Written questions by Reynolds.

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 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.

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.

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.

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.

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 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.

What his Department’s policy is on the use of cash for food vendor payments in NHS hospitals.

The Department does not have a policy on the use of cash for the payment of food vendors in National Health Service hospitals. These decisions are taken locally by NHS organisations.

What recent assessment his Department has made of the potential impact of midwifery recruitment freezes on maternal health outcomes in England; and what steps his Department is taking to reduce staffing shortages in maternity services in areas where (a) hospital access times are longer and (b) home birth provision has declined.

The Government is committed to tackling the retention and recruitment challenges that face the National Health Service.NHS England is leading a range of initiatives to boost the retention of existing staff. This includes building a compassionate and inclusive culture, supporting staff wellbeing, and promoting flexible working opportunities.On 11 August, we announced the Graduate Guarantee for nurses and midwives. The Graduate Guarantee will ensure that there are enough positions for every newly qualified midwife in England. The package of measures will unlock thousands of jobs and will ensure thousands of new posts are easier to access by removing barriers for NHS trusts, creating opportunities for graduates and ensuring a seamless transition from training to employment.Vacant maternity support worker posts will be temporarily converted to band 5 midwifery roles, backed by £8 million to create new opportunities specifically for newly qualified midwives and to further ease the recruitment strain.These new measures aim to tackle graduates’ concerns about job availability and ensure the NHS has the right staff to provide the best possible care to patients everywhere.Targeted retention work for midwives is being undertaken by NHS England, led by the Chief Nursing Officer for England. This work contains a range of measures, including creation of a midwifery and nursing retention self-assessment tool, mentoring schemes, strengthened advice and support on pensions, and embedding flexible retirement options. NHS England has also invested in unit-based retention leads which, alongside investment in workforce capacity, has seen a reduction in vacancy, leaver and turnover rates.There are four nationally run programmes to develop midwifery staff, at bands 6 and above, from ethnic minority groups to better support patients, in addition to local initiatives to better reflect the community of the women and babies they support.Responsibility for the delivery, implementation and funding decisions for services ultimately rests with the appropriate NHS commissioner. This includes waiting times and homebirth provisions.NHS commissioners are expected to develop clear plans for reverting temporary service changes or developing plans for the permanent reconfiguration of the service. All service changes should be based on clear evidence that they will deliver better outcomes for patients.

What his planned timeline is for publishing a Government response to the Hughes Report, published on 7 February 2024.

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.

What steps his Department is taking to expand access to degree apprenticeships in midwifery for (a) mature students, (b) career changers and (c) other people who face (i) financial and (ii) practical barriers to undertaking traditional university training routes.

We will publish a new workforce plan to deliver the transformed health service we will build over the next decade, and will treat patients on time again. This will include how we ensure we train healthcare staff, through all training routes including apprenticeships, to support patients in all of our communities.

What steps his Department is taking to raise public awareness of the symptoms of chronic urinary tract infections.

The National Health Service provides information on the symptoms of urinary tract infections (UTIs), including chronic UTIs, at the following link:https://www.nhs.uk/conditions/urinary-tract-infections-utis/The Department currently has no plans to raise public awareness of the symptoms of chronic UTIs. However, the Department, through the National Institute for Health and Care Research (NIHR), is funding research to improve the diagnosis and treatment of UTIs, including chronic UTIs. This research includes the development of antimicrobial-impregnated catheters to reduce episodes of catheter-associated UTIs as well as the TOUCAN study, with further information available at the following link:https://www.phctrials.ox.ac.uk/recruiting-trials/toucan-platform-for-uti-diagnostic-evaluationThis study is evaluating rapid point of care UTI diagnostic tests in general practice surgeries that not only enable faster detection of UTIs but also provide real-time information on antibiotic resistance, ensuring patients receive the correct treatment.

What steps his Department is taking to reduce waiting times for adolescent mental health services in Berkshire.

We know children and young people are not receiving the mental health care they need and that waits for mental health services are too long across England, including Berkshire. We are determined to change that as part of our shift to prevention and earlier intervention and in line with our Plan for Change.The Department’s Spending Review settlement means that annual National Health Service day-to-day spending will increase by £29 billion in real terms, representing a £53 billion cash uplift, by 2028/29 compared to 2023/24.In the Spending Review announcement, we have confirmed that we will fulfil the Government’s commitments to recruit an additional 8,500 additional mental health staff by the end of the Parliament and expand mental health support teams in schools in England to cover 100% of pupils by 2029/30.

Whether his Department has made an assessment of the potential merits of establishing a seven-day Community Diagnostic Centre at St Mark's Hospital in Maidenhead.

Slough Community Diagnostic Centre (CDC) is currently delivering temporary activity at St Mark’s Hospital in Maidenhead, and has done so since January 2024, in addition to activity at the permanent site at Upton Community Hospital, whilst the new facility is being completed. Once the new facility at Upton Community Hospital is completed later in 2025, all diagnostic activity will move to Upton Community Hospital, where it is expected that Slough CDC will be open 12 hours a day, seven days a week.The Elective Reform Plan, published on 6 January 2025, sets out that we will increase the number of CDCs offering services 12 hours a day, seven days a week, as well as delivering additional CDC capacity in 2025/26 by expanding a number of existing CDCs and building up to five new ones.NHS England is working with local National Health Service systems to identify the most appropriate locations for investments, including new CDCs. A key factor they will consider is that new CDCs are positioned in a location which addresses local need and will address health inequalities. Details will be set out in due course.

What his Department's planned timetable is for publishing its plans to reduce the time taken for patients to receive mental health treatment.

Long waits for mental health services are being driven by increasing demand to a system in desperate need of change. The Government is already responding by delivering new and innovative models of care in the community. We are piloting innovative models of care in the community, including six neighbourhood adult mental health centres that are open 24 hours a day, seven days a week and bring together community, crisis, and inpatient care.NHS England Planning Guidance for 2025/26 makes clear that for this year, to support reform and improvements, we expect all providers to reduce the variation in children and young people accessing services and improve productivity. We are also improving data quality so we can support providers to understand demand across their areas. Since July 2023, NHS England has included waiting times metrics for referrals to urgent and community-based mental health services in its monthly mental health statistics publication to help services to target the longest waits.It is important that mental health services within the National Health Service work closely with the voluntary sector to deliver new models of care. The 10-Year Health Plan will be published shortly, and this will set out how the overall health system will run.

What steps his Department is taking to accelerate the uptake of non-animal New Approach Methodologies in (a) regulatory testing and (b) scientific research.

National Institute for Health and Care Research (NIHR) funding is focused on translational, clinical, and applied health and care research. We therefore do not fund basic research or work involving animals, animal tissue, or both. However, the NIHR does work in close partnership with the Medical Research Council, which funds animal research in carefully defined circumstances and recognises the need for the robust application of the 3Rs, the replacement, reduction, and refinement of animal use in research.The Government will publish a strategy to support the development, validation, and uptake of alternative methods in basic, applied, translational, and regulatory research and testing later this year.