Written questions by Wrigley.

Whether NHS England distinguishes between the terms must, should, and are expected to in national planning guidance.

The Medium-Term Planning Framework sets national delivery targets for integrated care boards (ICBs) and providers over multiple years. It sets performance expectations, based on nationally determined policies and budgets, and outlines enabling activities which will help ICBs and providers to deliver against said expectations.Whilst the Medium-Term Planning Framework does not impose requirements as in legislation or the Government mandate, ‘must’ and ‘expected to’ language is used for priority targets and where a nationally consistent approach would be beneficial, for example to reduce unwarranted variation or to ensure that specific Government commitments are met. The word ‘should’ is used in cases where local flexibility is appropriate based on local determination, demographics, and/or prioritisation.No internal guidance is issued to staff within NHS England specifically on the use of language within the Medium Term Planning Framework, but the text is checked to ensure consistency with the aforementioned principles. A suite of supporting materials, including technical guidance, webinars, and planning standards, are developed and shared across NHS England regions and the wider National Health Service system to support a clear understanding of the expectations and potential approaches to delivery set out in the Medium-Term Planning Framework.The regionally led assurance process for planning returns allows NHS England to work with ICBs and providers to understand variance from the asks within the Medium-Term Planning Framework, where warranted.

Whether NHS England issues internal guidance to staff on the use of language in planning documents to avoid ambiguity about whether requirements are mandatory.

The Medium-Term Planning Framework sets national delivery targets for integrated care boards (ICBs) and providers over multiple years. It sets performance expectations, based on nationally determined policies and budgets, and outlines enabling activities which will help ICBs and providers to deliver against said expectations.Whilst the Medium-Term Planning Framework does not impose requirements as in legislation or the Government mandate, ‘must’ and ‘expected to’ language is used for priority targets and where a nationally consistent approach would be beneficial, for example to reduce unwarranted variation or to ensure that specific Government commitments are met. The word ‘should’ is used in cases where local flexibility is appropriate based on local determination, demographics, and/or prioritisation.No internal guidance is issued to staff within NHS England specifically on the use of language within the Medium Term Planning Framework, but the text is checked to ensure consistency with the aforementioned principles. A suite of supporting materials, including technical guidance, webinars, and planning standards, are developed and shared across NHS England regions and the wider National Health Service system to support a clear understanding of the expectations and potential approaches to delivery set out in the Medium-Term Planning Framework.The regionally led assurance process for planning returns allows NHS England to work with ICBs and providers to understand variance from the asks within the Medium-Term Planning Framework, where warranted.

Whether NHS England has sought legal advice on whether the effective mandating of the Federated Data Platform requires a new competitive procurement or a contract modification notice.

The NHS Federated Data Platform (NHS FDP) has not been formally mandated. Its role is, however, reinforced in the Medium Term Planning Framework 2026/27 to 2028/29, which can be found at the following link: https://www.england.nhs.uk/wp-content/uploads/2025/10/medium-term-planning-framework-delivering-change-together-2026-27-to-2028-29.pdf This framework sets the expectation that all providers and integrated care boards (ICBs) will onboard to the NHS FDP and begin using its core products, data capabilities, and population health management tools by 2028/29. The guidance highlights the importance of ensuring that providers across acute, community, and mental health sectors use the NHS FDP to support elective recovery, cancer, and urgent and emergency care. The NHS FDP was procured on the basis that every National Health Service trust and ICB would have a tenant within the platform. The existing contract supports use by community and mental health organisations as well as by acute providers. As such, a new competitive procurement or a contract modification notice is not required.

What steps his Department is taking to establish Staff Treatment Hubs.

Following the publication of the 10-Year Health Plan on 3 July 2025, work is underway to develop implementation and operational plans for the staff treatments hubs. This will determine factors such as location, budgets, timeframes, and capacity.The commitment to staff treatment hubs draws on various evidence sources including NHS England’s internal Staff Treatment Access Review. This demonstrated the clear productivity and economic argument for investing in the health of our National Health Service staff, particularly focusing on mental health and musculoskeletal treatment services as the main drivers of sickness absence in the NHS, as well as wider sectors.

Whether NHS organisations are expected to justify deviations from NHS England planning guidance where such guidance is non-mandatory.

The Medium-Term Planning Framework sets national delivery targets for integrated care boards (ICBs) and providers over multiple years. It sets performance expectations, based on nationally determined policies and budgets, and outlines enabling activities which will help ICBs and providers to deliver against said expectations.Whilst the Medium-Term Planning Framework does not impose requirements as in legislation or the Government mandate, ‘must’ and ‘expected to’ language is used for priority targets and where a nationally consistent approach would be beneficial, for example to reduce unwarranted variation or to ensure that specific Government commitments are met. The word ‘should’ is used in cases where local flexibility is appropriate based on local determination, demographics, and/or prioritisation.No internal guidance is issued to staff within NHS England specifically on the use of language within the Medium Term Planning Framework, but the text is checked to ensure consistency with the aforementioned principles. A suite of supporting materials, including technical guidance, webinars, and planning standards, are developed and shared across NHS England regions and the wider National Health Service system to support a clear understanding of the expectations and potential approaches to delivery set out in the Medium-Term Planning Framework.The regionally led assurance process for planning returns allows NHS England to work with ICBs and providers to understand variance from the asks within the Medium-Term Planning Framework, where warranted.

If he will take steps to ensure that the Levy review does not reduce access to (a) hormonal therapy and (b) surgery for trans and non-binary 18-25 year olds.

NHS England is currently carrying out a review of adult gender services. The review, chaired by Dr David Levy, has examined the model of care and operating procedures of each service, and has carefully considered experiences, feedback and outcomes from clinicians and patients. The review has been conducted in line with the publicly available terms of reference and key lines of enquiry. The Government will carefully consider the findings of the review.

What steps he is taking to support patients with overlapping conditions such as Myalgic Encephalomyelitis (ME), Long Covid, Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorder, Postural Tachycardia Syndrome (PoTS), and Mast Cell Activation Syndrome (MCAS).

The Department recognises the complex needs of people living with overlapping conditions such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), long COVID, Ehlers-Danlos syndrome, hypermobility spectrum disorders, postural tachycardia syndrome, and mast cell activation syndrome. Our approach focuses on improving care coordination and access to appropriate services.For ME/CFS, we have published a cross-government final delivery plan, which sets out actions to boost research, improve professional education, and enhance support for daily living, including community-based services and better benefit assessments. While the plan is specific to ME/CFS, it acknowledges overlaps with other complex, multi-system disorders and commits to exploring synergies during implementation.Additionally, the 10-Year Health Plan aims to transform services and outcomes for people living with complex conditions by prioritising integrated, personalised care. The plan focuses on earlier diagnosis and promotes multidisciplinary teams and community-based services to deliver coordinated support closer to home, reducing reliance on hospital care. Digital innovations, including remote monitoring and personalised care planning, will help manage long-term conditions more effectively. The Plan also commits to 95% of people with complex needs to have a personalised care plan by 2027. Personalised care plans will improve support for people with complex needs by ensuring that care is tailored to the individual and coordinated across services.In addition, research funded by the National Institute for Health and Care Research into post-viral syndromes and autonomic disorders will help improve understanding autonomic dysfunction and overlapping conditions, accelerate innovation and deliver evidence-based care for patients with complex, multi-system health needs.

What steps the NHS is taking to improve preventative measures for pulmonary fibrosis.

The causes of pulmonary fibrosis can be uncertain. However, measures exist to prevent the industrial exposure related causes of pulmonary fibrosis such as The Control of Substances Hazardous to Health Regulations 2002 and The Management of Health and Safety at Work Regulations 1999. Smoking can also cause pulmonary fibrosis. To support current smokers to quit, an additional £70 million will be provided in 2025/26 to support local authority-led Stop Smoking Services in England.

What steps he is taking to move funding away from being centered in the London and the Home Counties and towards research projects in (a) Devon and (b) other areas of the UK.

The Department funds health and care research through the National Institute for Health and Care Research (NIHR). NIHR research infrastructure spans England in order to build research capacity, including in Devon.The NIHR Research Delivery Network (RDN) is the main vehicle for clinical research delivery and will introduce a new national funding model in 2026/27 to ensure fair, transparent, and consistent funding across all regions, reducing variation, and supporting underserved areas.Devon hosts four NIHR-funded infrastructure: the Regional Research Delivery Network South West Peninsula; the Exeter Biomedical Research Centre and Clinical Research Facility; the HealthTech Research Centre for Sustainable Innovation; and the Applied Research Collaboration for the South West Peninsula, which supports the whole of Devon. In line with prior commitments, the Department has increased funding for infrastructure developing and delivering research outside the greater South East.The NIHR welcomes funding applications for research into any aspect of human health and care from across England and the United Kingdom. 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.Additionally, by investing in career development initiatives through the NIHR Academy, NIHR Infrastructure, and the RDN, the NIHR continues to fund high quality applied health and care research and training across England.

What steps he is taking to support patients with pulmonary fibrosis in Devon.

Royal Devon University Hospital provides a regional interstitial lung disease service covering Devon. The team provides clinical care, support, and access to services such as pulmonary rehabilitation. Patients with pulmonary fibrosis may attend pulmonary rehabilitation services in Exeter, North Devon, Torbay, and Plymouth.

If he will take steps to increase research funding for pulmonary fibrosis.

The Department funds research through the National Institute for Health and Care Research (NIHR). The NIHR funds clinical, public health, and social care research and works in partnership with the National Health Service, universities, local government, other research funders, patients, and the public. The NIHR welcomes applications for research on any aspect of human health and care, including pulmonary fibrosis. Applications are subject to peer review and judged in open competition, with awards being made based on the importance of the topic to patients and health and care services, value for money, and scientific quality. Since April 2020, the NIHR has spent £4.8 million on research projects and programmes relating to pulmonary fibrosis.

What steps he is taking to increase funding for research for pulmonary fibrosis.

The Department funds research through the National Institute for Health and Care Research (NIHR). The NIHR funds clinical, public health, and social care research and works in partnership with the National Health Service, universities, local government, other research funders, patients, and the public. The NIHR welcomes applications for research on any aspect of human health and care, including pulmonary fibrosis. Applications are subject to peer review and judged in open competition, with awards being made based on the importance of the topic to patients and health and care services, value for money, and scientific quality. Since April 2020, the NIHR has spent £4.8 million on research projects and programmes relating to pulmonary fibrosis.

What steps he is taking to support NHS staff working in Newton Abbot constituency.

The health and wellbeing of all National Health Service staff is a top priority. Local employers across the NHS have in place arrangements for supporting staff including occupational health provision, employee support programmes, and a focus on healthy working environments. At a national level, NHS staff have access to the SHOUT helpline for crisis support alongside the Practitioner Health service for more complex mental health and wellbeing support, including trauma and addiction.As set out in the 10-Year Health Plan, we will roll out Staff Treatment hubs to ensure all staff have access to high quality occupational health support, including for mental health. To further support this ambition, we will work with the Social Partnership Forum to introduce a new set of staff standards for modern employment, covering issues such as access to healthy meals, support to work healthily and flexibly, and tackling violence, racism and sexual harassment in the workplace.

If she will make an assessment of the potential merits of increasing the availability of medicinal cannabis for epilepsy patients in Devon.

The licenced cannabis-based medicine Epidyolex is available on the National Health Service in England for the treatment of seizures associated with Lennox-Gastaut syndrome, Dravet syndrome, and tuberous sclerosis complex. This follows approval from the Medicines and Healthcare products Regulatory Agency and the National Institute for Health and Care Excellence (NICE).NICE has assessed the available evidence, and concluded that there is a clear need for more evidence to support routine prescribing and funding decisions of unlicensed cannabis-based products for medicinal use. NHS funding decisions follow established procedures that ensure equitable distribution of funding, prioritising those medicines that have proved their safety, quality, and clinical and cost effectiveness.

Whether he has made a recent assessment of the adequacy of the level of pay of NHS staff in Newton Abbot constituency.

Pay for most staff employed by National Health Service organisations is set at a national level. The Government has remitted the independent NHS Pay Review Body and the Review Body on Doctors’ and Dentists’ Remuneration to make recommendations on headline pay for NHS staff. Within their reports they make an assessment of the level of pay to recommend, with regard to various factors such as recruitment and retention. The process for the 2026/27 pay round is already underway, with the Department publishing its evidence to the Pay Review Bodies on 30 October.

What assessment he has made of the potential impact of the increase in employers' National Insurance contributions on trends in the level of NHS staff on (a) GP practices, (b) care providers and (c) the health sector in Devon.

We are investing an extra £1.1 billion in general practice, the biggest cash increase in a decade. That funding has allowed us to recruit an extra 2,500 general practitioners and improve access for patients.General practices are valued independent contractors who provide over £13 billion worth of NHS services. Every year we consult with the sector both about what services they provide, and the money providers are entitled to in return under their contract, taking into account the cost of delivering services.This Government is committed to publishing a 10 Year Workforce Plan to set out action to create a workforce ready to deliver the transformed service set out in the 10-Year Health Plan. The 10 Year Workforce Plan will ensure that the National Health Service has the right people in the right places, with the right skills to care for patients, when they need it.We hugely value the critical role that health care providers play, we are determined to address the issues they face.

What steps his Department are taking to ensure retired NHS staff do not suffer financial hardship due to late pension payments.

The Department regularly meets with the NHS Business Services Authority (NHSBSA), which is responsible for administering the NHS Pension Scheme, to discuss performance levels. These discussions include the current increase in processing times for initial pension payments to retired National Health Service staff.The NHSBSA is working in partnership with the Department to ensure robust measures are in place to improve performance as a matter of urgency. The NHSBSA has reallocated internal resources, is actively recruiting and training new staff, and has enhanced communications with members and employers to help them plan accordingly. The Department is committed to supporting the NHSBSA in taking all necessary steps to ensure pension benefits return to being paid on-time.To minimise the risk of financial hardship, the NHSBSA is proactively contacting and prioritising cases involving vulnerable members and those experiencing ill health. A member whose first pension payment is delayed beyond 30 days will automatically receive interest on the overdue amount. Up-to-date information on processing times is made available to members via the NHSBSA website which is available at the following link:https://www.nhsbsa.nhs.uk/current-processing-times-nhs-pensions.The NHSBSA remains dedicated to providing the highest possible standard of service to retiring and retired NHS staff and will continue to keep members updated on progress.

If he will make an assessment of the potential merits of requiring vape liquid and vapes to be sold separately.

The Government is currently exploring a range of topics related to vaping and nicotine products.On 8 October, we launched a call for evidence which examines the size and shape of vapes, vape-like devices and tanks, the components of vaping products, as well as the role of technology in these devices. Further information is available at the following link:https://www.gov.uk/government/calls-for-evidence/tobacco-and-vapes-evidence-to-support-legislation/tobacco-and-vapes-evidence-to-support-legislation.The Department for Environment, Food and Rural Affairs banned the sale and supply of single use vapes due to the harm that they cause to the environment on 1 June 2025. They will continue to monitor the impact of these changes to ensure that they have the desired positive environmental impact.

Pursuant to the Answer of 15 July to Question 65984 on NHS Databases, what assessment he has made of the challenges of hosting the NHS Federated Data Platform on cloud services.

The NHS Federated Data Platform (FDP) Programme Team in NHS England have conducted a comprehensive assessment of the technical, operational, regulatory, and public trust considerations associated with hosting the platform on cloud services. It is a contractual requirement that all processing and storage of patient information take place within the United Kingdom. Data within the FDP and NHS Privacy Enhancing Technology cannot be accessed by provider personnel or contractors based outside the UK. This is stipulated in the overarching FDP Data Protection Impact Assessment and enforced through technical controls. All data is protected through strong encryption, access controls, and audit trails, in compliance with the UK General Data Protection Regulation and the Data Protection Act 2018. These measures ensure that National Health Service data remains fully under UK jurisdiction. Robust security measures are in place, including firewalls, intrusion detection and prevention systems, regular penetration testing, and vulnerability scanning. Live service teams continuously monitor the platform to identify and address any issues promptly. The FDP has been designed to be modular and standards-based, enabling integration with multiple systems and avoiding over-reliance on any single cloud provider. Following national guidance from the National Cyber Security Centre, the NHS has adopted the 14 cloud security principles as its core means of aligning of cloud and internet security throughout the NHS and healthcare providers. All NHS data stored on cloud services in the UK is encrypted, at rest and in transit, using the highest encryption standards.

What assessment he has made of the potential merits of a framework model for functional neurological disorder (FND) care, including (a) FND care pathways, (b) the requirement for multidisciplinary teams trained in FND, (c) follow-up appointments for patients, and (d) mandatory training for (i) GPs, (ii) neurologists, and (ii) A&E staff.

The National Institute for Health and Care Excellence (NICE) included information on functional neurological disorder (FND) in its guideline Suspected neurological conditions: recognition and referral, code NG127, which covers symptoms and the appropriate referral pathways. The NICE Clinical Knowledge Summaries also feature a detailed topic on FND, offering information on diagnosis and management. The guideline and Clinical Knowledge Summary are available, respectively, at the following two links:https://www.nice.org.uk/guidance/ng127https://cks.nice.org.uk/topics/functional-neurological-disorder/We will publish a 10 Year Workforce Plan to ensure that the National Health Service has the right people in the right places, and with the right skills, to deliver the best care for patients, including those with FND, when they need it. We have recently published a call for evidence to gather views from stakeholders on the specific professions, roles, skills, and training needed to implement the reforms outlined in our 10-Year Health Plan for England.More widely, the Elective Reform Plan has committed to reforming outpatient care, which will improve outcomes for patients with FND, through:¾ clinical pathway reform, by transforming clinical pathways to build on the opportunity to deliver more activity in the community and increase the opportunities for patients to be referred straight to diagnostic tests;¾ reducing unnecessary follow up care by using remote monitoring and widening access to Patient Initiated Follow Up so that more patients can have choice and control over if and when they require follow up care, freeing up appointments for patients who need them most; and¾ focusing on the smaller aspects of service delivery than can make a big difference to productivity, by focusing on waiting list validation being properly funded as a form of activity, better use of outpatient clinical capacity, and making better use of clinic templates and job planning so clinicians have the right balance of activity to meet demand.