Written questions by Naish.

Whether his Department has contingency plans in place to extend eligibility for coronavirus vaccinations if infection rates rise in winter 2025-26.

The aim of the COVID-19 vaccination programme is to prevent serious disease, hospitalisation and/or mortality arising from COVID-19. Population immunity to COVID-19 has been increasing due to a combination of naturally acquired immunity following recovery from infection and vaccine-derived immunity.COVID-19 is now a relatively mild disease for most people, though it can still be unpleasant. With rates of hospitalisation and death from COVID-19 having reduced significantly since COVID-19 first emerged, the focus of the independent expert Joint Committee on Vaccination and Immunisation (JCVI) advice programme has moved towards targeted vaccination of the oldest adults and individuals who are immunosuppressed. These are the two groups who continue to be at higher risk of serious disease, including mortality.On 13 November 2024, the JCVI published advice on who should be offered vaccination in autumn 2025. On 26 June 2025, the Government decided, in line with this advice, that a COVID-19 vaccine should be offered in autumn 2025 to the following groups:adults aged 75 years and over;residents in a care home for older adults; andindividuals aged six months and over who are immunosuppressed, as defined in the immunosuppression sections of tables three or four in the COVID-19 chapter of the UK Health Security Agency Green Book.While the JCVI keeps the available data under regular review, there are no plans to offer vaccination through the national programme outside these JCVI-advised groups for autumn 2025. All those individuals who are eligible are encouraged to take up the offer of vaccination.The JCVI has advised that the emergence of a new COVID-19 variant of concern which escaped from current widespread immunity, and therefore results in serious disease, in a wider range of individuals, is unlikely. However, if this scenario did emerge, the JCVI does not consider it likely that current vaccines would be effective. This means that expanding groups eligible for vaccination is unlikely to be clinically useful when compared with developing a new variant vaccine matched to the variant of concern. In this scenario, which the JCVI believes to be unlikely, new advice would be required on which groups were at risk of serious disease and should therefore be eligible for vaccination.

What steps his Department has taken to monitor NHS transport service performance standards.

Non-Emergency Patient Transport Services (NEPTS) are designed to provide transport for patients who have particular clinical or mobility needs that necessitate such support, which may include elderly or vulnerable patients. The eligibility criteria for NEPTS have been set nationally by NHS England, and the details are available at the following link: https://www.england.nhs.uk/wp-content/uploads/2022/05/B1244-nepts-eligibility-criteria.pdf The Healthcare Travel Cost Scheme (HTCS) is available for eligible patients and provides financial support to facilitate journeys to and from National Health Service funded secondary care. Details on the eligibility for HTCS is available at the following link:https://www.nhs.uk/nhs-services/help-with-health-costs/healthcare-travel-costs-scheme-htcs/.Local integrated care boards (ICBs) hold responsibility for the implementation of patient transport services at a local level, including monitoring and improving against performance targets. ICBs are best placed to work and consult with their local stakeholders, health and care organisations, and local authorities to decide how to best meet and deliver for the needs of their local population. NHS England is funding and co-ordinating a range of Patient Transport Pathfinder projects to explore more effective approaches to supporting patients with their NHS travel needs.

What steps his Department is taking to improve NHS hospital transport provision.

Non-Emergency Patient Transport Services (NEPTS) are designed to provide transport for patients who have particular clinical or mobility needs that necessitate such support, which may include elderly or vulnerable patients. The eligibility criteria for NEPTS have been set nationally by NHS England, and the details are available at the following link: https://www.england.nhs.uk/wp-content/uploads/2022/05/B1244-nepts-eligibility-criteria.pdf The Healthcare Travel Cost Scheme (HTCS) is available for eligible patients and provides financial support to facilitate journeys to and from National Health Service funded secondary care. Details on the eligibility for HTCS is available at the following link:https://www.nhs.uk/nhs-services/help-with-health-costs/healthcare-travel-costs-scheme-htcs/.Local integrated care boards (ICBs) hold responsibility for the implementation of patient transport services at a local level, including monitoring and improving against performance targets. ICBs are best placed to work and consult with their local stakeholders, health and care organisations, and local authorities to decide how to best meet and deliver for the needs of their local population. NHS England is funding and co-ordinating a range of Patient Transport Pathfinder projects to explore more effective approaches to supporting patients with their NHS travel needs.

What steps his Department has taken to ensure that vulnerable patients receive appropriate NHS transport services.

Non-Emergency Patient Transport Services (NEPTS) are designed to provide transport for patients who have particular clinical or mobility needs that necessitate such support, which may include elderly or vulnerable patients. The eligibility criteria for NEPTS have been set nationally by NHS England, and the details are available at the following link: https://www.england.nhs.uk/wp-content/uploads/2022/05/B1244-nepts-eligibility-criteria.pdf The Healthcare Travel Cost Scheme (HTCS) is available for eligible patients and provides financial support to facilitate journeys to and from National Health Service funded secondary care. Details on the eligibility for HTCS is available at the following link:https://www.nhs.uk/nhs-services/help-with-health-costs/healthcare-travel-costs-scheme-htcs/.Local integrated care boards (ICBs) hold responsibility for the implementation of patient transport services at a local level, including monitoring and improving against performance targets. ICBs are best placed to work and consult with their local stakeholders, health and care organisations, and local authorities to decide how to best meet and deliver for the needs of their local population. NHS England is funding and co-ordinating a range of Patient Transport Pathfinder projects to explore more effective approaches to supporting patients with their NHS travel needs.

What recent steps his Department has taken to approve the use of sepiapterin for people with phenylketonuria.

The Medicines and Healthcare Products Regulatory Agency (MHRA) is an executive agency of the Department and regulates medicine, medical devices and blood components for transfusion in the United Kingdom, with responsibility for ensuring medicines meet appropriate standards of safety, quality, and efficacy.The MHRA has several licensing routes that are available to companies to support access of innovative medicines or medicines with unmet need to patients. Sepiapterin is currently not approved by the MHRA, however, it will assess any market authorisation applications for sepiapterin against the high standards of quality, safety and efficacy should an application be received.

Whether funding will be ringfenced for independent patient advocacy and engagement services at local level after the proposed abolition of local Healthwatch.

Funding for independent patient advocacy and funding for local Healthwatch is currently not ring-fenced, and the Department has no plans to introduce a ring fence in future years.The abolition of local Healthwatch arrangements, and transfer of their functions to integrated care boards for health, and local authorities for social care, will require primary legislation. The timing of this is subject to the will of Parliament and will happen when Parliamentary time allows.Funding considerations will be undertaken after legislation has received parliamentary approval.

If his Department will ensure that people with (a) severe multiple disadvantage and (b) other rare conditions are included in the (i) design and (ii) delivery of services after the proposed abolition of local Healthwatch organisations.

Dr Dash’s report on patient safety across the health and care landscape was published in July 2025. The review recommends bringing together the work of local Healthwatch organisations with the engagement functions of integrated care boards and providers to ensure patient and wider community input into the planning and design of services.These changes will improve quality, including safety, by making it clear where responsibility and accountability sit at all levels of the system. The changes will make it easier for staff, patients and service users, including those with severe multiple disadvantage and other rare conditions, to feed directly into the system to improve quality of care. We believe that patients and users will have a stronger voice once it is heard inside the system.

What steps he will take to ensure that patients have access to independent statutory mechanisms for raising concerns about health and care services following the proposed abolition of local Healthwatch organisations.

The report by Dr Penny Dash, published in July, recommended bringing together the work of local Healthwatch organisations, and the engagement functions of integrated care boards (ICBs) and providers, to ensure patient and wider community input into the planning and design of services. The recommendations in the report were accepted, in full, by the Government. The abolition of local Healthwatch arrangements, and the transfer of their functions to ICBs and local authorities will require primary legislation. The timing of this is subject to the will of Parliament and will happen when Parliamentary time allows.

When NICE last reviewed its guidance on the (a) availability and (b) prescribing of T3 for the treatment of thyroid cancer; and whether he has plans to improve access to T3 for patients where it is clinically indicated.

The National Institute for Health and Care Excellence (NICE) has not made any recommendations on the use of liothyronine in the treatment of thyroid cancer. NICE published a guideline on the assessment and management of thyroid cancer in December 2022. There are currently no plans to review the guideline.NHS England produced advice for prescribers on the use of liothyronine, otherwise known as T3, in August 2023 that sets out details on those patients that may benefit from T3 and how prescribers can prescribe this medicine to those patients. It recommends liothyronine as part of the management of thyroid cancer in preparation for radioiodine remnant ablation and radioiodine therapy. The advice is available at the following link:https://www.england.nhs.uk/long-read/liothyronine-advice-for-prescribers/We are aware that liothyronine 20 microgram vials will be out of stock from October 2025 until the end of April 2026. NHS England will be issuing national communications containing advice during the period of disruption to supply of the licensed product, outlining the availability of unlicensed imports and other clinical alternatives. NHS England is not aware of any supply issues affecting oral presentations of liothyronine.

Whether her Department has made an assessment of the potential merits of extending the job guarantee scheme for newly qualified nurses and midwives to include (a) occupational therapists, (b) physiotherapists and (c) other allied health professionals.

There are no plans to expand the job guarantee scheme to the professions highlighted, but the Government is committed to supporting all clinical staff in their careers. The new 10 Year Workforce Plan will ensure the National Health Service has the right people in the right places, with the right skills to care for patients, when they need it.

What assessment his Department has made of the role of short-term, unplanned adult social care services in preventing hospital admissions for working-aged adults with (a) learning disabilities and (b) complex needs.

The Government and the National Health Service are working with local authorities and adult social care providers to help keep people well and independent for as long as possible, and to provide alternatives to hospital and care home admissions.We have set out priorities for the NHS and local authorities to begin to move to a neighbourhood health service that delivers more care closer to home and that better supports people with complex needs. We are asking local systems to systematically implement six core components of neighbourhood health, which will help people stay healthy and independent for longer and reduce unnecessary time spent in hospital. This includes integrated intermediate care services to prevent an avoidable hospital admission or as part of hospital discharge planning.NHS Operational Planning Guidance for 2025/26 sets an objective to deliver a minimum 10% reduction in the use of mental health inpatient care for people with a learning disability and autistic people. There is funding in NHS integrated care board baselines this financial year to improve community support provision and reduce reliance on inpatient care for people with a learning disability and autistic people, in line with the NHS Operational Planning Guidance.The Mental Health Bill was introduced in the House of Lords on 6 November 2024. Through our proposed reforms to the Mental Health Act, we want to ensure that people with a learning disability and autistic people get the support they need in the community, improve care, and prevent admission to hospitals.

What steps his Department is taking to support unplanned specialist social care services that help prevent hospital admissions for people with complex needs.

The Government and the National Health Service are working with local authorities and adult social care providers to help keep people well and independent for as long as possible, and to provide alternatives to hospital and care home admissions.We have set out priorities for the NHS and local authorities to begin to move to a neighbourhood health service that delivers more care closer to home and that better supports people with complex needs. We are asking local systems to systematically implement six core components of neighbourhood health, which will help people stay healthy and independent for longer and reduce unnecessary time spent in hospital. This includes integrated intermediate care services to prevent an avoidable hospital admission or as part of hospital discharge planning.NHS Operational Planning Guidance for 2025/26 sets an objective to deliver a minimum 10% reduction in the use of mental health inpatient care for people with a learning disability and autistic people. There is funding in NHS integrated care board baselines this financial year to improve community support provision and reduce reliance on inpatient care for people with a learning disability and autistic people, in line with the NHS Operational Planning Guidance.The Mental Health Bill was introduced in the House of Lords on 6 November 2024. Through our proposed reforms to the Mental Health Act, we want to ensure that people with a learning disability and autistic people get the support they need in the community, improve care, and prevent admission to hospitals.

What steps his Department is taking to help tackle air pollution.

Air pollution is one of the greatest environmental harms to public health. Our 10-Year Health Plan (10YHP) for England sets out how the Government plans to improve the health of the nation, including a focus on prevention of ill health. The plan sets out cross-Government action to tackle air pollution. This includes a review of the Environmental Improvement Plan, which will set out measures to reduce emissions and everyone’s exposure to air pollution.

If he will create a national register for care workers to improve (a) professional recognition and (b) workforce mobility.

We have launched an independent commission into adult social care, chaired by Baroness Casey. The Commission's Terms of Reference are sufficiently broad to enable Baroness Casey to define its remit to independently consider how to build a social care system fit for the future. This includes considering professional registration if the Commission sees fit.There is also work underway to improve professional recognition and workforce mobility.In April 2025, the Department published the expanded and revised Care Workforce Pathway, including a new enhanced care worker role category. These pathway role categories will guide workers in building their careers in adult social care by signposting training and development opportunities, highlighting routes for progression, and giving proper recognition to the highly skilled, complex care and support they provide. Additionally, the Learning and Development Support Scheme, backed this financial year by up to £12 million, funds learning and development opportunities, including learning outcomes outlined in the Care Workforce Pathway. Overall, this work is essential for raising the status of adult social care as a career and recognising the vital work that care professionals do.

If he will commission a review of emergency department staffing models to determine the (a) feasibility and (b) cost-effectiveness of embedding neurology teams in all major trauma centres.

The Department of Health and Social Care has no plans to commission such a review.

What steps his Department is taking to ensure that patients who cannot use the internet retain (a) telephone or (b) in-person routes to (i) book GP appointments and (ii) access triage services.

People unable to access the NHS App or online services, or visit their general practice (GP) in person, can ask for a feature called proxy access available through the NHS App. This function allows a trusted relative or carer to act on the patient’s behalf and can be set up through the patient’s GP surgery, so that they can help them manage their health and care. This is done through a proxy, or linked, account. Depending on the access that the GP surgery has enabled, proxy users may be able to act for the person they support, by ordering repeat prescriptions, booking appointments, viewing test results or vaccinations, and accessing all or part of the GP health record, to help with health-related tasks and managing health issues.While digital health tools like the NHS App offer convenience, they should be part of a wider offering that includes face-to-face support with appropriate help for people who struggle to access digital services.NHS England has published a framework for National Health Service action on digital inclusion and is developing further resources to support practical actions. All programmes are actively considering how they can contribute to improvements in healthcare inequalities and digital inclusion. Digital health tools are part of a wider offering that includes face-to-face support and telephone services, with appropriate help for people who struggle to access digital services.NHS England has successfully run a number of programmes to support patients, carers, and health service staff with their digital skills. These include: - the NHS App ‘Spoken Word’ Pilot project, designed to test the efficacy of promoting NHS digital health products and services in languages other than English;- the Digital Health Champions programme, a proof of concept to support citizens who have no or low digital skills with understanding how to access health services online; and- the Widening Digital Participation programme, aimed to ensure more people have the digital skills, motivation, and means to access health information and services online. GP surgeries also offer patients non-digital methods to manage their primary and secondary healthcare, and these methods usually consist of telephonic communication and letters. Patients can request a non-digital route by registering their preference with their GP surgery.

What recent assessment he has made of the potential impact of digital-first primary care systems on patients without internet access; and what steps he plans to take to reduce digital exclusion in the NHS.

People unable to access the NHS App or online services, or visit their general practice (GP) in person, can ask for a feature called proxy access available through the NHS App. This function allows a trusted relative or carer to act on the patient’s behalf and can be set up through the patient’s GP surgery, so that they can help them manage their health and care. This is done through a proxy, or linked, account. Depending on the access that the GP surgery has enabled, proxy users may be able to act for the person they support, by ordering repeat prescriptions, booking appointments, viewing test results or vaccinations, and accessing all or part of the GP health record, to help with health-related tasks and managing health issues.While digital health tools like the NHS App offer convenience, they should be part of a wider offering that includes face-to-face support with appropriate help for people who struggle to access digital services.NHS England has published a framework for National Health Service action on digital inclusion and is developing further resources to support practical actions. All programmes are actively considering how they can contribute to improvements in healthcare inequalities and digital inclusion. Digital health tools are part of a wider offering that includes face-to-face support and telephone services, with appropriate help for people who struggle to access digital services.NHS England has successfully run a number of programmes to support patients, carers, and health service staff with their digital skills. These include: - the NHS App ‘Spoken Word’ Pilot project, designed to test the efficacy of promoting NHS digital health products and services in languages other than English;- the Digital Health Champions programme, a proof of concept to support citizens who have no or low digital skills with understanding how to access health services online; and- the Widening Digital Participation programme, aimed to ensure more people have the digital skills, motivation, and means to access health information and services online. GP surgeries also offer patients non-digital methods to manage their primary and secondary healthcare, and these methods usually consist of telephonic communication and letters. Patients can request a non-digital route by registering their preference with their GP surgery.

How many Type 1 emergency departments in England currently operate without an on-site neurology service.

In 2021, NHS England’s Getting It Right First Time (GIRFT) programme shared its national specialty report for neurology following deep dive visits to all 24 neuroscience regions, then to the 67 trusts that together deliver neurology services to 139 sites.Data from the report shows that 28% of emergency admissions were at N4 sites, sties with a visiting neurologists only and no on-site service, and a further 4% at N5 sites, sites with no visiting neurologists.Building on the recommendations in the GIRFT national report, the NHS England Neurology Transformation Programme is developing guidance to support integrated care boards and service providers to deliver services for patients with acute neurological conditions efficiently and equitably.Earlier access to expert opinion improves outcomes and allows earlier discharge, reducing lengths of stay and inpatient care costs. Many admissions are potentially avoidable if appropriate ambulatory admission avoidance pathways for acute neurology are put in place.

What assessment his Department has made of the clinical impact of (a) delayed and (b) missed diagnosis of (i) autoimmune encephalitis and (ii) other acute neurological emergencies presenting to emergency departments without neurology cover.

The revised NHS England specialised neurology service specification, published on 13 August, following extensive consultation with clinical and charity partners, states that all patients should have access to acute neurology advice via a networked model of care. The national specialised commissioning team is also developing an integrated care system toolkit to support implementation, which includes acute neurology guidance.

What the median waiting time is for an emergency department patient to receive a consultant neurologist review in hospitals that do not have an on-site neurology team.

The information requested is not held centrally.