Written questions by Lewis.

If he will publish current waiting lists totals at each of the mesh removal centres set up following the publication of the Cumberlege report; and whether mesh-damaged women are given an option to attend mesh removal centres other than ones led by surgeons who implanted their mesh originally.

Tackling waiting lists is a key part of our Health Mission and we are taking steps to return to the 18-week standard. The Elective Reform Plan sets out how the National Health Service will reform elective care services to meet the 18-week referral to treatment standard by March 2029.There are nine specialist mesh centres across England, ensuring that women in every region with complications of mesh inserted for urinary incontinence and vaginal prolapse get the right support. Each mesh centre is led by a multi-disciplinary team to ensure patients get access to the specialist care and treatment that they need, including pain management and psychological support. NHS England publishes data on referral to treatment waiting times, which is available at the following link:https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/Data is published at the level of specialties, for example gynaecology, and is not routinely published at sub-speciality level. The most recent waiting time data held by NHS England from 2024 indicated that the average waiting time across the nine centres was 28 weeks.The surgery to remove mesh implanted for stress urinary incontinence and vaginal prolapse is a relatively new surgical discipline. Expertise is, therefore, concentrated in a limited number of specialist centres led by a core multi-disciplinary team, including consultant specialists in urogynaecology, urology, and pain management. Patients, when requesting treatment for mesh complications, can exercise patient choice and be referred to another centre, ensuring that they can be seen by another surgeon where appropriate.

If he will take steps to commission (a) research into, and (b) training programmes for, improved techniques for removal of failed pelvic mesh implants from injured women including those removal methods developed in Missouri by Dr Dionysios Veronikis currently unavailable in the United Kingdom.

The Department, through the National Institute for Health and Care Research (NIHR), is currently funding research to develop a patient-reported outcome measure (PROM) for prolapse, incontinence, and mesh complication surgery. This will enable women to self-report the ways in which any surgical treatment for these conditions, mesh and non-mesh related, has affected their quality of life. Once testing of the PROM is completed, women will be able to complete it as part of their care. It will also be suitable for use by national registries and with women taking part in clinical trials. The NIHR continues to welcome funding applications for research into any aspect of women’s health, including pelvic mesh.NHS England has established nine specialist mesh centres across England, ensuring that women in every region with complications of mesh inserted for urinary incontinence and vaginal prolapse get the right support. Each mesh centre is led by a multi-disciplinary team to ensure patients get access to the specialist care and treatment that they need, including pain management and psychological support.The National Health Service’s service specification sets out the standards of care expected from organisations funded by NHS England to provide specialised care. The specification for complications of mesh inserted for urinary incontinence, vaginal or internal, and external rectal prolapse states that specialised mesh centres must use trust appraisal systems to ensure that surgeons are appropriately trained, current in their practice, that they adhere to clinical and NICE guidance, comply with Pelvic Floor Registry data requirements, and report complications. The service specification is available at the following link:https://www.england.nhs.uk/publication/specialised-services-for-women-with-complications-of-mesh-inserted-for-urinary-incontinence-and-vaginal-prolapse-16-years-and-above/

How many legal cases brought against the NHS by mesh-damaged women have been settled (a) in and (b) out of court in each of the past ten years.

NHS Resolution (NHSR) manages clinical negligence and other claims against the National Health Service in England, and while the information is not available in the format requested, they have provided the data below. This information only covers England and not the rest of the United Kingdom, and NHSR has interpreted ‘in court’ as being where the court proceedings have been served, rather than where a case has gone to trial.Claims notified and open are not guaranteed to be settled in the same year and can take many years to be concluded. Claims notified in any given year will often relate to incidents that have occurred many years prior. Claims closed and settled in one year will often relate to claims notified in different years. Many of the claims notified will have been repudiated and settled without damages paid.It is also possible that the same claim may appear more than once in a dataset, across different year groups, for example, where the case has been closed as unsuccessful, challenged, reopened, and closed again at conclusion.The following table shows the number of clinical claims and incidents received between the financial years 2014/15 and 2023/24, where the claim has been identified as a vaginal mesh claim:Year of notificationNumber of claims2014/1552015/16122016/17152017/18542018/19702019/202092020/213962021/222262022/231662023/2499Total1,252Source: NHSR In addition, the following table shows the number of clinical claims settled between the financial years 2015/16 and 2023/24 with a damages payment, where the claim has been identified as a vaginal mesh claim, broken down by litigation status: Year of settlement and litigation statusNumber of claims2015/16#Litigation#No Litigation#2016/17#Litigation#No Litigation#2017/1816Litigation8No Litigation82018/19#Litigation8No Litigation#2019/20#Litigation11No Litigation#2020/2132Litigation22No Litigation102021/2261Litigation19No Litigation422022/23116Litigation27No Litigation892023/24101Litigation22No Litigation79Total356Source: NHSR Finally, the following table shows the number of clinical claims settled between the financial years 2015/16 and 2023/24 with no damages paid, where the claim has been identified as a vaginal mesh claim, broken down by litigation status:Year of settlement and litigation statusNumber of claims2015/16#Litigation#No Litigation82016/17#Litigation#No Litigation62017/18#Litigation#No Litigation72018/1943Litigation5No Litigation382019/20#Litigation#No Litigation432020/2190Litigation6No Litigation842021/22167Litigation64No Litigation1032022/23179Litigation28No Litigation1512023/24120Litigation10No Litigation110Total678Source: NHSRNotes: NHSR has supressed low figures as NHSR believe that disclosure of information to a member of the public would contravene one or more of the data protection principles. In some instances, for low numbers of claims, namely fewer than 5, in each category, the likelihood exists that individuals who are the subject of this information may be identified. As this information is sensitive personal data, NHSR believes it has a greater responsibility to protect those individuals’ identities, as disclosure could potentially cause damage and/or distress to those involved. Due to small numbers in the tables, NHSR has used a ‘#’ symbol in the relevant field.

What discussions he has had with the National Institute for Health and Care Excellence on the use of Fenfluramine to treat Lennox Gastaut Syndrome; and what representations his Department has had from hospitals in Southampton on this matter.

The National Institute for Health and Care Excellence (NICE) develops its guidance on new medicines independently and the Department has had no discussions with the NICE about its appraisal of fenfluramine for the treatment of Lennox Gastaut syndrome. Furthermore, I am not aware of any correspondence or representations from hospitals in Southampton on this matter.The NICE recently published draft guidance that recommends fenfluramine for the treatment of patients meeting specific clinical criteria, and registered stakeholders now have an opportunity to appeal. The NICE currently expects to publish final guidance on 26 March 2025.

What guidance his Department gives to medical practitioners on the (a) risks of harmful long-term effects resulting from the prescription of Lariam (Mefloquine) as an anti-malarial prophylaxis and (b) treatment recommended for alleviation of such effects when experienced by people after being prescribed Lariam.

Mefloquine, commercially known as Lariam, is effective in the prevention and treatment of malaria and is licensed for use by the Medicines and Healthcare products Regulatory Agency (MHRA) in the United Kingdom. The current product information for mefloquine states that neuropsychiatric adverse reactions may occur during treatment and includes warnings and precautions to minimise these risks. It also states that such adverse reactions may persist for months, or longer, even after discontinuation of the drug. It has not been established, however, that such adverse reactions may be permanent.The UK was involved in the European Union’s safety review in 2013 which concluded there was a need for additional measures to strengthen the existing safety warnings for neuropsychiatric effects. A range of regulatory actions were implemented in Europe and the UK, including a letter to healthcare professionals highlighting the strengthened warnings about psychiatric effects in the product information for mefloquine, prescribing guides and checklists for healthcare professionals, and an alert card for patients. These documents are available at the following link: https://www.medicines.org.uk/emc/product/9670/smpc An article highlighting the new advice was also published in the MHRA’s Drug Safety Update newsletter, which is available at the following link:https://www.gov.uk/drug-safety-update/mefloquine-strengthened-warnings-on-neuropsychiatric-side-effects Subsequently, in 2014, the mefloquine product information was revised to warn that some psychiatric reactions may occur after discontinuation of mefloquine and may persist for some time after discontinuation. These updates were implemented across Europe including in the UK. Annual reminder letters highlighting the main risks associated with mefloquine and the patient checklist and alert card were issued until 2021 after which time it was agreed that due to low use of the product and a lack of enquiries for the risk minimisation materials annual letters were no longer required. The patient checklist and alert card remain available in the UK.As with any medicine, clinicians are responsible for making prescribing decisions for their patients, considering best prescribing practice and the local commissioning decisions of their respective integrated care boards (ICBs). They are also expected to take account of appropriate national guidance on clinical effectiveness and safety, and are accountable for their prescribing decisions, both professionally and to their service commissioners. Prescribers are responsible for ensuring that any side effects experienced by their patients are addressed promptly; they should work with their patient to decide on the most suitable management plan, with the provision of the most clinically appropriate care for the individual always being the primary consideration.

What his policy is on patient confidentiality in relation to sharing information on (a) inquiry reports and (b) other relevant information on killings by mentally ill people with the (i) families of their victims and (ii) general public; and what his policy is on (A) publishing independent homicide reports and (B) intervening to consider publication in such cases, in the context of patient confidentiality.

It is important that in such cases, National Health Service organisations are as transparent as possible within the bounds of the law, and that independent homicide reports are published and shared in line with legal guidance and with engagement from families. These decisions are for the organisations which commissioned the reports on a case-by-case basis.In the case of the independent investigation into the care and treatment provided to Valdo Calocane, the NHS took the decision to publish the investigation’s report in full in line with the wishes of the families and given the level of detail already in the public domain.The Department will work with NHS England and partners to set out next steps for how future independent mental health homicide reports should be published to ensure that NHS organisations act as transparently as possible, in line with their legal obligations.

For what reason NHS hospitals have not commissioned beds available in care homes to restore capacity on hospital wards by enabling patients to be discharged.

Local authorities should determine the volume and type of services, including care home beds, that are required to meet their responsibilities under the Care Act 2014. National Health Service integrated care boards, local authorities, and providers should work together to ensure that efforts to discharge individuals from hospital into social care are joined up and make best use of the available resources, in line with the duty to cooperate as set out in Section 82 of the NHS Act 2006.In December 2024 there were, on average, 12,000 adult patients in acute hospital beds per day with delayed discharges, 5% fewer than in December 2023.

What assessment he has made of the potential implications of the differential effects of the changes in last year's budget to National Insurance Contributions on employers of Learning Disabilities nurses who work (a) directly for the NHS and (b) for independent health and social care suppliers who are contracted by the NHS to give support to its patients.

We have taken tough decisions to fix the foundations in the public finances at Autumn Budget, and this enabled the Spending Review settlement of a £22.6 billion increase in resource spending for the Department from 2023/24 outturn to 2025/26. The employer National Insurance rise will be implemented from April 2025, and NHS England has set out the approach to funding providers in planning guidance for the next financial year.

What recent assessment he has made of trends in the totals of students on (a) all BSc nursing degree courses, and (b) specific courses for the degree of BSc Nursing (Learning Disabilities) since 2016; what percentage of students on BSc Nursing (Learning Disabilities) degree courses were in receipt of NHS bursaries in the year prior to the discontinuation of such bursaries; and what percentage of students currently on BSc Nursing (Learning Disabilities) degree courses are in receipt of apprenticeships.

The National Health Service continues to offer rewarding careers, with many thousands of people choosing to study nursing and midwifery every year. The Department monitors the information published by the Universities and Colleges Admissions Service (UCAS) which shows that healthcare courses were in high demand during the pandemic and now we are seeing a decrease in number of applicants across these programmes. The following table shows the number of acceptances to undergraduate nursing courses in England, from 2019 to 2024:Year201920202021202220232024Acceptances19,77025,51025,81523,24020,79020,920Source: data is from UCAS, and is available at the following link: https://www.ucas.com/data-and-analysis/undergraduate-statistics-and-reports/ucas-undergraduate-end-cycle-data-resources-2024While the data from UCAS is not detailed enough to report acceptances to individual branches of nursing, the Office for Students tracks the number of starters on learning disabilities nursing routes, through their Higher Education Students Early Statistics Survey. The following table therefore shows the number of undergraduate starters on learning disabilities nursing courses from 2016 to 2023: Year20162017201820192020202120222023Starters495315375425580570535345Source: data is from the Office for Students, and is available at the following link: https://www.officeforstudents.org.uk/data-and-analysis/data-collection/get-the-heses-data/Prior to the student funding reforms in 2017, nursing, midwifery, and allied health professions training places were centrally commissioned by Health Education England (HEE). All students on HEE commissioned places would have been in receipt of a non-means tested NHS Bursary and had their tuition fees paid. However, the Department does not hold the information that is able to confirm the proportion of Bachelor of Science in Nursing (Learning Disabilities) students who were in receipt of means tested elements of the National Health Service’s bursaries scheme or other allowances available to students in the year prior to their discontinuation.The Department does not hold information on the percentage of students currently on Bachelor of Science in Nursing (Learning Disabilities) degree courses who are in receipt of apprenticeships.

With reference to his Oral Statement of 11 December 2024 on Puberty-suppressing Hormones, Official Report, Column 923, what guidance his Department issues to parents considering taking their children to other countries for (a) top surgery and (b) other gender reassignment surgery.

There is no published guidance regarding young people under 18 years old travelling abroad for gender reassignment surgery. NHS Children and Young People’s Gender Services, which are commissioned in line with NHS England's interim service specification and the Cass Review, do not make referrals for surgical interventions. The Government strongly discourages parents from taking their child abroad for gender reassignment surgery. Parents should seek advice from appropriate medical professionals if they believe their child has gender incongruence.

What his policy is on (a) doctors and (b) other qualified medical personnel administering pain-relieving drugs which may shorten lives; and whether regulations on that issue changed after the conviction of Harold Shipman.

A wide variety of medicines are used for the purpose of pain-relief, and they have differing levels of regulation. Some items can be bought off-the-shelf without a prescription, whilst others require authorisation from a medical professional. The Human Medicines Regulations 2012 set out the responsibilities which certain medical professionals may undertake regarding the supply and administration of regulated medicines. The Misuse of Drugs Act 1971 sets out the legal framework for the prevention of misuse of controlled drugs.Decisions about what medicines to prescribe and administer are made by the doctor or other qualified medical personnel responsible for that part of the patient’s care. They must always satisfy themselves that the medicines they consider appropriate for their patients can be safely prescribed and administered, and they must take account of appropriate national guidance on clinical effectiveness. Clinicians are responsible for the decisions they make regarding the administration of medicines, and they are regulated by the relevant regulatory body for their profession.Professional regulators are responsible for setting and enforcing their own standards for the healthcare professionals that they regulate. The General Medical Council (GMC) is the regulator of all medical doctors practising in the United Kingdom, and the Nursing and Midwifery Council (NMC) is the regulator of nurses and midwives in the UK. Both the GMC and the NMC are independent of the Government, are directly accountable to Parliament, and are responsible for operational matters concerning the discharge of their statutory duties.Following the Shipman Inquiry's Fourth Report, published on 14 July 2004, the Government introduced tighter controls on the procurement, storage, supply and prescribing of controlled drugs, and established national and regional monitoring by the Care Quality Commission (CQC) and a network of regional NHS Controlled Drug Accountable Officers. The CQC is responsible for making sure that health and care service providers, and other regulators, maintain a safe environment for the management and use of controlled drugs in England. The CQC does this under the Controlled Drugs (Supervision of Management and Use) Regulations 2013. These regulations strengthened system governance to monitor the safe use and prescribing of controlled drugs, and require greater co-ordination between the health system and police, to investigate and take action, to protect patients and the public against the misuse and diversion of controlled drugs. Further information on these regulations is available at the following link:https://www.legislation.gov.uk/uksi/2013/373/contents/made

What steps he plans to take to ensure the availability of learning disability nursing studies programmes in the South East.

Individual universities are responsible for the courses that they offer. We have launched a 10-Year Health Plan to reform the National Health Service. A central and core part of this plan will be our workforce, and how we ensure we train and provide the staff the NHS needs, including doctors and nurses, to care for patients across our communities.

If he will make it his policy to extend the remit of the Care Quality Commission to include vision rehabilitation services for blind and partially sighted people.

Under the Care Act 2014, local authorities in England have a legal duty to support people with sight loss to develop practical skills and strategies to maintain independence. The Care Quality Commission (CQC) is now assessing how local authorities are meeting the full range of their duties under Part 1 of the Care Act 2014. These assessments identify local authorities’ strengths and areas for development, facilitating the sharing of good practice and helping us to target support where it is most needed. Therefore, although the CQC is not currently required to assess vision rehabilitation services as a regulated activity, under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, this does mean that sensory services, including vision rehabilitation, form part of the CQC’s overall assessment of local authorities’ delivery of adult social care. In that context, the CQC will report on sensory services when there is something important to highlight, for example, something being done well, innovative practice, or an area for improvement. The CQC’s reports and ratings of local authorities are made public on their website.

What recent estimate he has made of the number of NHS patients harmed by cobalt poisoning from modular neck hip replacements in each of the last three years.

The Medicines and Healthcare products Regulatory Agency (MHRA) is aware of concerns regarding modular neck hips and the risk of cobalt poisoning. We are investigating the issue with our stakeholders including the British Orthopaedic Association, British Hip Society, and the National Joint Registry to support.The term modular neck covers a broad range of designs, and adverse incident reports of this sort typically include descriptions of symptoms rather than a definitive diagnosis of cobalt poisoning. In addition, it is not possible to uniquely identify cobalt poisoning from hip replacements in the ICD-10 coding scheme currently used in Hospital Episode Statistics.The UK Medical Devices Regulations provide clear requirements for manufacturers to undertake post-market surveillance activities to ensure safety action is taken, when appropriate. The MHRA is working towards implementing a future regime for medical devices regulation. This will put in place strengthened legal requirements for how manufacturers monitor and report on their devices once they are being used in the real world.