Written questions by Onn.

What assessment his Department has made of the potential impact of the dissolution of NHS Protect on levels of violence against NHS workers.

NHS England’s Violence Prevention and Reduction (VPR) Standard was initiated in 2019 following the cessation of NHS Protect in 2017.The VPR standard provides employers with guidance and resources to support them in their development of local strategies to prevent and reduce violence. The standard was refreshed in partnership with the Social Partnership Forum in December 2024. Additionally, my Rt Hon. Friend, the Secretary of State for Health and Social Care, accepted all recommendations related to additional action on violence prevention and reduction on 9 April 2025, as part of the Agenda for Change Pay Deal. These measures will be further strengthened by the introduction of a new set of staff standards at the national level, as detailed in the 10-Year Health Plan.

Whether tariffs for procedures under the Minor Surgery Directed Enhanced Service have been adjusted to account for inflation, staff costs and premises costs since 2004.

Practices sign up to deliver the Minor Surgery Directed Enhanced Service. The Primary Medical Services (Directed Enhanced Services) Directions 2025 set out the national requirements for the Minor Surgery Directed Enhanced Service, with further information available at the following link:https://assets.publishing.service.gov.uk/media/67e683d737baea91c58c9fd4/primary-medical-services-directed-enhanced-services-directions-2025.pdfHowever, please note that the service specification and payment arrangements for this directed enhanced service are determined locally by commissioners.

What methodology his Department used to calculate tariffs set out in the Minor Surgery Directed Enhanced Service for (a) joint injections and (b) minor surgical excisions.

Practices sign up to deliver the Minor Surgery Directed Enhanced Service. The Primary Medical Services (Directed Enhanced Services) Directions 2025 set out the national requirements for the Minor Surgery Directed Enhanced Service, with further information available at the following link:https://assets.publishing.service.gov.uk/media/67e683d737baea91c58c9fd4/primary-medical-services-directed-enhanced-services-directions-2025.pdfHowever, please note that the service specification and payment arrangements for this directed enhanced service are determined locally by commissioners.

What assessment his Department has made of the potential impact of levels of pancreatic enzyme replacement therapy, including Creon, on patient health outcomes.

The Department has made no formal assessment of the potential impact of levels of pancreatic enzyme replacement therapy (PERT) on health outcomes. However, the Department engages routinely with a range of representatives including local and regional pharmacy leads and patient charities to ensure that management strategies are improving access to PERT.The Department is aware of ongoing intermittent supply issues with PERT, including Creon capsules. Supplies of Creon and other licensed alternatives have improved in the past year, and specialist importers have sourced unlicensed stock to assist in covering the remaining gap in the market. We continue to work closely with the manufacturers to resolve the issues as soon as possible and to ensure patients have continuous access to medicines.We have widely disseminated comprehensive guidance to healthcare professionals about these supply issues, which provide advice on how to manage patients whilst there is disruption to supply. This includes serious shortage protocols to limit prescriptions to one month’s supply to ensure equitable distribution of available supplies and that Creon remains available for those patients who need it. The Department has issued additional management advice to healthcare professionals which directs clinicians to consider the unlicensed imports when licensed stock is unavailable and includes actions for integrated care boards to have local mitigation plans in place and implemented to ensure that no patient is left without PERT.

What guidance is currently issued to NHS trusts on post operative assessment following lower limb surgery, and whether this includes consideration of referral to podiatry or orthotics services.

It is recommended that all patients receiving surgery, including lower limb surgery, benefit from a structured perioperative care programme, which includes postoperative assessment as a key component. Our Elective Reform Plan commits to enhancing perioperative care, to reduce cancellations, shorten patients’ length of hospital stay, and minimise postoperative complications. The Getting It Right First Time (GIRFT) programme, part of NHS England, works with stakeholders to develop standardised best practice pathways for routine surgical procedures. GIRFT, along with a cross-specialty, multidisciplinary working group, has developed guidance on early screening, triaging, risk assessment, and health optimisation in perioperative pathways. This is available on the NHS England website along with further guidance for trusts on perioperative care covering clinical and operational improvement guide. GIRFT has also produced best practice pathways for primary knee and hip replacements. Guidance is offered on best practice from patient presentation through to post-discharge care and follow-up. Podiatry and orthotics referrals are not currently included in the pathways provided. However, GIRFT regularly engages with trusts to help gain insight and understanding into care delivery across England. National Institute for Health and Care Excellence guidelines, available on their website, include Perioperative Care in Adults guideline, reference code NG180, and orthopaedic standards including joint replacement (primary): hip, knee and shoulder guideline, reference code NG157.

What assessment his Department has made of the impact of alterations to indefinite leave to remain rules on NHS staffing levels.

There have been no recent alterations to indefinite leave to remain rules. However, the Government has launched a consultation on proposals to reform the current settlement rules in favour of an “earned settlement” model, that considers factors such as contribution, integration, and conduct. The consultation, which runs until February 2026, seeks views on how these reforms should apply to different groups, including health and care workers. The consultation is available at the following link:https://www.gov.uk/government/consultations/earned-settlement

What assessment his Department has made of the potential savings to the NHS from reducing the number of failed or repeated prescriptions for the same item.

No specific assessment has been made.As part of providing National Health Service pharmaceutical services, pharmacy contractors are required to dispense all prescriptions reasonably promptly. If there is an issue with a prescription, such as an error on the prescription or duplicate prescriptions, pharmacy teams are expected to raise the issue with the patient and use their professional judgement on how to proceed. This may include referring back to the general practitioner (GP) if the prescription needs to be changed, for example if the product prescribed is not available and the GP needs to consider what alternative would be suitable. If a prescription is not dispensed to the patient, the pharmacy will not be paid for that prescription.Prescribers are responsible for ensuring that suitable arrangements are in place for monitoring, follow-up, and review of any prescription-only medicines. Prescribers, pharmacies, and patients share responsibility to ensure patients are only receiving the medication they require.

What steps his Department is taking to ensure that Integrated Care Boards can continue to provide consistent care and support to service users while restructuring processes are ongoing.

As part of our 10-Year Health Plan, integrated care boards (ICBs) will become strategic commissioners with responsibility for using multi-year budgets to enhance local population health while achieving efficiencies. This will help to support the delivery of the three shifts, from hospital to community, from analogue to digital, and from sickness to prevention, that are needed to build a health service fit for the future.ICBs must continue to deliver their statutory responsibilities and will work with NHS England to ensure this is done effectively within the running costs allowance with savings reinvested in frontline services to deliver better care for patients.

What steps his Department is taking to ensure that children referred for (a) neurodevelopmental and (b) paediatric assessment continue to receive care during transitions between (i) services and (ii) providers.

It is the responsibility of the integrated care boards (ICBs) in England to make appropriate provision to meet the health and care needs of their local population, including pre-and-post diagnostic support for children with neurodevelopmental conditions, in line with relevant National Institute for Health and Care Excellence guidelines.The 10-Year Health Plan commits to establishing a new radical approach that will ensure that, as children and young people navigate the National Health Service, they feel comfortable and confident in managing their own health and care from 16 years old where appropriate. This will include supporting young people as they move from child to adolescent and adult services, making sure that care is developmentally appropriate throughout.A national transition framework is being developed to help local areas set up this model or to strengthen an existing one. The principles of age-appropriate services it will set out apply to young people receiving care for the first time as well as those already on a transition pathway.While this framework focuses on the broad principles of transition, future work will focus on specific considerations and conditions. Training is also being developed for healthcare staff to develop their skills in providing the best standards of care.In April 2023, NHS England published a framework and guidance to deliver improved outcomes in all-age autism assessment pathways. The guidance aims to help integrated care boards and the NHS to deliver improved outcomes for children, young people, and adults referred to an autism assessment service. This includes support for them and their families/carers, while they are waiting for a diagnostic assessment and once they have received the diagnostic outcome.

What assessment he has made of potential merits of introducing routine finger-prick blood glucose testing or urine testing for children who display one or more recognised symptoms of Type 1 diabetes.

A national task and finish group has been established by NHS England which brings together key experts from across the health system, including academia/research and leading national clinicians, to jointly assess the opportunities and challenges that are associated with a national screening programme for diabetes and to inform future national policy.Through our National Institute for Health and Care Research, we have supported the establishment of the Early Surveillance for Autoimmune diabetes, or “ELSA” study. This study is exploring the feasibility and benefits of screening for type 1 diabetes.

What assessment he has made of the potential impact of variations between integrated care boards for access to free Lyft shots on the management of Type 1 diabetes; and whether he has plans to ensure equal access to those medicines across England.

The Department has not made a specific assessment. Decisions on the prescribing of medicines in England are a matter for the National Institute for Health and Care Excellence (NICE). NICE has published advice on the management of Type 1 Diabetes, including advice on managing acute hypoglycaemia. This is available at the following link: https://cks.nice.org.uk/topics/diabetes-type-1/management/ Glucose gels, such as Lift shots, are available on prescription for Type 1 diabetes hypoglycaemia episodes if deemed clinically appropriate and with regard to national guidance.

What steps he is taking to improve access to Lyft shots prescribed for children with Type 1 diabetes in (a) Great Grimsby and Cleethorpes constituency and (b) England.

The Department has not made a specific assessment. Decisions on the prescribing of medicines in England are a matter for the National Institute for Health and Care Excellence (NICE). NICE has published advice on the management of Type 1 Diabetes, including advice on managing acute hypoglycaemia. This is available at the following link: https://cks.nice.org.uk/topics/diabetes-type-1/management/ Glucose gels, such as Lift shots, are available on prescription for Type 1 diabetes hypoglycaemia episodes if deemed clinically appropriate and with regard to national guidance.

What recent assessment his Department has made of the adequacy of gluten free prescribing provision for people with coeliac disease.

No recent assessment has been made by the Department. However, a review was undertaken in 2019, which confirmed that the position in England remains that gluten free (GF) bread and mixes can be provided to all eligible coeliac patients on a National Health Service prescription. A wide range of these items continues to be listed in Part XV of the Drug Tariff.NHS England developed guidance on Prescribing Gluten Free Foods in Primary Care in 2018 which states that NHS commissioners can restrict the prescribing of GF foods to bread and mixes only. Under the current legislation, integrated care boards may choose to further restrict product choice, or end prescribing of GF foods altogether, if they feel this is appropriate for their population, whilst taking account of their legal duties to advance equality and having regard to reducing health inequalities. NHS England currently has no plans to update the guidance.

What steps his Department is taking to support access to NHS prescriptions for people unable to operate online health services.

People who are unable to use online health services are still able to access the NHS via traditional routes. To get a prescription without online services, patients can visit their GP surgery and request a paper repeat prescription slip or fill out a form, or call their GP to request a telephone appointment to discuss their needs.NHS England has successfully run several programmes to support patients, carers, and health service staff with their digital skills. These include:- The Digital Health Champions programme, a proof of concept to support citizens who have no or low digital skills with understanding how to access health services online.- The Widening Digital Participation programme, aimed to ensure more people have the digital skills, motivation and means to access health information and services online.- The NHS App ‘Spoken Word’ Pilot project, designed to test the efficacy of promoting NHS digital health products and services in languages other than English. We have also recruited over 2,000 NHS App ambassadors and 1,400 libraries to help people to learn how to use it. NHS England has published a framework for NHS action on digital inclusion and is developing further resources to support practical actions. All programmes are actively considering how they can contribute to improvements in healthcare inequalities and digital inclusion.

What assessment he has made of the adequacy of the current tariff for the Minor Surgery Directed Enhanced Service in the context of rising operational costs.

General practices (GPs) are paid for minor surgery directed enhanced services through global sum payments, although they have the option to opt out of these services, and if so, the relevant deductions will be made from their global sum payments.Every year we consult with the profession about what services GPs provide, including Directed Enhanced Services, and the money providers are entitled to in return under their contracts.We are investing an additional £889 million in GPs to reinforce the front door of the National Health Service, bringing total spend on the GP Contract to £13.2 billion in 2025/26. This is the biggest increase in over a decade and means we are reversing the recent trend with a rising share of total NHS resources going to GPs. We are pleased that the General Practitioners Committee England is supportive of the contract changes.

What assessment his Department has made of the adequacy of safety levels at Castle Hill Hospital.

The Department recently sought information from the Care Quality Commission (CQC) regarding their regulatory oversight of Castle Hill Hospital. The CQC last inspected Castle Hill Hospital in November 2022, where it was rated as Requires Improvement overall. The full inspection report and detail are available at the following link:https://www.cqc.org.uk/location/RWA16Castle Hill Hospital is part of the Hull University Teaching Hospitals NHS Trust. The trust is subject to enhanced surveillance and attends a monthly Quality Improvement Board chaired by NHS England, which the CQC also attends. The trust’s action plan is monitored by the Board.The trust was told by the CQC to take several actions to ensure that clinical care and treatment across the trust was delivered safely and in accordance with national guidance. The CQC continues to monitor the trust to ensure required improvements are made.In light of the police investigation and the completion of three external reviews into the trust, the CQC is considering new information to determine any further regulatory action. Any inspection activity will be reported on and published on the CQC’s website.

What discussions his Department is having with the Care Quality Commission on carrying out further inspections at Castle Hill Hospital.

The Department recently sought information from the Care Quality Commission (CQC) regarding their regulatory oversight of Castle Hill Hospital. The CQC last inspected Castle Hill Hospital in November 2022, where it was rated as Requires Improvement overall. The full inspection report and detail are available at the following link:https://www.cqc.org.uk/location/RWA16Castle Hill Hospital is part of the Hull University Teaching Hospitals NHS Trust. The trust is subject to enhanced surveillance and attends a monthly Quality Improvement Board chaired by NHS England, which the CQC also attends. The trust’s action plan is monitored by the Board.The trust was told by the CQC to take several actions to ensure that clinical care and treatment across the trust was delivered safely and in accordance with national guidance. The CQC continues to monitor the trust to ensure required improvements are made.In light of the police investigation and the completion of three external reviews into the trust, the CQC is considering new information to determine any further regulatory action. Any inspection activity will be reported on and published on the CQC’s website.

What guidance his Department has issued on when the absence of senior leadership may necessitate intervention by a commissioner in an integrated care board.

Integrated care board (ICB) chairs are appointed by NHS England subject to the approval of my Rt Hon. Friend, the Secretary of State for Health and Social Care, in line with NHS England’s guidance, where the ICB chair position has become vacant before a successor can be approved by the Secretary of State, the ICB board may be chaired by an acting chair, which is normally, but not always, the deputy chair. The ICB governance guidance, updated in July 2024, made it a requirement for all ICBs to have a deputy chair. Information on further related requirements is available in the guidance at the following link:https://www.england.nhs.uk/long-read/guidance-on-integrated-care-board-constitutions-and-governance/ICB chief executives are appointed by the ICB chair subject to the approval of NHS England. All ICBs are required to have an Accountable Officer; an Acting CEO can cover temporary periods of absence.

What information his Department holds on whether the (a) Chair and (b) Chief Executive of Humber and North Yorkshire integrated care board remain in post.

The Chair of the Humber and North Yorkshire Integrated Care Board (ICB) resigned from the post on 12 March 2025. The ICB is currently identifying a Non-Executive Member to act as Chair for a short period. The Chief Executive is currently taking a leave of absence, and acting CEO arrangements are currently in place.

What assessment his Department has made of the potential need for Commissioner intervention in Northern Lincolnshire and Goole NHS Foundation Trust, in the context of the absence of senior leadership.

There are currently temporary senior leadership arrangements in place at Northern Lincolnshire and Goole NHS Foundation Trust. Humber and North Yorkshire Integrated Care Board and NHS England’s North East and Yorkshire Regional Team continue to provide ongoing support to the trust, ensuring that the temporary acting arrangements are successfully in place and offering any additional support that is required.NHS England will continue to provide ongoing support to the trust and its senior leadership team to ensure that our patients and public continue to receive the highest quality of care possible across the Humber region.