Written questions by Frith.

What plans he has to publish a national strategy for palliative and end of life care.

The Government is developing a Palliative Care and End-of-Life Care Modern Service Framework (MSF) for England, for publication later this year.The MSF will drive improvements in the services that patients and their families receive at the end of life and will enable integrated care boards to address challenges in access, quality, and sustainability through the delivery of high-quality, personalised care. This will be aligned with the ambitions set out in last year’s 10-Year Health Plan.Further information about the MSF is set out in my Written Statement HCWS1087, made on 24 November 2025.

Pursuant to Written Parliamentary Question 107115, how many people with a learning disability are recorded as beneficiaries of the NHS Low Income Scheme.

The NHS Low Income Scheme is administered by the NHS Business Services Authority (NHS BSA) on behalf of the Department. The NHS BSA does not collect or record information on applicants’ medical or health conditions, including whether they have a learning disability. As such, no data is held on the number of people with a learning disability who are beneficiaries of the scheme.

What steps he is taking to help ensure that NHS England staff who have taken partial retirement receive fair redundancy payments..

The Voluntary Redundancy (VR) scheme being used by NHS England is the national ‘model Voluntary Redundancy’ scheme approved by HM Treasury for use across the National Health Service. The national ‘model VR scheme’ directs that voluntary redundancy payments should be made in accordance with Section 16 of the NHS Terms and Conditions Handbook. These terms and conditions ​are developed and maintained through the NHS Staff Council for staff covered by Agenda for Change. They include provisions about how redundancy pay should be calculated in instances where an individual has taken some, or all, of the pension. NHS England has completed an Equality Impact Assessment on the implementation of the national model VR scheme.

If he will consider extending NHS sight test eligibility criteria by listing learning disability as a risk factor.

Whilst adults with a learning disability do not automatically qualify for free National Health Service sight tests, they may qualify under other categories of exemption, for example being in receipt of income-related benefits or through the NHS low-income scheme.To support children and young people with learning disabilities, free NHS sight tests are available within special educational settings across England, that choose to host a service.

What assessment his Department has made of the potential merits of providing free prescriptions for inhalers to people with asthma who are moving into adulthood.

There are no plans to review the list of medical conditions that entitle someone to apply for a medical exemption certificate.There are extensive arrangements in place in England to ensure that prescriptions are affordable for everyone. Approximately 89% of prescription items are dispensed free of charge in the community in England, and there are a wide range of exemptions from prescription charges already in place for which those with asthma may be eligible. Eligibility depends on the patient’s age, whether they are in qualifying full-time education, whether they are pregnant or have recently given birth, or whether they are in receipt of certain benefits or a war pension.People on low incomes can apply for help with their health costs through the NHS Low Income Scheme, which provides help based on a comparison between a person’s income and their requirements.People who need to pay and who need many prescription items could save money with a prescription prepayment certificate (PPC). PPCs allow people to claim as many prescriptions as needed for a set cost. An annual PPC costs £114.50 and will save money if they need 12 or more items in 12 months. To help spread the cost, people can pay for an annual PPC through 10 monthly direct debits, which works out as just over £2 per week. A three month PPC for £32.05 is also available.

What steps his Department is taking to support the use of evidence-based off-label medicines where there is no commercial incentive for a pharmaceutical company to seek a marketing authorisation.

The Medicines and Healthcare products Regulatory Agency (MHRA) is an executive agency of the Department of Health and Social Care and regulates medicine, medical devices and blood components for transfusion in the UK. The MHRA is responsible for ensuring medicines meet appropriate standards of safety, quality, and efficacy.In the UK, off-label prescribing refers to the use of a licensed medicine outside the terms of its marketing authorisation, such as for a different condition, dose, or age group. The MHRA regulates the licensing, safety and quality of medicines and monitors adverse effects but does not control medical practice. Responsibility for off-label prescribing lies with the prescriber, who must ensure it is in the patient’s best interests, supported by evidence, and discussed with the patient.The General Medical Council (GMC) provides professional standards, while NHS trusts and the National Institute for Health and Care Excellence (NICE) may set local or national policies to guide safe and appropriate use.Where there is no commercial incentive for a pharmaceutical company to seek a marketing authorisation, the use of independent, evidence-based guidelines (such as those developed by NICE, professional bodies, or specialist societies) can support clinical decision-making and standardise safe practice. Published research, systematic reviews, and expert consensus also provide a foundation for justifying off-label use in areas such as paediatrics, oncology, and rare diseases.Thus, the MHRA oversees the medicine itself, while prescribers, the GMC, and the NHS govern how off-label prescribing is carried out in practice, supported by independent clinical evidence and guidelines when licensing is not pursued.The MHRA encourages Marketing Authorisation Holders to vary their licences when there is sufficient evidence to change the indication approved. The MHRA will reach out to ask companies to assess when appropriate. This does not indicate that the MHRA will approve the licence, but are prepared to assess the evidence provided.

What steps his Department is taking to engage with the pharmaceutical industry on price negotiations relating to Enhertu; and if he will take steps to help ensure that Enhertu becomes an (a) affordable and (b) accessible treatment option for patients with HER-2 low (i) metastatic and (ii) unresectable breast cancer.

Decisions on whether new medicines should be routinely funded by the NHS in England are made on the basis of recommendations from the National Institute for Health and Care Excellence (NICE) following an evaluation of a treatment’s costs and benefits. These are very difficult decisions to make, and it is important that they are made independently and on the basis of the available evidence.NICE has been able to recommend Enhertu in advanced breast cancer for treating HER2-positive unresectable or metastatic breast cancer after one or more anti-HER2 treatments, and for treating HER2-positive unresectable or metastatic breast cancer after two or more anti-HER2 therapies.On 29 July 2024, NICE published final guidance on Enhertu for use in the treatment of HER2-low metastatic breast cancer, and it was unable to recommend this life-extending treatment. The only obstacle to access for NHS patients to Enhertu is price, and the Secretary of State met the manufacturers of Enhertu, AstraZeneca and Daiichi Sankyo, to encourage them to re-enter discussions with NHS England with a view to reaching a price at which NICE would be able to recommend Enhertu. However, despite NICE and NHS England offering unprecedented flexibility, the companies were unable to offer Enhertu at a cost-effective price. NICE’s guidance will therefore remain unchanged, however, the door remains open for the companies to enter into a new NICE appraisal if they are willing to offer Enhertu at a cost-effective price.

What his Department's planned timetable is for distributing interim payments for people affected by sodium valproate and pelvic mesh.

The Government is carefully considering the work done by the Patient Safety Commissioner and her report, which set out options for redress for those harmed by valproate and pelvic mesh. This is a complex issue involving input from different Government departments. The Government will provide a further update to the Patient Safety Commissioner’s report.

What assessment his Department has made of the impact of palliative and end of life care on patients; and how the 10 year plan will ensure that there is adequate provision of these services.

No formal assessment has been made on the impact of palliative care and end of life care on patients, but we know that currently approximately 600,000 people die per year in the United Kingdom. Palliative care services are included in the list of services an integrated care board must commission. This promotes a more consistent national approach and supports commissioners in prioritising palliative care and end of life care provision.Whilst it is too soon to say what will be in the 10-Year Health Plan, the Department is investing £3 million through the National Institute for Health and Care Research in a new Policy Research Unit in Palliative and End of Life Care. This unit launched in January 2024 and will build the evidence base on palliative care and end of life care, with a specific focus on inequalities.

What role his Department plans for hospices to play in shifting care into the community.

We want a society where every person receives high-quality, compassionate care from diagnosis through to the end of life. The Government is determined to shift more healthcare out of hospitals and into the community, to ensure patients and their families receive personalised care in the most appropriate setting, and hospices will have a big role to play in that shift.Whilst the majority of palliative care and end of life care is provided by National Health Service staff and services, we recognise the vital part that voluntary sector organisations, including hospices, also play in providing support to people at end of life and their loved ones.In February, I met with key palliative care and end of life care and hospice stakeholders, in a roundtable format, with a focus on long-term sector sustainability within the context of our 10-Year Health Plan.

What assessment his Department has made of the potential merits of applying a currency model to the commissioning of palliative and end of life care services.

Palliative care services are included in the list of services an integrated care board must commission. This promotes a more consistent national approach and supports commissioners in prioritising palliative care and end of life care.A suite of new community service currency models, including for palliative and end of life care in children and adults, have been developed and published in the 2025/26 NHS Payment Scheme. Further information on the new community service currency models and the 2025/26 NHS Payment Scheme is available, respectively, at the following two links:https://www.england.nhs.uk/wp-content/uploads/2025/04/25-26NHSPS-Community-Currency-Guidance.pdfhttps://www.england.nhs.uk/publication/2025-26-nhs-payment-scheme/Currency models will help us to understand:the needs and complexity of our populations, allowing us to develop services around these needs;the resources, care contacts, and costs of supporting patients to meet these needs; andquality indicators and outcome measures to understand the effects of the care provided.Combining these three elements provides an understanding of the overall value, and will support the achievement of the Government’s priorities for palliative care and end of life care.

If his Department will provide guidance to Integrated Care Boards on the minimum provision of palliative care that should be available for hospices in their area.

Palliative care services are included in the list of services an integrated care board (ICB) must commission. This promotes a more consistent national approach and supports commissioners in prioritising palliative care and end of life care.Whilst the majority of palliative care and end of life care is provided by National Health Service staff and services, we recognise the vital part that voluntary sector organisations, including hospices, also play in providing support to people at end of life and their loved ones.To support ICBs in this duty, NHS England has published statutory guidance and service specifications. It is included in the statutory guidance that ICBs must work to ensure that there is sufficient provision of care services to meet the needs of their local populations, which can include the hospice services available within the ICB’s catchment area.

Whether long-term reform hospice care funding will be included in the NHS 10-year plan.

The 10-Year Health Plan will set out how the Government will fix our broken National Health Service. Too many people, towards the end of their lives, are not receiving the support and care they deserve, and we know that waiting times for services are far too long. We are determined to change that, by changing the way services operate, rather than by simply funding more of the same.Whilst it is too soon to say what will be in the 10-Year Health Plan, we are continuing to support the hospice sector with a £100 million capital funding boost for adult and children’s hospices in England to ensure they have the best physical environment for care. We are also providing £26 million of revenue funding to support children and young people’s hospices for 2025/26. This is a continuation of the funding which until recently was known as the Children and Young People’s Hospice Grant.

Whether he has had discussions with NHS England on the reason that some NHS Trusts are not yet offering access to givinostat through the Early Access Programme.

The Department understands the impact that Duchenne muscular dystrophy has on those living with it and their families, and the urgent need for new treatment options.Officials from the Department have had discussions with NHS England regarding access to givinostat through the Early Access Programme (EAP). Under the EAP, givinostat is free to both the patients taking part in it, and to the National Health Service, although NHS trusts must still cover the cost of administering it to patients.Participation to the programme is decided at an individual NHS trust level and NHS England has published guidance for integrated care systems (ICS) on free of charge medicines schemes such as EAPs, including providing advice on the 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 schemes, 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 steps his Department is taking to ensure that all eligible NHS Trusts participate in the Early Access Programme for givinostat.

The Department understands the impact that Duchenne muscular dystrophy has on those living with it and their families, and the urgent need for new treatment options.Officials from the Department have had discussions with NHS England regarding access to givinostat through the Early Access Programme (EAP). Under the EAP, givinostat is free to both the patients taking part in it, and to the National Health Service, although NHS trusts must still cover the cost of administering it to patients.Participation to the programme is decided at an individual NHS trust level and NHS England has published guidance for integrated care systems (ICS) on free of charge medicines schemes such as EAPs, including providing advice on the 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 schemes, 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 progress he has made on the 2025-2026 pay review for NHS staff.

On 30 September 2024, the Government issued remit letters to the independent Pay Review Bodies (PRBs) covering the National Health Service’s staff groups, formally beginning the 2025/26 pay round months in advance of recent annual pay rounds. The Department published its written evidence to the PRBs covering the NHS’s staff groups for the 2025/26 pay round on 10 December 2024, and oral evidence sessions took place with those PRBs in January and February 2025.We have now received the NHS Pay Review Body covering Agenda for Change staff and the Pay Review Body on Doctors' and Dentists' Remuneration’s reports. The Government is considering the recommendations and will respond formally in due course.

What recent progress his Department has made on the Women's Health Strategy in relation to (a) healthy lifestyle choices, (b) breast cancer and (c) women's health generally.

The Government is committed to prioritising women’s health as we build a National Health Service fit for the future.The Government and the NHS provide a range of services to support people, including women, to make healthy lifestyle choices. For example, through stop smoking services, sexual health services, and weight management services. The National Smoke-free Pregnancy Incentives Scheme is also supporting pregnant women to quit smoking.Reducing unwarranted variation in cancer treatment is a strategic priority for the NHS. On World Cancer Day this year, the Department announced a major world-leading artificial intelligence trial to transform cancer care, helping radiologists catch breast cancer earlier. Also, in February 2025 NHS England launched its first-ever awareness campaign to highlight the benefits of breast screening and encourage more women to participate. Further information about this campaign is available at the following link:https://www.england.nhs.uk/2025/02/nhs-launches-first-ever-breast-screening-campaign-to-help-detect-thousands-of-cancers-earlier/We are continuing to improve the health of women and girls, for example by supporting those who have experienced pregnancy loss through a full rollout of baby loss certificates, through menopause support in the workplace, access to emergency hormonal contraception, and by boosting women’s participation in research and clinical trials.

What steps his Department is taking to address health inequalities in breast cancer prevention by ensuring that women in disadvantaged areas have (a) safe and (b) affordable access to (i) facilities and (ii) resources to maintain a healthy (A) lifestyle, (B) diet and (C) level of physical activity.

Tackling health inequalities, including in breast cancer prevention, requires a whole-Government effort. That is why there is ongoing work across the Government, from housing and education to employment and welfare, to ensure that health is built into all policies.NHS England is working with integrated care systems, local authorities, and the directors of public health to embed regional and local solutions to reducing inequalities, ensuring that communities, including in deprived areas, have the power and resources to improve health outcomes, for instance through the maintenance of a healthy lifestyle.The Department for Environment, Food and Rural Affairs is developing an ambitious new cross-Government Food Strategy that will set the food system up for long-term success and provide wide ranging improvements. The Food Strategy will work to provide healthier, more easily accessible food to help people live longer, healthier lives.By aligning policy efforts across health, social care, local government, and the voluntary sector, the Government is committed to driving real change, so that everyone, regardless of their background, has the opportunity to live a longer, healthier life.The Government’s goal is to reduce the time people spend in ill health, support independence, and close the healthy life expectancy gap, ensuring that no one’s health outcomes are determined by their background or where they are born.

Whether he has made an assessment of the potential merits of (a) investing in auditory verbal therapy and (b) expanding access to support for deaf children and their families.

Audiology services are locally commissioned, and the responsibility for meeting the needs of non-hearing children lies with local National Health Service commissioners. It is important that local commissioners have the discretion to decide how best to meet the needs of their local population, and we are giving systems greater control and flexibility over how funding is deployed to support this.We expect local commissioning to be informed by the best available evidence, relevant National Institute for Health and Care Excellence guidelines, and guidance issued by NHS England. In 2019, NHS England, with input from the National Deaf Children’s Society, produced a guide for commissioners and health and local authority providers which supports non-hearing children and young people. This is available at the following link:https://www.england.nhs.uk/wp-content/uploads/2019/11/what-works-chswg-guide.pdfThe Government is committed to breaking down barriers to opportunities and ensuring that every child, including children with hearing loss, has the best start in life. I met with Auditory Verbal UK and heard their views about the potential benefits of guidance on auditory verbal therapy, which I agreed to consider.

Whether he plans to issue guidance to ICBs on providing equality of access to auditory verbal therapy for deaf babies and young children.

Audiology services are locally commissioned, and the responsibility for meeting the needs of non-hearing children lies with local National Health Service commissioners. It is important that local commissioners have the discretion to decide how best to meet the needs of their local population, and we are giving systems greater control and flexibility over how funding is deployed to support this.We expect local commissioning to be informed by the best available evidence, relevant National Institute for Health and Care Excellence guidelines, and guidance issued by NHS England. In 2019, NHS England, with input from the National Deaf Children’s Society, produced a guide for commissioners and health and local authority providers which supports non-hearing children and young people. This is available at the following link:https://www.england.nhs.uk/wp-content/uploads/2019/11/what-works-chswg-guide.pdfThe Government is committed to breaking down barriers to opportunities and ensuring that every child, including children with hearing loss, has the best start in life. I met with Auditory Verbal UK and heard their views about the potential benefits of guidance on auditory verbal therapy, which I agreed to consider.