Written questions by Jarvis.

What steps he is taking to help increase public awareness of (a) frailty of and (b) fall prevention among people aged 65 and over.

The National Health Service website has public information and advice on fall prevention. The Chartered Society of Physiotherapy’s (CSP) Get up and go – a guide to staying steady is a 32-page guide for the public and patients on how to prevent falls, and was produced by Saga in partnership with the CSP and the Office for Health Improvement and Disparities.To help healthcare systems support people living with frailty, NHS England has developed a RightCare frailty toolkit. The RightCare toolkit aims to support systems to understand the priorities in frailty care and the key actions to take. It provides a way to assess and benchmark current systems, in order to find opportunities for improvement.NHS England’s Falls and Fragility Fractures RightCare Pathway defines the core components of an optimal service for people who have suffered from a fall or who are at risk of falls and fragility fractures. It recommends that the commissioners responsible for falls and fragility fractures for their population should work across the system to ensure that schemes to deliver the higher value interventions are in place.The National Institute for Health and Care Excellence has also recently published guidance in April 2025 on the assessment and prevention of falls in older people and in people aged 50 years old and over who are at higher risk. The guidance aims to reduce the risk and incidence of falls, and the associated distress, pain, injury, loss of confidence, loss of independence, and mortality.

What steps he is taking to help improve the (a) recruitment and (b) retention of staff in the NHS cancer workforce.

Recruitment to National Health Service roles is managed locally by trusts and systems. However, NHS England is taking a range of actions to support the recruitment and retention of staff in the NHS cancer workforce.To grow the workforce, NHS England has been expanding specialty training places in key cancer professions, including histopathology, clinical radiology, and gastroenterology. Targeted national campaigns and outreach activities, for example in clinical oncology, also promote cancer career pathways, with a focus on increasing applications.To improve retention, NHS England is investing in structured career development and education support. The Aspirant Cancer Career and Education Development programme provides a nationally agreed framework for capability, career development, and education for nurses, allied health professionals, and the support workforce working in cancer care.

What steps his Department is taking to reduce waiting lists for audiology assessments.

NHS England is supporting provider organisations and integrated care boards, who are the commissioners of audiology services, to improve performance and reduce waiting lists. This includes capital investment to upgrade audiology facilities in National Health Service trusts, expanding audiology testing capacity via community diagnostic centres, and direct support through a national audiology improvement collaborative.

What assessment he has made of the potential impact of increases in employer National Insurance contributions on (a) levels of staff costs for homecare providers and (b) the delivery of social care services.

The Government assessed the impact of the cost pressures facing adult social care as part of the wider consideration of local government spending within the Spending Review process. This assessment took account of a range of factors that could affect the delivery of social care services, including changes to employer National Insurance Contributions.To enable local authorities to deliver key services such as adult social care, the Government has made available up to £3.7 billion of additional funding for social care authorities in 2025/26. There is also an extra £502 million of support for local authorities in England to manage the impact of changes to employer National Insurance Contributions announced at the Autumn Budget 2024.In addition, the Spending Review allows for an increase of over £4 billion of funding available for adult social care in 2028/29 compared to 2025/26.

What assessment he has made of the adequacy of waiting times for cardiology services.

The latest data from March 2025 show that 60.9% of waits for cardiology services are within 18 weeks, which is a 1.6% improvement on the same month in the previous year. While this shows progress, we know there is more to do.That is why, as well as our commitment to returning to the 92% referral-to-treatment standard for elective care by March 2029, the Elective Reform Plan commits to significant elective reform in cardiology. This includes a key milestone for 2025/26, as set out in National Health Service operational planning guidance, that by the end of March 2026, 65% of waits will be within 18 weeks, with the expectation of a 5% improvement from each provider.Cardiology is one of five priority specialties identified for significant elective reform in the Elective Reform Plan, due to it being a large volume specialty with waiting list challenges and a high proportion of non-surgical care. Reforms will include increasing specialist cardiology input earlier in patient care pathways, and developing standard and efficient care pathways for common cardiology symptoms. It also includes improving access to cardiac diagnostic tests, including through implementing more straight-to-test pathways, where a general practitioner can refer a patient directly to secondary care for a test, which can reduce unnecessary outpatient appointments and improve waiting times even further for patients across England. These improvements to common cardiology pathways help standardise patient care, reduce inequalities, and improve access to care, especially in the early stages of the pathways, for patients across England.

What steps his Department is taking to help reduce staffing shortages in Child and Adolescent Mental Health Services.

This year the Department is investing an extra £688 million in children and young people’s mental health services. This will allow us to hire more staff, deliver more talking therapies, and get waiting lists down through our Plan for Change. Early interventions in mental health support for young people can have positive ramifications for the rest of their lives. We will deliver on our commitment to get every child who needs it access to mental health support within school, and over the course of this year we will roll that support out to nearly a million extra children. Under Government plans, all pupils will have access to mental health support in school by 2029/30. As part of our mission to build a National Health Service that is fit for the future and that is there when people need it, we will recruit 8,500 mental health workers across child and adult mental health services to help ease the pressure on busy services. We continue to work with NHS England to consider options to deliver this commitment, alongside publishing a refreshed workforce plan to deliver the transformed health service we will build over the next decade. In addition, targeted retention work has been undertaken through the NHS Retention Programme which works with trusts to help them understand why staff have left. This has focused on better support for line managers and improved support for new joiners.

If his Department will reintroduce a NHS dementia diagnosis target.

The Government remains committed to recovering the dementia diagnosis rate to the national ambition of 66.7% and agrees that timely diagnosis is vital to ensuring that people with dementia can access the treatment and support they need.The Darzi Investigation found that there were too many targets set for the National Health Service, which made it hard for local systems to prioritise their actions or to be held properly accountable.This is why we have taken a new approach to NHS Planning Guidance this year, reducing the number of national directives from 32 to 18. We will only turn the NHS around by doing things differently. These are the first steps on our journey for the long-term reform of the NHS.NHS Planning Guidance is not an exhaustive list of everything the NHS does, and the absence of a target does not mean it is not an area of focus.

What steps his Department is taking to ensure that cancer test results requested by secondary care are routinely shared with patients' GPs in a timely manner.

The Government is supporting NHS England to ensure that information on diagnoses and treatment, including cancer test results, are shared between services routinely and in a timely manner.NHS England has been supporting National Health Service trusts and foundation trusts in acquiring and developing the effectiveness of their electronic patient records, and support is available to bring trusts to an optimum level of digital maturity which will further reduce barriers to the sharing of information needed to treat patients. Further information can be found at the following link:https://www.england.nhs.uk/long-read/data-and-clinical-record-sharing/The Department supported the NHS’s Connecting Care Records programme which joins up information based on the individual rather than through one organisation. Through targeted investment, local Connecting Care Record systems have been established in all integrated commissioning board areas. 97% of trusts and 92% of primary care networks are now connected, in order to share information such as medications, allergies, test results, and clinical correspondence.Furthermore, my Rt Hon. Friend, the Secretary of State for Health and Social Care has announced the intention for there to be a single patient record which would provide a comprehensive patient record, reducing duplication when patients have to repeat their medical history when interacting with the NHS.

What steps his Department is taking to improve early diagnosis of foetal alcohol spectrum disorder.

The Government recognises that foetal alcohol spectrum disorders (FASD) can have a significant impact on the early years of development for children. As a result, it is crucial to diagnose FASD as early as possible. As part of the prevention efforts around FASD, the Department promotes a precautionary approach by advising that the safest option during pregnancy is to avoid alcohol altogether.The Department asked the National Institute for Health and Care Excellence (NICE) to produce a quality standard in England for FASD, to help the health care system improve both diagnosis and support for individuals affects by FASD. This was published in March 2022 and is available at the following link:https://www.nice.org.uk/guidance/qs204Healthcare providers continue to advise pregnant women about the risks of alcohol consumption, document alcohol use, and refer children with probable prenatal alcohol exposure for assessment.

Whether the NHS plans to fund abiraterone for patients with high-risk non-metastatic prostate cancer.

The Department has had no such discussions. Abiraterone does not have a marketing authorisation for use in the treatment of high-risk, non-metastatic prostate cancer and has not been evaluated for that indication by the National Institute for Health and Care Excellence (NICE). The NICE makes recommendations for the National Health Service in England on the vast majority of new and significant licence indications, but does not evaluate medicines that are used outside their marketing authorisations or “off-label”.NHS England considered abiraterone as an off-label treatment for the treatment of hormone sensitive, non-metastatic prostate cancer through its clinical policy development process in 2024/25. Through this process NHS England confirmed that there was sufficient supporting evidence to support the routine commissioning of abiraterone in this indication, but it has not been possible to identify the necessary recurrent funding to support the commissioning of abiraterone for this purpose, or any other treatments within the prioritisation round. Should the funding position change and a further prioritisation round take place, abiraterone for the treatment of hormone sensitive, non-metastatic prostate cancer will be reconsidered.

What steps he is taking to provide diagnostic training for GPs to recognise the symptoms of hyperemesis gravidarum.

We recognise that hyperemesis gravidarum is a debilitating condition that can have a devastating impact on women and their families.The standard of medical training is the responsibility of the General Medical Council (GMC), which is an independent statutory body. The GMC has the general function of promoting high standards of education and co-ordinating all stages of education to ensure that medical students and newly qualified doctors are equipped with the knowledge, skills, and attitudes essential for professional practice.The curriculum for general practice (GP) specialty training is set by the Royal College of General Practitioners (RCGP), and must meet the standards set by the GMC and be formally approved by them. The curriculum emphasises the skills and approaches a GP must develop in order to ensure accurate and timely diagnoses and treatment plans for their patients. This is assessed by the Membership of the Royal College of General Practitioners Examination. The RCGP GP training curriculum includes “emesis” as a symptom of concern during pregnancy.Qualified GPs are responsible for ensuring their own clinical knowledge remains up-to-date, and for identifying learning needs across their whole scope of practice, as part of their continuing professional development and professional evaluation by the GMC.

What steps his Department is taking to ensure proactive management of medicine shortages.

There are approximately 14,000 licensed medicines and the overwhelming majority are in good supply. Where supply issues do arise, we know how frustrating and distressing these can be for patients, and we work closely with industry, the National Health Service, and the Medicines and Healthcare products Regulatory Agency to resolve the issues as quickly as possible, to ensure patients can access the medicines they need.Medicine supply chains are complex, global, and highly regulated and there are a number of reasons why supply can be disrupted, many of which are not specific to the United Kingdom and outside of Government control, including manufacturing difficulties, access to raw materials, sudden demand spikes or distribution issues, and regulatory issues.While we can’t always prevent supply issues from occurring, we have a range of well-established processes and tools to manage them when they arise and mitigate risks to patients. These include close and regular engagement with suppliers, use of alternative strengths or forms of a medicine to allow patients to remain on the same product, expediting regulatory procedures, sourcing unlicensed imports from abroad, adding products to the restricted exports and hoarding list, and use of Serious Shortage Protocols. In addition, we will issue communications to the NHS which provides management advice and information on the issue to healthcare professionals, including pharmacists, so they can advise and support their patients.The resilience of UK supply chains is a key priority, and we are committed to helping to build long term supply chain resilience for medicines. We are continually learning and seeking to improve the way we work to both manage and help prevent supply issues and avoid shortages. The Department, working closely with NHS England, is taking forward a range of actions to improve our ability to mitigate and manage shortages and to strengthen our resilience.

What steps his Department is taking to support parents caring for children with long covid; and whether his Department plans to develop a long-term strategy to fund (a) biomedical research and (b) treatment for long covid in (i) adults and (ii) children.

The Government is committed to ensuring that families have the support that they need. The Care Act 2014 requires local authorities to deliver a wide range of sustainable, high-quality care and support services, including support for carers, which can include parents.Across the National Health Service in England, there are services supporting people with post-COVID syndrome, often described as long COVID. These services offer physical, cognitive, and psychological assessment, and, where appropriate, refer patients onto existing services for treatment and rehabilitation. Further information can be found via the NHS website, at the following link:https://www.england.nhs.uk/coronavirus/post-covid-syndrome-long-covid/The National Institute for Health and Care Research (NIHR) and the Medical Research Council (MRC) remain committed to funding high-quality research to understand the causes, consequences, and treatment for long COVID. We are actively exploring next steps for research in this area.Between 2019/20 and 2023/24, through the NIHR and MRC, we have invested over £57 million on research into long COVID, with almost £40 million of this through two specific research calls on long COVID. The funded projects aim to improve our understanding of the diagnosis and underlying mechanisms of the disease and the effectiveness of both pharmacological and non-pharmacological therapies and interventions, as well as to evaluate the effectiveness of clinical care.This includes funded clinical trials to test and compare different treatments such as antihistamines, anticoagulants, and anti-inflammatory medicines, as well as trials such as the approximately £1.5 million REGAIN trial funded through the NIHR. REGAIN is the first randomised trial to show a benefit from rehabilitation for people with long COVID, and the first high-quality evidence confirming the sustained clinical benefit and lack of harm with rehabilitation programmes for long COVID which combine exercise with behavioural support, to measure their effects on symptoms, health, and other outcomes.The approximately £1.9 million CLoCk study, co-funded by the NIHR and the MRC, developed an agreed definition of long COVID in children and young people as well as the associated symptoms, which will help harmonise research and improve understanding of the condition.Funding is available and we welcome funding applications for research into long COVID in both adults and children. These applications are subject to peer review and judged in open competition, with awards being made on the basis of the importance of the topic to patients and health and care services, value for money, and scientific quality.To support clinical leadership in this area, NHS England has worked in partnership with the British Society of Physical and Rehabilitation Medicine to develop a new Clinical Post-COVID Society to facilitate the ongoing sharing of best practice and to support people affected by long COVID. Further information about the society can be found at the following link:https://www.clinicalpcs.org.uk

What recent assessment he has made of trends in the level of maternity unit closures; and what steps he is taking to prevent the closure of maternity units.

There are real issues in maternity care, but also outstanding examples of care. It will not be an overnight recovery, but we will be making steady improvements to ensure all women receive safe, personalised, and compassionate care.The Government continues to work with the National Health Service as it delivers its three-year maternity and neonatal plan to improve maternity and neonatal services.The reconfiguration of services is a local decision that should be informed by clinical best practice, following appropriate engagement with patients and stakeholders. All service changes should be based on clear evidence that they will deliver better outcomes for patients.Responsibility for the delivery, implementation, and funding decisions for services ultimately rests with the appropriate NHS commissioner. Substantial planned service change should be subject to a full public consultation and should meet the Government and NHS England’s ‘tests’ to ensure good decision-making. The Government has not made an assessment of the closures to maternity services, as these are decisions best made locally.It is right that NHS services reflect changing demographics and birth rates, to ensure resources are used efficiently. At the same time, we expect maternity providers to listen to women and ensure they are given a choice at all stages of their pregnancy.

What steps he is taking to ensure that integrated care boards provide gluten free bread prescriptions for patients with coeliac disease.

The Department has undertaken two national consultations in recent years on the prescribing of gluten-free foods in primary care. The rationale for this was the increased availability of these products in supermarkets and other food outlets at a time when the annual cost to the National Health Service of prescribing such items was £15.7 million. The first of these proposed changes to prescribing arrangements resulted in the Government’s decision to restrict such foods to bread and mixes.NHS England’s guidance, Prescribing Gluten-Free Foods in Primary Care, was developed to communicate to local commissioners, now integrated care boards (ICBs), the changes in legislation. Wording is included in the guidance which states that commissioners may further restrict the prescribing of gluten-free foods by selecting bread only, mixes only, or may choose to end the prescribing of gluten-free foods altogether, if they feel this is appropriate for their population, and whilst taking account of their legal duties to advance equality and have regard to reducing health inequalities. In NHS England’s guidance, there are no limits on the amount of bread or mixes that can be prescribed.Decisions about the commissioning and funding of local health services are the responsibility of local ICBs. NHS England’s guidance should be taken into account when ICBs formulate local policies, and prescribers are expected to reflect local policies in their prescribing practice. The guidance does not remove the clinical discretion of prescribers in accordance with their professional duties.

Whether his Department plans to review the (a) licensing and (b) prescribing guidelines for the anti-malarial drug Lariam.

The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for ensuring that medicines, medical devices, and blood components for transfusion meet applicable standards of safety, quality, and efficacy. The MHRA rigorously assesses the available data, including from the Yellow Card scheme, and seeks advice from the Commission on Human Medicines, the MHRA’s independent advisory committee, where appropriate, to inform regulatory decisions, including amending the product information.Mefloquine, commercially known as Lariam, is effective in the prevention and treatment of malaria and is licensed for use by the 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.Patient safety is our top priority, and no medicine would be approved unless it met our expected standards of safety, quality, and effectiveness. Our role is to continually monitor the safety of medicines during their use, including Larium. We have robust, safety monitoring and surveillance systems in place for all healthcare products.  When a safety issue is confirmed, we always act promptly to inform patients and healthcare professionals and take appropriate steps to mitigate any identified risk.As with any medicine, clinicians are responsible for making prescribing decisions for their patients, taking into account best prescribing practice and the local commissioning decisions of their respective integrated care board.Clinicians 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. The national guidance for mefloquine is available at the following link:https://cks.nice.org.uk/topics/malaria-prophylaxis/prescribing-information/mefloquine/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 assessment his Department has made of the potential side effects of the anti-malarial drug Lariam on civilian patients prescribed it in the UK.

The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for ensuring that medicines, medical devices, and blood components for transfusion meet applicable standards of safety, quality, and efficacy. The MHRA rigorously assesses the available data, including from the Yellow Card scheme, and seeks advice from the Commission on Human Medicines, the MHRA’s independent advisory committee, where appropriate, to inform regulatory decisions, including amending the product information.Mefloquine, commercially known as Lariam, is effective in the prevention and treatment of malaria, and is licensed for use by the 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.Patient safety is our top priority, and no medicine would be approved unless it met our expected standards of safety, quality, and effectiveness. Our role is to continually monitor the safety of medicines during their use, including Larium. We have robust, safety monitoring and surveillance systems in place for all healthcare products.  When a safety issue is confirmed, we always act promptly to inform patients and healthcare professionals and take appropriate steps to mitigate any identified risk.

Whether he plans to increase the provision of pacemakers and implanted defibrillators.

The volume of implantable devices purchased by cardiac providers has increased by 22% in 2024/25, when compared with the same period in 2023/24. Commissioned providers determine the need for cardiac implantable electronic device (CIED) implantation using a multi-disciplinary team approach, which considers the needs of the individual patient and clinical guidelines.In 2023/24, approximately 60,000 CIEDs, which includes implantable cardioverter defibrillators and pacemakers, were implanted by National Health Service providers, as per the National Audit of Cardiac Rhythm Management report 2025.

What steps his Department is taking to support integrated care boards to offer ear wax removal services for patients when the ear wax is contributing to (a) hearing loss and (b) other symptoms.

Integrated care boards (ICBs) have a statutory responsibility to commission cost-effective healthcare to meet the needs of their local population. This includes the arrangement of services for ear wax removal.Manual ear syringing is no longer advised by the National Institute for Health and Care Excellence (NICE) due to the risks associated with it, such as trauma to their ear drum or infection, so general practitioners (GPs) will often recommend home treatment remedies to alleviate ear wax build-up.However, in line with the NICE’s guidance, a person may require ear wax removal treatment if the build-up of earwax is linked with hearing loss. A GP could then consider referring the patient into audiology services, which ICBs are responsible for commissioning.ICBs should therefore arrange for the provision of ear wax removal services when a patient has a clinical need for ear wax removal beyond home treatments.

What assessment he has made of the adequacy of access to (a) compression treatment and (b) other follow-up care for women with arm lymphoedema after breast cancer treatment.

No assessment has been made on the adequacy of access to compression treatment or follow-up care for women with arm lymphoedema after breast cancer treatment.Local health service commissioners – through Integrated Care Boards - determine what lymphoedema services are needed locally, based on the needs of their local population.The NHS’ roll-out of personalised care ensures people with cancer have a holistic needs assessment, covering both their physical and psychosocial needs, and are referred to services where appropriate. Lymphoedema support is in the NHS’ Personalised Stratified Follow-Up (PSFU) handbook as a required part of PSFU pathways, however it does not cover the specifics of treatment.We know that more should be done to support people living with and beyond cancer. The National Cancer Plan, coming later this year, will set out how we will seek to improve the experience and outcomes for people at every stage of the cancer pathway. It will look at how we can improve communication and coordination for patients, so that they feel informed and in control of their care.