate service or outcome, meaning timelier, more joined-up care for patients. Patients will still have a choice about where they receive care.Safeguards within the SPoA model include senior clinical oversight of triage decisions and the ability for primary care clinicians to re‑escalate concerns where symptoms persist, worsen, or remain unexplained. These arrangements aim to ensure patients who require specialist assessment are not inappropriately managed in the community, and that shared clinical judgement remains central to decision‑making.

How many days were taken by NHS England staff as sick leave in total in each month since January 2024; and what the average number was.

NHS England publishes monthly information on the sickness absence of staff employed by NHS bodies, including NHS England. This is available at the following link:https://digital.nhs.uk/data-and-information/publications/statistical/nhs-sickness-absence-rates