Written questions by Buckley.

Whether his Department will take steps to establish a cross-departmental long-term conditions taskforce to help (a) improve care for those with long-term conditions and (b) people back into work.

The Government wants a society where every person, including those with a long-term condition, and their families and carers, receives high-quality, compassionate continuity of care. We will change the National Health Service so that it becomes not just a sickness service, but one able to prevent ill health in the first place. This will help us be better prepared for the change in the nature of disease and allow our services to focus more on the management of chronic, long-term conditions.Integrated care boards (ICBs) are responsible for commissioning most services for people with long term conditions. ICBs are allocated funding by NHS England to meet local needs and priorities, and improve outcomes. NHS England continues to set national standards, service specifications, and clinical access policies, to which ICBs are expected to apply.We recognise that, in order to ensure the NHS is fit for the future, we must improve care for those with long-term conditions. One of the working groups supporting the development of the 10-Year Health Plan has been asked to develop a vision for how the NHS can evolve to provide responsive, joined-up care to better support individuals with complex health needs who may require frequent, ongoing engagement with the NHS. The group, chaired by Dr Claire Fuller and Caroline Abrahams CBE, will consider what improved care would look like for both individuals living with a single or multiple long-term conditions, including, for example, mental health conditions or disabilities, as well as individuals with multiple complex needs, including those that are frail or approaching the end of their life.We know that appropriate work is generally good for health and wellbeing. We want everyone to get work and get on in work, whoever they are and wherever they live.Disabled people and people with health conditions are a diverse group, so access to the right work and health support, in the right place, at the right time, is key.The Department of Health and Social Care and the Department for Work and Pensions are committed to supporting disabled people and people with health conditions, and have a range of support available so individuals can stay in work and get back into work, including those that join up employment and health systems. Measures include joining up health and employment support around the individual through Employment Advisors in NHS Talking Therapies and Individual Placement and Support in Primary Care, as well as support from Work Coaches and Disability Employment Advisers in Jobcentres and Access to Work grants.As part of the Get Britain Working plan, the Government is launching Keep Britain Working, an independent review into the role of United Kingdom employers in reducing health-related inactivity, and to promote healthy and inclusive workplaces.As ICBs are responsible for commissioning most services for people with long term conditions, most of the data regarding the prevalence of long-term health conditions is collected at the ICB level, although the 10-Year Health Plan will also be focussing on the improved use of data in the health system, as part of the shift from analogue to digital.

What support his Department provides to local NHS Integrated Care Systems to tackle chronic kidney disease through delivering person-centred care.

The National Institute for Health and Care Excellence (NICE) guidance, Chronic kidney disease: Assessment and management [NG203], updated in November 2021, sets out best practice for clinicians in the diagnosis and management of chronic kidney disease (CKD). The guidance covers the care and treatment of patients at risk of CKD. It includes recommendations on the monitoring of patients at risk of CKD and aims to prevent or delay the progression of the disease. The guidance is available at the following link: https://www.nice.org.uk/guidance/ng203 NHS England, through the Renal Services Transformation Programme and regional renal networks, is implementing initiatives to provide better, integrated care, reduce health inequalities, and focus on the prevention and timely intervention for kidney disease. Regional renal clinical networks have already prioritised CKD diagnosis and the prevention of disease progression within their core function. This includes assessing the concordance with NICE guidance around the use of drugs to mitigate the consequences of CKD. Regional renal clinical networks also prioritise CKD diagnosis and prevention within their transformation ambitions, facilitating earlier treatment. This includes considerations to develop a unified approach to testing populations at risk of developing CKD, and includes raising awareness of diagnostic tools like urine albumin creatinine tests, enabling CKD diagnosis at stages 1 and 2. NHS England aims to improve awareness and access to these important urine and blood tests across primary and secondary care. In addition, the transformation programme launched a renal toolkit earlier last year, for use by systems, that outlines principles to support better management of patients identified with CKD throughout their patient journey.No assessment has been made of the adequacy of the implementation of NHS England’s Renal Services Transformation Programme by local National Health Service integrated care systems.

Whether the NHS Ten Year Plan will prioritise action to combat kidney disease to reduce healthcare inequalities.

The Government is committed to building a fairer Britain by tackling the structural inequalities that contribute to poor health, particularly for disadvantaged groups. We are dedicated to ensuring that people live well for longer and spend less time in ill health, regardless of where they are born or their financial circumstances.Our Health Mission in England will focus on addressing the social determinants of health, with the goal of halving the gap in healthy life expectancy between the richest and poorest regions. We will work across Government to address the root causes of health inequalities, including barriers of access to health and care services. We will prioritise prevention, shift more care into the community, and intervene earlier in life to raise the healthiest generation of children in our history.The 10-Year Health Plan will ensure a better health service for everyone, regardless of condition or service area. On 21 October 2024, we launched a national conversation on the future of the National Health Service, inviting views from across the country on how to deliver a health service fit for the future. Patients, staff, and organisations, including those with experience of, or expertise in, kidney disease, can make themselves heard by logging onto the online portal, which is available at the following link:http://change.nhs.ukNo formal assessment has been made of the potential impact of healthcare inequalities in kidney disease on NHS waiting lists.We recognise that patients have been let down for too long whilst they wait for the care they need, including for kidney disease. Currently, the overall waiting list stands at 7.64 million patient pathways, with over six million people waiting. The Government is committed to putting patients first. This means making sure that patients are seen on time and ensuring that people have the best possible experience during their care.Today, fewer than 60% of patients are being seen within 18 weeks. We will ensure 92% of patients return to waiting no longer than 18 weeks from Referral to Treatment within our first term, a standard which has not been met consistently since September 2015.Tackling waiting lists is a key part of our Health Mission. We will start by delivering an extra 40,000 operations, scans, and appointments each week, as the first step in our commitment to ensuring patients are treated within 18 weeks. We will also address the challenges in diagnostic waiting times, providing the number of computed tomography, magnetic resonance imaging, and other tests that are needed to reduce elective waits.NHS England has established the Renal Services Transformation Programme (RSTP), which aims to reduce unwarranted variation in the quality and accessibility of renal care, to improve outcomes and services for those with kidney disease. NHS England, through the RSTP and regional renal clinical networks, is implementing initiatives to provide better, integrated care, to reduce health inequalities, and to focus on prevention and timely intervention for kidney disease.Working in collaboration with the NHS RightCare Programme and the renal community, the RSTP has developed a renal toolkit to provide integrated care boards, regional renal clinical networks, and providers with tools, case studies, and principles to support the transformation of services at a local level. The toolkit outlines principles to support better management of patients identified with chronic kidney disease (CKD) throughout their patient journey. The RSTP is working closely with NHS England’s regional renal clinical networks to review this toolkit, to work with local partners to develop transformation programmes that will focus on the early identification and management of kidney disease, and which will seek to reduce the number of patients progressing through the various stages of CKD and reduce the number of patients requiring dialysis. By supporting prevention and early intervention, the need for late-stage treatments will be reduced.

What assessment his Department has made of the potential impact of healthcare inequalities in kidney disease on NHS waiting lists.

The Government is committed to building a fairer Britain by tackling the structural inequalities that contribute to poor health, particularly for disadvantaged groups. We are dedicated to ensuring that people live well for longer and spend less time in ill health, regardless of where they are born or their financial circumstances.Our Health Mission in England will focus on addressing the social determinants of health, with the goal of halving the gap in healthy life expectancy between the richest and poorest regions. We will work across Government to address the root causes of health inequalities, including barriers of access to health and care services. We will prioritise prevention, shift more care into the community, and intervene earlier in life to raise the healthiest generation of children in our history.The 10-Year Health Plan will ensure a better health service for everyone, regardless of condition or service area. On 21 October 2024, we launched a national conversation on the future of the National Health Service, inviting views from across the country on how to deliver a health service fit for the future. Patients, staff, and organisations, including those with experience of, or expertise in, kidney disease, can make themselves heard by logging onto the online portal, which is available at the following link:http://change.nhs.ukNo formal assessment has been made of the potential impact of healthcare inequalities in kidney disease on NHS waiting lists.We recognise that patients have been let down for too long whilst they wait for the care they need, including for kidney disease. Currently, the overall waiting list stands at 7.64 million patient pathways, with over six million people waiting. The Government is committed to putting patients first. This means making sure that patients are seen on time and ensuring that people have the best possible experience during their care.Today, fewer than 60% of patients are being seen within 18 weeks. We will ensure 92% of patients return to waiting no longer than 18 weeks from Referral to Treatment within our first term, a standard which has not been met consistently since September 2015.Tackling waiting lists is a key part of our Health Mission. We will start by delivering an extra 40,000 operations, scans, and appointments each week, as the first step in our commitment to ensuring patients are treated within 18 weeks. We will also address the challenges in diagnostic waiting times, providing the number of computed tomography, magnetic resonance imaging, and other tests that are needed to reduce elective waits.NHS England has established the Renal Services Transformation Programme (RSTP), which aims to reduce unwarranted variation in the quality and accessibility of renal care, to improve outcomes and services for those with kidney disease. NHS England, through the RSTP and regional renal clinical networks, is implementing initiatives to provide better, integrated care, to reduce health inequalities, and to focus on prevention and timely intervention for kidney disease.Working in collaboration with the NHS RightCare Programme and the renal community, the RSTP has developed a renal toolkit to provide integrated care boards, regional renal clinical networks, and providers with tools, case studies, and principles to support the transformation of services at a local level. The toolkit outlines principles to support better management of patients identified with chronic kidney disease (CKD) throughout their patient journey. The RSTP is working closely with NHS England’s regional renal clinical networks to review this toolkit, to work with local partners to develop transformation programmes that will focus on the early identification and management of kidney disease, and which will seek to reduce the number of patients progressing through the various stages of CKD and reduce the number of patients requiring dialysis. By supporting prevention and early intervention, the need for late-stage treatments will be reduced.

What assessment he has made of the implications for his policies of healthcare inequalities in kidney disease.

The Government is committed to building a fairer Britain by tackling the structural inequalities that contribute to poor health, particularly for disadvantaged groups. We are dedicated to ensuring that people live well for longer and spend less time in ill health, regardless of where they are born or their financial circumstances.Our Health Mission in England will focus on addressing the social determinants of health, with the goal of halving the gap in healthy life expectancy between the richest and poorest regions. We will work across Government to address the root causes of health inequalities, including barriers of access to health and care services. We will prioritise prevention, shift more care into the community, and intervene earlier in life to raise the healthiest generation of children in our history.The 10-Year Health Plan will ensure a better health service for everyone, regardless of condition or service area. On 21 October 2024, we launched a national conversation on the future of the National Health Service, inviting views from across the country on how to deliver a health service fit for the future. Patients, staff, and organisations, including those with experience of, or expertise in, kidney disease, can make themselves heard by logging onto the online portal, which is available at the following link:http://change.nhs.ukNo formal assessment has been made of the potential impact of healthcare inequalities in kidney disease on NHS waiting lists.We recognise that patients have been let down for too long whilst they wait for the care they need, including for kidney disease. Currently, the overall waiting list stands at 7.64 million patient pathways, with over six million people waiting. The Government is committed to putting patients first. This means making sure that patients are seen on time and ensuring that people have the best possible experience during their care.Today, fewer than 60% of patients are being seen within 18 weeks. We will ensure 92% of patients return to waiting no longer than 18 weeks from Referral to Treatment within our first term, a standard which has not been met consistently since September 2015.Tackling waiting lists is a key part of our Health Mission. We will start by delivering an extra 40,000 operations, scans, and appointments each week, as the first step in our commitment to ensuring patients are treated within 18 weeks. We will also address the challenges in diagnostic waiting times, providing the number of computed tomography, magnetic resonance imaging, and other tests that are needed to reduce elective waits.NHS England has established the Renal Services Transformation Programme (RSTP), which aims to reduce unwarranted variation in the quality and accessibility of renal care, to improve outcomes and services for those with kidney disease. NHS England, through the RSTP and regional renal clinical networks, is implementing initiatives to provide better, integrated care, to reduce health inequalities, and to focus on prevention and timely intervention for kidney disease.Working in collaboration with the NHS RightCare Programme and the renal community, the RSTP has developed a renal toolkit to provide integrated care boards, regional renal clinical networks, and providers with tools, case studies, and principles to support the transformation of services at a local level. The toolkit outlines principles to support better management of patients identified with chronic kidney disease (CKD) throughout their patient journey. The RSTP is working closely with NHS England’s regional renal clinical networks to review this toolkit, to work with local partners to develop transformation programmes that will focus on the early identification and management of kidney disease, and which will seek to reduce the number of patients progressing through the various stages of CKD and reduce the number of patients requiring dialysis. By supporting prevention and early intervention, the need for late-stage treatments will be reduced.

What steps his Department plans to take to improve access to treatment to manage (a) chronic kidney disease and (b) common complications to help slow the progression of the disease.

NHS England is working to detect people at risk of kidney disease through the NHS Health Check Programme. The programme, which is available for everyone between the ages of 40 and 74 years old who is not already on a chronic disease register, assesses people’s health and risk of developing certain health problems. Using this information, patients are supported to make behavioural changes and access treatment which helps to prevent and detect kidney disease earlier.The NHS Long Term Plan has committed to a number of key ambitions to improve care and outcomes for individuals with cardiovascular disease (CVD), including enhanced diagnostic support in the community, better personalised planning, and increasing access to cardiac rehabilitation. These ambitions will support the delivery of the aim to help prevent 150,000 heart attacks, strokes, and dementia cases by 2029. Specific priorities include the management of CVD risk factors, such as hypertension, or high blood pressure, atrial fibrillation, or an abnormal, fast irregular heartbeat, and high cholesterol, ensuring early and rapid access to diagnostic tests and treatment. NHS England is working to identify opportunities for improved integration of CVD management across clinical specialities.The UK National Screening Committee (UK NSC) reviewed chronic kidney disease (CKD) and glomerulonephritis in 2011, concluding that a population-wide screening programme would not be recommended. Although the UK NSC has not since looked at the evidence for a targeted programme, it can be alerted to any new published peer-reviewed evidence which may suggest the case for a new screening programme. Further information is available at the following link:https://www.gov.uk/government/publications/uk-nsc-annual-call-submitting-a-screening-proposal/uk-nsc-annual-call-how-to-submit-a-proposalThe National Health Service provides access to tests and therapies to diagnose, code, and treat patients with early-stage CKD. NHS England, through the Renal Services Transformation Programme and regional renal networks, is implementing initiatives to provide better, integrated care, reduce health inequalities, and focus on prevention and timely intervention for kidney disease within both primary and secondary care. Regional renal clinical networks prioritise CKD diagnosis and prevention within their transformation ambitions, facilitating earlier treatment. This includes considerations to develop a unified approach to testing populations at risk of developing CKD, and includes raising awareness of diagnostic tools like urine albumin creatinine tests, enabling CKD diagnosis at stages 1 and 2. NHS England aims to improve awareness and access to these important urine and blood tests across primary and secondary care. In addition, the transformation programme launched a renal toolkit last year for use by systems, that outlines principles to support better management of patients identified with CKD throughout their patient journey.The National Institute for Health and Care Excellence (NICE) guidance, Chronic kidney disease: Assessment and management [NG203], updated in November 2021, sets out best practice for clinicians in the diagnosis and management of CKD. The guidance covers the care and treatment of patients at risk of CKD. It includes recommendations on the monitoring of patients at risk of CKD and aims to prevent or delay the progression of the disease. The guidance is available at the following link:https://www.nice.org.uk/guidance/ng203The management of CKD has evolved over the last two decades. Increasingly, there are drug interventions to slow the progression of kidney disease, mitigate the risk of cardiovascular events associated with CKD, and reduce the additional risk of acute kidney injury. NICE guidance continues to be updated as evidence accumulates, and NHS England, through the Renal Clinical Reference Group, supports that process through advice and horizon scanning, as therapeutic interventions are introduced. The renal clinical networks have all established work examining the management of CKD, including diagnosis and intervention.

What steps his Department is taking to increase the rate of early diagnosis of chronic kidney disease for (a) people with (i) diabetes, (ii) cardiovascular disease and (iii) other associated risk conditions and (b) all people.

NHS England is working to detect people at risk of kidney disease through the NHS Health Check Programme. The programme, which is available for everyone between the ages of 40 and 74 years old who is not already on a chronic disease register, assesses people’s health and risk of developing certain health problems. Using this information, patients are supported to make behavioural changes and access treatment which helps to prevent and detect kidney disease earlier.The NHS Long Term Plan has committed to a number of key ambitions to improve care and outcomes for individuals with cardiovascular disease (CVD), including enhanced diagnostic support in the community, better personalised planning, and increasing access to cardiac rehabilitation. These ambitions will support the delivery of the aim to help prevent 150,000 heart attacks, strokes, and dementia cases by 2029. Specific priorities include the management of CVD risk factors, such as hypertension, or high blood pressure, atrial fibrillation, or an abnormal, fast irregular heartbeat, and high cholesterol, ensuring early and rapid access to diagnostic tests and treatment. NHS England is working to identify opportunities for improved integration of CVD management across clinical specialities.The UK National Screening Committee (UK NSC) reviewed chronic kidney disease (CKD) and glomerulonephritis in 2011, concluding that a population-wide screening programme would not be recommended. Although the UK NSC has not since looked at the evidence for a targeted programme, it can be alerted to any new published peer-reviewed evidence which may suggest the case for a new screening programme. Further information is available at the following link:https://www.gov.uk/government/publications/uk-nsc-annual-call-submitting-a-screening-proposal/uk-nsc-annual-call-how-to-submit-a-proposalThe National Health Service provides access to tests and therapies to diagnose, code, and treat patients with early-stage CKD. NHS England, through the Renal Services Transformation Programme and regional renal networks, is implementing initiatives to provide better, integrated care, reduce health inequalities, and focus on prevention and timely intervention for kidney disease within both primary and secondary care. Regional renal clinical networks prioritise CKD diagnosis and prevention within their transformation ambitions, facilitating earlier treatment. This includes considerations to develop a unified approach to testing populations at risk of developing CKD, and includes raising awareness of diagnostic tools like urine albumin creatinine tests, enabling CKD diagnosis at stages 1 and 2. NHS England aims to improve awareness and access to these important urine and blood tests across primary and secondary care. In addition, the transformation programme launched a renal toolkit last year for use by systems, that outlines principles to support better management of patients identified with CKD throughout their patient journey.The National Institute for Health and Care Excellence (NICE) guidance, Chronic kidney disease: Assessment and management [NG203], updated in November 2021, sets out best practice for clinicians in the diagnosis and management of CKD. The guidance covers the care and treatment of patients at risk of CKD. It includes recommendations on the monitoring of patients at risk of CKD and aims to prevent or delay the progression of the disease. The guidance is available at the following link:https://www.nice.org.uk/guidance/ng203The management of CKD has evolved over the last two decades. Increasingly, there are drug interventions to slow the progression of kidney disease, mitigate the risk of cardiovascular events associated with CKD, and reduce the additional risk of acute kidney injury. NICE guidance continues to be updated as evidence accumulates, and NHS England, through the Renal Clinical Reference Group, supports that process through advice and horizon scanning, as therapeutic interventions are introduced. The renal clinical networks have all established work examining the management of CKD, including diagnosis and intervention.

What assessment his Department has made of the adequacy of the implementation of NHS England’s Renal Services Transformation Programme by local NHS Integrated Care Systems.

The National Institute for Health and Care Excellence (NICE) guidance, Chronic kidney disease: Assessment and management [NG203], updated in November 2021, sets out best practice for clinicians in the diagnosis and management of chronic kidney disease (CKD). The guidance covers the care and treatment of patients at risk of CKD. It includes recommendations on the monitoring of patients at risk of CKD and aims to prevent or delay the progression of the disease. The guidance is available at the following link: https://www.nice.org.uk/guidance/ng203 NHS England, through the Renal Services Transformation Programme and regional renal networks, is implementing initiatives to provide better, integrated care, reduce health inequalities, and focus on the prevention and timely intervention for kidney disease. Regional renal clinical networks have already prioritised CKD diagnosis and the prevention of disease progression within their core function. This includes assessing the concordance with NICE guidance around the use of drugs to mitigate the consequences of CKD. Regional renal clinical networks also prioritise CKD diagnosis and prevention within their transformation ambitions, facilitating earlier treatment. This includes considerations to develop a unified approach to testing populations at risk of developing CKD, and includes raising awareness of diagnostic tools like urine albumin creatinine tests, enabling CKD diagnosis at stages 1 and 2. NHS England aims to improve awareness and access to these important urine and blood tests across primary and secondary care. In addition, the transformation programme launched a renal toolkit earlier last year, for use by systems, that outlines principles to support better management of patients identified with CKD throughout their patient journey.No assessment has been made of the adequacy of the implementation of NHS England’s Renal Services Transformation Programme by local National Health Service integrated care systems.

If he will make an assessment with Cabinet colleagues of the potential impact of trends in the number of people with kidney disease on the economy.

The Government recognises that long-term sickness continues to be the most common reason for economic inactivity among the working age population.  As part of the Get Britain Working plan, more disabled people and those with health conditions will be supported to enter and stay in work, by devolving more power to local areas so they can shape a joined-up work, health, and skills offer that suits the needs of the people they serve.There are no current plans to make an assessment with Cabinet colleagues of the potential impact of trends in the number of people with kidney disease on the economy.

Whether his Department is taking steps to raise public awareness of the potential health risks of open (a) coal and (b) wood fires for cooking and heating in the home.

The Government recognises the importance of raising awareness of air pollution and the associated health impacts. The Department of Health and Social Care is supporting the Department for Environment, Food and Rural Affairs on their comprehensive Clean Air Strategy, which will include consideration of interventions to reduce emissions so that everyone’s exposure to air pollution is reduced. In addition, the Department for Environment, Food and Rural Affairs is undertaking a review of how we communicate air quality information to ensure members of the public, and vulnerable groups in particular, have what they need to protect themselves. The Government will also continue to raise awareness about the impact of domestic solid fuel burning.

If he will make an assessment of the potential impact of removing the exemption of care homes from the Smoke and Carbon Monoxide Alarm (England) Regulations 2015 on public health.

We have no current plans to assess the impact of removing this exemption. The Smoke and Carbon Monoxide Alarm (England) Regulations 2015, later amended by the Carbon Monoxide Regulations 2022, are for rented residential premises in England. The regulations exclude a range of settings, including care homes.

What steps he is taking to help ensure long-term funding for hospices.

The Government is determined to shift more healthcare out of hospitals and into the community, to ensure that patients and their families receive personalised care in the most appropriate setting, and palliative and end of life care, including hospices, will have a big role to play in that shift.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. To support ICBs in this duty, NHS England has published statutory guidance and service specifications.Whilst the majority of palliative and end of life care is provided by National Health Service staff and services, we recognise the vital part that voluntary sector organisations, including hospices, also play in providing support to people at end of life and their loved ones.Most hospices are charitable, independent organisations which receive some statutory funding for providing NHS services. The amount of funding charitable hospices receive varies by ICB area, and will, in part, be dependent on the breadth of a range of palliative and end of life care provision within their ICB footprint.I recently met with NHS England, and discussions have begun on how to reduce inequalities and variation in access to, and quality of, palliative and end of life care.  We will consider next steps on palliative and end of life care, including funding, in the coming months.

What recent assessment his Department has made of the adequacy of the level of funding for hospices.

We want a society where every person receives high-quality, compassionate care, including at the end of their life. I know that hospices provide fantastic services to many people. The government is going to shift the focus of healthcare out of the hospital and into the community. We recognise the value of the voluntary sector, including hospices, and we will continue to work closely with the sector to understand the pressures they are under.