Written questions by Naish.

Pursuant to the Answer of 2 December 2024 to Question 15949 on Achalasia: Health Services, when the NHS England Specialised Commissioning Paediatric Medicine: Gastroenterology, Hepatology and Nutrition Service Specification was last updated.

Pathways for managing patients with achalasia are set out in the NHS England Specialised Commissioning Paediatric Medicine: Gastroenterology, Hepatology and Nutrition Service Specification. The current specification was published in 2013/14, and there are no plans to update this specification at this time. The specification sets out that patients with achalasia should be managed within Specialist Paediatric Gastroenterology Centres under the care of an expert multidisciplinary team.Patients with achalasia may also receive care from a specialist surgical team, within Specialised Surgery in Children services, to help manage their condition. The NHS England Specialised Surgery in Children service specification sets out standards for these services, and an updated specification is due for publication in 2026.

What steps his Department is taking to improve (a) diagnosis and (b) treatment of achalasia.

The Government is committed to improving the diagnosis and treatment of achalasia. Work is underway to support an increase in the use of the Advice and Refer/Single Point of Access model, which can in turn improve waiting times for all gastro patients, including those with achalasia or suspected achalasia.More broadly, the Neighbourhood Health Framework has now been published, and will enable a more joined-up approach that delivers more preventative, local, personalised, and digitally enabled care for everyone, including for people living with achalasia. Central to the plans are neighbourhood health centres, which will bring more care closer to where people live. This is supported by the NHS App, which will become a health companion that makes it easier for patients to access the National Health Service. It will give patients a seamless experience across their health journey.

What steps his Department is taking to help support people with short and long-term spinal cord injuries.

Our 10-Year Health Plan will have profound and positive impacts on care for patients with spinal cord injury. More tests and scans are delivered in the community, better joined-up working between services, and greater use of technology will all support people in the management of long-term conditions, including spinal cord injuries.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.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.

What assessment his Department has made of the potential merits of lowering the income threshold for the NHS salary sacrifice car scheme.

No specific assessment has been made. Employers in the National Health Service offer a broad range of salary sacrifice schemes which have varying values and requirements. The interaction with the national minimum wage must be considered for all employees who participate in one or more of these schemes. Participation must not mean that an employee’s cash earnings fall below the National Minimum Wage. This is not new policy and is not specific to the NHS.

When the 10-Year Workforce Plan will be published; what discussions he has had with external stakeholders since has taken place since the consultation closed on 7 November 2025.

The Government will publish the 10 Year Workforce Plan in spring 2026.  This plan will set out action to create a National Health Service workforce that is able to deliver the transformed service set out in the 10-Year Health Plan. It is important we do this in a robust and joined up way. We are therefore engaging extensively with partners to ensure this plan delivers for staff and patients.That engagement began well before the call for evidence was closed. In early November, ministers hosted an event with nearly one hundred representatives of partner organisations to hear views from across the health system.Engagement is now continuing while we analyse the submissions to our call for evidence, including a roundtable with medical royal colleges on 14 January that I chaired.

What steps his Department is taking to align the number of nursing graduates with the availability of entry-level jobs.

On 11 August 2025, the Government announced the Graduate Guarantee for nurses and midwives. The guarantee will ensure that there are enough positions for every newly qualified nurse in England. The package of measures will unlock thousands of jobs and will ensure thousands of new posts are easier to access by removing barriers for National Health Service trusts, creating opportunities for graduates and ensuring a seamless transition from training to employment.

What steps he is taking to prevent universities from withdrawing nursing courses due to employment challenges faced by graduates.

To address graduate employment issues, in August 2025 the Government introduced the Graduate Guarantee.While the Government is committed to ensuring sustainable training pathways for healthcare professions, higher education institutions are independent providers and are responsible for making their own decisions about course delivery and viability based on learner demand and provider capacity.

What assessment his Department has made of the adequacy of guidance provided to NHS staff considering partial retirement under the NHS partial retirement scheme in relation to the potential impact on future redundancy entitlements.

Partial retirement does not mean that National Health Service staff are ineligible for redundancy payments. However, taking partial retirement may change the way in which contractual redundancy payments are calculated.The rules concerning the calculation of redundancy payments for National Health Service staff who have previously taken pension benefits are determined in accordance with their contracts of employment, and statutory redundancy entitlements.Redundancy terms for NHS staff on the Agenda for Change contract are set out under section 16 of the NHS Staff Terms and Conditions of Service handbook. This also applies to NHS staff whose redundancy terms refer to section 16. This section states that service used for the purposes of calculating previous pension benefits will not count for the calculation of a contractual redundancy payment. Statutory redundancy entitlements are unaffected.The Department commissions NHS Employers to provide guidance for employers on a range of topics, including NHS redundancy arrangements and retirement options for NHS staff. The NHS Employers guidance clearly sets out the position in relation to partial retirement and redundancy.

When Section 16 of the NHS Staff Terms and Conditions (Agenda for Change) handbook was last reviewed in relation to the partial retirement scheme introduced in October 2023; and whether his Department has any plans to update this section to ensure fairness for staff who took partial retirement.

Section 16 of the NHS Terms and Conditions of Service handbook, also referred to as Agenda for Change, was last updated in 2015. This section sets out the contractual redundancy provisions for staff covered by these terms and conditions and took effect in England from 1 April 2015.We have no current plans to update this section. These provisions were agreed and ratified in partnership by the NHS Staff Council, the collective bargaining structure made up of trade union and employer representatives. Any future changes to the handbook, including this section, would require the Department to issue a mandate to allow negotiations to be undertaken by the NHS Staff Council.

If he will estimate the number of newly-qualified nurses who lose their professional status because they have been unable to secure employment within two years of graduation.

The Nursing Midwifery Council (NMC) is the independent regulator of nurses and midwives in the United Kingdom, and nursing associates in England. It sets the standards that registrants must meet to demonstrate that they are capable of practising safely and effectively.There is no requirement for nurses to be in employment in order to maintain their registration with the NMC. Registrants must pay an annual registration fee and revalidate every three years by submitting a range of evidence demonstrating their skills and adherence to the NMC Code of professional standards and behaviours. They must also demonstrate that they have practised for a minimum of 450 hours over the three year revalidation period.The NMC publishes an annual leavers survey to understand why people leave its permanent register, alongside annual and mid-year registration data reports. The annual and mid-year registration data tables includes a breakdown of leavers by the years since initial registration, which is available at the following link: https://www.nmc.org.uk/about-us/reports-and-accounts/registration-statistics/

Whether an Equality Impact Assessment was conducted on the differential treatment of NHS staff who have taken partial retirement under the NHS partial retirement scheme.

There is no National Health Service partial retirement scheme. Partial retirement has existed as an option for some members of the NHS Pension Schemes since 2008. It was extended to members of the 1995 Section of the legacy NHS Pension Scheme in 2023.

What assessment his Department has made of the differences between NHS and Civil Service redundancy provisions for staff who have taken partial retirement; and whether his Department has considered aligning NHS provisions with the Civil Service Compensation Scheme where partial retirement does not affect redundancy entitlements.

This specific assessment has not been made. Contractual redundancy provisions for staff covered by the NHS Terms and Conditions of Service handbook, also referred to as Agenda for Change, in England were agreed and ratified in partnership by the NHS Staff Council, the collective bargaining structure made up of trade union and employer representatives. Any future changes to the handbook, including this section, would require the Department to issue a mandate to allow negotiations to be undertaken by the NHS Staff Council.

What assessment he has made of the potential impact of changes to safe staffing levels in mental health services on patient safety; whether the Department has revised its definition of safe staffing levels in response to workforce shortages; and what steps he is taking to ensure that staffing standards are maintained at levels that protect both patient safety and staff wellbeing.

No assessment has been made. NHS England is currently updating guidance on how trusts should set their staffing levels, via the Developing Workforce Safeguards and Safe Staffing in Mental Health Services 2018 framework, to reflect current evidence and operations. Staffing any service and any shift should be built around the needs of patients which should be the aim of all National Health Service providers.Guidance on safe staffing levels also specifies that every NHS organisation should have a strategic workforce plan which is discussed and agreed at the trust board level and should also have escalation processes to cover staffing shortages or changes.

What steps he is taking with Cabinet colleagues to tackle health disparities amongst people who lived in the most deprived areas of the UK.

The Government is committed to increasing the amount of time people spend in good health and to preventing premature deaths, with a vision of ensuring that all individuals, regardless of background or location, live longer, healthier lives. Our 10-Year Health Plan for the National Health Service in England sets out a reimagined service designed to tackle inequalities in both access and outcomes, as well as to give everyone, no matter who they are or where they come from, the means to engage with it on their own terms.For example, we know that the Carr-Hill formula is considered outdated, and evidence suggests that general practitioners (GPs) serving in deprived parts of England receive on average 9.8% less funding per needs-adjusted patient than those in less deprived communities, despite having greater health needs and significantly higher patient-to-GP ratios. This is why we are currently reviewing the formula to ensure that resources are targeted where they are most needed.Additionally, much of what determines health and wellbeing is influenced by factors other than health services. As a result, we are taking bold action across Government on the social determinants of health to build a fairer Britain. Recent cross-Government action has included the introduction of Awaab’s Law and reform of the Decent Homes Standard for the social and private rented sector, the English Devolution Bill, and a new statutory health and heath inequalities duty for Strategic Authorities.

What steps his Department is taking to address the rising legal costs of clinical negligence.

The rising costs of clinical negligence claims against the National Health Service in England are of great concern to the Government. Costs have more than doubled in the last 10 years and are forecast to continue rising, putting further pressure on NHS finances.As announced in the 10-Year Health Plan for England, David Lock KC is providing expert policy advice on the rising legal costs of clinical negligence and how we can improve patients’ experience of claims. The review is ongoing, following initial advice to ministers and the recent National Audit Office report.We welcome the report by the National Audit Office. The results of David Lock’s work will inform future policy making in this area. No decisions on policy have been taken at this point, and the Government will provide an update on the work done and next steps in due course.

What steps his Department is taking to establish Staff Treatment Hubs.

Following the publication of the 10-Year Health Plan on 3 July 2025, work is underway to develop implementation and operational plans for the Staff Treatments Hubs. This will determine factors such as location, budgets, timeframes and capacity

What consideration his Department has given to repealing S2(4) of the Law Reform (Personal Injuries) Act 1948.

The rising costs of clinical negligence claims against the National Health Service in England are of great concern to the Government. Costs have more than doubled in the last 10 years and are forecast to continue rising, putting further pressure on NHS finances.As announced in the 10-Year Health Plan for England, David Lock KC is providing expert policy advice on the rising legal costs of clinical negligence and how we can improve patients’ experience of claims. The review is ongoing, following initial advice to ministers and the recent National Audit Office report.We welcome the report by the National Audit Office. The results of David Lock’s work will inform future policy making in this area. No decisions on policy have been taken at this point, and the Government will provide an update on the work done and next steps in due course.

What steps his Department is taking to improve workplace catering and break facilities for healthcare workers.

Good physical working environments are important for staff wellbeing and retention. Staff need to be given the time and space to rest and recover from their work, particularly when working on-call or overnight. This is recognised as a priority in the NHS People Promise which sets out the importance of employers prioritising spaces for staff to rest and recuperate, and ensuring access to hot food and drinks.In May 2024, NHS England and NHS Charities Together launched a £10 million Workforce Wellbeing Programme to support National Health Service staff in England. It will provide tailored health and wellbeing support to NHS staff, including grants to improve facilities. A three-year programme of work named Great Food, Good Health, led by NHS England, aims to improve the experience and quality of nutritious food that patients, staff, and visitors receive in hospital. As part of this, the NHS made clear that NHS organisations must be able to demonstrate they have suitable 24/7 food service provision.

What steps his Department is taking to update healthcare professional regulation.

The Government is committed to modernising the regulatory frameworks for all healthcare professionals in the United Kingdom.As a first step, we aim to consult on secondary legislation to modernise the General Medical Council’s regulatory framework early this year and to lay this legislation before Parliament in the same year. We also plan to update the governing legislation of the Nursing and Midwifery Council and the Health and Care Professions Council within the current parliamentary period.

What steps he is taking to end the blanket use of body mass index thresholds to determine eligibility for joint replacement surgery.

I refer the Hon. Member to the answer I gave on 20 November 2025 to Question 89688.