Written questions by Harding.

What plans his Department has to increase the number of specialist Parkinson's nurses serving residents of Esher and Walton constituency.

The Government will publish 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, including specialists across the full scope of National Health Service care. It will ensure that the NHS has the right people in the right places, with the right skills to care for patients, including those with Parkinson’s disease, when they need it. This 10 Year Workforce Plan will set out how we will deliver that change by making sure that staff are better treated, have better training, more fulfilling roles, and hope for the future.We have set up a United Kingdom-wide Neuro Forum, facilitating formal, twice-yearly meetings across the Department, NHS England, devolved administrations, and health services and Neurological Alliances of all four nations. The new forum brings key stakeholders together to share learnings across the system and discuss challenges, best practice examples, and potential solutions for improving the care of people with neurological conditions, including Parkinson’s. The forum has identified areas for initial focus, including the workforce, which featured as a key item on the agenda at the second meeting of the forum in September 2025.

Pursuant to the Answer of 5 June 2025 to Question 55860 on Chronic Fatigue Syndrome: Health Services, whether he has a new target date for publication of that plan.

The myalgic encephalomyelitis, also known as chronic fatigue syndrome, final delivery plan will be published shortly. The plan will focus on boosting research, improving attitudes and education, and bettering the lives of people with this debilitating disease.

What steps he is taking to increase the availability of specialist clinical provision for people with Huntington’s Disease in Surrey.

Working under the UK Rare Diseases Framework, the Government is committed to improving the lives of those living with rare diseases, such as Huntington’s Disease.Integrated care boards (ICBs) are responsible for working with their local communities to understand the needs of the local populations and make decisions about how best to commission services that meet those needs, including the treatment of Huntington’s Disease, in partnership with other local commissioners and organisations. Details on local clinical provisions are best answered by the ICB, in this case NHS Surrey Heartlands.

What steps he (a) has taken and (b) is taking to (i) increase and (ii) improve the availability of specialist clinical provision for people with Huntington’s Disease.

Working under the UK Rare Diseases Framework, the Government is committed to improving the lives of those living with rare diseases, such as Huntington’s Disease.Surrey Heartlands Integrated Care Board (ICB) commissions a specialist service that provides support to people with Huntington’s Disease. The service works closely with the Huntington’s Disease clinic at St George’s University Hospitals NHS Foundation Trust. As of November 2024, there are 18 full time equivalent neurology consultants employed in National Health Service trusts within the Surrey Heartlands ICB region. This is seven more than a year previously.At the national level, there are several initiatives supporting service improvement and better care for patients with neurological conditions, including those with Huntington’s disease, such as the RightCare Progressive Neurological Conditions Toolkit and the Getting It Right First Time Programme for Neurology. NHS England has also established a Neurology Transformation Programme, a multi-year, clinically led programme to develop a new model of integrated care for neurology services. The National Neurosciences Advisory Group developed clinical pathways for adults with movement disorders, including Huntington’s disease. This is being used to inform the proposed changes to the neurology service model, which will in turn be used to revise the service specification for neurology.

What steps he is taking to improve treatment outcomes for people with Huntington’s Disease; and what research his Department is supporting into that disease.

Working under the UK Rare Diseases Framework, the Government is committed to improving the lives of those living with rare diseases, such as Huntington’s Disease. One of the priorities of the Framework is improving access to specialist care, treatment and drugs. In England, we published the 2025 Rare Diseases Action Plan on 28 February 2025, which provides further information.The Department funds research into Huntington’s disease via the National Institute for Health and Care Research (NIHR). The NIHR welcomes high quality funding applications for research into any aspect of human health and care, including Huntington’s disease. For example, the NIHR’s UCL Biomedical Research Centre (BRC) supported the TRACK-HD study. This identified biomarkers for Huntington’s disease and generated a database of brain scans available to scientists and led to the development of a rating scale to measure disease progression. BRC-funded researchers have also developed the first human test for the protein, which has now been validated and used as an endpoint in clinical trials.

How many and what proportion of integrated care boards have specialist clinicians for Huntington’s Disease; and whether Surrey Heartlands ICB has specialist clinicians for Huntington’s Disease.

Working under the UK Rare Diseases Framework, the Government is committed to improving the lives of those living with rare diseases, such as Huntington’s Disease.Surrey Heartlands Integrated Care Board (ICB) commissions a specialist service that provides support to people with Huntington’s Disease. The service works closely with the Huntington’s Disease clinic at St George’s University Hospitals NHS Foundation Trust. As of November 2024, there are 18 full time equivalent neurology consultants employed in National Health Service trusts within the Surrey Heartlands ICB region. This is seven more than a year previously.At the national level, there are several initiatives supporting service improvement and better care for patients with neurological conditions, including those with Huntington’s disease, such as the RightCare Progressive Neurological Conditions Toolkit and the Getting It Right First Time Programme for Neurology. NHS England has also established a Neurology Transformation Programme, a multi-year, clinically led programme to develop a new model of integrated care for neurology services. The National Neurosciences Advisory Group developed clinical pathways for adults with movement disorders, including Huntington’s disease. This is being used to inform the proposed changes to the neurology service model, which will in turn be used to revise the service specification for neurology.

Whether his Department plans to establish a specialist Huntington’s Disease Centre in Surrey.

Working under the UK Rare Diseases Framework, the Government is committed to improving the lives of those living with rare diseases, such as Huntington’s Disease.Surrey Heartlands Integrated Care Board (ICB) commissions a specialist service that provides support to people with Huntington’s Disease. The service works closely with the Huntington’s Disease clinic at St George’s University Hospitals NHS Foundation Trust. As of November 2024, there are 18 full time equivalent neurology consultants employed in National Health Service trusts within the Surrey Heartlands ICB region. This is seven more than a year previously.At the national level, there are several initiatives supporting service improvement and better care for patients with neurological conditions, including those with Huntington’s disease, such as the RightCare Progressive Neurological Conditions Toolkit and the Getting It Right First Time Programme for Neurology. NHS England has also established a Neurology Transformation Programme, a multi-year, clinically led programme to develop a new model of integrated care for neurology services. The National Neurosciences Advisory Group developed clinical pathways for adults with movement disorders, including Huntington’s disease. This is being used to inform the proposed changes to the neurology service model, which will in turn be used to revise the service specification for neurology.

What proportion of infants with hydrocephalus initially present symptoms after 8 weeks of age.

It is vitally important that babies are diagnosed as early as possible so treatment can be provided. Current National Institute for Health and Care Excellence (NICE) guidance recommends measuring the head circumference of babies in the first week, at approximately eight weeks, and at other times only if there are concerns. The baby’s general practitioner, or nominated primary care examiner, has responsibility for ensuring the six-to-eight-week newborn infant physical examination screen, where head size is measured, is completed for all registered babies. The Department is seeking advice from the NICE and the royal colleges on the value of a clinical review of the current guidelines surrounding infant head circumference.The Healthy Child Programme sets out the requirements for health visiting services, including five mandated reviews, where the child’s health and development is assessed. This includes when the baby is 10 to 14 days old, and at six to eight weeks old, as well as additional contacts depending on need, providing an opportunity to identify any health or development concerns and to make appropriate referrals. The Department and the NHS National Disease Registration Service do not hold information on the proportion of infants diagnosed after eight weeks.

What assessment he has made of the potential merits of routine monitoring of infant head circumference after 8 weeks of age as a diagnostic tool for early identification of hydrocephalus.

It is vitally important that babies are diagnosed as early as possible so treatment can be provided. Current National Institute for Health and Care Excellence (NICE) guidance recommends measuring the head circumference of babies in the first week, at approximately eight weeks, and at other times only if there are concerns. The baby’s general practitioner, or nominated primary care examiner, has responsibility for ensuring the six-to-eight-week newborn infant physical examination screen, where head size is measured, is completed for all registered babies. The Department is seeking advice from the NICE and the royal colleges on the value of a clinical review of the current guidelines surrounding infant head circumference.The Healthy Child Programme sets out the requirements for health visiting services, including five mandated reviews, where the child’s health and development is assessed. This includes when the baby is 10 to 14 days old, and at six to eight weeks old, as well as additional contacts depending on need, providing an opportunity to identify any health or development concerns and to make appropriate referrals. The Department and the NHS National Disease Registration Service do not hold information on the proportion of infants diagnosed after eight weeks.

What assessment his Department has made of the potential impact of community pharmacy closures on (a) local health provision and (b) patient outcomes in (i) England and (ii) Surrey.

Since 2019, there have been a total of 39 pharmacy closures in Surrey, and four in the Esher and Walton Constituency. In Surrey, this has broken down as: seven closures in 2019; six in 2020; four in 2021; two in 2022; and 15 in 2023, with a further five having closed between January and 30 September 2024. In Esher and Walton, there were no closures between 2019 and 2022. Three closed in 2023, and one closed between January and 30 September 2024.We are aware of the reduction in the number of pharmacies in recent years, and recognise that pharmacy closures can impact on local communities. Local authorities are required to undertake a pharmaceutical needs assessment (PNA) every three years to assess whether their population is adequately served, and must keep these assessments under review. Integrated care boards give regard to the PNAs when reviewing applications from the new contractors. Contractors can also apply to open a new pharmacy to offer benefits to patients that were not foreseen by the PNA.Patients can also access the approximately 400 Distance Selling Pharmacies who must operate nationally and send medicines to patients’ home free of charge. In rural areas, dispensing doctors can also supply medicines.

How many community pharmacies have closed in (a) Surrey and (b) Esher and Walton constituency in each year since 2019.

Since 2019, there have been a total of 39 pharmacy closures in Surrey, and four in the Esher and Walton Constituency. In Surrey, this has broken down as: seven closures in 2019; six in 2020; four in 2021; two in 2022; and 15 in 2023, with a further five having closed between January and 30 September 2024. In Esher and Walton, there were no closures between 2019 and 2022. Three closed in 2023, and one closed between January and 30 September 2024.We are aware of the reduction in the number of pharmacies in recent years, and recognise that pharmacy closures can impact on local communities. Local authorities are required to undertake a pharmaceutical needs assessment (PNA) every three years to assess whether their population is adequately served, and must keep these assessments under review. Integrated care boards give regard to the PNAs when reviewing applications from the new contractors. Contractors can also apply to open a new pharmacy to offer benefits to patients that were not foreseen by the PNA.Patients can also access the approximately 400 Distance Selling Pharmacies who must operate nationally and send medicines to patients’ home free of charge. In rural areas, dispensing doctors can also supply medicines.

What the average per-patient funding for GP practices was in (a) England and (b) NHS Surrey Heartlands in 2023-4.

This data is published annually by NHS England in the NHS Payments to General Practice Report and will be available in due course.

What the average GP practice patient list is; what the largest patient list was at a GP practice in 2023-4; and what assessment his Department has made of the potential impact of GP list sizes on patient (a) experience and (b) outcomes.

Data on patients registered at a general practice (GP) is published on a monthly basis, and is as follows for 2023/24: at the beginning of 2023/24, 1 April 2023, the largest practice had 106,308 patients, and the median average practice had 8,383 patients; and at the end of 2023/24, 1 April 2024, the largest practice had 98,469 patients, and the median average practice had 8,620 patients.NHS England has overall responsibility for ensuring that there are sufficient primary medical services to meet the reasonable requirements of patients throughout the country. To do so, they will contract providers, such as GPs, to provide these services. GPs are required to provide services to meet the reasonable needs of the patients registered at their practice. This includes making their own workforce plans, and so there is no Government recommendation for how many patients a GP should have assigned.We expect commissioners to act if services are not meeting the reasonable needs of their patients. Under GP Contract regulations, practices can apply to their commissioner to close their patient list to new registrations for a period of time for a number of reasons, including workload and staffing considerations.This data is taken from the Patients Registered at a GP Practice data set, from NHS England Digital. It should be noted that practices can operate across multiple sites or use a digital first approach, which can account for a particularly large patient list. Further information on the data set is available at the following link:https://digital.nhs.uk/data-and-information/publications/statistical/patients-registered-at-a-gp-practice

What steps he plans to take to improve the (a) performance of and (b) patient experience at the GP practices in the bottom 5% of the 2024 GP Patient Survey.

We know that general practices (GPs) are working hard to deliver for their patients, and are delivering more appointments than ever before, however we know that some patients are struggling to access the care they need, and GPs are struggling to deliver it.The GP Contract requires NHS England to arrange an annual review of GP contractors’ performance against their contractual obligations. Integrated care boards also consider concerns or complaints raised by patients, and can take action where services are not meeting the needs of their local population.