Written questions by Glen.

What progress has been made by his Department in encouraging more reclassification applications to the Medicines and Healthcare products Regulatory Agency (MHRA); whether reclassification applications will form part of the MHRA's forthcoming strategy; and what assessment he has made of the potential impact of reclassification applications on (a) the NHS, (b) patients and (c) the Exchequer.

The Government supports the reclassification of medicines where it is safe and appropriate to do so, as this can improve patient access and support selfcare while maintaining high standards of public health protection. The Medicines and Healthcare products Regulatory Agency (MHRA) actively engages with industry to encourage well evidenced reclassification applications and has updated its guidance and processes to provide greater clarity and efficiency.Reclassification forms part of the MHRA’s wider strategic work to support proportionate regulation and improve access to medicines, including through closer engagement with industry and the use of scientific advice to support high quality applications.Where successful, reclassification can benefit the National Health Service by reducing pressure on primary care services, enable patients to access appropriate treatments more conveniently through pharmacies or over the counter supply, and deliver wider economic benefits by supporting selfcare and reducing unnecessary healthcare utilisation. Each application is assessed on its individual merits to ensure that any reclassification maintains patient safety and delivers overall public benefit.However, reclassification is not appropriate in all circumstances. In particular, where the need for ongoing clinical oversight remains important, or where cost or ability to pay could create barriers to equitable access for some patients, prescription supply through the NHS may remain the most appropriate route. Consideration of patient affordability and health inequalities forms part of the overall assessment of whether reclassification is in the public interest.

What assessment he has made of the potential impact of reclassifying medicines from prescription-only to over-the-counter on costs to the NHS.

The Government supports the reclassification of prescription only medicines (POMs) to over the counter (OTC) medicines, including for cost savings to the National Health Service, where it is safe and appropriate to do so, as this can improve patient access and support selfcare while maintaining high standards of public health protection.Decisions on whether POMs can be safely reclassified for OTC sale are taken by the Medicines and Healthcare products Regulatory Agency following an assessment of the safety, quality, and efficacy of the medicine and whether it can be appropriately used without the direct supervision of a prescriber.

Whether he has made progress on improving spinal cord injury services following the 2016 service review.

While no formal assessment has been made of the potential merits of commissioning local spinal cord injury services, specialist services for spinal cord injury are currently commissioned by NHS England Specialised Commissioning, in line with the service specification published by the Clinical Reference Group.Progress has been made on improving spinal cord injury services following the 2016 review, through, for example, the development of the Getting It Right First Time (GIRFT) Programme for spinal services, which is 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.Additionally, 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.More recently, 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.Our 10-Year Health Plan also sets out a vision for a health and care system that delivers more personalised, integrated, and proactive care for people with long-term and complex conditions, including 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 their spinal cord injuries.

What assessment he has made of the adequacy of the availability of diagnostic and treatment pathways for Spinal Cord Injury across Integrated Care Boards.

While no formal assessment has been made of the adequacy of the availability of diagnostic and treatment pathways for spinal cord injury across integrated care boards (ICBs), NHS England Specialised Commissioning has a Clinical Reference Group (CRG) for rehabilitation and complex disability and spinal cord injury services. Specialist services for spinal cord injuries are commissioned in line with the service specification published by the CRG. 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. The National Institute for Health and Care Excellence (NICE) also has guidance on the assessment and early management of spinal cord injuries, which is available at the following link: https://www.nice.org.uk/guidance/ng41 Additionally, last year, NICE published new guidance on rehabilitation for chronic neurological disorders, which includes rehabilitation for spinal cord injury. While NICE guidelines are not mandatory, the Government expects ICB commissioners to take them fully into account in designing services that meet the needs of their local population and to work towards their implementation over time.

What steps his Department is taking to ensure that expert commissioning knowledge is maintained within the Offices for Pan-ICB Commissioning; and what steps he has taken to prevent a loss of specialist expertise during the staff transfer process.

NHS England is responsible for the design and operation of offices for pan-integrated care board commissioning and for managing associated workforce changes. In implementing these arrangements, NHS England has sought to retain experienced commissioning staff and specialist knowledge to support consistent, high‑quality commissioning across systems. Staff transfers have been managed in line with established employment and transfer arrangements, with a focus on continuity and skills retention. The Department continues to engage with NHS England on the implementation of commissioning reforms.

What guidance he has issued to ICBs on commissioning pathways on access to spinal cord injury services for patients with a spinal cord injury.

While no formal assessment has been made of the adequacy of the availability of diagnostic and treatment pathways for spinal cord injury across integrated care boards (ICBs), NHS England Specialised Commissioning has a Clinical Reference Group (CRG) for rehabilitation and complex disability and spinal cord injury services. Specialist services for spinal cord injuries are commissioned in line with the service specification published by the CRG. 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. The National Institute for Health and Care Excellence (NICE) also has guidance on the assessment and early management of spinal cord injuries, which is available at the following link: https://www.nice.org.uk/guidance/ng41 Additionally, last year, NICE published new guidance on rehabilitation for chronic neurological disorders, which includes rehabilitation for spinal cord injury. While NICE guidelines are not mandatory, the Government expects ICB commissioners to take them fully into account in designing services that meet the needs of their local population and to work towards their implementation over time.

What steps he has taken to ensure that providers of spinal cord injury services are (a) guided by national care pathways, (b) subject to national care standards and (c) report on national outcome measures.

While no formal assessment has been made of the adequacy of the availability of diagnostic and treatment pathways for spinal cord injury across integrated care boards (ICBs), NHS England Specialised Commissioning has a Clinical Reference Group (CRG) for rehabilitation and complex disability and spinal cord injury services. Specialist services for spinal cord injuries are commissioned in line with the service specification published by the CRG. 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. The National Institute for Health and Care Excellence (NICE) also has guidance on the assessment and early management of spinal cord injuries, which is available at the following link: https://www.nice.org.uk/guidance/ng41 Additionally, last year, NICE published new guidance on rehabilitation for chronic neurological disorders, which includes rehabilitation for spinal cord injury. While NICE guidelines are not mandatory, the Government expects ICB commissioners to take them fully into account in designing services that meet the needs of their local population and to work towards their implementation over time.

What assessment he has made of the potential merits of commissioning specialist local spinal cord injury services.

While no formal assessment has been made of the potential merits of commissioning local spinal cord injury services, specialist services for spinal cord injury are currently commissioned by NHS England Specialised Commissioning, in line with the service specification published by the Clinical Reference Group.Progress has been made on improving spinal cord injury services following the 2016 review, through, for example, the development of the Getting It Right First Time (GIRFT) Programme for spinal services, which is 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.Additionally, 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.More recently, 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.Our 10-Year Health Plan also sets out a vision for a health and care system that delivers more personalised, integrated, and proactive care for people with long-term and complex conditions, including 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 their spinal cord injuries.

What discussions he has had with Ministers in the devolved nations regarding establishing a UK wide sodium valproate redress scheme.

Though the Patient Safety Commissioner’s report covered England-only, we recognise that any response by the Government to the recommendations of the Hughes Report in England will likely have implications for the devolved administrations and their constituents.Government officials are therefore working closely with officials across the United Kingdom in considering the recommendations in the Hughes Report. I recently met with my counterparts across the four nations and will continue productive engagement as we progress work in this area.The Department continues to take forward work to explore redress for those affected by pelvic mesh and sodium valproate, which includes recommendations made by the Patient Safety Commissioner in the Hughes Report.We recognise the importance of these issues for all those affected. This remains a cross-Government policy area involving multiple organisations, and given the complexity of the issues involved, it is important we get this right.I also met with the Patient Safety Commissioner in December 2025, to discuss progress following the Hughes Report and have made clear the Department’s expectation of continued, proactive engagement with the Patient Safety Commissioner and key stakeholders.

What steps his Department is taking to help improve coordination between health, education, and social care services for families affected by sodium valproate.

Everyone who has been harmed from sodium valproate has our deepest sympathies.The Independent Medicines and Medical Devices Safety Review, First Do No Harm, identified significant shortcomings in National Health Service care pathways for people harmed by sodium valproate. NHS England has acknowledged variation in the availability and adequacy of care pathways, the impact of delayed diagnosis and misdiagnosis on long-term outcomes, and the need for improved care coordination for those requiring lifelong support, including co-ordination with non-health care services.In response, NHS England has commissioned a Fetal Exposure to Medicines Services Pilot, being delivered by the NHS in Newcastle and Manchester. The pilot provides multidisciplinary diagnostic assessment and is informing the development of improved care pathways, better coordination of care, and reduced reliance on emergency care. Findings from the pilot will inform future decisions on the commissioning of services, subject to funding.In addition, we work closely with the Department for Education and across the Government to ensure co-ordination between health, education, and social care services for children and their families. The Health and Opportunity Missions of the Government highlight the importance of joined up working and integrated delivery.

What steps he is taking to improve (a) levels of access to and (b) the quality of (i) palliative and (ii) end of life care across England.

Palliative care services are included in the list of services an integrated care board (ICB) must commission. To support ICBs in this duty, NHS England has published statutory guidance and service specifications.  The statutory guidance states that ICBs must work to ensure that there is sufficient provision of care services to meet the needs of their local populationsNHS England has also developed a palliative care and end of life care dashboard, which brings together all relevant local data in one place. The dashboard helps commissioners understand the palliative care and end of life care needs of their local population, enabling ICBs to put plans in place to address and track the improvement of health inequalities, and ensure that funding is distributed fairly, based on prevalence.The Department and NHS England are currently looking at how to improve the access, quality, and sustainability of all-age palliative care and end of life care in line with the 10-Year Health Plan.We will closely monitor the shift towards the strategic commissioning of palliative care and end of life care services to ensure that services reduce variation in access and quality, although some variation may be appropriate to reflect both innovation and the needs of local populations.Additionally, through the National Institute for Health and Care Research, the Department is investing £3 million in a Policy Research Unit in Palliative and End of Life Care. This unit, launched in January 2024, is building the evidence base on palliative care and end of life care, with a specific focus on inequalities.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 charitable hospices play as well. This is why we are supporting the hospice sector with a £100 million capital funding boost for eligible adult and children’s hospices in England to ensure they have the best physical environment for care.We are also providing £26 million in revenue funding to support children and young people’s hospices for 2025/26.  I am pleased to confirm the continuation of this vital funding for the next three financial years, from 2026/27 to 2028/29 inclusive. This funding will see approximately £26 million, adjusted for inflation, allocated to children and young people’s hospices in England each year, via their local ICBs on behalf of NHS England, as happened in 2024/25 and 2025/26.  This amounts to approximately £80 million over the next three years.

What progress he has made on improving (a) access to, (b) quality of and (c) sustainability of (i) palliative care and (ii) end of life care for people of all ages through the 10 Year Health Plan, published on 3 July 2025.

Palliative care services are included in the list of services an integrated care board (ICB) must commission. To support ICBs in this duty, NHS England has published statutory guidance and service specifications.  The statutory guidance states that ICBs must work to ensure that there is sufficient provision of care services to meet the needs of their local populations.NHS England has also developed a palliative care and end of life care dashboard, which brings together all relevant local data in one place. The dashboard helps commissioners understand the palliative care and end of life care needs of their local population, enabling ICBs to put plans in place to address and track the improvement of health inequalities, and ensure that funding is distributed fairly, based on prevalence.The Department and NHS England are currently looking at how to improve the access, quality, and sustainability of all-age palliative care and end of life care in line with the 10-Year Health Plan.We will closely monitor the shift towards the strategic commissioning of palliative care and end of life care services to ensure that services reduce variation in access and quality, although some variation may be appropriate to reflect both innovation and the needs of local populations.Additionally, through the National Institute for Health and Care Research, the Department is investing £3 million in a Policy Research Unit in Palliative and End of Life Care. This unit, launched in January 2024, is building the evidence base on palliative care and end of life care, with a specific focus on inequalities.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 charitable hospices play as well. This is why we are supporting the hospice sector with a £100 million capital funding boost for eligible adult and children’s hospices in England to ensure they have the best physical environment for care.We are also providing £26 million in revenue funding to support children and young people’s hospices for 2025/26.  I am pleased to confirm the continuation of this vital funding for the next three financial years, from 2026/27 to 2028/29 inclusive. This funding will see approximately £26 million, adjusted for inflation, allocated to children and young people’s hospices in England each year, via their local ICBs on behalf of NHS England, as happened in 2024/25 and 2025/26.  This amounts to approximately £80 million over the next three years.

Pursuant to the Answer of 23 July 2025 to Question 68387 on Epilepsy and Pregnancy: Sodium Valproate, whether his Department plans to (a) mandate central tracking and annual reporting on how many women (i) received the Pregnancy Protection Porgramme and (ii) signed the risk acknowledgement form.

NHS England has worked collaboratively with the Medicines and Healthcare products Regulatory Agency (MHRA) on the safer use of valproate containing medicines.There are no plans to mandate central tracking and annual reporting on how many women (i) received the Pregnancy Protection Programme and (ii) signed the risk acknowledgement form.This is because such a measure would not be helpful, at an aggregated and anonymised level without a holistic review of each patient’s clinical and social circumstances. This could only be achieved with a national clinical audit. Such audits are expensive and can only be justified when there is significant room for improvement in outcomes, which is not the case in this instance.

How many NHS employees with a declared terminal diagnosis die when in (a) employment and (b) retirement.

Whilst the Department does not hold the information requested, it does hold information on the number of National Health Service staff applications for NHS pension benefits on the grounds of serious ill-health. These pensions may be paid where members of the NHS Pension Scheme are terminally ill and have a life expectancy of less than 12 months.The following table shows the number of applications for serious ill-health pensions accepted by the scheme administrator, the NHS Business Services Authority (NHSBSA), for the last five complete scheme years, and is correct as of 2 September 2025: Scheme YearTotal Applications Accepted2020/212142021/222222022/232582023/242652024/25259Source: NHSBSA Notes: These figures do not include NHS staff who are terminally ill but do not meet the criteria for a serious ill-health pension, those who choose to not apply, and those who are not members of the NHS Pension Scheme. Therefore, the numbers of NHS employees with terminal diagnoses who die in employment and retirement may be greater than those set out in the table.

Pursuant to the Answer of 23 July 2025 to Question 68387 on Epilepsy and Pregnancy: Sodium Valproate, whether his Department is taking steps to guarantee that every female valproate patient aged 13-54 received documented counselling and signs the annual risk form before continuing treatment.

NHS England has worked collaboratively with the Medicines and Healthcare products Regulatory Agency (MHRA) on the safer use of valproate containing medicines.The Medicines and Pregnancy Registry monitors prescribing of valproate and highlights the number of pregnancies potentially exposed to valproate. The Registry is available at the following link: https://tabanalytics.data.england.nhs.uk/t/Public/views/MedsPreg/TitlePage?%3Aembed=y&%3Aiid=1&%3AisGuestRedirectFromVizportal=y.This data demonstrates a reduction in prescribing valproate to women and girls as well as a reduction in the number of possible exposed pregnancies since the Pregnancy Prevention Programme (PPP) was introduced in 2018. Analysis shows the implementation of the PPP by ICBs is consistent across the country.No such guarantee is being pursued. The existing measures described above including the regulatory position is a strong statement of the expected quality of care which is monitored through the Medicines and Pregnancy Registry.

Pursuant to the Answer of 23 July 2025 to Question 68387 on Epilepsy and Pregnancy: Sodium Valproate, what steps his Department is taking to ensure (a) consistent and (b) effective implementation of the Pregnancy Prevention Programme by Integrated Care Boards.

NHS England has worked collaboratively with the Medicines and Healthcare products Regulatory Agency (MHRA) on the safer use of valproate containing medicines and there have been several steps to ensure that integrated care boards (ICBs) lead the implementation of the regulations set out by the MHRA. The agency issued a National Patient Safety Alert on valproate in November 2023, which is available at the following link:https://www.gov.uk/drug-device-alerts/national-patient-safety-alert-valproate-organisations-to-prepare-for-new-regulatory-measures-for-oversight-of-prescribing-to-new-patients-and-existing-female-patients-natpsa-slash-2023-slash-013-slash-mhraThe Medicines and Pregnancy Register monitors prescribing of valproate and highlights the number of pregnancies potentially exposed to valproate. This data demonstrates a reduction in prescribing valproate to women and girls as well as a reduction in the number of possible exposed pregnancies since the Pregnancy Prevention Programme (PPP) was introduced in 2018. Analysis shows the implementation of the PPP by ICBs is consistent across the country. The register is available at the following link:https://tabanalytics.data.england.nhs.uk/t/Public/views/MedsPreg/TitlePage?%3Aembed=y&%3Aiid=1&%3AisGuestRedirectFromVizportal=yOther information available to patients, clinical practitioners and prescribers includes: information from the MHRA; Decision Support Tools and Patient Information leaflets issued by NHS England; and the Valproate Integrated Quality Improvement Programme offered by NHS England. These are available at the following links:https://www.gov.uk/guidance/valproate-reproductive-riskshttps://www.england.nhs.uk/personalisedcare/shared-decision-making/decision-support-tools/https://www.southeastclinicalnetworks.nhs.uk/our-networks/valproate/https://www.england.nhs.uk/patient-safety/sodium-valproate/

Pursuant to the Answer of 23 July 2025 to Question 68387 on Epilepsy and Pregnancy: Sodium Valproate, what his Departments planned timeline is for establishing a centralised register caputring Pregnancy Prevention Programme interventions and acknowledgements, linked to prescribing data.

NHS England has worked collaboratively with the Medicines and Healthcare products Regulatory Agency on the safer use of valproate containing medicines. The best way to a centralised register is through the single patient record and the use of this to populate the federated data platfor, which would allow for the functionality of a centralised register. This is enabled by the Transformation Directorate to ensure that clinical care can be effectively and accurately coded.The Medicines and Pregnancy Register monitors prescribing of valproate and highlights the number of pregnancies potentially exposed to valproate. This data demonstrates a reduction in prescribing valproate to women and girls as well as a reduction in the number of possible exposed pregnancies since the Pregnancy Prevention Programme (PPP) was introduced in 2018. Analysis shows the implementation of the PPP by ICBs is consistent across the country. The register is available at the following link:https://tabanalytics.data.england.nhs.uk/t/Public/views/MedsPreg/TitlePage?%3Aembed=y&%3Aiid=1&%3AisGuestRedirectFromVizportal=y

Pursuant to the Answer of 9 July 2025 to Question HL9069 on Epilepsy and Pregnancy: Sodium Valproate, how many women prescribed Valproate (a) received the pregnancy prevention programme and (b) signed the acknowledgement of risk form.

There is no central record of the number of women who have ‘received’ the Pregnancy Prevention Programme, nor whether they have signed the Annual Risk Acknowledgement Form.Responsibility for the implementation of the new regulatory measures relating to valproate was assigned to integrated care boards (ICBs) in November 2023, via a National Patient Safety alert, which is available at the following link:https://www.gov.uk/drug-device-alerts/national-patient-safety-alert-valproate-organisations-to-prepare-for-new-regulatory-measures-for-oversight-of-prescribing-to-new-patients-and-existing-female-patients-natpsa-slash-2023-slash-013-slash-mhraICBs across the country have taken action in response to this alert. The Cheshire and Mersey ICB is a particular exemplar. NHS England monitors primary care prescribing and the exposure to valproate during pregnancy using the Medicines in Pregnancy Registry, with further information available at the following link:https://tabanalytics.data.england.nhs.uk/t/Public/views/MedsPreg/TitlePage?%3Aembed=y&%3Aiid=1&%3AisGuestRedirectFromVizportal=yThis shows a significant reduction in the number of pregnancies during which valproate may have been taken. In the last six-month reporting period, the data indicates that there were up to 11 pregnancies during which valproate may have been prescribed. This is across a population of approximately 15,000 women between the ages of 13 to 54 years old who are prescribed valproate each month.

When he plans to make a decision on the future of (a) UKHSA Porton Down and (b) the single science hub at Harrow.

On 17 July 2025, my rt. Hon. Friend, the Secretary of State for Health and Social Care, announced that the Government will proceed with plans to develop new state-of-the-art scientific facilities at Harlow, Essex. The move to Harlow will only affect UK Health Security Agency (UKHSA) staff and therefore anyone on the site employed by the Defence Science and Technology Laboratory will be unaffected.The Harlow site, with its proximity to the Oxford-Cambridge Investment Corridor, also represents a significant growth opportunity. Moving UKHSA facilities to the area will unlock opportunities for partnerships with industry and academia.This process will not be immediate. We expect the new site at Harlow to open in stages, beginning in the mid-2030s and concluding by 2038, and therefore given the criticality of the work carried out at both Colindale and Porton Down, these two sites will remain open until that time. UKHSA staff will receive extensive support throughout the next decade on this transition.

What discussions his Department has had with the Treasury on (a) the Hughes Report and the recommendations for valproate, (b) redress for those harmed by sodium valproate.

The Government is carefully considering the work 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 in due course.