Written questions by Wrigley.

If he will take steps to improve access to the NHS for transgender adults.

The Government wants all patients, including transgender adults, to feel safe and confident in accessing National Health Service health services. This is part of our mission to ensure that the NHS is there for everyone when they need it, providing equal access to health care which promotes choice and inclusivity. Transgender adults may seek access to NHS gender services specifically and these should be available when needed. NHS England has increased the number of adult Gender Dysphoria Clinics in England from seven to 12. The rollout of these new clinics is helping to tackle long waiting times, which had increased due to a shortage of specialist clinical staff to meet the rapidly rising demand. NHS England is currently undertaking a review of adult gender services, chaired by Dr David Levy. The review will examine the model of care and operating procedures of each service, and will carefully consider experiences, feedback, and outcomes from clinicians and patients, with the aim of producing an updated service specification.

What steps his Department is taking with NHS England to ensure that eligible patients have access to Givinostat employee assistance programmes.

ITF Pharma UK, the United Kingdom marketing authorisation holder for givinostat, is providing access to givinostat through a type of compassionate use scheme called an Early Access Programme (EAP). Under the EAP, givinostat is free to both patients taking part in it and to the National Health Service, 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 does not have any initiatives to encourage participation in compassionate use schemes, which are the responsibility of individual pharmaceutical companies. Participation in the EAP for givinostat, which must be through one of the 23 NorthStar Centres in the UK, is decided at an individual NHS trust level, although there is general advice that trusts should engage with the relevant commissioner if they choose to participate, so that any impacts on the wider service can be taken into account. A NorthStar Centre will not be able to provide givinostat if its local trust has not approved participation.NHS England has published guidance for integrated care systems (ICS) on free of charge medicines schemes such as EAPs, including providing advice on potential financial, administrative, and clinical risks. The guidance aims to support the NHS to drive value from the medicines and ensure consistent and equitable access to medicines across England. ICSs should follow the recommendations to determine whether to implement any free of charge scheme, including assessing suitability and any risks in the short, medium, and long term. The guidance is available at the following link:https://www.england.nhs.uk/long-read/free-of-charge-foc-medicines-schemes-national-policy-recommendations-for-local-systems/

What guidance his Department has issued to NHS Trusts on tackling administrative barriers to access to Givinostat treatment.

ITF Pharma UK, the United Kingdom marketing authorisation holder for givinostat, is providing access to givinostat through a type of compassionate use scheme called an Early Access Programme (EAP). Under the EAP, givinostat is free to both patients taking part in it and to the National Health Service, 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 does not have any initiatives to encourage participation in compassionate use schemes, which are the responsibility of individual pharmaceutical companies. Participation in the EAP for givinostat, which must be through one of the 23 NorthStar Centres in the UK, is decided at an individual NHS trust level, although there is general advice that trusts should engage with the relevant commissioner if they choose to participate, so that any impacts on the wider service can be taken into account. A NorthStar Centre will not be able to provide givinostat if its local trust has not approved participation.NHS England has published guidance for integrated care systems (ICS) on free of charge medicines schemes such as EAPs, including providing advice on potential financial, administrative, and clinical risks. The guidance aims to support the NHS to drive value from the medicines and ensure consistent and equitable access to medicines across England. ICSs should follow the recommendations to determine whether to implement any free of charge scheme, including assessing suitability and any risks in the short, medium, and long term. The guidance is available at the following link:https://www.england.nhs.uk/long-read/free-of-charge-foc-medicines-schemes-national-policy-recommendations-for-local-systems/

What steps his Department is taking to ensure that NHS Trusts are (a) aware of and (b) encouraged to participate in the Givinostat Early Access Programme.

ITF Pharma UK, the United Kingdom marketing authorisation holder for givinostat, is providing access to givinostat through a type of compassionate use scheme called an Early Access Programme (EAP). Under the EAP, givinostat is free to both patients taking part in it and to the National Health Service, 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 does not have any initiatives to encourage participation in compassionate use schemes, which are the responsibility of individual pharmaceutical companies. Participation in the EAP for givinostat, which must be through one of the 23 NorthStar Centres in the UK, is decided at an individual NHS trust level, although there is general advice that trusts should engage with the relevant commissioner if they choose to participate, so that any impacts on the wider service can be taken into account. A NorthStar Centre will not be able to provide givinostat if its local trust has not approved participation.NHS England has published guidance for integrated care systems (ICS) on free of charge medicines schemes such as EAPs, including providing advice on potential financial, administrative, and clinical risks. The guidance aims to support the NHS to drive value from the medicines and ensure consistent and equitable access to medicines across England. ICSs should follow the recommendations to determine whether to implement any free of charge scheme, including assessing suitability and any risks in the short, medium, and long term. The guidance is available at the following link:https://www.england.nhs.uk/long-read/free-of-charge-foc-medicines-schemes-national-policy-recommendations-for-local-systems/

What steps he is taking to ensure access to Givinostat for families of children with Duchenne muscular dystrophy.

ITF Pharma UK, the United Kingdom marketing authorisation holder for givinostat, is providing access to givinostat through a type of compassionate use scheme called an Early Access Programme (EAP). Under the EAP, givinostat is free to both patients taking part in it and to the National Health Service, 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 does not have any initiatives to encourage participation in compassionate use schemes, which are the responsibility of individual pharmaceutical companies. Participation in the EAP for givinostat, which must be through one of the 23 NorthStar Centres in the UK, is decided at an individual NHS trust level, although there is general advice that trusts should engage with the relevant commissioner if they choose to participate, so that any impacts on the wider service can be taken into account. A NorthStar Centre will not be able to provide givinostat if its local trust has not approved participation.NHS England has published guidance for integrated care systems (ICS) on free of charge medicines schemes such as EAPs, including providing advice on potential financial, administrative, and clinical risks. The guidance aims to support the NHS to drive value from the medicines and ensure consistent and equitable access to medicines across England. ICSs should follow the recommendations to determine whether to implement any free of charge scheme, including assessing suitability and any risks in the short, medium, and long term. The guidance is available at the following link:https://www.england.nhs.uk/long-read/free-of-charge-foc-medicines-schemes-national-policy-recommendations-for-local-systems/

Food and Rural Affairs, what steps his Department is taking to help reduce sewage overflows in Devon.

For too long, water companies have discharged unacceptable levels of sewage into our rivers, lakes and seas. Storm overflows are safety valves within our combined sewage system to protect properties from flooding. The Storm Overflow Discharge Reduction Plan sets stretching targets to reduce the harms from storm overflows. This ambitious plan is guiding future investment in sector. Water companies are investing around £12 billion between 2025-2030, a record amount, to improve nearly 3,000 storm overflows across England and Wales, and reduce spills by 45% compared to 2021 levels. In Devon, a large spill reduction programme of works will be undertaken by South West Water, in the next 5 years to improve overflows in the Exe river & estuary catchments. This will see improvements to Combined Storm Overflows, pumping stations & sewage treatment works. We are also carrying out a full review of the water sector to shape further legislation that will transform how our water system works and clean up rivers, lakes and seas for good.

Food and Rural Affairs, if he will take steps to reduce sewage infiltration in Devon.

For too long, water companies have discharged unacceptable levels of sewage into our rivers, lakes and seas. Regulators are working with South West Water on their Drainage and Wastewater Management Plans and will be ensuring they look at the investment needs for the issues raised relating to reducing infiltration in their sewerage system, leaks from the system, and removing surface water. As part of its Waterfit programme, South West Water is carrying out surface water separation programmes within the catchments of Dawlish, Goodrington, Mothecombe, Millandreath & Ilfracombe, with the purpose of spill reduction and bathing water protection.

Which Department is responsible for ensuring the mandatory installation of post boxes.

The government is not responsible for ensuring the mandatory installation of post boxes.Section 29(6) of the Postal Services Act 2011 requires Ofcom, as the independent regulator, to “secure the provision of sufficient access points to meet the reasonable needs of users of the universal postal service”.Royal Mail is currently required by Ofcom’s Designated Universal Service Provider (DUSP) condition 1.8.1 to provide a post box within half a mile, by straight line distance, of the premises of at least 98% of users of postal services.

Food and Rural Affairs, what assessment his Department has made of the potential impact of combined sewerage systems on untreated sewage overflow in Devon.

For too long, water companies have discharged unacceptable levels of sewage into our rivers, lakes and seas. Storm overflows are safety valves within our combined sewage system to protect properties from flooding. The Storm Overflow Discharge Reduction Plan sets stretching targets to reduce the harms from storm overflows. This ambitious plan is guiding future investment in sector. Water companies are investing around £12 billion between 2025-2030, a record amount, to improve nearly 3,000 storm overflows across England and Wales, and reduce spills by 45% compared to 2021 levels. In Devon, a large spill reduction programme of works will be undertaken by South West Water, in the next 5 years to improve overflows in the Exe river & estuary catchments. This will see improvements to Combined Storm Overflows, pumping stations & sewage treatment works. We are also carrying out a full review of the water sector to shape further legislation that will transform how our water system works and clean up rivers, lakes and seas for good.

Food and Rural Affairs, what recent discussions he has had with water companies on sewage infiltration.

For too long, water companies have discharged unacceptable levels of sewage into our rivers, lakes and seas. Regulators are working with South West Water on their Drainage and Wastewater Management Plans and will be ensuring they look at the investment needs for the issues raised relating to reducing infiltration in their sewerage system, leaks from the system, and removing surface water. As part of its Waterfit programme, South West Water is carrying out surface water separation programmes within the catchments of Dawlish, Goodrington, Mothecombe, Millandreath & Ilfracombe, with the purpose of spill reduction and bathing water protection.

Food and Rural Affairs, if he will make an assessment of the potential implications for his policies of the number of cracks in sewerage systems in Devon.

For too long, water companies have discharged unacceptable levels of sewage into our rivers, lakes and seas. Regulators are working with South West Water on their Drainage and Wastewater Management Plans and will be ensuring they look at the investment needs for the issues raised relating to reducing infiltration in their sewerage system, leaks from the system, and removing surface water. As part of its Waterfit programme, South West Water is carrying out surface water separation programmes within the catchments of Dawlish, Goodrington, Mothecombe, Millandreath & Ilfracombe, with the purpose of spill reduction and bathing water protection.

Food and Rural Affairs, what recent discussions he has had with water companies on replacing combined sewerage systems with segregated sewerage systems in Devon.

For too long, water companies have discharged unacceptable levels of sewage into our rivers, lakes and seas. Storm overflows are safety valves within our combined sewage system to protect properties from flooding. The Storm Overflow Discharge Reduction Plan sets stretching targets to reduce the harms from storm overflows. This ambitious plan is guiding future investment in sector. Water companies are investing around £12 billion between 2025-2030, a record amount, to improve nearly 3,000 storm overflows across England and Wales, and reduce spills by 45% compared to 2021 levels. In Devon, a large spill reduction programme of works will be undertaken by South West Water, in the next 5 years to improve overflows in the Exe river & estuary catchments. This will see improvements to Combined Storm Overflows, pumping stations & sewage treatment works. We are also carrying out a full review of the water sector to shape further legislation that will transform how our water system works and clean up rivers, lakes and seas for good.

Food and Rural Affairs, what recent discussions he has had with water companies on the use of water butts to prevent sewage overflow in Devon.

Defra have had no recent discussions with water companies about the use of water butts to prevent sewage overflow in Devon. However, as part of a well-designed sustainable drainage system (SuDS), water butts can help in reducing pressure on sewerage. This Government is strongly committed to requiring standardised SuDS in new developments. These should be to designs that cope with changing climatic conditions as well as delivering wider water infrastructure benefits, reduce run off and help to improve water quality, amenity and biodiversity. It is also important to ensure appropriate adoption and maintenance arrangements are in place.

Food and Rural Affairs, if he will make an assessment of the time needed to reconfigure sewerage systems in Devon.

For too long, water companies have discharged unacceptable levels of sewage into our rivers, lakes and seas. Storm overflows are safety valves within our combined sewage system to protect properties from flooding. The Storm Overflow Discharge Reduction Plan sets stretching targets to reduce the harms from storm overflows. This ambitious plan is guiding future investment in sector. Water companies are investing around £12 billion between 2025-2030, a record amount, to improve nearly 3,000 storm overflows across England and Wales, and reduce spills by 45% compared to 2021 levels. In Devon, a large spill reduction programme of works will be undertaken by South West Water, in the next 5 years to improve overflows in the Exe river & estuary catchments. This will see improvements to Combined Storm Overflows, pumping stations & sewage treatment works. We are also carrying out a full review of the water sector to shape further legislation that will transform how our water system works and clean up rivers, lakes and seas for good.

Food and Rural Affairs, if he will make an assessment of the potential merits of replacing combined sewerage systems with segregated sewerage in Devon.

For too long, water companies have discharged unacceptable levels of sewage into our rivers, lakes and seas. Storm overflows are safety valves within our combined sewage system to protect properties from flooding. The Storm Overflow Discharge Reduction Plan sets stretching targets to reduce the harms from storm overflows. This ambitious plan is guiding future investment in sector. Water companies are investing around £12 billion between 2025-2030, a record amount, to improve nearly 3,000 storm overflows across England and Wales, and reduce spills by 45% compared to 2021 levels. In Devon, a large spill reduction programme of works will be undertaken by South West Water, in the next 5 years to improve overflows in the Exe river & estuary catchments. This will see improvements to Combined Storm Overflows, pumping stations & sewage treatment works. We are also carrying out a full review of the water sector to shape further legislation that will transform how our water system works and clean up rivers, lakes and seas for good.

Food and Rural Affairs, what assessment his Department has made on the potential impact of infiltration on sewage in Devon.

For too long, water companies have discharged unacceptable levels of sewage into our rivers, lakes and seas. Regulators are working with South West Water on their Drainage and Wastewater Management Plans and will be ensuring they look at the investment needs for the issues raised relating to reducing infiltration in their sewerage system, leaks from the system, and removing surface water. As part of its Waterfit programme, South West Water is carrying out surface water separation programmes within the catchments of Dawlish, Goodrington, Mothecombe, Millandreath & Ilfracombe, with the purpose of spill reduction and bathing water protection.

Food and Rural Affairs, what information his Department holds on the number and proportion of homes that use a (a) combined and (b) segregated sewerage system in Devon.

Defra does not hold the specific information on sewerage operations in different regions. It is the responsibility of the sewerage undertaker to manage its own operation, in this case South West Water.

Food and Rural Affairs, if he will make an estimate the cost to the public purse of reconfiguring sewerage systems in Devon.

For too long, water companies have discharged unacceptable levels of sewage into our rivers, lakes and seas. Storm overflows are safety valves within our combined sewage system to protect properties from flooding. The Storm Overflow Discharge Reduction Plan sets stretching targets to reduce the harms from storm overflows. This ambitious plan is guiding future investment in sector. Water companies are investing around £12 billion between 2025-2030, a record amount, to improve nearly 3,000 storm overflows across England and Wales, and reduce spills by 45% compared to 2021 levels. In Devon, a large spill reduction programme of works will be undertaken by South West Water, in the next 5 years to improve overflows in the Exe river & estuary catchments. This will see improvements to Combined Storm Overflows, pumping stations & sewage treatment works. We are also carrying out a full review of the water sector to shape further legislation that will transform how our water system works and clean up rivers, lakes and seas for good.

Whether she has plans to announce any changes to the benefit system for financial year 2024-25.

Our Get Britain Working White Paper sets out that we plan to develop proposals for long term reform of the system of health and disability benefits.We are working to develop proposals for Health and Disability reform in the months ahead and will set them out in a Green Paper in Spring.The Get Britain Working White Paper also sets out our plans to bring down economic inactivity levels and take the first steps to delivering our long-term ambition to achieve an 80% employment rate. It can be accessed here:https://www.gov.uk/government/publications/get-britain-working-white-paper

If she will make it her policy that all changes to financial support for (a) people who are unwell and (b) disabled people be preceded by a public consultation.

We are working to develop proposals for health and disability reform in the months ahead and will set them out in a Green Paper ahead of the Spring Statement. This will launch a public consultation on the proposals. This Government is committed to putting the views and voices of disabled people at the heart of all that we do, so we will consult on these proposals, where appropriate, with disabled people and representative organisations.