Written questions by Ellis.

What discussions his Department has had with local authorities in Lancashire on the delivery of Best Start Family Hubs.

Awaiting answer.

Whether his Department plans to issue updated guidance to local authorities on minimum contact standards for adult social care front-door services, including call handling, voicemail and email triage; and whether local authorities will be required to publish performance metrics.

Awaiting answer.

What assessment his Department has made of the effectiveness of the regulatory classification of melatonin in the UK compared with other countries.

Awaiting answer.

If he will request that NHS England and NICE evaluate the use of Tirzepatide, currently prescribed for weight loss on the NHS, as a potential treatment for Bile Acid Malabsorption.

Awaiting answer.

Whether he plans to review the prescription payment penalty charge system.

There are no plans for such a review. NHS Penalty Charge Notices are issued in accordance with the National Health Service (Penalty Charge) Regulations 1999.

What data collection exists on the outcomes of people with a dementia diagnosis in care home settings.

NHS England collects and publishes data about people with dementia registered at each general practice (GP) in England. Dementia diagnosis counts are published with ethnicity and age breakdowns, prescriptions of anti-psychotic medications, and record of receiving a care plan review. Diagnosis rates are calculated by comparing recorded diagnoses to estimated dementia prevalence.From April 2023 data has also been collected on counts of patients on the GP’s dementia register which are aggregated into the following residential types:- residential care home;- nursing home;- private residence;- no permanent address;- other residential type; and- inconclusive residential type.

What steps he is taking to ensure the validity of online evidence submitted to the National Maternity and Neonatal Investigation Call for Evidence, including the verification methods for submissions.

The call for evidence only collects personal category data that is necessary to support its analysis and further our understanding of the experiences of different groups of women and families, in line with United Kingdom data protection proportionality principles. Individuals’ names or other identifiable information are not collected because they were not deemed necessary for analysis.Surveys are hosted by SurveyOptic, who are monitoring their network for unusual spikes in activity and will flag anything unusual to the investigation team to prevent bots. Throughout the analysis process, responses that appear to be duplicative, whether identical or near identical, will be removed.

(i) whether Vaccine Damage Payment Scheme (VDPS) claims are matched to assessors with condition-specific expertise, (ii) whether the Department for Health and Social Care holds audits or quality assurance exercises on the accuracy and consistency of medical determinations under the VDPS since 2021, and (iii) what steps are being taken to ensure the transparency and accountability of the VDPS medical assessment process.

Each claim to the Vaccine Damage Payment Scheme (VDPS) is assessed on a case-by-case basis by a medical assessor. All medical assessors are General Medical Council registered doctors, who have undertaken specialised training in vaccine damage and disability assessment.The NHS Business Services Authority (NHSBSA), as the administrator of the VDPS, is responsible for managing quality assurance with the medical assessment supplier. Medical assessors write a comprehensive medical assessment report for each claim, explaining how they reached their decision and what evidence they considered. NHSBSA shares this report with the claimant.If a claim is rejected, the claimant can challenge the medical assessor’s decision by submitting a mandatory reversal request. The original decision will then be reviewed.

How many of the Trusts outlined in the national maternity review were made aware of (a) their inclusion before the review was publicly announced and (b) why they had been chosen to be included in the review.

All trusts were made aware that they had been selected for inclusion in the national maternity and neonatal investigation before it was publicly announced.The Chair’s selection of the trusts for the local reviews has been made with a view to ensure a diverse mix of trusts, including variation in case mix, trust type, and geographic and demographic coverage. By taking this approach, the investigation can capture learning from a wide range of provision and experiences, ensuring the findings are relevant across the system.The rationale of these selected sites has taken into consideration several criteria, including data indicating trusts with poor outcomes or experience, in particular from Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK, or MBRRACE-UK, perinatal mortality rates from 2021 to 2023, and the Care Quality Commission maternity patient survey from 2024.The Chair also considered trusts proposed by bereaved and harmed families who have experienced failures in maternity care.

What steps his Department is taking to support primary care providers in assessing hereditary cancer risk for people without a clear family history.

Genomic testing in the National Health Service in England is provided through the NHS Genomic Medicine Service and delivered by a national genomic testing network of seven NHS Genomic Laboratory Hubs (GLHs). The NHS GLHs deliver laboratory based genetic testing as directed by the National Genomic Test Directory (the Test Directory), which includes tests for over 7,000 rare diseases and over 200 cancer clinical indications, including both whole genome sequencing (WGS) and non-WGS testing. The Test Directory includes a range of tests for inherited cancer as part of its coverage of rare and inherited disease and cancer related genomic indications. Further information on the Test Directory is available at the following link:https://www.england.nhs.uk/publication/national-genomic-test-directories/The Test Directory sets out the eligibility criteria for patients to access testing as well as the genomic targets to be tested, the method that should be used, and the clinical specialities able to request the test. A robust and evidence based process and policy is in place to routinely review the Test Directory and ensure that genomic testing continues to be available for all patients for whom it would be of clinical benefit, while delivering value for money for the NHS. Further information is available at the following link:https://www.england.nhs.uk/genomics/the-national-genomic-test-directory/Qualified general practitioners (GPs) are responsible for ensuring their own clinical knowledge remains up-to-date, and for identifying learning needs across their whole scope of practice. The Royal College of General Practitioners provides a number of resources on cancer prevention, diagnosis, and care for GPs, relevant for the primary care setting.NHS England is supporting GPs in referring cancer patients earlier in various ways. This includes encouraging GP direct access to tests for patients who fall outside of urgent suspected cancer referrals and sharing evidence-based assessments of where cancer recognition and referral guidance could be improved with the National Institute for Health and Care Excellence, to inform referral updates. NHS England also funds Gateway-C, an early diagnosis education platform aimed at primary care.

What steps his Department is taking to ensure that every ICB retains its Women’s Health Champion.

The network of women’s health champions brings together senior leaders in women’s health from every integrated care system (ICS) to share best practice to improve women’s health outcomes across the life course and reduce health inequalities. The role is a voluntary commitment.The network continues to meet every one to two months to share insight and discuss best practice on local implementation of women’s health services across ICSs. Meetings continue to be well-attended with insightful, positive discussion. The Parliamentary Under-Secretary of State for Patient Safety, Women’s Health and Mental Health also attended the March 2025 Network of Champions meeting and had the opportunity to hear firsthand about their excellent work and ideas for the future.

What steps his Department is taking to help reduce gynaecology waiting lists in Lancashire and South Cumbria ICB.

Reducing waiting lists is a key part of the Government’s Health Mission, and we are committed to cutting waiting times across all specialities and integrated care boards (ICBs). We have committed to returning to the National Health Service constitutional standard, that 92% of patients wait no longer than 18 weeks from referral to treatment, by March 2029. We are making good progress, with waiting lists cut by over 230,000 since the Government came into office, including nearly 14,000 fewer waits for gynaecology treatment.We also delivered 5.2 million additional appointments between July 2024 and June 2025, exceeding our pledge of two million. However, we know that there is more to do and have confirmed over £6 billion of additional capital investment to expand capacity across diagnostics, electives, and urgent care. This includes expanding the number of surgical hubs, which provide valuable and protected capacity across elective specialities, including gynaecology. As of November 2025, there are 123 operational elective surgical hubs in England, three of which are in the NHS Lancashire and South Cumbria ICB. Over half of the 123 provide gynaecology services. The Elective Reform Plan, published in January 2025, also committed to:increasing the relative funding available to support gynaecology procedures with the largest waiting lists;ensuring that independent sector providers play a greater role in providing support for the most challenged specialities, such as gynaecology; andreforming and optimising clinical pathways across a number of specialities. In gynaecology, this includes supporting the delivery of innovative models offering patients care closer to home and piloting gynaecology pathways in community diagnostic centres for patients with post-menopausal bleeding.

What steps his Department is taking to ensure pregnant women’s access to birthing choice is protected.

The NHS Long Term Plan and the accompanying guidance, Universal Personalised Care, made commitments to deliver choice and personalised care in maternity services. The NHS Long Term Plan and the Universal Personalised Care guidance are available, respectively, at the following two links:https://www.england.nhs.uk/long-term-plan/https://www.england.nhs.uk/personalisedcare/comprehensive-model/The Maternity Programme supports local maternity systems to improve choice and deliver personalised care for women and their families.NHS England has published guidance which sets out the four birthing choices: home birth; birth in a unit run by midwives; hospital birth; and unassisted birth. This guidance is available at the following link:https://www.nhs.uk/pregnancy/labour-and-birth/preparing-for-the-birth/where-to-give-birth-the-options/The provision of arrangements for home birth and information on how this is provided is the responsibility of local National Health Service trusts, who are directed as appropriate by their integrated care board.

What guidance his Department provides to pregnant women to ensure they receive adequate information on all four birth settings.

The NHS Long Term Plan and the accompanying guidance, Universal Personalised Care, made commitments to deliver choice and personalised care in maternity services. The NHS Long Term Plan and the Universal Personalised Care guidance are available, respectively, at the following two links:https://www.england.nhs.uk/long-term-plan/https://www.england.nhs.uk/personalisedcare/comprehensive-model/The Maternity Programme supports local maternity systems to improve choice and deliver personalised care for women and their families.NHS England has published guidance which sets out the four birthing choices: home birth; birth in a unit run by midwives; hospital birth; and unassisted birth. This guidance is available at the following link:https://www.nhs.uk/pregnancy/labour-and-birth/preparing-for-the-birth/where-to-give-birth-the-options/The provision of arrangements for home birth and information on how this is provided is the responsibility of local National Health Service trusts, who are directed as appropriate by their integrated care board.

What steps his Department is taking to help ensure that home birth is presented as an (a) guaranteed and (b) consistently-available option to pregnant women.

The NHS Long Term Plan and the accompanying guidance, Universal Personalised Care, made commitments to deliver choice and personalised care in maternity services. The NHS Long Term Plan and the Universal Personalised Care guidance are available, respectively, at the following two links:https://www.england.nhs.uk/long-term-plan/https://www.england.nhs.uk/personalisedcare/comprehensive-model/The Maternity Programme supports local maternity systems to improve choice and deliver personalised care for women and their families.NHS England has published guidance which sets out the four birthing choices: home birth; birth in a unit run by midwives; hospital birth; and unassisted birth. This guidance is available at the following link:https://www.nhs.uk/pregnancy/labour-and-birth/preparing-for-the-birth/where-to-give-birth-the-options/The provision of arrangements for home birth and information on how this is provided is the responsibility of local National Health Service trusts, who are directed as appropriate by their integrated care board.

What targets his Department has on reducing inequalities in (a) baby deaths and (b) pregnancy loss.

A number of interventions specifically aimed at addressing maternal and neonatal inequalities are underway. These include the Perinatal Equity and Anti-Discrimination Programme, delivery of an inequalities dashboard, and projects on removing racial bias from clinical education and embedding genetic risk equity. Additionally, all local maternity and neonatal systems have published Equity and Equality actions plans to tackle inequalities for women and babies from ethnic minorities and those living in the most deprived areas.An important aspect of both the National Maternity and Neonatal Investigation and the National Maternity and Neonatal Taskforce announced in June 2025, is to address inequalities in maternal and neonatal care and promote health equity in the delivery of those services.The Government remains committed to setting an explicit target to close the Black and Asian maternal mortality gap, and is taking an evidence-based approach to ensure that any targets set are women and baby-centred.

What steps he is taking to support the (a) mental health and (b) wellbeing needs of British farmers.

We know that too many people are not receiving the mental health care they need, and we recognise that British farmers, and others living and working in isolated communities, may face particular challenges in accessing the mental health services that they need.We are working with NHS England on a refreshed workforce plan, which will revolve around the three shifts to deliver our 10-Year Health Plan: moving more care from hospitals to communities; making better use of technology in health and care; and focusing on preventing sickness, not just treating it, including in rural and agricultural communities.Specifically in relation to farmers mental health and wellbeing, the Department for Environment, Food and Rural Affairs (Defra) is supporting access to farmer mental health support services by funding the Farmer Welfare Grant. This aids organisations in delivering projects which will support mental health and build resilience in local farming communities. One recipient, the Farming Community Network, is using the funding to expand their FarmWell platform. This online resource provides business and personal resilience advice on topics including mental health, isolation, depression, and suicide.Defra is also developing options in consultation with communities, farming support organisations, and experts across Government, as to how it can further support the investment in mental health interventions for those in agricultural communities.

What steps he is taking to help ensure that UKMDR audit fees remain affordable for UK based businesses who source medical devices from overseas manufacturers.

In Great Britain, medical devices are regulated under the Medical Device Regulations 2002 (MDR 2002), which is available at the following link:https://www.legislation.gov.uk/uksi/2002/618/contents/madeManufacturers of the lowest risk medical devices can self-declare the conformity of their devices against these regulations, and manufacturers of medium and high-risk medical devices must seek third party conformity assessment from an approved body to obtain a UK Conformity Assessed (UKCA) marking.Fees are set by the approved body themselves and vary depending on the specific service provided.To protect supply, the government continues to accept CE-marked medical devices on the Great Britain market until 30 June 2028 or 2030, depending on the type of device and the legislation it complies with. If a device has a valid CE marking, the manufacturer is therefore not required to also obtain a UKCA marking. We will consult further on our long-term approach to the recognition of CE-marked medical devices later this year.The Medicines and Healthcare products Regulatory Agency (MHRA) is currently developing a reformed regulatory framework for medical devices, designed to protect patient safety, while improving access to innovative medical devices. This will introduce an international reliance framework, allowing the MHRA to use the expertise and decision-making of other regulatory partners to introduce a new, streamlined, route to market for certain devices with prior approval from comparable regulatory countries (Australia, Canada and the US). This will reduce unwarranted regulatory burden on manufacturers of medical devices with overseas approval.

Whether he plans to review the medical conditions on the list of exemptions for prescription charges.

There are no plans to review the list of medical conditions that entitle someone to apply for a medical exemption certificate.There are extensive arrangements in place in England to ensure that prescriptions are affordable for everyone. Approximately 89% of prescription items are dispensed free of charge in the community in England, and there is a wide range of exemptions from prescription charges already in place for which those with chronic illnesses may be eligible. Eligibility depends on the patient’s age, whether they are in qualifying full-time education, whether they are pregnant or have recently given birth, whether they have a qualifying medical condition or whether they are in receipt of certain benefits or a war pension.People on low incomes can apply for help with their health costs through the NHS Low Income Scheme. People who need to pay and need many prescription items could save money with a prescription prepayment certificate (PPC). PPCs allow people to claim as many prescriptions as they need for a set cost, with 3-month and 12-month certificates available. The 12-month PPC can be paid for in direct debit instalments.

What steps his Department is taking to help reduce waiting lists for diagnostic services at Preston Royal Hospital Lancashire Teaching Hospitals NHS Foundation Trust.

Lancashire Teaching Hospitals NHS Foundation Trust (the Trust) has agreed a Diagnostic Improvement Programme with key focuses including:Increasing capacity within its Community Diagnostic Centre (Preston Healthport CDC), where a number of diagnostic services are available in a community setting offering care closer to home over a period of extended working hours.Upgrading of the CT scanner in the emergency department (ED) at Royal Preston Hospital in July 2025 which will improve testing productivity by i) reducing unplanned downtime (for example through reduced maintenance requirements) and ii) minimising the staff training needed to operate different types of machine.Working to develop new opportunities to recruit and retain diagnostic staff. The Trust also makes use of mutual aid. In the NHS, mutual aid is the voluntary cooperation and resource-sharing between different healthcare organisations or sectors to meet shared needs, especially during emergencies or when systems are under extreme pressure. The Trust continues to scope other options to increase capacity and support from other local organisations via mutual aid.Performance at the Trust has significantly improved against the Diagnostics Waiting Times and Activity data collection (DM01) six-week target from 49.3 percent of patients on the waiting list waiting in excess of 6 weeks from referral in June 2024, to 39.6 percent in June 2025.Nationally, the government is supporting the NHS to recover diagnostic services and bring down waiting times through investment in new capacity and technology. At the Spending Review in June 2025, the Chancellor of the Exchequer announced £6 billion in capital funding across 5 years for new diagnostic, elective and urgent and emergency capacity in the NHS. This includes £600 million in 2025/26.