Written questions by Smart.

Whether his Department has made an assessment of the potential merits of allowing over-the-counter sales of vitamin B12 injections in the UK.

The Medicine and Healthcare products Regulatory Agency (MHRA) has authorised several medicines for use in different circumstances associated with vitamin B12 deficiency. The legal status assigned to medicines is dependent on an assessment of the product against the criteria for either Prescription Only Medicine status or General Sales List status, and the classification is determined via the marketing authorisation.The criteria for classification are set out in Regulation 62 of the Human Medicines Regulations 2012 [SI 2012/2016 as amended], and Regulation 62(3) is clear that if the medicine is usually prescribed for parenteral administration, that is by injection, then the medicinal product must by law be classified as a prescription only medicine. Other aspects within Regulation 62 also apply in consideration of the most suitable legal status of vitamin B12 injection and its use in deficiency states.Currently, United Kingdom law specifies that all products administered by injection must be subject to a prescription. The MHRA is therefore unable to reclassify the status of injections, including Vitamin B12, to medicines, as this would not be consistent with the legislation.

Pursuant to the Answer of 26 March 2025 to Question 38407 on Diethylstilbestrol, whether he plans to issue an apology to women who (a) experienced long-term health impacts, (b) were compelled to place their children up adoption and (c) experienced poor maternity care due to being prescribed Diethylstilbestrol between 1950 and 1980.

The government took action regarding Diethylstilbestrol (DES) in the early 1970s. In 1971, it was recognised that DES could cause a distinct type of cancer in the daughters of women who took DES in early pregnancy. Shortly afterwards, its use was contraindicated in pregnancy, pre-menopausal women, children and young adults and the Committee on Safety of Medicines wrote to all doctors in May 1973 to advise against the use of DES in pregnancy and pre-menopausal women.Since 1992, the National Cancer Institute (NCI) at the US National Institutes of Health has been conducting the DES Follow-up Study of more than 21,000 mothers, daughters, and sons, exposed in the womb during the mother’s pregnancy, to better understand the long-term health effects of exposure to DES. The findings of this study have been published in the scientific literature.As such, work has been undertaken to contact historic users of DES. Our sympathies are with anyone harmed by its historic use.The UK Health Security Agency advises that routine cervical screening is appropriate for those who believe they were exposed to DES in utero. Further information is available at the following link:https://www.gov.uk/government/publications/cervical-screening-programme-and-colposcopy-management/5-screening-and-management-of-immunosuppressed-individualsParticipation in the National Breast Screening Programme is also recommended. Pregnant women who know that they were exposed in utero to DES should inform their obstetrician and be aware of the increased risks of ectopic pregnancy and preterm labour.The MHRA continuously assesses the benefit risk balance of all medicines at the time of initial licensing and throughout their use in clinical practice, carefully evaluating any emerging evidence on their benefits and risks.

How much NHS England has spent on (a) drug and (b) alcohol treatment in (i) prisons, (ii) young offender institutions, (iii) immigration removal centres and (iv) other secure settings in the last three financial years.

A detailed analysis of NHS England’s spend on drug and alcohol treatment in prisons, young offender institutions (YOIs), immigration removal centres (IRCs), and other secure settings is not available at the level requested. This is because mental health and substance misuse are not necessarily individual contracts and, in most instances, are part of combined total healthcare contracts. Therefore, we are only able to report combined figures for both mental health and substance misuse treatment. The following table shows the combined costs of mental health and substance misuse treatment in the secure estate, from 2021/22 to 2023/24:Schedule of mental health and substance misuse in secure settings2021/222022/232023/24Mental health and substance misuse in adult prisons£205,900,000£195,700,000£211,000,000Mental health and substance misuse in YOI's and other youth secure settings£13,600,000£13,000,000£18,300,000Mental health and substance misuse in IRC's£2,800,000£4,300,000£4,700,000

If he will take steps to introduce statutory regulation for (a) counsellors and (b) psychotherapists to help ensure minimum standards of (i) training, (ii) supervision and (iii) professional conduct.

There are no current plans to extend statutory regulation to therapists and counsellors, and no recent assessment has been made of the potential impact of the lack of statutory regulation on patient safety.When considering which professions should be protected in law the Government is clear that the level of regulatory oversight must be proportionate to the risks to the public, and that statutory regulation of healthcare professionals should only be used where the risks to public and patient protection cannot be addressed in other ways, such as through employer oversight or accredited voluntary registration. Decisions about which professions are regulated, and which professional job titles are protected, are made by the Government and by Parliament.Health professionals that are not subject to statutory regulation can join voluntary registers accredited by the Professional Standards Authority for Health and Social Care (PSA). The Government would encourage anyone accessing mental health services to use a practitioner who is subject to statuary regulation or voluntary registration accredited by the PSA.

What steps his Department is taking to help prevent people without accreditation from offering paid counselling services.

There are no current plans to extend statutory regulation to therapists and counsellors, and no recent assessment has been made of the potential impact of the lack of statutory regulation on patient safety.When considering which professions should be protected in law the Government is clear that the level of regulatory oversight must be proportionate to the risks to the public, and that statutory regulation of healthcare professionals should only be used where the risks to public and patient protection cannot be addressed in other ways, such as through employer oversight or accredited voluntary registration. Decisions about which professions are regulated, and which professional job titles are protected, are made by the Government and by Parliament.Health professionals that are not subject to statutory regulation can join voluntary registers accredited by the Professional Standards Authority for Health and Social Care (PSA). The Government would encourage anyone accessing mental health services to use a practitioner who is subject to statuary regulation or voluntary registration accredited by the PSA.

Whether his Department has made an assessment of the potential impact of levels of statutory regulation of (a) counsellors and (b) psychotherapists on patient safety.

There are no current plans to extend statutory regulation to therapists and counsellors, and no recent assessment has been made of the potential impact of the lack of statutory regulation on patient safety.When considering which professions should be protected in law the Government is clear that the level of regulatory oversight must be proportionate to the risks to the public, and that statutory regulation of healthcare professionals should only be used where the risks to public and patient protection cannot be addressed in other ways, such as through employer oversight or accredited voluntary registration. Decisions about which professions are regulated, and which professional job titles are protected, are made by the Government and by Parliament.Health professionals that are not subject to statutory regulation can join voluntary registers accredited by the Professional Standards Authority for Health and Social Care (PSA). The Government would encourage anyone accessing mental health services to use a practitioner who is subject to statuary regulation or voluntary registration accredited by the PSA.

What steps his Department is taking to increase recruitment in NHS mental health services in Greater Manchester.

As part of our mission to build a National Health Service that is fit for the future, we will recruit an additional 8,500 mental health workers nationally to reduce wait times and provide faster treatment. To ensure the NHS has the right people, in the right places, with the right skills to deliver the care patients need when they need it, we will also publish a refreshed Long Term Workforce Plan later this year to deliver the transformed health service we will build over the next decade and treat patients on time again. The Greater Manchester Mental Health NHS Foundation Trust reports that recruitment to substantive posts has improved, and the use of temporary staff has reduced, with the overall vacancy rate reducing to 9.4% in January 2025, against an in-year target of 11.4%.The trust recognises the need to retain its skilled workforce, and it has seen significant improvements in its turnover, which has reduced from more than 17% in June 2023 to 9.8% in January 2025, against an in-year target of 12.5%. In the Pennine Care NHS Foundation Trust, recruitment to substantive posts has also improved, whilst the use of temporary staff has reduced. Its vacancy rate in January 2025 had reduced to 8.5%, against an in-year target of 9.5%. Plans are in place to address vacancies within the nursing and medical workforce, and improvements in retaining the skilled workforce have resulted in a turnover which has reduced from 12.1% in June 2023 to 9.5% in January 2025, against a target of 9.6%. In addition, a child and adolescent mental health services recruitment campaign is running across Greater Manchester between January and July 2025, to recruit to roles within this specialism.

If his Department will increase the number of dementia specialist nurses working in transitions of care roles.

The Government wants a society where every person with dementia receives high-quality, compassionate care from diagnosis through to the end of life.The provision of dementia health care services is the responsibility of local integrated care boards (ICBs), and may include dementia-specialist nurses. We expect ICBs to commission services based on local population needs, taking account of National Institute for Health and Care Excellence guidelines. These guidelines recommend providing people living with dementia with a single named health or social care professional who is responsible for coordinating their care.In addition to dementia-specialist nurses, we want all health and care staff to have received appropriate training to provide high quality care to people with dementia. Employers in the health system are responsible for ensuring that their staff are trained to the required standards to deliver appropriate treatment for patients. The required training needs are set out in the Dementia Training Standards Framework, which is available through Skills For Health.

Whether the future of NHS continuing healthcare will form part of the scope of the (a) NHS 10-year Health Plan for England and (b) Casey Commission.

We have committed to developing a 10-Year Health Plan to deliver a National Health Service fit for the future. It will set the vision for what good joined-up care looks like for people with a combination of health and care needs.The independent commission into adult social care, to be chaired by Baroness Casey, is part of our critical first steps towards delivering a National Care Service. The commission will start a national conversation about what people expect from adult social care. The commission will be split over two phases. The first phase, reporting in 2026, will focus on how we can make the most of existing resources to improve people’s lives over the medium term. Phase two, reporting by 2028, will then consider the long-term transformation of adult social care, setting us on the road to fundamental reform that will build a social care system fit for the future.

What steps his Department is taking to support the mental health of parents of (a) twin and (b) multiples.

Support is already available for parents, including those of twins and multiples, who experience mental health difficulties during the perinatal period. Perinatal mental health services are available in all 42 integrated care system areas of England, and offer specialist psychiatric and psychological assessments and care for women with moderate/severe or complex mental health problems during the perinatal period. These services have also expanded to provide care to women up to two years after birth, improve access to evidence-based psychological therapies, and provide a mental health assessment and signposting support for partners as needed.In January 2025, the Department announced £126 million for the continuation of the Family Hubs and Start for Life programmes in 2025/26 in 75 local authorities with high levels of deprivation. This includes £36.5 million for bespoke perinatal mental health and parent-infant relationship support.In addition, NHS Talking Therapies services are also available for parents who need support with any mental health problems during the perinatal period. Anyone can refer themselves online via the National Health Service website or by contacting their general practitioner.

What steps his Department is taking to provide symptom management treatments to support people with multiple sclerosis to (a) manage their condition and (b) remain in employment.

The majority of people with multiple sclerosis (MS) can be cared for through routine access to primary and secondary care. NHS England commissions the specialised elements of MS care that patients may receive from 27 neurology centres across England. Within specialised centres, neurological multidisciplinary teams ensure that patients can access a range of health professionals, including specialist nurses, psychologists, and allied health professionals such as dieticians and speech and language therapists, and that they can receive specialised treatment and support according to their needs.There are a number of initiatives supporting service improvement and better care for patients with MS in England, including the Getting It Right First Time Programme for Neurology, the RightCare Progressive Neurological Conditions Toolkit, and the Neurology Transformation Programme.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.

What steps his Department is taking to help reduce the health risks for mothers giving birth to (a) twins and (b) multiples.

The Government is determined to ensure that all women receive safe, personalised, and compassionate care and continues to work with the National Health Service as it delivers its three-year maternity and neonatal plan to achieve this.The latest data shows that 1.4% of maternities result in multiple births, however pregnancies for twins and multiples are associated with significantly higher risks for stillbirth and preterm birth, and many multiples spend time in neonatal care. We are ensuring high quality care is implemented across England to improve these outcomes. The NHS is rolling out version three of the Saving Babies Lives Care Bundle, which provides maternity units with detailed guidance to reduce stillbirths, neonatal brain injuries, neonatal deaths, and preterm births, including specific guidance for multiple pregnancies. This has been fully implemented by over 100 providers.Additionally, last year, we launched a £50 million National Institute for Health and Care Research challenge fund to task researchers and policymakers with finding new ways to tackle poor pregnancy outcomes such as preterm birth.

What assessment he has made of the potential impact of closing the Suicide Prevention Grant Fund on organisations engaged in suicide prevention activities.

The Suicide Prevention Grant Fund came to an end on 31 March 2025, as planned from the outset of the grant. There are currently no plans to run another grant fund.Voluntary and community sector organisations play a valuable role in suicide prevention, including supporting the delivery of the cross-sector national suicide prevention strategy for England. We will be evaluating the impact of the fund, and the services that have been provided by the grant-funded organisations. Learning from this evaluation will help to inform the delivery of the Government’s mission to reduce the lives lost to suicide.

If his Department will take steps to support people who have reported (a) long-term health and (b) personal impacts due to being prescribed Diethylstilbestrol (DES) between 1950 and 1980.

The Medicines and Healthcare products Regulatory Agency (MHRA) regulates medicines supplied in the United Kingdom. Our activity spans the whole of a medicine’s lifecycle. Diethylstilboestrol (DES) is an oestrogenic hormone formerly used in the treatment of threatened miscarriage. In 1971, it was identified in a US study that DES could cause a distinct type of cancer in the daughters of women who took DES in early pregnancy. It was subsequently contraindicated in pregnancy, pre-menopausal women, children and young adults. The issue of DES and vaginal carcinoma in the daughters of women who took DES in pregnancy was reviewed by the predecessor to the Commission on Human Medicines, the Committee on Safety of Medicines (CSM) in the early 1970s. In 1973, the CSM wrote to all doctors to inform them of the results of the US study and the absence of identified cases in the UK.DES may still be prescribed in the UK for certain types of cancer, including cancer of the prostate and metastatic post-menopausal cancer of the breast. The product information for DES clearly describes the risk of harms related to its use in pregnancy and for this reason its use is contra-indicated in pregnant women; it is not suitable for pre-menopausal women, and should not be prescribed to children or young people due to its carcinogenic potential. The use of DES is now only justified in the management of malignant disease.The MHRA continuously assesses the benefit risk balance of all medicines at the time of initial licensing and throughout their use in clinical practice, carefully evaluating any emerging evidence on their benefits and risks.A small increased risk of breast cancer in women who received DES whilst pregnant was first identified in the 1980s and confirmed in further studies in the 1990s, when longer follow up of women who had taken DES was available. No increased risk of other cancers has been established, including endometrial cancer or ovarian cancer.Since 1992 the National Cancer Institute at the US National Institutes of Health has been conducting the DES Follow-up Study of more than 21,000 mothers, daughters, and sons, exposed in the womb during the mother’s pregnancy, to better understand the long-term health effects of exposure to DES. The findings of this follow up have been published in the scientific literature.Daughters of individuals exposed to DES are at increased risk of clear cell cancer of the cervix and vagina. The current advice from the UK Health Security Agency is that routine cervical screening is appropriate for those who believed they were exposed to DES in utero; the advice is available at the following link:https://www.gov.uk/government/publications/cervical-screening-programme-and-colposcopy-management/5-screening-and-management-of-immunosuppressed-individualsParticipation in the National Breast Screening Programme is also recommended. Pregnant women who know that they were exposed in utero to DES should inform their obstetrician and be aware of the increased risks of ectopic pregnancy and preterm labour.

If he will encourage the adoption of the Mental Wellbeing Impact Assessment toolkit across (a) Government Departments and (b) local authorities.

We would like the mental health impacts on adults, children, and young people to be considered in all policymaking across Government. We are considering how to support the relevant departments to do this.Mental health cannot just be the responsibility of the health system. As part of the 10 Year Plan shift to prevention, we will work across Whitehall, and the wider public and voluntary sector, to address the socioeconomic determinants of mental health.

Whether his Department has plans to issue updated guidance on the placement of dementia patients in hospital wards.

The National Institute for Health and Care Excellence’s (NICE) guidance on dementia states which aspects of care should be expected to ensure quality dementia care in hospital. This includes appropriate admission to hospital, comprehensive assessments, and personal history taking. Further information on the NICE’s dementia guidance is available at the following link:https://www.nice.org.uk/guidance/ng97The NICE’s guidance on the transition between inpatient hospital settings and community or care home settings for adults with social care needs covers the transition between inpatient hospital settings and community or care homes for adults with social care needs. Further information on the NICE’s transition guidance is available at the following link:https://www.nice.org.uk/guidance/ng27The NICE’s guidance will be reviewed if there is new evidence that is likely to change the recommendations. The 10-Year Health Plan will address the challenges diagnosed by Lord Darzi and set the vision for what good joined-up care looks like for people with a combination of complex health and care needs. It will set out how we support and enable health and social care services to work together better to provide that joined-up care. The Government is launching an independent commission into adult social care as part of our critical first steps towards delivering a National Care Service.To improve care for patients with dementia, NHS England's RightCare team has refreshed the RightCare Dementia Scenario. The scenario works through the dementia well pathway journey, from diagnosing well through to dying well, detailing optimal and suboptimal approaches, with associated costings for each.

Whether his Department is taking steps to hold Capita accountable where it fails to provide GPs with accurate annual pension statements under the Primary Care Support England scheme.

Capita, who delivers Primary Care Support England (PCSE), does not issue pension statements to general practitioners (GPs), as this is the responsibility of NHS Pensions, which is managed by the NHS Business Services Authority (NHS BSA). PCSE updates GP pension records once the appropriate type one or type two annual certificate is submitted to PCSE for processing by the GP.In order for NHS Pensions to generate an annual pension benefits statement, it is necessary for the GP’s pension record to be up to date, with no missing annual certificate for prior years. NHS England works closely with PCSE and NHS Pensions to ensure that GPs are supported, through a series of webinars and guidance documents, to submit accurate information in a timely manner. NHS England tracks PCSE’s performance on a monthly basis against contractual performance targets. NHS England continues to work with PCSE, NHS Pensions, and GP representative bodies to rectify historical gaps in GP records.More generally, the importance of checking PCSE Online to ensure that all required type one or type two forms are showing as approved, and to submit certificates if there are any missing years to get records up to date, is highlighted in communications to GPs.

What assessment he has made of the potential impact of issues with the reconciliation of pension contributions by Capita on GPs.

General practitioners (GPs) are required to submit either a type one or type two annual certificate each year to Primary Care Support England (PCSE). Each certificate received by PCSE is reconciled on an individual basis, and the GP’s record is updated accordingly. Where the information cannot be reconciled, or the information is incomplete, PCSE will return the certificate to the GP outlining what information is required.NHS England regularly monitors the number of outstanding certificates and missing data, working closely with PCSE to resolve issues. In addition, NHS England works closely with the British Medical Association and NHS Pensions to manage complaints and proactively resolve issues. NHS England also monitors PCSE’s performance on a monthly basis against contractual performance targets.Supporting GPs to accurately submit current and historic type one or type two annual certificates remains a priority for NHS England and PCSE. Since the PCSE Online solution for submitting type one and type two certificates electronically went live in 2021, PCSE has developed user guides and held webinars to educate GPs on how to complete forms accurately.

What steps his Department is taking to reduce delays in transferring dementia patients from hospitals to social care settings.

Almost one million people in the United Kingdom are living with dementia, and that figure is expected to rise. Each of those people, alongside their friends, families and carers, have their own unique and important story of living with dementia, and this government wants a society where every person with dementia receives high-quality, compassionate care from diagnosis through to the end of life.We are working to reduce delayed discharges by improving local partnership working between the National Health Service and social care systems, ensuring that people are not stuck in hospital beds when they are well enough to go home.In December 2024, working with the Local Government Association and NHS England, we published a High Impact Change Model for improving the timely and effective discharge of people with dementia or delirium into the community. This resource offers practical guidance and a set of recommended actions that systems should consider for optimising the discharge process and deliver best practice for an individual’s journey to, during and following discharge. The model is available at the following link:https://www.local.gov.uk/our-support/partners-care-and-health/better-care-fund-support-programme-2023-25/high-impact-change

What steps his Department is taking to ensure NHS hospital staff receive adequate (a) training and (b) support to manage dementia patients in general hospital wards.

Employers in the health system are responsible for ensuring that their staff are trained to the required standards to deliver the appropriate treatment for patients. Individual trusts are responsible for ensuring that their staff are trained to carry out their role, and for investing in the future of their staff through providing continuing professional development funding.The required training needs are set out in the Dementia Training Standards Framework, commissioned and funded by the Department and developed in collaboration with the sector, which is available at the following link:https://www.skillsforhealth.org.uk/info-hub/dementia-2015-updated-2018/The framework sets out the essential knowledge, skills, and expected learning outcomes applicable across the health and care spectrum. The National Institute for Health and Care Excellence has also issued guidance on Assessment, Management and Support for People Living With Dementia, which covers staff training and education, and which is available at the following link:https://www.nice.org.uk/guidance/ng97/chapter/Recommendations#staff-training-and-education