Written questions by Smart.

With reference to his Oral Statement of 11 December 2024 on Puberty-suppressing Hormones, Official Report, column 914-916, whether the clinical trial into the use of puberty suppressing hormones for gender incongruence will begin early this year; and when his Department intends to update parents and young people on the (a) timetable and (b) eligibility of the clinical trial.

The PATHWAYS study proposal, including the clinical trial of puberty-suppressing hormones, is going through all the usual review and approval stages. These include an independent academic peer review and consideration by the National Institute for Health and Care Research’s funding committee. The study will need to secure full ethical approval before it can be set up and recruitment can open. The design of the study, including the timetable and eligibility criteria, will be finalised as part of the approvals process. It is planned to commence this year. Subject to the study achieving the necessary approvals, the study protocol will be made available in the public domain, as is usual for publicly funded studies.

What steps his Department is taking to ensure that the process of issuing death certificates following the change to the responsibilities of medical examiners on 9 September 2024 does not lead to undue delays in families being able to arrange funerals.

The Government is monitoring the impact of the death certification reforms, including the Medical Certificate of Cause of Death Regulations 2024, which came into legal effect on 9 September 2024. Early data indicates the median time taken to register a death appears to have risen by one day, from seven days to eight days. This figure is for all deaths, as it includes those certified by a doctor and those investigated by a coroner. The average time taken to register has increased further over the recent Christmas weeks, but this was expected given increases are observed during this period every year; the average is expected to decrease again as more data becomes available for January and February 2025. The median time taken to register a death varies depending on the type of certification. Deaths certified by a doctor, that comprise approximately 80% of deaths registered each week, have typically had a median time to registration of seven days. We note that the medical examiner system was active on a non-statutory basis before the introduction of the statutory system on 9 September 2024, and this makes direct ‘before’ and ‘after’ comparisons challenging to draw conclusions from.The core purposes of the death certification reforms are to introduce scrutiny of the cause of death to detect and deter malpractice, to improve reporting, and crucially to put the bereaved at the centre of the process by offering a conversation with the medical examiner about the cause of death. The expectation on doctors and medical examiners is clear, that they should complete certification as quickly and efficiently as possible, and the Government is working with all stakeholders to make sure this is the case.

When the Minister for Health and Secondary Care plans to respond to the correspondence of 6 November 2024 from the hon. Member for Hazel Grove on funding for Stepping Hill Hospital.

I replied to the hon. Member on 29 January 2025.

What steps his Department is taking to (a) support and (b) encourage Integrated Care Boards to prescribe semaglutide for weight management.

Obesity medicines can be effective for some patients living with obesity when prescribed alongside diet, physical activity, and behavioural support. Exactly what is most appropriate for an individual is down to health care professionals to advise, in discussion with patients, and considering relevant clinical guidance.The National Institute for Health and Care Excellence recommended semaglutide as an option for weight management, alongside a reduced-calorie diet and increased physical activity, for adults that meet the eligibility criteria, and only if it is used within a specialist weight management service providing multidisciplinary management of overweight or obesity.Integrated care boards (ICBs) are responsible for arranging the provision of health services within their area in line with local priorities, considering population need and relevant guidance. This includes the commissioning of NHS specialist weight management services.National Health Service organisations, including ICBs, are continuing to look at the best way to manage access to treatments for obesity.

What steps his Department is taking to increase the supply of semaglutide in Hazel Grove constituency.

The Department monitors and manages medicine supply at a national level so that stocks remain available to meet regional and local demand. Information on stock levels within individual constituencies is not held centrally. The Department is not aware of any current supply issues for semaglutide. Ozempic and Wegovy, injectable forms of semaglutide, are currently available, and Rybelsus, an oral tablet containing semaglutide, is also available. The Department continues to monitor the situation, ensuring that medicines remain available for new patients with type 2 diabetes, as well as those unable to obtain their existing treatment. The General Pharmaceutical Council, General Medical Council, Health and Care Professions Council, Nursing and Midwifery Council, and Pharmaceutical Society of Northern Ireland have also issued a joint statement stressing the importance of health and care professionals meeting regulatory standards in relation to these medicines. The guidance is clear, that medications licensed to treat type 2 diabetes should not be prescribed for weight loss, except where specifically licenced for this use. Any patient who is worried about their condition, or access to these medications, should speak to their clinician in the first instance.

Whether he plans to include Annatto (E160b) on the list of allergens that must be labelled under UK food labelling regulations.

There are many potential food ingredients that may cause an allergic reaction to sensitised people. The current 14 regulated allergens are recognised as being the most common and potent allergens of public health concern across Europe.   Further information is available at the following link:https://www.food.gov.uk/business-guidance/allergen-guidance-for-food-businessesThe prevalence of allergy to the additive Annatto (E160b) is currently unknown in the United Kingdom. The Food Standards Agency (FSA) is currently working with the British Society for Allergy and Clinical Immunology and other stakeholders on gathering information on hidden and emerging food allergens which will help in assessing the need for further research and work in this area. If further information is received on the prevalence of Annatto as an allergy we will review this evidence. The FSA continues to monitor the situation closely but has no current recommendations to Ministers on amending the list of 14 regulated allergens.The FSA continues to work to make it easier for people with food hypersensitivities, namely allergies, intolerances, and coeliac disease, to have access to clear and accurate information which is a fundamental part of their work. Their research is available at the following link:https://www.food.gov.uk/research/food-hypersensitivity

What steps his Department is taking to (a) encourage NHS trusts in Greater Manchester to participate in the Early Access Programme for Givinostat and (b) to help tackle barriers to participation.

NHS England does not have any initiatives to encourage participation in compassionate use schemes, which are the responsibility of individual pharmaceutical companies.Participation in the Early Access Programme (EAP) for givinostat, which must be through one of the 23 NorthStar Centres in the United Kingdom, is decided at an individual National Health Service trust level although there is general advice that trusts should engage with the relevant commissioner if they choose to participate. A NorthStar Centre will not be able to provide givinostat if its local trust has not approved participation. Under the EAP, givinostat is free to both patients taking part in it and to the NHS, but the trusts must still cover the cost of administering it to patients. Only Duchenne muscular dystrophy clinicians can make requests for givinostat for their patients. Decisions are made on a case-by-case basis for individual named patients aligned to eligibility criteria.NHS England hopes that all NHS trusts, including in Greater Manchester, who receive a request from a NorthStar Centre to provide givinostat to an eligible patient approve this request. NHS England will work with partners to ensure that Trusts understand the urgent need to make access possible for eligible patient.

What steps his Department is taking to improve the diagnosis and recognition of Lyme Disease.

I refer the hon. Member to the answer I gave to the hon. Member for South Cambridgeshire on 12 November 2024 to Question 13156.

What his planned timetable is to spend the additional funding allocated for new radiotherapy machines on 28 October 2024.

The £70 million investment in new radiotherapy machines will ensure that the most advanced treatment is available to patients. Following publication of the 10-Year Health Plan, we will publish the new national cancer plan, which will include further details on how we will improve outcomes for cancer patients, including improving waiting times for patients.The funding will be spent in 2025/26, with the exact timetable and allocation of machines still to be determined. The funding will be used to replace outdated machines, and allocated to trusts using criteria that NHS England is currently developing. These criteria will be shared with providers in due course.

What steps his Department is taking to ensure the new additional funding for new radiotherapy machines aligns with the (a) NHS Long-Term Plan and (b) the upcoming 10-year cancer strategy.

The £70 million investment in new radiotherapy machines will ensure that the most advanced treatment is available to patients. Following publication of the 10-Year Health Plan, we will publish the new national cancer plan, which will include further details on how we will improve outcomes for cancer patients, including improving waiting times for patients.The funding will be spent in 2025/26, with the exact timetable and allocation of machines still to be determined. The funding will be used to replace outdated machines, and allocated to trusts using criteria that NHS England is currently developing. These criteria will be shared with providers in due course.

What steps his Department is taking to raise (a) public and (b) professional awareness of (i) inflammatory bowel disease and (ii) other unseen disabilities in the context of access to (A) healthcare and (B) social support for people with those conditions.

NHS England’s Getting It Right First Time Programme on gastroenterology aims to reduce variations in care, increase early diagnosis and proactive management of Crohn’s disease and colitis, and increase access to inflammatory bowel disease (IBD) specialist nurses.The National institute for Health and Care Excellence (NICE) has also produced a range of guidance on IBD, Crohn’s disease and colitis, to support early diagnosis and effective management of these conditions. It ensures that the care provided to people with IBD is based on the best available evidence. In the last two years, the NICE has recommended four new drugs for the treatment of moderate to severe Crohn’s disease and ulcerative colitis, including Upadacitinib, Risankizumab, Mirikizumab, and Etrasimod.NHS England’s National Bladder and Bowel Health Project is delivering better care for people with IBD, with a focus on developing clinical pathways. NHS England commissions specialised colorectal services nationally to support the equity of access to high-quality treatment for patients with IBD requiring complex surgery. This work is supported within NHS England by the clinical leadership of the Specialised Colorectal Services Clinical Reference Group, which is made up of experts in surgery, medicine, radiology, pathology, and nursing, alongside patient and public voice representatives.To raise awareness of IBD among general practitioners and other primary care staff, the Royal College of General Practitioners has produced an Inflammatory Bowel Disease Toolkit. The toolkit outlines when to suspect IBD, the appropriate investigative tests and diagnostic tools for IBD, how to manage a flare-up of symptoms, and how to support patients with IBD.Under the Equality Act 2010, health and social care organisations must make reasonable adjustments to ensure that disabled people are not disadvantaged. NHS England has issued guidance for National Health Service commissioners with respect to the Reasonable Adjustments Digital Flag (the Flag). The Flag has been developed to enable health and care workers to record, share, and view, in digital records, details of the reasonable adjustments required by an individual across the NHS, wherever the person is treated. The Flag was built and launched by NHS England in September 2023, and is being implemented in phases. NHS organisations will be required to fully comply with the requirements of the Flag by 31 December 2025.

If he will make it his policy to create a cross-governmental strategy for the prevention of ill health that would include measures on tackling (a) health and (b) other lifestyle factors that affect a person's risk of developing dementia that are (i) within and (ii) not within people's control, such as air pollution.

As part of the Government’s health mission, we will shift from sickness to prevention, to tackle ill health, prevent premature deaths, and build a fairer United Kingdom where everyone lives longer, healthier lives.We have committed to developing a 10-year plan to deliver a National Health Service fit for the future. We will carefully be considering policies, including those that impact people with dementia care needs, with input from the public, patients, and health staff as we develop the plan.Since 2018, dementia risk reduction has been incorporated in the NHS Health Check to increase dementia awareness and motivate people to make positive changes to reduce their risks.We recognise that air pollution is one of the risk factors for dementia. The National Institute for Health and Care Research is supporting research to explore the link between dementia and air pollution, including a project to address how air pollution mitigation measures impact on neurological endpoints.

What steps his Department is taking to improve (a) support and (b) care pathways in the NHS for people diagnosed with inflammatory bowel disease.

NHS England’s National Bladder and Bowel Health Project is delivering better care for people with inflammatory bowel disease (IBD), with a focus on developing best practice clinical pathways. NHS England commissions specialised colorectal services nationally to support equity of access to high-quality treatment for patients with IBD requiring complex surgery. This work is supported within NHS England by the clinical leadership of the Specialised Colorectal Services Clinical Reference Group.NHS England’s Getting It Right First Time Programme on gastroenterology aims to reduce variations in care, increase early diagnosis and proactive management of Crohn’s disease and colitis, and increase access to IBD specialist nurses.We have also committed more broadly to ensuring patients get the care they need as quickly as possible. Funding announced in the Autumn Budget for elective care will also support the delivery of an additional 2 million operations, scans, and appointments during our first year in Government, which is equivalent to 40,000 per week, across all specialties, as a first step in our commitment to ensuring that patients can expect to be treated within 18 weeks. As part of this package, £1.5 billion of capital funding in 2025/26 will enable new surgical hubs and diagnostic scanners to build capacity for over 30,000 additional procedures and over 1.25 million diagnostic tests, as they come online.

What steps his Department is taking to increase the number of dentists in Hazel Grove constituency.

The Government plans to tackle the challenges for patients trying to access National Health Service dental care with a rescue plan to provide 700,000 more urgent dental appointments, and recruit new dentists to the areas that need them most. To rebuild dentistry in the long term and increase access to NHS dental care, we will reform the dental contract, with a shift to focus on prevention and the retention of NHS dentists.The responsibility for commissioning primary care services, including NHS dentistry, to meet the needs of the local population has been delegated to integrated care boards (ICBs) across England. For the Hazel Grove constituency, this is the Greater Manchester ICB.

What steps his Department is taking to improve the (a) diagnosis and (b) treatment of (i) endometriosis and (ii) adenomyosis.

The Government is committed to prioritising women’s health and improving the diagnosis, treatment, and ongoing care for gynaecological conditions. National Institute for Health and Care Excellence (NICE) guidelines support healthcare professionals to diagnose and treat conditions. The NICE has published a Women’s and reproductive health guidelines, which is available at the following link:https://www.nice.org.uk/hub/indevelopment/gid-hub10001In April 2024, the NICE published updated recommendations on the treatment of endometriosis when fertility is a priority, and in November 2024, published updated recommendations on the diagnosis and management of endometriosis. The NICE has also published a guideline on heavy menstrual bleeding assessment and management. This guideline contains recommendations for the diagnosis of women with suspected adenomyosis. Women's health is also embedded into the Royal College of General Practitioners’ curriculum for trainee general practitioners.Tackling waiting lists is a key part of the Government’s Health Mission, and we are urgently looking into waiting times for gynecological issues, including for endometriosis and adenomyosis. Funding has been confirmed to support the delivery of our commitment of an extra 40,000 National Health Service operations, scans, and appointments per week, as a first step to delivering on the 18-week standard.

What assessment his Department has made of the potential (a) impact of the Greater Manchester Dental Quality Access Scheme on access to NHS dental services in Greater Manchester and (b) merits of replicating that scheme in other areas.

The Department and NHS England are aware of several local access schemes across the country and are keen to learn from all initiatives, including the Greater Manchester Dental Quality Access Scheme.Local schemes are considered in the development of national policy. Integrated care boards are responsible for commissioning primary care services, including National Health Service dentistry, to meet the needs of the local populations, and to determine the priorities for investment.

What steps his Department is taking to ensure insulin is distributed to (a) large and (b) small pharmacies across the UK.

The Department continues to work with all suppliers to ensure that insulin products are distributed and available for both small and large pharmacies.There are ongoing global supply issues with Tresiba FlexTouch 100 units per millilitre pre-filled pens and Fiasp FlexTouch 100 units per millilitre pre-filled pens. We have issued communications to National Health Service healthcare professionals, providing comprehensive management guidance, advice, and information to allow them to support their patients in the management of the supply issues.

What steps he plans to take to reduce waiting times for autism diagnosis; and what steps he is taking to improve access to diagnostic services for (a) children and (b) adults.

The Department is currently considering next steps to improve diagnostic assessment and support for autistic people. It is the responsibility of integrated care boards (ICBs) to make available appropriate provision to meet the health and care needs of their local population, including autism assessment and support services, in line with National Institute for Health and Care Excellence guidelines.On 5 April 2023, NHS England published a national framework and operational guidance to deliver improved outcomes in all-age autism assessment pathways. This guidance will help ICBs and the National Health Service to deliver improved outcomes for children, young people, and adults referred to an autism assessment service. The guidance also sets out what support should be available before an assessment and what support should follow a recent diagnosis of autism, based on the available evidence.In 2024/25, £4.3 million is available nationally to improve services for autistic children and young people, including autism assessment services.

What steps he is taking to ensure ADHD testing is accessible to children in Greater Manchester.

The Department is currently considering next steps to improve access to attention deficit hyperactivity disorder (ADHD) services. It is the responsibility of integrated care boards to make available appropriate provision to meet the health and care needs of their local population, including ADHD care pathways, in line with relevant National Institute for Health and Care Excellence guidelines.We are supporting a taskforce that NHS England is establishing to look at ADHD service provision and its impact on patient experience. The taskforce will bring together expertise from across a broad range of sectors, including the National Health Service, education, and justice, to better understand the challenges affecting people with ADHD and help provide a joined-up approach in response to concerns around rising demand.NHS Greater Manchester advises that it has launched a public engagement exercise to gather views on improving children and young people’s ADHD services in Greater Manchester. The engagement exercise, which runs until 29 November 2024, seeks to address several issues including long wait times, levels of ongoing support for patients, the referral and assessment process, and how services vary across Greater Manchester.

What steps he is taking to help ensure that people diagnosed with autism at the age of 30 or later receive comparable (a) support and (b) resources to people diagnosed in childhood; and what plans he has to tackle disparities in services.

The Department is currently considering next steps to improve support for autistic people of all ages. It is the responsibility of integrated care boards (ICBs) to make available appropriate provision to meet the health and care needs of their local population, including support services for autistic people of all ages, in line with National Institute for Health and Care Excellence (NICE) guidelines. The NICE guideline, Autism spectrum disorder in adults: diagnosis and management, aims to improve access and engagement with interventions and services, and the experience of care, for autistic adults.On 5 April 2023, NHS England published a national framework and operational guidance to deliver improved outcomes in all-age autism assessment pathways. This guidance will help ICBs and the National Health Service to deliver improved outcomes for children, young people, and adults referred to an autism assessment service. The guidance sets out what support should be available before an assessment and what support should follow a recent diagnosis of autism based on the available evidence. This includes setting out specific considerations for developing post-diagnostic support for adults diagnosed as autistic.