Written questions by McDonnell.

What assessment he has made of the potential merits of renegotiating current private finance debt to fund neighbourhood health centres with any potential savings.

Private finance initiative contracts are not held by the Department. Contracts are held between the local National Health Service trust and their respective private finance company.The Department’s Private Finance Centre of Best Practice (CoBP) team, together with the National Infrastructure and Service Transformation Authority, provides expert support and advice to public authorities with private finance initiative contracts, to improve the performance of existing contracts and manage their expiry.The Department focuses on supporting trusts to assess the costs and performance of their contracts, to help maximise support for frontline services and make every penny of our NHS funding count. The Department supports trusts on a case-by-case basis considering all options available whilst maintaining contractual compliance. The contracts were let for a prescribed period of time, with the terms set at the outset with limited areas for renegotiation. The CoPB team, however, continues to assess opportunities to refinance debt where possible and where it would provide value for money.As set out in the 10 Year Infrastructure Strategy (the Strategy) and the 10-Year Health Plan, in addition to significant capital investment, the Government would explore the feasibility of using new Public Private Partnership (PPP) Neighbourhood Health Centres (NHCs).The Budget, published on 26 November 2025, builds on the Strategy and the 10-Year Health Plan by confirming that the NHS Neighbourhood Rebuild Programme will deliver new NHCs through upgrading and repurposing existing buildings and building new facilities through a combination of public sector investment and a new model of PPPs.To ensure the NHC PPPs are managed transparently and are fiscally sustainable, these partnerships will be budgeted for as if they are on a balance sheet.Delivering new NHCs through a combination of public investment and PPPs will also allow, for the first time, for evidence to be built and compared between different delivery models.

What estimate he has made of how much the NHS budget will need to grow to keep pace with patient need, drug prices, inflation and private finance debt in each of the next five years.

The financial pressures and the cost of new commitments for the National Health Service are analysed as part of the Spending Review process. The outcome of the most recent Spending Review is given in the policy paper Spending Review 2025, which is available at the following link:https://www.gov.uk/government/publications/spending-review-2025-document/spending-review-2025-htmlAs set out in the document, this level of funding growth will support the NHS to deliver on the Government's priorities, including delivery of the Government’s Plan for Change commitment, meaning that by the end of this Parliament, 92% of patients will start consultant led treatment for nonurgent conditions within 18 weeks of referral. At the 2025 Autumn Budget, the Government protected the NHS envelope announced at the 2025 Spending Review. This will see the NHS in England receive an over £15 billion real terms increase in annual resource budgets by the end of the period, between 2025/26 and 2028/29.

What are the findings of the department’s business case on new private finance in the NHS.

As set out in the 10 Year Infrastructure Strategy (the Strategy) and the 10-Year Health Plan, in addition to significant capital investment, the Government would explore the feasibility of using new Public Private Partnership (PPP) models for taxpayer-funded projects in very limited circumstances, where they could represent value for money. This included the potential use of PPPs to deliver Neighbourhood Health Centres (NHCs).A business case was developed by the Department and supported by National Infrastructure and Service Transformation Authority (NISTA). The business case was considered by ministers and has resulted in the announcement in the Budget published on 26 November 2025.The Budget builds on the Strategy and the 10-Year Health Plan by confirming that the NHS Neighbourhood Rebuild Programme will deliver new NHCs through upgrading and repurposing existing buildings and building new facilities through a combination of public sector investment and a new model of PPPs.This new PPP model is being developed by NISTA, and is supported by the Department, and will ensure private sector expertise is harnessed to deliver these assets on time and on budget.The new model will build on lessons from the past and other models currently in use, and will draw on lessons learnt, including the National Audit Office’s 2025 report on private finance.To ensure the NHC PPPs are managed transparently and are fiscally sustainable, these partnerships will be budgeted for as if they are on a balance sheet.Delivering new NHCs through a combination of public investment and PPPs will also allow, for the first time, for evidence to be built and compared between different delivery models.

What estimate his Department has made of the potential impact of the changes to income thresholds in the Statement of Changes in Immigration Rules, HC 997, published on 1 July 2025, on the number of people employed on Skilled Worker Visas who no longer have leave to remain.

The Immigration Rules, published on 1 July 2025, set out the wider salary changes across the Skilled Worker route. This increased salary requirement does not apply to the Health and Care Worker visa.From 9 April 2025, the minimum salary for the Health and Care Worker visa, which is part of the Skilled Worker route, increased to £25,000 per year. For healthcare roles that are eligible for the Health and Care Worker visa, the salary threshold is linked to national pay scales for the specific job, or the minimum of £25,000, whichever is higher.Entry level National Health Service Agenda for Change band 3 roles do not meet the new minimum salary threshold for a Health and Care Worker visa. However, Agenda for Change NHS pay band 3 staff currently on the Health and Care Worker visa are not required to meet the new minimum salary threshold until the point at which they need to renew their visa. At this point, we expect the majority of staff to have accrued two or more years’ experience and therefore be at the top of pay band 3, which is above the new minimum salary threshold.The Department continues to monitor trends in the size of the care workforce using a range of intelligence, including monthly tracking based on data collections from independent providers.

If he will provide information on the (a) new Public Private Partnerships and (b) in what way they differ from Private Finance Initiatives.

The Government announced, in the 10 Year Infrastructure Strategy document on the 19 June 2025 and the 10-Year Health plan published on 3 July 2025, that it will explore the feasibility of using new Public Private Partnerships (PPPs) to deliver certain types of primary and community health infrastructure.A decision whether to use PPPs in these circumstances will be taken by the 2025 Autumn Budget, based on the co-development of a model and business case between the National Infrastructure and Service Transformation Authority and the Department. The Department conducted a successful preliminary market engagement exercise over the summer, and this is feeding into the business case, which is still in development.Any new PPP models will be subject to further market-testing and will build on lessons learned from past experience, models currently in use, and the March 2025 National Audit Office report Lessons Learned: private finance for infrastructure.

Which companies have expressed an interest in investing in Public Private Partnerships.

The Government announced in the 10 Year Infrastructure Strategy document, published on 19 June, and its 10 Year Health Plan, published on 3 July, that it will explore the feasibility of using new Public Private Partnerships (PPPs) to deliver certain types of primary and community health infrastructure.A decision whether to use PPPs in these circumstances will be taken in the Autumn Budget 2025, based on co-development of a model and business case between the Department and the National Infrastructure and Service Transformation Authority.Any new model will be market-tested and informed by past lessons and recent Government reviews to ensure better outcomes and value for money.To better understand market appetite and lessons learned from previous PPPs, the Department conducted a successful preliminary market engagement exercise over the course of the summer. We had in excess of 320 interested parties who registered an interest, including advisors, construction, equity, debt, facilities management, and managed service providers. This preliminary market engagement exercise was not inviting expression of interest to invest, instead, it was focused on testing market appetite for a new PPP model and discussing lessons learnt.

If he will take steps to introduce a 24/7 single point of access for (a) palliative and (b) end of life care (i) advice, (ii) guidance and (iii) support.

Integrated care boards (ICBs) are responsible for the commissioning of palliative care and end of life care services, to meet the needs of their local populations. To support ICBs in this duty, NHS England has published statutory guidance and service specifications. The guidance makes specific reference to commissioners defining how their services will meet population needs 24 hour a day, seven day a week, and includes a priority action for ensuring that staff, patients, and carers can access the care and advice they need, whatever time of day.NICE guidance on the service delivery of end of life care for adults also includes recommendations about 24 hour a day, seven day a week access to care. Although NICE guidance is not mandatory, there is an expectation that commissioners and service providers take the guidelines into account when making decisions about how to best meet the needs of their local communities.I have tasked officials to look 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.

With reference to the 10 year health plan, what steps his taking to provide (a) palliative and (b) end of life care in the community.

We want a society where every person receives high-quality, compassionate care from diagnosis through to the end of life.Palliative care services are included in the list of services an integrated care board (ICB) must commission. This promotes a more consistent national approach and supports commissioners in prioritising palliative and end of life care. ICBs, including the Staffordshire and Stoke-on-Trent ICB, which covers the Stafford constituency, are responsible for the commissioning of palliative and end of life care services, to meet the needs of their local populations. To support ICBs in this duty, NHS England has published statutory guidance and service specifications.As set out in the Government’s recently published 10-Year Health Plan, we are determined to shift more care out of hospitals and into the community, to ensure patients and their families receive personalised care in the most appropriate setting. Palliative care and end of life care services, including hospices, will have a big role to play in that shift, and were highlighted in the plan as being an integral part of neighbourhood teams.The Government and the National Health Service will closely monitor the shift towards the strategic commissioning of palliative and end of life care services to ensure that, in future, services reduce variation in access and quality, although some variation may be appropriate to reflect both innovation and the needs of local populations.Officials will present further proposals to ministers over the coming months, outlining how to operationalise the required shifts in palliative care and end of life care to enable the shift from hospital to community, including as part of neighbourhood health teams.

What steps he is taking to help ensure that the 10 year health plan enables equitable access to (a) palliative and (b) end of life care.

Integrated care boards (ICBs) are responsible for the commissioning of palliative and end of life care services, to meet the needs of their local populations. To support ICBs in this duty, NHS England has published statutory guidance and service specifications.One of the three shifts that the 10-Year Health Plan will deliver is the shift of healthcare from the hospital into the community, to ensure patients and their families receive personalised care in the most appropriate setting. Palliative care and end of life care services will have a big role to play in that shift and were highlighted in the plan as being an integral part of neighbourhood teams.I have tasked officials to look at how to improve the access, quality, and sustainability of all- age palliative and end of life care, in line with the 10-Year Health Plan.

What his planned publication date is of the ME/CFS Delivery Plan; and for what reason it has been delayed.

We aim to publish the final delivery plan by the end of June. We have listened to key myalgic encephalomyelitis, also known as chronic fatigue syndrome (ME/CFS), stakeholders to allow for more time to develop the plan and help ensure we can be as ambitious as possible to make the most impact for those living with ME/CFS.It will also enable the final delivery plan to align more closely with wider related Government strategies such as the forthcoming 10-Year Health Plan. The extension to the publication timeline will allow vital further engagement with the ME/CFS Task and Finish Group and those, across Government and beyond, responsible for actions in the final delivery plan. Through this engagement, we will further scope and develop new and stronger actions seeking to deliver meaningful change for the ME/CFS community.

What assessment he has made of the potential impact of the proposed abolition of NHS England on (a) Genomics England and (b) the provision of whole genome sequencing to patients with rare cancers by the NHS Genomics Medicine Service.

Genomics is a powerful healthcare technology, aiding diagnosis and informing treatment for rare diseases and certain cancers.Ministers and senior Department officials will work with the new Executive Team at the top of NHS England, led by Sir Jim Mackey, to jointly lead this transformation. As we work to return many of NHS England’s current functions to the Department, we will ensure that we continue to evaluate impacts of all kinds. Throughout the transition, we will retain our focus on patient care, ensuring continuity of care and that there are no risks to patient safety.In addition, the National Cancer Plan for England will be published in the second half of this year, and will not be adversely affected by the work to bring the two organisations together. The plan will seek to improve every aspect of cancer care to better the experiences and outcomes for people with cancer, including outcomes for people with rare cancers.

Care, if he will ensure that the cross-government delivery plan for ME/CFS will include (a) an apology to patients for their historic treatment and (b) clear steps that demonstrate his commitment to delivering a new approach.

The content of the myalgic encephalomyelitis, also known as chronic fatigue syndrome (ME/CFS), delivery plan has not yet been finalised. The responses to the 2023 interim delivery plan consultation, along with continued close engagement with stakeholders, will inform the development of the final ME/CFS delivery plan, which we aim to publish in the coming months. The plan will focus on boosting research, improving attitudes and education, and bettering the lives of people with this debilitating disease.People with ME/CFS deserve the most appropriate treatment and to be confident that the National Health Service can offer that treatment. I recognise that care for people with ME/CFS has varied widely, and in the worst cases has left some people feeling that their illness is not recognised by the health and care system. We know that more research, better services, and a better understanding of the condition all have the potential to make a huge difference to the quality of life of people with ME/CFS.

Whether steps to strengthen care for (a) ME, (b) Long Covid and (c) other infection-associated chronic conditions will be included in plans to bolster the UK’s preparedness for future pandemics.

Ensuring that the United Kingdom is prepared for a future pandemic is a top priority for the Government, and we are embedding lessons from the COVID-19 pandemic in our approach to pandemic preparedness. We aim to have flexible, adaptable, and scalable capabilities that can respond to any infectious disease or other threat, rather than relying on plans for specific threats.The Government’s response to module one of the COVID-19 inquiry sets out the changes we have made to risk planning and data management to help ensure that we are reducing any disproportionate impacts on any groups or individuals, and targeting support where it can be of best help in civil emergency planning and management. The response is available at the following link:https://www.gov.uk/government/publications/uk-government-response-to-the-covid-19-inquiry-module-1-reportThe Government is committed to ensuring that there are quality services for people suffering with long COVID in every part of the country. NHS England has invested significantly in supporting people with long COVID. This includes setting up specialist post-COVID-19 services nationwide for adults, and children and young people, developing digital self-management tools, and investing in ensuring that general practice teams are equipped to support people affected by the condition.The Government has also invested over £57 million into long COVID research. This aims to improve our understanding of the diagnosis and underlying mechanisms of the disease and the effectiveness of both pharmacological and non-pharmacological therapies and interventions, and to evaluate clinical care.

Whether he has made an assessment with Cabinet colleagues of the potential impact of (a) debt collection practices and (b) the use of bailiffs by (i) private companies, (ii) local authorities and (iii) other public bodies on the mental health of people in financial difficulties.

We recognise the effect that debt collection practices and the use of bailiffs can have on some people’s mental health. That is why we have worked with colleagues at HM Treasury and the Money and Pensions Service to promote the mental health Breathing Space scheme, which gives those with mental ill health facing financial difficulties space to receive debt advice, without pressure from creditors or mounting debts.

If he will include an expansion of (a) radiology and (b) oncology speciality training places in the next iteration of the Long Term Workforce Plan.

We are committed to training the staff we need, including radiologists and oncologists, to ensure patients are cared for by the right professional, when and where they need it.We will ensure that the number of medical specialty training places meets the demands of the National Health Service in the future. NHS England will work with stakeholders to ensure that any growth is sustainable and focused in the service areas where need is greatest.This summer we will publish a refreshed Long Term Workforce Plan to deliver the transformed health service we will build over the next decade, and treat patients on time again. We will set out next steps in due course.

What plans his Department has to increase speciality training places in (a) radiology and (b) oncology.

We are committed to training the staff we need, including radiologists and oncologists, to ensure patients are cared for by the right professional, when and where they need it.We will ensure that the number of medical specialty training places meets the demands of the National Health Service in the future. NHS England will work with stakeholders to ensure that any growth is sustainable and focused in the service areas where need is greatest.This summer we will publish a refreshed Long Term Workforce Plan to deliver the transformed health service we will build over the next decade, and treat patients on time again. We will set out next steps in due course.

If he will make an assessment of the potential merits of requiring NHS trusts to develop long-term plans for the (a) cancer and (b) diagnostic workforce including (i) training and (ii) consultant posts.

The Government recognises that a cancer-specific approach is needed to meet the challenges in cancer care, and to improve outcomes for people living with cancer. Following publication of the 10-Year Health Plan, we will publish a new national cancer plan, which will include further details on how we will improve outcomes for cancer patients. We will continue to ensure that we train the staff we need to ensure patients are cared for by the right professional, when and where they need it, and the cancer plan will reflect this.In summer 2025, we will publish a refreshed Long Term Workforce Plan to deliver the transformed health service we will build over the next decade and treat patients on time again. We will ensure the National Health Service has the right people, in the right places, with the right skills to deliver the care patients need when they need it.

What assessment he has made of the potential impact of recruitment freezes in the NHS diagnostics workforce on plans to ensure same day scan results in Community Diagnostic Centres.

We are aware of cases where trusts have put recruitment restrictions in place for diagnostic services. How systems and trusts resource plan internally within their budgets is a matter for local discretion, and as such we will not be taking action at a national level.The National Health Service is committed to maintaining timely and high-quality diagnostic services, including delivering same-day scan results in Community Diagnostic Centres wherever possible.As set in the Elective Reform Plan, published in January 2025, we will introduce more straight-to-test pathways, deliver the optimal standards of tests per hour, and make better use of technology, including by upgrading the NHS app. These initiatives intend to drive efficiencies within diagnostic pathways and support patients to be tested more quickly, using existing capacity.Investment in recent years has also enabled the NHS to grow the diagnostics workforce. This includes an increase in the number of specialty training places for key roles, such as radiologists, radiographers, and other diagnostic professionals, alongside initiatives to improve retention and reduce reliance on outsourcing.This summer we will publish a refreshed Long Term Workforce Plan, to deliver the transformed health service we will build over the next decade and treat patients on time again. We will ensure the NHS has the right people, in the right places, with the right skills to deliver the care patients need when they need it.

If he will ensure that a code is created for myalgic encephalomyelitis in the SNOMED CT classification system in primary care.

Codes are created for SNOMED CT by one of the following organisations:- UK National Release Centre (NRC), hosted by the Technology and Information Standards (TIS) group in NHS England;- SNOMED International, a not-for-profit organisation that owns, administers and develops SNOMED CT;- any other NRC in any other SNOMED CT member country.All requests made to NHS England must be compliant with the Editorial Policy and are processed in accordance with the SNOMED CT UK Edition Governance and Change Request Process. Concepts are added or changed in SNOMED CT by NHS England terminologists in line with International and UK Editorial Principles as defined by SNOMED International at the recommendation of international clinical advisory groups. The authoring process includes a technical quality assurance and peer review. Once the authoring process has been completed and quality assured, the files are published on the Terminology Reference data Update Distribution website.There is currently a code in SNOMED CT for myalgic encephalomyelitis. The Fully Specified Name (FSN) is ‘Chronic fatigue syndrome (disorder)’. The FSN for a code is not intended for use by a clinician. Instead, a clinician is expected to make use of the synonyms for the code, which include myalgic encephalomyelitis.Clinical systems usually display a ‘preferred term’, deemed to be the most clinically appropriate way of expressing a concept. The preferred term for the code ‘Chronic fatigue syndrome (disorder)’ is ‘Chronic fatigue syndrome’.NHS England is reviewing the preferred term to align it with the current most clinically appropriate term for the UK, with the preferred term ‘ME/CFS - myalgic encephalomyelitis/ chronic fatigue syndrome’ being considered.

How codes are created for the SNOMED CT classification system in primary care.

Codes are created for SNOMED CT by one of the following organisations:- UK National Release Centre (NRC), hosted by the Technology and Information Standards (TIS) group in NHS England;- SNOMED International, a not-for-profit organisation that owns, administers and develops SNOMED CT;- any other NRC in any other SNOMED CT member country.All requests made to NHS England must be compliant with the Editorial Policy and are processed in accordance with the SNOMED CT UK Edition Governance and Change Request Process. Concepts are added or changed in SNOMED CT by NHS England terminologists in line with International and UK Editorial Principles as defined by SNOMED International at the recommendation of international clinical advisory groups. The authoring process includes a technical quality assurance and peer review. Once the authoring process has been completed and quality assured, the files are published on the Terminology Reference data Update Distribution website.There is currently a code in SNOMED CT for myalgic encephalomyelitis. The Fully Specified Name (FSN) is ‘Chronic fatigue syndrome (disorder)’. The FSN for a code is not intended for use by a clinician. Instead, a clinician is expected to make use of the synonyms for the code, which include myalgic encephalomyelitis.Clinical systems usually display a ‘preferred term’, deemed to be the most clinically appropriate way of expressing a concept. The preferred term for the code ‘Chronic fatigue syndrome (disorder)’ is ‘Chronic fatigue syndrome’.NHS England is reviewing the preferred term to align it with the current most clinically appropriate term for the UK, with the preferred term ‘ME/CFS - myalgic encephalomyelitis/ chronic fatigue syndrome’ being considered.