Written questions by Hayes.

To which outdoor areas he plans to extend restrictions on smoking.

The Government will soon introduce the Tobacco and Vapes Bill, which stands to be the most significant public health intervention in a generation and will put us on track to a smoke-free United Kingdom.The Government supports measures that will create a smoke-free environment, helping to reduce 80,000 preventable deaths, reduce the burden on the National Health Service, and reduce the burden on the taxpayer. More details will be set out shortly.

How many orthodontists were paid more than £1 million by the NHS in each of the last five years.

Data is not held centrally on the net pensionable earnings paid by the National Health Service to an orthodontist and how many orthodontists were paid more than £1 million by the NHS. Data is published on dentists earnings and expenses, however this does not differentiate between NHS and private earnings or reference orthodontists specifically. This data is available at the following link:https://digital.nhs.uk/data-and-information/publications/statistical/dental-earnings-and-expenses-estimates/2022-23

What powers he has to change the leadership of the General Dental Council.

The General Dental Council (GDC) is the independent regulator of dentistry in the United Kingdom. As an independent body, the GDC is responsible for the discharge of its statutory duties and the Government is unable to direct the GDC’s administrative functions or processes.The GDC is accountable for the discharge of its statutory duties through the requirement for it to submit annual reports to the Privy Council; through scrutiny the Health and Care Select Committee may choose to undertake; and through annual performance reviews by the Professional Standards Authority for Health and Social Care, who can escalate serious or intractable concerns to both Government and Parliament.The Privy Council may make orders which determine the composition of the Council and processes for the appointment of the Chair of the Council, as set out by Schedule 1 of the Dentists Act 1984.

What steps he is taking to ensure that women in need of urgent gynaecologist appointments can be seen in person.

This Government is committed to putting patients first, especially where their health is deteriorating as they wait too long for the care they need. This means making sure that patients are seen on time and prioritised according to need to ensure the best possible care. Providers are responsible for delivering appointments in the most appropriate way for patients. Most hospital attendances happen in person, with only 14.7% of outpatient attendances in 2022/23 delivered remotely in gynaecology.

Whether he plans to maintain free prescriptions for pensioners not in receipt of (a) pension credit and (b) other benefits.

In England, people aged 60 years old and over are entitled to free prescriptions. There are currently no plans to change the upper age exemption or criteria for free prescriptions due to pension credit and other qualifying benefits.Approximately 89% of prescription items are dispensed free of charge in the community in England. For pensioners aged under 60 who are not eligible for exemption from prescription charges help with their health costs may be available through the NHS Low Income Scheme. Prescription prepayment certificates (PPCs) are also available. PPCs allow people to claim as many prescriptions as they need for a set cost, with three-month and 12-month certificates available. The 12-month PPC can be paid for in instalments.

Whether he has had recent discussion with NHS England about improving early detection of Ductal Carcinoma in situ in women.

Improving early diagnosis of cancer, including breast cancer, is a priority for NHS England. NHS England has an ambition to diagnose 75% of cancers at stage 1 or 2 by 2028, which will help tens of thousands of people live longer. The National Health Service in England carries out approximately 2.1 million breast cancer screens each year in hospitals and mobile screening vans, usually in convenient community locations.Ductal carcinoma in situ (DCIS) is usually detected on a mammogram through the breast screening programme. In the United Kingdom, one in five breast cancers found by screening are non-invasive breast cancer, including DCIS. The Department and NHS England have regular ongoing meetings in regard to the breast screening programme and breast cancer awareness.The Department is committed to improving waiting times for cancer patients across England by delivering an extra 40,000 operations, scans, and appointments each week, as the first step to ensuring early diagnosis and faster treatment.

What the cost to the public purse was of staff diversity networks in his Department in each of the last five years.

Department diversity and inclusion staff networks spent a total of £814.40 from 2020/21 to 2023/24, as listed below:- No spend identified in 2020/21;- £198.00 spent in 2021/22;- £500.00 spent in 2022/23; and- £116.40 spent in 2023/24.The spend was in relation to events and seminars, relating to significant dates for diversity and inclusion networks. No information on network spend is available for the year 2019/20 due to a change in our financial and human resources reporting system, where some of the detail was not transferred. Requests for expenditure are managed through the central human resources team where a robust process is applied to ensure impartiality, value, and increasing staff development.

If he will take steps to ensure the supply of pancreatic enzyme replacement therapies for people with cystic fibrosis.

The Department has been working with suppliers to address current supply issues with pancreatic enzyme replacement therapy (PERT), including Creon, used in the treatment of cystic fibrosis and certain cancers, including pancreatic cancer. The supply issues are impacting countries throughout Europe, and have been caused by the limited availability of raw ingredients and manufacturing capacity constraints in producing the volumes needed to meet demand. The Department is continuing to work with all suppliers of PERT to help resolve the supply issues in the short and longer term. This includes asking that they expedite deliveries, source stock from other markets, and increase production.We have issued comprehensive guidance to healthcare professionals about these supply issues, which provides advice on how to manage patients whilst there is disruption to supply. This guidance is being kept under review, and updates will be made as necessary. Serious Shortage Protocols are in place for Creon 10,000 and 25,000 capsules to limit prescriptions to one months’ supply, to allow demand management.We understand how frustrating and distressing medicine supply issues can be. While we can’t always prevent supply issues from occurring, the Department has a range of well-established processes and tools to manage them when they arise, and to help mitigate risks to patients.

If he will take further steps to support hospices providing palliative care services.

We want a society where every person receives high-quality, compassionate care, including at end of life. We understand that, financially, times are difficult for many voluntary and charitable organisations, including hospices, due to the increased cost of living. We want a society where these costs are manageable for both voluntary organisations, like hospices, and the people whom they serve.The Government is going to shift the focus of healthcare out of the hospital and into the community, and we recognise that hospices will play a vital role. We will consider next steps on palliative and end of life care more widely in the coming months.

If he will take steps with NHS England to help improve testing facilities for suspected liver disease in (a) rural and (b) deprived areas.

Early detection of liver disease, including in rural and deprived areas, is vital to enable interventions and encourage behavioural change that can potentially lead to recovery. Liver disease is also one of the primary risk factors for liver cancer.NHS England is ensuring that National Health Service laboratories across the country receive the upgrades to laboratory digital capabilities required to offer Intelligent Liver Function Tests, which are effective at quickly identifying patients at high risk of liver disease and cirrhosis. We will work with the NHS to further support investment into pathology laboratories and the development of national early diagnosis pathways.The Community Liver Health Check programme is delivering Fibroscans and lifestyle advice in the community, from mobile units across many local areas, to identify people at high risk of liver cancer, targeting drug and alcohol service users, homeless people, and people with type 2 diabetes, among others. As of the end of June 2024, the programme has delivered over 61,000 Fibroscans and referred over 4,500 people into liver ultrasound surveillance every six months.The primary care case finding programme, which uses primary care records to identify patients at high risk of cirrhosis and offer them blood tests and Fibroscans, began in 12 primary care networks in January 2024. As of the end of June 2024, the pilot had tested over 8,900 patients, and referred 142 into liver ultrasound surveillance every six months.People from deprived backgrounds are more at risk of liver disease and liver cancer, and these programmes specifically target those with the highest risk, to identify the most in need patients first.

What steps he is taking to help support early diagnosis of liver disease.

Early detection of liver disease, including in rural and deprived areas, is vital to enable interventions and encourage behavioural change that can potentially lead to recovery. Liver disease is also one of the primary risk factors for liver cancer.NHS England is ensuring that National Health Service laboratories across the country receive the upgrades to laboratory digital capabilities required to offer Intelligent Liver Function Tests, which are effective at quickly identifying patients at high risk of liver disease and cirrhosis. We will work with the NHS to further support investment into pathology laboratories and the development of national early diagnosis pathways.The Community Liver Health Check programme is delivering Fibroscans and lifestyle advice in the community, from mobile units across many local areas, to identify people at high risk of liver cancer, targeting drug and alcohol service users, homeless people, and people with type 2 diabetes, among others. As of the end of June 2024, the programme has delivered over 61,000 Fibroscans and referred over 4,500 people into liver ultrasound surveillance every six months.The primary care case finding programme, which uses primary care records to identify patients at high risk of cirrhosis and offer them blood tests and Fibroscans, began in 12 primary care networks in January 2024. As of the end of June 2024, the pilot had tested over 8,900 patients, and referred 142 into liver ultrasound surveillance every six months.People from deprived backgrounds are more at risk of liver disease and liver cancer, and these programmes specifically target those with the highest risk, to identify the most in need patients first.

If he will take steps to improve early diagnosis rates for pancreatic cancer.

Pancreatic cancer is the deadliest common cancer, and earlier diagnosis is imperative in improving treatment options and survivorship. The Government is committed to improving early diagnosis rates for all cancers, and as part of this, supports the NHS Long Term Plan, which includes a principal priority to increase the proportion of cancers diagnosed at stages 1 and 2 to 75% by 2028. This threshold is key to improving outcomes and survival rates for all types of cancer, including pancreatic.We know that pancreatic cancer is difficult to diagnose due to the non-specific nature of its symptoms. To improve diagnosis and outcomes, NHS England is delivering a range of interventions including implementing non-specific symptom pathways for patients who have symptoms that do not align to a tumour type, as is often the case with pancreatic cancer. 96 pathways are in place, and more are being introduced. NHS England is also increasing general practice direct access to diagnostic tests, alongside providing a route into pancreatic cancer surveillance for those at inherited high-risk, to identify lesions before they develop into cancer, and diagnose cancers sooner.Additionally, NHS England’s Getting it Right First Time programme has appointed a team of five specialist clinicians to lead a national review into services for pancreatic cancer patients in England. The new workstream supports the delivery of the Optimal Care Pathway, a Pancreatic Cancer UK-led initiative which has brought together 300 health professionals and people affected to agree on how standards of diagnosis, treatment, and care of those with pancreatic cancer and their families can be improved.

What steps he is taking to increase access to NHS dental services in (a) South Holland and the Deepings constituency and (b) Lincolnshire.

The Government plans to tackle the challenges patients face when trying to access National Health Service dental care with a rescue plan to provide 700,000 more urgent dental appointments, and to recruit new dentists to areas that need them most. To rebuild dentistry in the long term and increase access to NHS dental care, we will reform the dental contract, with a shift to focus on prevention and retention of NHS dentists.We recognise that access to NHS dental care in Lincolnshire has been challenging over recent years. The Lincolnshire Integrated Care Board (ICB), which includes South Holland and the Deepings constituency, has taken a number of steps to help improve access in this area, but we know more must be done. The steps that the Lincolnshire ICB has recently taken to improve access includes uplifting the minimum Unit of Dental Activity rate to £28 across the region, to help recruit and retain staff, and implementing the New Patient Premium.

If he will take steps to improve the (a) diagnosis of and (b) age-appropriate support for young onset dementia.

NHS England is committed to delivering high quality care and support for every person with dementia at every age, and central to this is the provision of personalised care.The Well Pathway for Dementia includes diagnosing well, living well, supporting well, and dying well, and highlights that services need to be integrated, commissioned, monitored, and aligned with the National Institute for Health and Care Excellence’s standards for each component of the pathway. It makes it clear that the needs, wishes, and preferences of each individual, including those with young onset dementia, should be taken into account when planning and providing their care.

What steps he is taking to help raise awareness of liver disease.

Awareness of liver disease can be raised by providing information to the public and by supporting health and care professionals to discuss liver disease with their patients. The NHS.UK website provides the public with essential information on types of liver disease, their possible causes, symptoms, treatment, and prevention. Further information is available at the following link:https://www.nhs.uk/conditions/liver-disease/In May 2022, the Department published guidance for health and care professionals on promoting awareness of liver disease in professional practice. Further information on this guidance is available at the following link:https://www.gov.uk/government/publications/liver-disease-applying-all-our-health/liver-disease-applying-all-our-health#promoting-awareness-of-liver-disease-in-your-professional-practiceFurthermore, the United Kingdom’s clinical guidelines for alcohol treatment, published by the Office for Health Improvement and Disparities for consultation in October 2023, contain clinical guidance and advice for professionals on the early identification of liver disease among people with alcohol use disorders, and on the treatment of alcohol use disorders in people diagnosed with liver disease. Further information on the guidance is available at the following link:https://www.gov.uk/government/publications/liver-disease-applying-all-our-health/liver-disease-applying-all-our-healthThe Department is currently reviewing these guidelines following a consultation.

If he will take steps to increase access to specialist dementia nurses in hospitals.

NHS England is committed to delivering high quality care and support for every person with dementia, and central to this is the provision of personalised care and support planning for post diagnostic support.Provision of dementia health care services is the responsibility of local integrated care boards (ICBs). NHS England would expect the ICBs to commission services based on local population needs, taking account of the National Institute for Health and Care Excellence’s guidelines, and working closely with the third sector in their geographical area to offer appropriate services. Local authorities are required to provide or arrange services that meet the social care needs of the local population, including carers, under the Care Act 2014.