Written questions by Lewis.

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.

If she will commission an assessment of the value for money of vice-chancellors’ salaries in universities which are in receipt of public money.

Higher education (HE) providers are independent and therefore responsible for decisions around pay, including for Vice-Chancellors and other senior staff. The government does not have a role in intervening in pay and staffing matters.The department acknowledges that Vice-Chancellors manage large and complex organisations, and therefore, deserve a salary that reflects the responsibilities and challenges of their roles.However, Vice-Chancellors' salaries should not be excessive or disproportionate. Where providers are facing financial challenges, we expect them to work with staff and unions to help identify how best to reduce unnecessary spend. All efficiency measures taken by the sector should provide better long-term value both for students and for the country.In addition, transparency is crucial for students, staff, and the public. Therefore, the Office for Students, the independent regulator in England, requires HE providers to provide and publish justifications for Vice-Chancellors' remuneration. If concerns arise regarding senior staff pay, the Office for Students has the authority to conduct independent reviews to ensure that a provider’s governance arrangements are appropriate and effective.

Communities and Local Government, for what positions other than (a) new regional mayors and (b) parish and town councillors will elections be held in May 2026 in areas where local authority elections have been postponed for 12 months.

The postponed elections of councillors to the county councils of East Sussex, Essex, Hampshire, Norfolk, Suffolk, Surrey and West Sussex and the unitary councils of Isle of Wight and Thurrock are due to take place in May 2026. In addition, scheduled elections of councillors to district councils within the county areas listed above are due to take place in May 2026.

If she will expand the statutory requirements for local authorities to make mandatory the provision of free journeys for companions of people with (a) physical disabilities, (b) visual impairment and (c) learning disabilities who cannot travel on buses without those companions.

The English National Concessionary Travel Scheme (ENCTS) provides free off-peak bus travel to those with eligible disabilities and those of state pension age, currently sixty-six. The ENCTS costs around £700 million annually and any changes to the statutory obligations, such as extending the eligibility criteria, would therefore need to be carefully considered for its impact on the scheme’s financial sustainability. Local authorities in England have the power to go beyond their statutory obligations under the ENCTS and offer additional discretionary concessions, such as offering companion passes for those travelling with someone eligible for the ENCTS.

Communities and Local Government, what the (a) earliest and (b) latest dates are at which she expects elections to be held to (i) the new unitary authority for the area currently covered by Hampshire County Council and (ii) other new unitary authorities for areas covered by County Councils whose elections have been postponed.

Government has agreed to postpone scheduled local elections for Surrey, Norfolk and Suffolk; Essex and Thurrock; Hampshire and the Isle of Wight; East Sussex and West Sussex from May 2025, until May 2026 only. This postponement is crucial in order to ensure that we can reorganise local government and deliver devolution as quickly as possible. For any area in which elections are postponed, we will work with areas to move to elections to new ‘shadow’ unitary councils as soon as possible as is the usual arrangement in the process of local government reorganisation. The exact date of elections to new unitary authorities in any area will depend on the proposals that are developed and submitted to government by councils in that area, and the decisions that are taken on implementing any such proposal. We also intend for Mayoral elections to take place as soon as possible in these areas.

Communities and Local Government, what her policy is on retaining parliamentary constituency boundaries when grouping the areas currently covered by county councils to form the wider areas to be covered by new unitary authorities.

Local government boundaries are not directly related to Parliamentary constituency boundaries. Local government boundary changes may be considered when undertaking a future Parliamentary constituency boundary review.

Communities and Local Government, if she will take steps to enhance the (a) remit and (b) powers of Town and Parish Councils following the replacement of District and County Councils by unitary authorities; and what the proposed relationship between those two levels of local authorities will be after reorganisation.

The English Devolution White Paper was clear that we know people value the role of governance at the community scale. All levels of local government have a part to play in bringing improved structures to their area through reorganisation. We will therefore want to see stronger community arrangements when reorganisation happens in the way councils engage at a neighbourhood or area level.Local authorities act independently of central government. Town and parish councils can work with other tiers of local government to determine how they can best serve their communities in their area.

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.

What recent steps he has taken to facilitate the (a) recovery and (b) disclosure of medical records held in (i) the Merlin database and (ii) other Departmental archives of service personnel present at UK atomic bomb tests.

The Government is deeply grateful to all those who participated in the UK nuclear testing programme. We recognise their Service and the huge contribution they have made to the UK’s security.I have asked officials to look seriously into unresolved questions regarding medical records as a priority, and this is now underway. This work will enable us to better understand what information the Department holds in relation to the medical testing of Service personnel who took part in the UK nuclear weapons tests.

Commonwealth and Development Affairs, what information his Department holds on how much and what proportion of the annual budgets of the BBC (a) World Service and (b) Monitoring Service are funded by FCDO; and what discussions he has had with the BBC on preventing cuts in those services.

The Government provides approximately one-third of the funding for the BBC World Service, with the remainder funded from the BBC Licence Fee. The BBC are operationally and editorially independent and set the budget for the World Service. The Foreign, Commonwealth and Development Office (FCDO) provided £104.4 million of grant funding to the World Service in 2023/24, the most recent year for which there are published audited accounts.FCDO Ministers engage routinely with the BBC on the World Service. The BBC discussed their plans for the World Service in 2025/26 with the FCDO, as part of the Spending Review process.HMG does not provide any funding for BBC Monitoring.

Whether she made an assessment of the potential merits of including within the terms of reference for the Independent Review of the Loan Charge consideration of the (a) mis-selling by scheme promoters, (b) advice on legality given by accountants, (c) impact of retrospective pursuit on mental health and welfare and (d) measures for protection against recurrence in future; and if she will take steps to revise the terms of reference to include those matters.

On 23 January, the Government launched the Independent Review of the Loan Charge, honouring a commitment made at the Budget. The objectives of the review are to help bring the matter to a close for those affected; ensure fairness for all taxpayers; and ensure that appropriate support is in place for those subject to the Loan Charge. The terms of reference for the review have been published here: www.gov.uk/government/publications/independent-review-of-the-loan-charge. As I set out in my letter to the reviewer, we want the review to bring the Loan Charge to a close for those people who still owe substantial amounts of money but can see no way to resolve their debts. It is now for the reviewer to conduct his review and make recommendations to the Government. The Government is also taking action to prevent disguised remuneration in the future. At the Budget, the Government announced the most ambitious ever package to close the tax gap, raising £6.5 billion of additional tax revenue in 2029-30. The package includes measures to tackle promoters of tax avoidance schemes and to address non-compliance in umbrella companies, where most disguised remuneration now takes place.

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 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.

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.

Innovation and Technology, if he will take steps to ensure (a) social media companies and (b) website providers that have been found to have hosted illegal content viewed by people that have subsequently committed serious crimes face financial sanctions.

The Online Safety Act 2023 places duties on social media companies and search services. These include duties to tackle illegal content on their services. These services will need to put systems and processes in place to reduce the risk that users post this illegal content. They will also need to take it down where it does appear. If companies fail to comply with any of these duties, Ofcom has a range of strong enforcement powers, including issuing fines and applying to the court to initiate business disruption measures.

When she plans to publish a substantive Answer to Question 20914 on Gender Dysphoria: Surgery, tabled on 18 December 2024.

A response to Parliamentary Question 20914 has now been provided; we apologise for the delay.

What recent representations she has received (a) directly and (b) via other Departments from the Special Educational Needs and Disability Transport Operators Group on the potential inclusion of (i) drivers and (ii) passenger assistants in any (A) grant and (B) compensation scheme to offset the impact of changes in employer national insurance contributions; and if she will include this cohort in any such scheme.

The government will provide support for departments and other public sector employers for additional employer National Insurance contributions (NICs) costs only. This funding will be allocated to departments, with the Barnett formula applying in the usual way. This is the usual approach the Government takes to supporting the public sector with additional employer NICs costs, as was the case with the previous Government’s Health and Social Care Levy. This does not include support for the private sector, including private sector firms contracted by central/local government. For private sector organisations that contract with local or central government, the impact of tax changes would be taken into account along with all other changes to their cost base in the usual way through contract negotiations. The definition of who is in scope as a public sector employee is based on Office of National Statistics classification of the entity paying employer NICs. This applies to employees who are directly employed by the public sector, but not, for example, where services are contracted out. The public sector comprises central government, local government and public corporations.

If she will make an assessment of the potential impact of changes made to employer's National Insurance contributions at the Autumn Budget 2024 on the (a) staffing levels of and (b) level of (i) economic and (ii) social contributions to charities; and if she will make it her policy to exempt the charitable sector from these changes.

In order to repair the public finances and help raise the revenue required to support public services, the government has taken the difficult decision to increase employer National Insurance contributions (NICs).HMRC published on 13 November a Tax Information and Impact Note that covers the impact of the changes on charities as employers.The Government has protected the smallest businesses and charities from the impact of the increase to employer National Insurance by increasing the Employment Allowance from £5,000 to £10,500, which means that 865,000 employers will pay no NICs at all next year, more than half of employers will see no change or will gain overall from this package, and all eligible employers will be able to employ up to four full-time workers on the National Living Wage and pay no NICs. All charities are eligible for the Employment Allowance, even if they are wholly or mainly carrying out functions of a public nature.More broadly, within the tax system, we provide support to charities through a range of reliefs and exemptions, including reliefs for charitable giving, with more than £6 billion in charitable reliefs provided to charities, CASCs and their donors in 2023-24.

Whether people previously diagnosed with (a) Down Syndrome and (b) other severe learning difficulties will be required to undergo a further assessment when their (i) personal independence payment and (ii) employment support allowance are migrated to universal credit.

People claiming Employment Support Allowance are being migrated to Universal Credit, but anyone on Personal Independence Payment will remain on it. Customers who move to UC following the receipt of a migration notice from ESA have their LCW or LCWRA moved with them to UC.So, for the vast majority of cases there is no need for a new WCA.The Work Capability Assessment is a functional assessment that applies to both UC & Employment and Support Allowance. Receipt of other benefits such as Personal Independence Payment (PIP) do not provide an automatic passport to LCW or LCWRA as the assessment criteria are different. Therefore, customers in receipt of PIP only, may be referred for a WCA if they declare a health condition when making their claim to Universal Credit.

What the Government's policy is on the potential prosecution of UK nationals returning to the UK after serving as volunteer fighters in the Ukrainian armed forces if they hold (a) both Ukrainian and UK citizenship, (b) sole UK citizenship but born to Ukrainian parents and (c) sole UK citizenship without Ukrainian antecedents; and whether official guidance for volunteers returning to the UK is publicly available.

Foreign, Commonwealth and Development Office (FCDO) travel advice to Ukraine states: 'If you travel to Ukraine to fight, or to assist others engaged in the war, your activities may amount to offences under UK legislation. You could be prosecuted on your return to the UK'. Their full advice is available here: Ukraine travel advice - GOV.UK.The Crown Prosecution Service (CPS), which acts independently of police and government, will consider any information that is referred by the police and any decision to prosecute will be considered on a case-by-case basis and in accordance with the Code for Crown Prosecutors.To date, the CPS has not prosecuted any cases involving UK-linked foreign fighters in the conflict between Russia and Ukraine.