Written questions by Robertson.

Pursuant to the Answer of 4 March 2025 to Question 32576 on Fires: Air Pollution, whether the UK Health Security Agency and its predecessor has made an assessment of the impact of air pollution caused by backyard burning of domestic waste on public health.

The UK Health Security Agency (UKHSA), formerly Public Health England, has published systematic reviews of the epidemiological studies on the health impacts associated with outdoor and indoor exposure to solid fuel burning. This included biomass and coal, and respiratory diseases in children and adults. The evidence suggests that burning solid fuels indoors could contribute to the risk of chronic obstructive pulmonary disease and lung cancer in adults, while the evidence for other respiratory effects is less clear. The results regarding outdoor exposure and the health effects were too limited to draw firm conclusions.The evidence of links between exposure to air pollution and a wider range of health effects, such as adverse birth outcomes, diabetes, and increased dementia risk, also continues to build, with varying strengths of evidence. This was noted in the Chief Medical Officer’s Annual Report on air pollution 2022, which the UKHSA contributed to. This report is available at the following link:https://www.gov.uk/government/publications/chief-medical-officers-annual-report-2022-air-pollution

What discussions he has had with the National Institute for Health and Care Excellence on health technology assessment methods for evaluating novel therapies for Alzheimer's disease.

Department officials have regular discussions with the National Institute of Health and Care Excellence (NICE) about a range of topics, including its health technology assessment methods.The NICE develops its guidance independently on the basis of an assessment of the available evidence, in line with its published health technology evaluation manual. The NICE keeps its methods and processes under review to ensure that they are appropriate to emerging new treatments and aligned with best practice.The NICE has established a Health Technology Assessment Innovation Laboratory (HTA Lab) that aims to address the challenges that may arise in the assessment of innovative health technologies.The NICE’s HTA Lab carried out a project to identify the key issues that are likely to emerge during the evaluation of the disease modifying treatments for dementia, including those licensed for Alzheimer’s disease. The project concluded that the NICE’s current approach and methods are appropriate for evaluating these treatments. The report is available at the following link:https://www.nice.org.uk/about/what-we-do/our-research-work/hta-lab-projects#dmdts

What assessment his Department has made of the effectiveness of the Innovative Medicines Fund in providing access to non-cancer medicines.

The Innovative Medicines Fund was launched in June 2022, building on the successful Cancer Drugs Fund and supporting patient access to the most promising new medicines while further evidence is collected on their use to address clinical uncertainty.Since the fund’s establishment in June 2022, over 1,050 patients have been registered to receive treatment with 16 products treating 16 different conditions. NHS England has made interim funding available via the fund for 14 products, and two products have been recommended for managed access across three indications in the fund.A high proportion of topics assessed by the National Institute for Health and Care Excellence as having potential for managed access have gone on to secure a positive recommendation for routine commissioning, bypassing the need for further data collection and reappraisal through the fund. The National Institute for Health and Care Excellence’s overall approval rate for non-cancer medicines is very high, with 88% of all of medicines it has evaluated recommended for National Health Service funding for some of or all the eligible patient population.

How many non-cancer medicines have been approved for use by the Innovative Medicines Fund in each year since June 2022.

The following table shows the number of non-cancer medicines that have been approved for use by the Innovative Medicines Fund, broken down by those available via managed access agreements and interim funding agreements:YearManaged accessInterim funding2022/23--2023/24-42024/25310Source: NHS England.The National Institute for Health and Care Excellence’s overall approval rate for non-cancer medicines is very high, with 88% of all of medicines it has evaluated recommended for National Health Service funding for some or all of the eligible patient population.

Whether his Department has produced an impact assessment on the potential impact of reducing the proportion of the NHS budget allocated to mental health services.

For 2025/26, mental health spending is forecast to amount to £15.6 billion. This represents a significant spending uplift of £320 million in real terms on mental health compared to the previous financial year.In addition, integrated care boards are forecast to meet the Mental Health Investment Standard over the 2025/26 financial year, meaning that local health services will invest a greater share of their budgets into frontline mental health services.No formal impact assessment has been made, as mental health spending is forecast to be almost exactly the same as it was for 2024/25, with a small reduction of just 0.07% in the share of recurrent National Health Service spending for 2025/26. This change is driven by additional investment in the NHS to support elective recovery, and by investment to improve general practice and pharmacy services and meet the rising costs of new medicines and medical devices.

What assessment his Department has made of the potential impact of the recent National Living Wage increase and National Insurance Contributions rise on the financial viability of community equipment providers.

At the 2024 Autumn Budget, the Government announced a £22.6 billion increase in day-to-day health spending and a £3.1 billion increase in the capital budget over financial years 2024/2025 and 2025/2026. Departmental budgets beyond 2025/26 will be set through phase two of the Spending Review, which will conclude and be published in June 2025.The rise in employer National Insurance contributions (ENIC) will be implemented from April 2025, and NHS England has published planning guidance setting out the funding available to integrated care boards and the overall approach to funding for National Health Service providers in the next financial year, which takes account of a variety of pay and non-pay factors and pressures on providers of secondary healthcare. The NHS Payment Scheme is equally applicable to NHS and non-NHS providers of secondary healthcare, and published national prices include an estimate of ENIC costs.Local NHS procuring authorities, whether integrated care boards or NHS providers, are responsible for discussing and agreeing contracts with community equipment providers, which will take into account the resources available to them. Economic growth is the Government’s number one mission, and the Government supports businesses to invest, grow, and export, creating jobs and opportunities across the country. To support the growth mission, the Government is driving forward work to implement a modern Industrial Strategy, to reset trade relations, to support small business, and to deliver a new deal for working people.

What steps his Department is taking to support community equipment providers in managing rising operational costs while ensuring continued service provision.

At the 2024 Autumn Budget, the Government announced a £22.6 billion increase in day-to-day health spending and a £3.1 billion increase in the capital budget over financial years 2024/2025 and 2025/2026. Departmental budgets beyond 2025/26 will be set through phase two of the Spending Review, which will conclude and be published in June 2025.The rise in employer National Insurance contributions (ENIC) will be implemented from April 2025, and NHS England has published planning guidance setting out the funding available to integrated care boards and the overall approach to funding for National Health Service providers in the next financial year, which takes account of a variety of pay and non-pay factors and pressures on providers of secondary healthcare. The NHS Payment Scheme is equally applicable to NHS and non-NHS providers of secondary healthcare, and published national prices include an estimate of ENIC costs.Local NHS procuring authorities, whether integrated care boards or NHS providers, are responsible for discussing and agreeing contracts with community equipment providers, which will take into account the resources available to them. Economic growth is the Government’s number one mission, and the Government supports businesses to invest, grow, and export, creating jobs and opportunities across the country. To support the growth mission, the Government is driving forward work to implement a modern Industrial Strategy, to reset trade relations, to support small business, and to deliver a new deal for working people.

What discussions he has had with representatives from the community equipment sector on the potential impact of costs on service availability and patient access.

At the 2024 Autumn Budget, the Government announced a £22.6 billion increase in day-to-day health spending and a £3.1 billion increase in the capital budget over financial years 2024/2025 and 2025/2026. Departmental budgets beyond 2025/26 will be set through phase two of the Spending Review, which will conclude and be published in June 2025.The rise in employer National Insurance contributions (ENIC) will be implemented from April 2025, and NHS England has published planning guidance setting out the funding available to integrated care boards and the overall approach to funding for National Health Service providers in the next financial year, which takes account of a variety of pay and non-pay factors and pressures on providers of secondary healthcare. The NHS Payment Scheme is equally applicable to NHS and non-NHS providers of secondary healthcare, and published national prices include an estimate of ENIC costs.Local NHS procuring authorities, whether integrated care boards or NHS providers, are responsible for discussing and agreeing contracts with community equipment providers, which will take into account the resources available to them. Economic growth is the Government’s number one mission, and the Government supports businesses to invest, grow, and export, creating jobs and opportunities across the country. To support the growth mission, the Government is driving forward work to implement a modern Industrial Strategy, to reset trade relations, to support small business, and to deliver a new deal for working people.

Whether the review of postgraduate medical training will be carried out in full.

The postgraduate medical training review announced by the Chief Medical Officer for England and National Medical Director of NHS England is underway and on track. NHS England launched an extensive engagement and listening exercise to consider the future of postgraduate medical training in February 2025. This engagement exercise will run through to June, with findings evaluated and reported in the summer.

What steps he is taking to reduce the use of temporary care environments in patient care.

The Government recognises that long waits in accident and emergency departments are unacceptable and lead to worse patient outcomes. Patients should expect and receive the highest standard of service, and we are determined to tackle the issue of corridor care.NHS England published guidance in September 2024 regarding the use of temporary escalation spaces, which is available at the following link:https://www.england.nhs.uk/long-read/principles-for-providing-safe-and-good-quality-care-in-temporary-escalation-spaces/In January 2025, the NHS England mandate and operational planning guidance for 2025/26 were published. These set out the priorities and actions to be taken to reform and improve urgent and emergency care services. This includes increasing the proportion of patients admitted, discharged, and transferred from emergency departments within 12 hours across 2025/26 compared to 2024/25.We will shortly set out the further improvements and actions to be taken to support urgent and emergency care services this year.

What assessment he has made of the potential merits of publishing year-round data on the number of patients treated in temporary care environments.

We continue to keep the data which is available and published to support improvements to urgent and emergency care services under review.NHS England has been working with trusts since last year to put in place new reporting arrangements related to the use of temporary escalation spaces, like corridors, in order to drive improvement. Subject to a review of data quality, this information will be published later this year, and we will consider how this data could be published on a more regular basis.

What steps he is taking to ensure that the NHS Health Check digitisation (a) reaches all communities equitably and (b) does not exacerbate health inequalities for dementia.

The NHS Health Check Online service is being developed to improve access and engagement with the cardiovascular disease (CVD) prevention programme by enabling people to take a check at home, at a time convenient to them. The digital service will complement the face-to-face programme and is based on extensive user research and behavioural insight to ensure the service meets user needs.Increasing uptake in the NHS Health Check Programme through the new online service, for those who are willing and able to do so, will free up primary care capacity to target resources towards underserved groups at the highest risk of CVD.A six-month pilot in three local authorities will begin from spring 2025, and, as part of the independent evaluation, we will examine the impact on health inequalities. The results of this will inform the development and rollout of the online service in future.The online service will follow the same assessments and criteria as the current service, signposting people to behavioural support, such as smoking cessation, and clinical management where appropriate. This includes making people aware of the signs and symptoms of dementia and being signposted to memory services as appropriate.

What steps his Department is taking to (a) expand capacity in dementia diagnostics and (b) facilitate access to new dementia treatments when available.

The Government is committed to transforming diagnostic services and will support the National Health Service to increase diagnostic capacity to meet the demand for diagnostic services through investment in new capacity, including magnetic resonance imaging and computed tomography scanners. Our Elective Reform Plan, published in January 2025, builds on the investments already made with an ambitious vision for the future of diagnostic testing. This will include more straight-to-test pathways, increasing and expanding community diagnostic centres (CDCs) and better use of technology. With 170 community diagnostic centres (CDCs) due to be up and running by the end of March 2025, CDCs can take on more of the growing diagnostic demand within elective care. We will also deliver additional CDC capacity in 2025/26 by expanding several existing CDCs and building up to five new ones. NHS England has a dedicated team in place which has been planning for the roll out of new treatments for Alzheimer’s disease, if and when they are approved for use. To prepare for the new generation of dementia treatments in development, NHS England is working to ensure the diagnostic and treatment capacity, clinical pathway redesign and investment are in place to support the adoption of any new licensed and National Institute of Health and Care Excellence (NICE) recommended treatments as soon as possible.NICE and the Medicines and Healthcare products Regulatory Agency have piloted enhanced information sharing arrangements for new disease-modifying treatments enabling the organisations to fully align their processes and make faster decisions on the use of these medicines within the NHS in England.

What steps he is taking to (a) pilot and (b) support the adoption of new diagnostic tools for dementia (i) including blood tests and (ii) generally.

The Government is committed to transforming diagnostic services and will support the National Health Service to increase diagnostic capacity to meet the demand for diagnostic services through investment in new capacity, including magnetic resonance imaging and computed tomography scanners.The Department funds research into dementia via the National Institute for Health and Care Research (NIHR). Alongside Alzheimer’s Research UK, Alzheimer’s Society and the People’s Postcode Lottery, the NIHR is funding the Blood Biomarker Challenge which seeks to produce the clinical and economic data that could make the case for the use of a blood test in the NHS to support diagnosis of dementia.

What steps his Department is taking to increase the availability of (a) CT and (b) MRI scans for diagnosing Alzheimer’s disease.

The Government is committed to transforming diagnostic services and will support the National Health Service to increase diagnostic capacity to meet the demand for diagnostic services through investment in new capacity, including magnetic resonance imaging and computed tomography scanners.Our Elective Reform Plan, published in January 2025, builds on the investments already made with an ambitious vision for the future of diagnostic testing. This will include more straight-to-test pathways, increasing and expanding community diagnostic centres (CDCs) and better use of technology.With 170 CDCs due to be up and running by the end of March 2025, CDCs can take on more of the growing diagnostic demand within elective care. We will also deliver additional CDC capacity in 2025/26 by expanding several existing CDCs and building up to five new ones.

What steps he is taking to help tackle dementia cases which could be (a) prevented and (b) delayed by addressing modifiable risk factors.

For most people, their local general practice surgery is the first port of call when a health problem starts, so excellent primary care is the key to unlocking timely diagnosis of progressive health conditions like dementia.The NHS Health Check aims to prevent heart disease, stroke, kidney disease, and some cases of dementia among adults aged between 40 and 74 years old. Through the check, people aged between 65 and 74 years old should be made aware of the signs and symptoms of dementia and be signposted to memory services as appropriate.The Government is investing in dementia research across all areas, from causes, diagnosis and prevention to treatment, care and support, including for carers.

What the average waiting time from referral to diagnosis has been for people being referred to memory assessment services in the last five years.

A timely diagnosis is vital to ensuring that a person with dementia can access the advice, information, care, and support that can help them to live well and remain independent for as long as possible.The Government is committed to transforming diagnostic services, including the detection and diagnosis of dementia, and will support the National Health Service to increase capacity to meet the demand for diagnostic services. The Government and NHS England remain committed to recovering the dementia diagnosis rate to the national ambition of 66.7%.The Dementia Care Pathway: Full Implementation Guidance, commissioned by NHS England, outlines the dementia care pathway and associated benchmarks to support improvements in the delivery and quality of care and support, for people living with dementia and their families and carers. The guide showcases good-practice examples of services that have successfully reduced their waiting times. Further information is available at the following link:https://www.rcpsych.ac.uk/docs/default-source/improving-care/nccmh/dementia/nccmh-dementia-care-pathway-full-implementation-guidance.pdfTo support recovery of the dementia diagnosis rates and implementation of the Dementia Care Pathway, NHS England has developed a dashboard for management information purposes. The aim is to support commissioners and providers of memory services with appropriate data and enable targeted support where needed.

What the annual average integrated care board spend on memory assessment services has been for each year between 2014 and 2024.

It is the responsibility of integrated care boards (ICBs) to work with the third sector in their geographical area to offer services that meet the needs of their population. NHS England would expect ICBs to take account of the National Institute for Health and Care Excellence’s guidelines when commissioning services for their local population.

Whether he plans to establish a full investigation into exploitation within social care.

We have seen unacceptable increases in unethical practices and exploitation in the adult social care sector. The Government is delivering legislation to improve employment rights, and the Fair Work Agency in the Employment Rights Bill will bring together existing state enforcement functions and, over time, take on enforcement of a wider range of employment rights.The Department also continues to work closely with regulators, local authorities, other departments, and enforcement bodies to share concerns and intelligence about illegal or unethical practices in adult social care. The Gangmasters and Labour Abuse Authority investigates reports of worker exploitation and illegal activity, such as human trafficking, modern slavery, forced labour, as well as offences under the National Minimum Wage Act, working with HM Revenue and Customs, and the Employment Agencies Acts, working with the Employment Agency Standards Inspectorate. The Home Office has also begun delivery of new measures, meaning that any business employing overseas workers found guilty of serious employment law breaches, such as failing to comply with National Minimum Wage, will have action taken against them, up to and including having their visa sponsorship licences refused or revoked.

What steps his Department is taking to support research and innovation into Creutzfeldt-Jakob disease.

The Department funds research through the National Institute of Health and Care Research (NIHR). Since 2002, the Department has made available over £43 million of funding for research and surveillance of Creutzfeldt-Jakob Disease (CJD) and prion diseases including into the treatment and testing for CJD and mitigation strategies to reduce the risk of secondary transmission of the disease. The NIHR welcomes research proposals on all aspects of human health including CJD and prion disease. Research applications are subject to peer review and judged in open competition, with awards being made based on the importance of the topic to patients and health and care services, value for money and scientific quality.