Written questions by Bishop.

What steps his Department is taking to ensure specialist emotional and practical support is available for parents caring for children with life-limiting and life-threatening conditions.

We recognise the challenges families caring for a seriously ill child face, which is why NHS England have published statutory guidance and service specifications on commissioning children’s palliative care and end of life care. This specifically references access to emotional support and practical advice for parents and loved ones. Local authorities and ICBs jointly commission short‑breaks packages for children with life‑limiting conditions, and provide respite care where necessary. Additionally, from April 2025, the Carer’s Allowance earnings limit increased from £151 a week to £196 to support carers. The Minister for Care also chairs a cross-government meeting with DWP, DBT and DfE ministers to consider how we can provide carers with better recognition and support.

What support is available to GP practices operating from newly built premises that subsequently experience (a) building and (b) maintenance problems not identified at the (i) planning and (ii) construction stage.

The provision and maintenance of premises are typically the responsibility of general practice (GP) partners, who are either owner-occupiers or tenants of their surgery buildings. This includes addressing any building or maintenance issues identified after the planning and construction phases. The National Health Service reimburses partners for the recurring costs of operating in the property, for instance rent, notional rent, or mortgage costs, and funds services in the GP Contract.GP owner-occupiers are responsible for all maintenance and repair of their property. For GPs that rent their premises, their lease agreement sets out who is responsible for maintenance. A Full Repairing and Insuring lease requires the practice to handle all repairs, while a Tenant's Internal Repairing lease means the landlord covers external and structural issues.Commissioners may award improvement grants to GPs to fund extensions, improvements, and enhanced physical access. This can be up to 100% of a project’s value, subject to discretion and the integrated care boards available budget, under provisions of the NHS (General Medical Services) Premises Costs Directions 2024.The £102 million Primary Care Utilisation and Modernisation Fund, announced at the 2024 Autumn Budget, is upgrading more than a thousand GP surgeries across England by April 2026.Where facilities are an issue, it is imperative that GPs work with the local commissioner. There may be capital or revenue solutions to GP premises and facilities’ needs.

What support his Department has provided to GP practices operating from newly built premises with (a) building and (b) maintenance issues; and what assessment he has made of the effectiveness of that support in helping to resolve those issues with landlords.

The provision and maintenance of premises is typically the responsibility of GP partners, who are either owner-occupiers or tenants of their surgery buildings. The National Health Service reimburses partners for the recurring costs of operating in the property (rent, notional rent or mortgage cost) and funds services in the GP contract.GP owner-occupiers are responsible for all maintenance and repair of their property. For GP practices that rent their premises, their lease agreement sets out who is responsible for maintenance. A ‘Full Repairing and Insuring’ (FRI) lease requires the practice to handle all repairs, while a ‘Tenant’s Internal Repairing’ (TIR) lease means the landlord covers external and structural issues.Commissioners may award improvement grants to GP practices to fund extensions, improvements, and enhanced physical access. This can be up to 100% of a project’s value, subject to discretion and the integrated care board’s available budget, under provisions of the NHS (General Medical Services) Premises Costs Directions 2024.The £102 million Primary Care Utilisation & Modernisation Fund, announced at Autumn Budget 2024, is upgrading more than a thousand GP surgeries across England by April 2026.Where facilities are an issue, it is imperative that General Practices work with the local Commissioner. There may be capital or revenue solutions to general practice premises and facilities’ needs.

What steps his Department is taking to reduce regional disparities in the (a) treatment and (b) outcomes of patients with peripheral arterial disease.

Peripheral arterial disease (PAD), like other cardiovascular conditions, shares risk factors and is largely preventable. However, access to timely diagnosis and treatment can vary significantly across regions. NHS England is working to reduce these disparities and improve outcomes for patients.To support this, NHS England introduced the Vascular PAD Quality Improvement Framework, which was incentivised through a two-year scheme between 2022 and 2024. This framework helps ensure that patients across the country receive timely and effective interventions, such as revascularisation, by encouraging all providers to meet consistent standards of care. It aims to reduce variation in how quickly and effectively patients are treated, regardless of where they live. In addition, the National Vascular Registry (NVR) collects and publishes data on the outcomes of major vascular procedures across NHS hospitals. This includes procedures for PAD, such as angioplasty, bypass surgery, and amputations. By highlighting both good practice and areas needing improvement, the NVR supports hospitals and commissioners in identifying and addressing regional gaps in care quality and outcomes. While there is no dedicated public awareness campaign for PAD at present, information is available on the National Health Service website, and NHS England continues to work with clinical experts and professional bodies to improve care and reduce regional variation.

What plans he has to establish specialist care pathways for people with bipolar to (a) improve treatment and (b) reduce misdiagnosis.

It is unacceptable that too many people are not receiving the mental health care they need, and we know that waits for mental health services are far too long, including for people with bipolar disorder. We are determined to change that.As part of our mission to build a National Health Service that is fit for the future, we will provide access to a specialist mental health professional in every school in England, create a network of open access community Young Futures hubs, recruit an additional 8,500 mental health workers to cut wait times and provide faster treatment, and modernise the Mental Health Act.We are also committed to new models of care for mental health, including reforming care for people experiencing a mental health crisis. We are testing neighbourhood mental health centres for people aged 18 years old and over with serious mental illness. These six pilot schemes are based in Tower Hamlets, Lewisham, Sheffield, York, Birmingham, and Whitehaven.These models will offer 24/7 open access care closer to home, with an integrated service including healthcare providers, local authorities, and the voluntary sector. These pilots build on international evidence which shows that similar models have led to a reduction in hospitalisation and waiting times, and support our efforts to move more care into the community.

What steps his Department is taking to help ensure that all NICE-approved medicines for osteoporosis are included in (a) ICS and (b) local formularies.

The National Institute for Health and Care Excellence (NICE) makes recommendations for the National Health Service on whether new licensed medicines should be routinely funded by the NHS based on an assessment of their costs and benefits.The NHS in England is legally required to fund medicines recommended by the NICE, usually within three months of final guidance.The 2025/26 NHS Standard Contract, which applies to all contracts between NHS commissioners and providers, stipulates that, where any service involves or may involve the prescribing of medicines, the provider must ensure that its formulary reflects all relevant positive NICE technology appraisals.The NICE has also published guidance on developing and updating local formularies, which is intended to support commissioners and healthcare providers, including those working within integrated care systems, in developing formularies that reflect local needs, reducing variation in prescribing, and allowing for the rapid adoption of new medicines and treatments. This guidance is available at the following link:https://www.nice.org.uk/guidance/mpg1

What steps his Department is taking to support maternity services in the Forest of Dean constituency.

Several steps are being taken to support maternity services in the Forest of Dean constituency, in addition to those being delivered nationally through the three-year delivery plan for maternity and neonatal services across England. These include, but are not limited to:the trust actively working to recruit additional staff and retain existing staff, including through the adoption of flexible working arrangements and a ‘retire and return’ scheme for midwives without on-call commitments, and with plans to recruit an additional 26 midwives by the end of March 2025;a new programme to manage predicted staff turnover and reduce reliance on temporary staffing; anddedicated support through the Maternity Safety Support Programme, following the Care Quality Commission’s (CQC) Section 31 notice in March 2024. The maternity leadership team has been expanded to support staff and implement the improvements identified by the CQC.

What assessment he has made of the potential merits of developing a national strategy to place defibrillators in high need areas.

The Government is committed to improving access to Automated External Defibrillators (AEDs) in public spaces and reducing inequalities in access to these life saving devices. Following the depletion of the existing AED fund, launched in in September 2023, the Government approved a further £500,000 in August 2024 to fulfil existing applications to the fund.The Department selected a joint bid from Smarter Society as its independent partners to manage grant applications. Smarter Society has reviewed funding applications against requirements specified by the Department. Although no decision has been made to develop a national strategy to place defibrillators in high need areas, these requirements are to ensure that resources are allocated to where there is the greatest need, for instance remote communities with extended ambulance response times, places with high footfall and high population densities, hotspots for cardiac arrest including sporting venues and venues with vulnerable people, and deprived areas.

If he will make an assessment of the adequacy of the NHS sight test fee; and if he will take steps to increase that fee.

The level of the National Health Service sight test fee is considered annually and takes into account discussions with the Optical Fee Negotiating Committee, consideration of patient access to sight testing services, which continue to be widely available, and affordability for the NHS.

What assessment his Department has made of the potential impact on health outcomes of universal access to Fracture Liaison Services.

The Government and NHS England support the clinical case for services which help to prevent fragility fractures and support the patients who sustain them. According to the Fracture Liaison Service Database 2022, at least 60 trusts in England had access to a Fracture Liaison Service. My Rt Hon. Friend, the Secretary of State for Health and Social Care is committed to rolling out fracture liaison services across every part of the country by 2030.Costs and benefits will be assessed, taking into consideration the evidence gathered from the 60 services already in operation in England.

What assessment his Department has made of the potential impact on acute hospital bed usage of universal access to Fracture Liaison Services.

The Government and NHS England support the clinical case for services which help to prevent fragility fractures and support the patients who sustain them. My Rt Hon. Friend, the Secretary of State for Health and Social Care is committed to rolling out Fracture Liaison Services across every part of the country by 2030.Impacts will be assessed, including on acute hospital bed usage, taking into consideration the evidence gathered from the 60 services already in operation in England.

What steps his Department is taking to tackle (a) staffing shortages and (b) infrastructure problems in hospitals in Gloucestershire.

Information on local plans to tackle staff shortages is not collected centrally by the Department. National Health Service organisations are responsible for their own recruitment, and develop their own workforce plans based on service needs.At a national level, we are committed to training the staff the NHS needs and will work closely with partners in education to do this. NHS England continues to lead a range of initiatives to boost the retention of existing staff and ensure the NHS remains an attractive career choice for new recruits.Repairing and rebuilding our hospital estate is a vital part of our ambition to create an NHS that is fit for the future through our 10-Year Health Plan. That is why my Rt. Hon. Friend, the Chancellor of the Exchequer announced that health capital spending is set to increase to £13.6 billion in 2025/26, representing record levels of capital investment into healthcare.This includes over £1 billion to continue to tackle dangerous reinforced autoclaved aerated concrete and make inroads into the backlog of critical maintenance, repairs, and upgrades across the NHS estate.

What steps he is taking to improve access to (a) treatment and (b) support services for people with arthritis; and what steps he is taking to increase awareness of the condition.

Services for those with musculoskeletal (MSK) conditions, including arthritis, are commissioned locally by integrated care boards (ICBs). The Department expects MSK services to be fully incorporated into integrated care system planning and decision-making. As announced in the Get Britain Working white paper, we are delivering the joint Department for Work and Pensions, Department of Health and Social Care, and NHS England, Getting It Right First-Time (GIRFT) MSK Community Delivery Programme. With a £3.5 million funding boost, GIRFT teams will deploy their proven Further Faster model to work with ICB leaders to further reduce MSK community waiting times, including for those with arthritis, and improve data and metrics and referral pathways to wider support services. We will deliver an extra 40,000 operations, scans, and appointments per week during our first year in Government, as a first step in our commitment to ensuring that patients can expect to be treated within 18 weeks. The Government announced £1.5 billion of new capital investment in the Autumn Budget, including investment for new diagnostic scanners and surgical hubs. This investment in scanners will build capacity for over 30,000 additional procedures and 1.25 million diagnostic tests as they come online. To support health and care professionals in the early diagnosis and management of rheumatoid arthritis and osteoarthritis, and in the provision of services for people living with arthritis, the National Institute for Health and Care Excellence has published expert guidance for rheumatoid arthritis and osteoarthritis, with both pieces of guidance available, respectively, at the following two links: https://www.nice.org.uk/guidance/ng100 https://www.nice.org.uk/guidance/ng226 The Department funds research into MSK conditions, including arthritis, through the National Institute for Health and Care Research (NIHR). Through this route, the Department spent approximately £26.3 million on MSK research in 2023/24, and £79.2 million since 2019/20. In particular, the Leeds Biomedical Research Centre aims to improve treatment for osteoarthritis. The NIHR, in collaboration with Versus Arthritis, also funds a dedicated UK Musculoskeletal Translational Research Collaboration, aligning investment in MSK translational research and creating a United Kingdom-wide ambition and focus to drive cutting edge research and improve outcomes for patients. In order to improve awareness and understanding of arthritis amongst primary care professionals, including general practitioners, the Royal College of General Practitioners has produced an e-learning module on inflammatory arthritis, in partnership with the British Society of Rheumatology.

What steps his Department is taking to fund research into potential treatments for brain tumours to help (a) extend life expectancy and (b) alleviate suffering.

Research is crucial in tackling cancer, which is why the Department of Health and care invests over £1.5 billion per year in health research through the National Institute for Health and Care Research (NIHR). NIHR research expenditure for all cancers was £121.8 million in 2022/23.In the five years between 2018/19 and 2022/23, the NIHR directly invested £11.3 million in research projects and programmes focused on brain tumours. In addition, our wider investments in NIHR research infrastructure, including facilities, services and the research workforce, are estimated to be £31.5 million, between 2018/19 and 2022/23, and have enabled 227 brain cancer research studies to take place in the same period. In total, NIHR investments have enabled 8,500 people to participate in potentially life-changing research in the National Health Service over this time.In September 2024, the NIHR announced new research funding opportunities for brain cancer research, spanning both adult and paediatric populations. This includes a national NIHR Brain Tumour Research Consortium, to ensure the most promising research opportunities are made available to adult and child patients, and a new funding call to generate high quality evidence in brain tumour care, support, and rehabilitation.The NIHR welcomes funding applications for research into any aspect of human health, including cancer. 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.

If he will take steps to ensure that people in rural communities have access to mental health support within a one-hour radius using public transport.

Waiting lists for those referred for support are too high including those in rural communities.People with mental health issues are not getting the support or care they deserve and need, which is why we will fix the system to ensure we give mental health the same attention and focus as physical health and that people can be confident of accessing high quality mental health support when they need it.Nationally, we plan to recruit an additional 8,500 mental health workers across children and adult mental health services in England to reduce delays and provide faster treatment. We will also introduce access to a specialist mental health professional in every school and roll out Young Futures hubs in every community.In addition, people of all ages who are in crisis or who are concerned about a family or loved one can now call 111, select the mental health option, and speak to a trained mental health professional. National Health Service staff can guide callers with next steps such as organising face-to-face community support or facilitating access to alternative services, like crisis cafés or safe havens, which provide a place for people to stay as an alternative to accident and emergency or a hospital admission. It is the responsibility of integrated care boards (ICB) to commission care to meet the needs of their local population.

What steps he is taking to ensure that mental health services in rural communities are adequately (a) staffed and (b) supported.

Waiting lists for those referred for support are too high including those in rural communities.People with mental health issues are not getting the support or care they deserve and need, which is why we will fix the system to ensure we give mental health the same attention and focus as physical health and that people can be confident of accessing high quality mental health support when they need it.Nationally, we plan to recruit an additional 8,500 mental health workers across children and adult mental health services in England to reduce delays and provide faster treatment. We will also introduce access to a specialist mental health professional in every school and roll out Young Futures hubs in every community.In addition, people of all ages who are in crisis or who are concerned about a family or loved one can now call 111, select the mental health option, and speak to a trained mental health professional. National Health Service staff can guide callers with next steps such as organising face-to-face community support or facilitating access to alternative services, like crisis cafés or safe havens, which provide a place for people to stay as an alternative to accident and emergency or a hospital admission. It is the responsibility of integrated care boards (ICB) to commission care to meet the needs of their local population.

What assessment he has made of the potential merits of introducing a hub and spoke model to community pharmacy.

The Government is working towards introducing legislation to enable hub and spoke dispensing between different legal entities this year. This change will be enabled via amendments to both primary and secondary legislation and is subject to the usual parliamentary processes.

What steps his Department is taking to support the families of people diagnosed with brain tumours.

I know that treatment for all cancers is a difficult time for patients and their families. This government will shift more healthcare out of hospitals and into the community, to support patients and their families with more personalised care in the most appropriate setting. We will also get the NHS diagnosing and treating cancer earlier, including through investment in MRI and CT scanners, and improve patients’ and families’ experience.

What steps his Department is taking to increase the availability of mental health support for winter 2024-25.

We do not underestimate how challenging winter will be again this year for the National Health Service. The national approach on priorities for winter planning was issued on 16 September 2024. As part of this, maintaining patient safety and experience will continue to be an overriding priority.Building on what we know works, this winter the NHS is implementing a range of initiatives to support those who need care, including that patients will be assessed at the front door of accident and emergency units so that they can then be directed to the most appropriate place to get care, including mental health care.People with common mental health conditions such as depression and anxiety can self-refer to NHS Talking Therapies Services or be referred by their general practitioner. The Autumn Budget prioritised the funding to deliver expansions of NHS Talking Therapies, demonstrating our commitment to addressing the root cause of mental health issues.Anyone in England experiencing a mental health crisis can now speak to a trained NHS professional at any time through a new mental health option on NHS 111. Trained NHS staff will assess patients over the phone and guide callers with next steps such organising face-to-face community support or facilitating access to alternatives services, such as crisis cafés or safe havens which provide a place for people to stay as an alternative to accident and emergency or a hospital admission.

What recent discussions he has had with NHS England officials on their role in supporting the development of a roll-out plan for universal Fracture Liaison Services.

Fracture Liaison Services (FLS) are a globally recognised care model for secondary fracture prevention. This government is committed to expanding access to these important preventative services.FLS provision is ultimately a matter for Integrated Care Boards, who are best placed to make commissioning decisions according to local need. I refer the hon. Member to the answer I gave to the hon. Member for Strangford on 05/11/2024 to Question UIN 13008. Officials are continuing to work closely with NHS England on how to ensure better quality and access to FLSs – including on how best to support systems.