Written questions by Reynolds.

What data his Department holds on average working hours for midwives at NHS trusts serving the Maidenhead constituency; and what consideration he has given to introducing legal limits on midwives' working hours to help improve workforce retention and patient safety.

The Department has access to very limited data on paid working hours under an individual’s substantive contract. This data is not a reliable way to measure average working hours since it leaves out work done through bank or agency roles, any work outside the hospital and community health services sector, and “discretionary” work that is unpaid.Employers have a duty of care to consider staff rights and wellbeing when balancing the demands of around the clock care in the best interest of patients and the rules around working hours, rest breaks, and paid leave as set out in the Working Time Regulations 1998. In general, the safeguards relating to working hours under National Health Service staff terms and conditions of service are stronger than the legal minimums. Working hours and shift expectations are made clear in employees’ contracts of employment. Certain exemptions may apply during emergencies or other unforeseeable events, allowing some rules to be changed or excluded under collective agreements. Employers have local arrangements agreed with trade unions and staff, to address modifications in the event of emergencies.

What steps he plans to take to ensure that the final statutory guidance issued under the Down Syndrome Act 2022 includes explicit requirements for Down syndrome-specific training for professionals in health, education and social care sectors.

Under the Down Syndrome Act, my Rt Hon. Friend, the Secretary of State for Health and Social Care, is required to give statutory guidance to relevant authorities in health, social care, education, and housing services on what they should be doing to meet the needs of people with Down syndrome. The consultation on the draft guidance was launched on 5 November 2025 and will remain open until 30 March 2026.Relevant authorities, as defined in the schedule to the act, have a duty to have due regard to the final guidance once it is published. The act does not create any new functions beyond this duty. Rather, it brings together existing statutory requirements and guidance that relevant authorities must and/or should already be complying with to support people with Down syndrome and people with other conditions and/or a learning disability who have similar needs.Under existing legislation, Care Quality Comision registered providers must ensure that staff receive appropriate professional development which is necessary for them to carry out their duties and must receive specific training on learning disability and autism appropriate to their role, as per Section 20 of the Health and Social Care Act 2008, Section 181(7) of the Health and Care Act 2022 and Regulation 18 of the Health and Social Care Act 2008 Regulated Activities) Regulations 2014. We expect that providers should be considering whether specific training on Down syndrome is required for their staff, and the draft guidance under the Down Syndrome Act sets out that some staff who work frequently with people with Down syndrome may require additional training on Down syndrome.

What progress has been made in implementing workforce recommendations from the National Maternity and Neonatal Taskforce; and what measures are being taken to help tackle (a) midwife burnout and (b) midwifes working too many hours at maternity services serving Maidenhead constituents.

The health and wellbeing of our National Health Service staff, including midwives, is a top priority.The independent National Maternity and Neonatal Investigation, chaired by Baroness Amos, is expected to publish findings in the Spring. My Rt Hon. Friend, the Secretary of State for Health and Social Care, will chair the National Maternity and Neonatal Taskforce to address the recommendations and develop a new national action plan to drive improvements across maternity and neonatal care.As set out in the 10-Year Health Plan, we will work with the Social Partnership Forum to introduce a new set of staff standards for modern employment.It is for local NHS trusts to determine what working patterns may be required to meet local service needs in the interest of patients, considering the provisions set out in the Working Time Regulations 1998.

What assessment he has made of the fairness of the current means tested social care system for people with dementia in cases where individuals are required to sell their homes or exhaust lifetime savings to fund care.

The adult social care system is means tested and provides funded support for those with the least financial means. While the Department sets the minimum thresholds for accessing local authority support, local authorities have the discretion to set more generous thresholds if they choose.Individuals are not required to sell their home to pay for care if they, their spouse, or another eligible relative still lives there, as the property is disregarded in the financial assessment. In cases where a person’s property is included in the financial assessment, the universal deferred payment agreement (DPA) scheme means that the person should not be forced to sell their home in their lifetime to pay for their care. By entering into a DPA, a person can defer paying the costs of their care and support in a care home until a later date.The Government has launched an Independent Commission into adult social care as part of our critical first steps towards delivering a National Care Service. The commission will deliver recommendations for the transformation of adult social care, addressing demographic change, how services should be organised to deliver this, and how to best create a fair and affordable adult social care system.

What steps he is taking to prevent sudden cardiac deaths in people aged 35 and under.

To reduce the risks of sudden cardiac death, NHS England has published a national service specification for inherited cardiac conditions which includes services for young adults with previously undiagnosed cardiac disease. NHS England is currently reviewing this service specification and is working with a broad range of stakeholders as part of the review.

Whether he will review the current eligibility criteria for NHS-funded COVID-19 vaccinations, in light of the emergence of a new variant and rising hospitalisations.

The Joint Committee on Vaccination and Immunisation carefully considered the latest evidence on the risk of hospitalisation and mortality in specific groups, as well as cost-effectiveness analysis, in order to provide the Government with advice on the autumn 2025 programme. The evidence indicates that whilst the risk from COVID-19 is now much lower for most people, adults aged 75 years old and over, residents in care homes for older adults, and those who are immunosuppressed are those at highest risk of serious COVID-19 disease.Therefore, a more targeted vaccination programme aimed at individuals with a higher risk of developing serious disease, and where vaccination was considered potentially cost-effective, was advised for autumn 2025.The latest UK Health Security Agency’s (UKHSA) data in the national flu and COVID-19 surveillance report supports the current eligibility, showing that there is a strong association between age and COVID-19 hospitalisation rates. The highest hospital admission rate for COVID-19 in the report published on 27 November 2025 was in those aged 85 years old and over.Currently XFG and its sub lineages, sometimes called the ‘Stratus’ variant, are the most prevalent SARS-CoV-2 lineages in England. This lineage is closely related to previous variants that circulated in the United Kingdom. At this time there is no indication that XFG causes more serious disease, or that the vaccines being used in the autumn 2025 campaign will not be effective against it. The UKHSA will continue to monitor both COVID-19 outcomes and variant prevalence as we enter the winter season.

When he plans to respond to question 81028, tabled on 10 October 2025.

I refer the hon. Member to the answer I gave on 1 December 2025 to Question 81028.

What steps his Department is taking in response to research by the UK BioIndustry Association published on 6 November 2025 showing that around half of rare disease medicines approved by the European Medicines Agency (EMA) are not being reimbursed for patients in England.

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for developing authoritative, evidence-based recommendations for the National Health Service on whether new medicines represent a clinically and cost-effective use of resources. NICE plays a key role in supporting the adoption of innovative new medicines to improve outcomes for patients, at a price that reflects their value and is fair to the taxpayer.NICE has a strong track record of recommending medicines for the treatment of rare diseases and its standard technology appraisal process has been proven to be suitable for the evaluation of these medicines, where companies engage constructively in the appraisal and commercial discussions with NHS England. NICE’s approval rate for medicines for rare diseases is in line with its overall approval rate for new medicines, with 91% of medicines licensed for rare diseases recommended for some or all of the eligible patient population since April 2024.NICE’s also operates a separate highly specialised technologies programme (HST) which is reserved for a small number of medicines for very rare and very severe diseases. The HST programme uses a much higher cost-effectiveness threshold than a standard NICE appraisal, that recognises the challenges of developing medicines for very small patient populations.The Government remains committed to improving the lives of people living with rare diseases through the UK Rare Diseases Framework, which includes improving access to specialist care, treatment, and drugs as one of its four priorities. We are committed to ensuring that this priority is a key driver of the action plans published under this framework.

What steps his Department is taking to ensure that people living with rare diseases in England have timely access to innovative medicines.

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for developing authoritative, evidence-based recommendations for the National Health Service on whether new medicines represent a clinically and cost-effective use of resources. NICE plays a key role in supporting the adoption of innovative new medicines to improve outcomes for patients, at a price that reflects their value and is fair to the taxpayer.NICE has a strong track record of recommending medicines for the treatment of rare diseases and its standard technology appraisal process has been proven to be suitable for the evaluation of these medicines, where companies engage constructively in the appraisal and commercial discussions with NHS England. NICE’s approval rate for medicines for rare diseases is in line with its overall approval rate for new medicines, with 91% of medicines licensed for rare diseases recommended for some or all of the eligible patient population since April 2024.NICE’s also operates a separate highly specialised technologies programme (HST) which is reserved for a small number of medicines for very rare and very severe diseases. The HST programme uses a much higher cost-effectiveness threshold than a standard NICE appraisal, that recognises the challenges of developing medicines for very small patient populations.The Government remains committed to improving the lives of people living with rare diseases through the UK Rare Diseases Framework, which includes improving access to specialist care, treatment, and drugs as one of its four priorities. We are committed to ensuring that this priority is a key driver of the action plans published under this framework.

What assessment his Department has made of the suitability of the National Institute for Health and Care Excellence’s approach to evaluating the cost-effectiveness of rare disease medicines.

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for developing authoritative, evidence-based recommendations for the National Health Service on whether new medicines represent a clinically and cost-effective use of resources. NICE plays a key role in supporting the adoption of innovative new medicines to improve outcomes for patients, at a price that reflects their value and is fair to the taxpayer.NICE has a strong track record of recommending medicines for the treatment of rare diseases and its standard technology appraisal process has been proven to be suitable for the evaluation of these medicines, where companies engage constructively in the appraisal and commercial discussions with NHS England. NICE’s approval rate for medicines for rare diseases is in line with its overall approval rate for new medicines, with 91% of medicines licensed for rare diseases recommended for some or all of the eligible patient population since April 2024.NICE’s also operates a separate highly specialised technologies programme (HST) which is reserved for a small number of medicines for very rare and very severe diseases. The HST programme uses a much higher cost-effectiveness threshold than a standard NICE appraisal, that recognises the challenges of developing medicines for very small patient populations.The Government remains committed to improving the lives of people living with rare diseases through the UK Rare Diseases Framework, which includes improving access to specialist care, treatment, and drugs as one of its four priorities. We are committed to ensuring that this priority is a key driver of the action plans published under this framework.

If his Department will commit to appointing a new National Clinical Director for Rare Diseases.

Working under the UK Rare Diseases Framework the Government is committed to improving the lives of those living with rare diseases. NHS England and the Department are strongly supportive of clinical leadership and recognise that national clinical directors play an important role in policy development and implementation. There are over 7,000 types of rare disease which span the range of clinical specialities. As such, NHS England and the Department expect to continue to draw upon the range of clinical expertise that their national clinical directors hold to inform our work in this area, as well as that of expert clinicians delivering services for rare diseases, such as those commissioned by specialised commissioning. In addition, there is a National Medical Director for Specialised Services who provides national leadership and advice for the healthcare of rare disease and oversight for the portfolio of rare diseases which NHS England commissions services for.

What estimate he has made of the number of people in the Bracknell Forest wards of Maidenhead constituency who are unable to register with an NHS dentist.

Patients in England are not registered with a National Health Service dental practice, although many NHS dental practices do tend to see patients regularly. There is no geographical restriction on which practice a patient may attend. Some dental practices may operate local waiting list arrangements. Therefore, data is not available on the number of people who are unable to register with a dentist in the Maidenhead constituency.The responsibility for commissioning primary care services, including NHS dentistry, to meet the needs of the local population has been delegated to the integrated care boards (ICBs) across England. For the Maidenhead constituency, this is the Frimley ICB.The data for the NHS Frimley ICB shows that 40% of adults were seen by an NHS dentist in the previous 24 months up to June 2025, which is the same as the average for England, and 56% of children were seen by an NHS dentist in the previous 12 months up to June 2025, compared to 57% in England.We are aware of the challenges faced in accessing a dentist, particularly in underserved areas, and the Government is taking action to improve this. We have asked ICBs to commission extra urgent dental appointments across the country, with appointments more heavily weighted towards those areas where they are needed the most. The Government is also considering the outcomes of the consultation on immediate improvements to dental care and will publish a response shortly.ICBs are also recruiting posts through the Golden Hello scheme. This recruitment incentive will see dentists receiving payments of £20,000 to work in those areas that need them most for three years.We are committed to reforming the dental sector and we will deliver fundamental contract reform before the end of this Parliament.

What assessment he has made of the adequacy of the availability of NHS dental services in the Bracknell Forest wards of Maidenhead constituency; and what steps he is taking to improve access to NHS dentistry in the Ascot, Binfield with Warfield, and Winkfield and Cranbourne areas.

Patients in England are not registered with a National Health Service dental practice, although many NHS dental practices do tend to see patients regularly. There is no geographical restriction on which practice a patient may attend. Some dental practices may operate local waiting list arrangements. Therefore, data is not available on the number of people who are unable to register with a dentist in the Maidenhead constituency.The responsibility for commissioning primary care services, including NHS dentistry, to meet the needs of the local population has been delegated to the integrated care boards (ICBs) across England. For the Maidenhead constituency, this is the Frimley ICB.The data for the NHS Frimley ICB shows that 40% of adults were seen by an NHS dentist in the previous 24 months up to June 2025, which is the same as the average for England, and 56% of children were seen by an NHS dentist in the previous 12 months up to June 2025, compared to 57% in England.We are aware of the challenges faced in accessing a dentist, particularly in underserved areas, and the Government is taking action to improve this. We have asked ICBs to commission extra urgent dental appointments across the country, with appointments more heavily weighted towards those areas where they are needed the most. The Government is also considering the outcomes of the consultation on immediate improvements to dental care and will publish a response shortly.ICBs are also recruiting posts through the Golden Hello scheme. This recruitment incentive will see dentists receiving payments of £20,000 to work in those areas that need them most for three years.We are committed to reforming the dental sector and we will deliver fundamental contract reform before the end of this Parliament.

Whether he plans to allow inhalers to be sold over the counter without a prescription.

At present, inhalers used for conditions such as asthma and chronic obstructive pulmonary disease are authorised as prescription-only medicines (POM). This classification reflects the clinical need for a healthcare professional to confirm diagnosis, advise on correct inhaler technique, determine appropriate dosing, monitor treatment response, and detect any adverse reactions. The prescription requirement also supports the systematic recording of use and helps prevent inappropriate or excessive use.It is also important to note that inhalers themselves are not a class of medicine per se but a delivery device for a range of medicines.If a manufacturer or marketing authorisation holder wishes to pursue POM to pharmacy medicine reclassification for any type of medicine or their mode of delivery, the appropriate route is to submit a major reclassification application to the Medicines and Healthcare products Regulatory Agency (MHRA). This is a formal dossier that must present a robust evidential case in support of reclassification.The MHRA publishes guidance on the requirements for reclassification applications, including what constitutes a “major” reclassification. The MHRA is open to early dialogue with sponsors to clarify expectations and help focus application efforts via the provision of scientific advice. Until such an application is received and assessed under the statutory framework, the prescription requirement remains in place.Should a comprehensive dossier be submitted, the MHRA will consider it in line with its public-health mandate. The MHRA remains open to innovations that improve patient access and convenience, provided they uphold safety, clinical outcomes, and quality of care.

Whether his Department is taking steps to introduce an (a) diagnostic protocol for bowel cancer in patients under 50 and (b) a mandatory referral for colonoscopy after two presentations of unresolved rectal bleeding.

The Department is committed to ensuring that people of all ages with symptoms of bowel cancer are diagnosed as quickly as possible. Clinicians should use their judgment in line with National Institute for Health and Care Excellence (NICE) guidance to ensure that every patient receives timely and appropriate investigation for bowel cancer, including patients aged under 50 years old presenting with unresolved rectal bleeding. Guidance on referral for suspected cancer is developed and maintained by NICE. The guideline NG12 sets out the symptoms which should prompt referral for urgent investigation. For lower gastrointestinal cancer, there are several indications for patients aged under 50 years old which would be expected to result in referral. Further information can be found on the NICE website at the following link: https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#lower-gastrointestinal-tract-cancers

What structures are in place within the NHS to (a) oversee and (b) manage financial efficiency in healthcare settings; and whether his Department has considered establishing a dedicated executive function to support this work.

Financial efficiency within the National Health Service is managed primarily by integrated care boards (ICBs) and NHS trusts, which are responsible for local financial planning, budget control, and delivery of efficiency savings. Progress is monitored and supported by both NHS England regional and national teams including as part of the new Financial Performance and Improvement Programme. For example, as part of 2025/2026 planning, NHS England provided every provider and system with a tailored and benchmarked productivity and efficiency data pack setting out opportunities to support the development of efficiency and savings schemes.NHS England have also established an executive chaired group to oversee the development of a coherent, organisation-wide strategy and associated policies for delivering programmes to improve productivity and efficiency across the NHS.

What steps the Medicines and Healthcare products Regulatory Agency is taking to ensure transparency in the (a) operation and (b) maintenance of the UK orphan medicines register.

The Medicines and Healthcare Products Regulatory Agency (MHRA) is an executive agency of the Department of Health and Social Care and regulates medicine, medical devices and blood components for transfusion in the UK, with responsibility for ensuring medicines meet appropriate standards of safety, quality and efficacy.The United Kingdom Orphan Register is publicly available at the following link:https://www.gov.uk/government/publications/orphan-registered-medicinal-products/orphan-registerThe register is updated by the MHRA when a new orphan medicinal product or new orphan indication is authorised or their market protection expires. A process of checks to be carried out on the register on a periodic basis has been implemented to ensure that accuracy of the website is maintained.

Whether his Department plans to examine options for a separate evaluation process for orphan medicines claiming significant benefit over existing treatments.

There are no plans to introduce a separate evaluation process for orphan medicines. The National Institute for Health and Care Excellence (NICE) makes recommendations for the National Health Service on whether all new licensed medicines, including medicines for rare diseases, should be routinely funded by the NHS based on an assessment of their costs and benefits. NICE operates a separate highly specialised technologies programme for the evaluation of a small number of treatments for very rare, very severe diseases which uses a much higher cost-effectiveness threshold that recognises the challenges of bringing treatments for very rare diseases to market.NICE’s methods have been proven to be suitable for the evaluation of rare disease medicines, where companies are willing to price their medicines fairly. NICE’s approval rate for medicines for rare diseases is in line with its overall approval rate for new medicines, and from April 2024 to April 2025, NICE recommended all 15 of the rare disease drugs that it evaluated through its standard technology appraisal programme.

What assessment his Department has made of the potential impact of the National Institute for Health and Care Excellence not having updated its methods on evaluating the wider societal costs of rare diseases since 2017.

There are no plans to introduce a separate evaluation process for orphan medicines. The National Institute for Health and Care Excellence (NICE) makes recommendations for the National Health Service on whether all new licensed medicines, including medicines for rare diseases, should be routinely funded by the NHS based on an assessment of their costs and benefits. NICE operates a separate highly specialised technologies programme for the evaluation of a small number of treatments for very rare, very severe diseases which uses a much higher cost-effectiveness threshold that recognises the challenges of bringing treatments for very rare diseases to market.NICE’s methods have been proven to be suitable for the evaluation of rare disease medicines, where companies are willing to price their medicines fairly. NICE’s approval rate for medicines for rare diseases is in line with its overall approval rate for new medicines, and from April 2024 to April 2025, NICE recommended all 15 of the rare disease drugs that it evaluated through its standard technology appraisal programme.

What recent assessment his Department has made of trends in the level of regional variations in the proportion of NHS Continuing Healthcare applications that are approved; and what steps he is taking to ensure consistency in decision making across Integrated Care Boards.

The Department works closely with NHS England to monitor levels of regional variation in eligibility for NHS Continuing Healthcare (CHC). This includes NHS England implementing an operational assurance regime across regions which promotes accurate assessment, equal access, standardisation, and consistency within CHC funding.This assurance regime has a specific focus on reducing unwarranted variation in CHC across the country. To support this further during 2025/26, NHS England has increased their regional assurance meetings from every three months to every two months.To support improved patient experience in relation to CHC, the NHS Performance and Assessment Framework for 2025/26 also includes an assurance standard for Integrated Care Boards to monitor the percentage of Standard CHC referrals completed within 28 days.