Written questions by Whittome.

Asking what assessment he has made of the potential impact of the General Practice Contract 2026–27 for England on a) patient safety and b) the long-term sustainability of general practice.

The Department and NHS England assessed the potential impacts of the proposed changes to the GP Contract on patient safety and the long-term sustainability of general practices (GPs) for 2026/27 throughout the policy-development process.In early 2026, we concluded the 2026/27 GP Contract consultation. This year we expanded the consultation to engage with wider stakeholders across GPs and patient voice organisations. These were the General Practitioners Committee England, the Royal College of General Practitioners, National Voices, the Institute of General Practice Management, Healthwatch England, NHS Confederation, now NHS Alliance following its merge with NHS Providers, and the National Association of Primary Care. The feedback we received from stakeholders across the system has been constructive and comprehensive, enabling us to refine proposals and address concerns while developing the final contract package. Overall, the changes are designed to help increase capacity in GPs, support patient access, shift from treatment to prevention through changes to the Quality and Outcomes Framework and vaccinations, enable practices to prioritise clinically urgent needs, and ensure GPs remain sustainable for the future. The changes make progress on commitments in the 10-Year Health Plan as well as key commitments to bring back the family doctor and end the 8:00am scramble. The Department and NHS England will continue to monitor the impact of the GP Contract through workforce data, patient access metrics, and patient experience data.

When his Department plans to make a decision on whether the Federated Data Platform and Associated Services contract with Palantir Technologies will be extended; and what contingency plans his Department has in place to ensure ongoing provision of the programme if that contract is ended.

We continually assess performance against the contract, and performance of the programme as a whole, and publish data on uptake and benefits each quarter. The National Health Service Federated Data Platform (FDP) programme is significantly exceeding its benefits forecast and has exceeded every target since it’s ‘go live’ in March 2024. It is also assessed regularly by the Government's National Infrastructure and Service Transformation Authority, on behalf of HM Treasury. The NHS FDP is one of only 14% of Government major programmes to receive a ‘Green’ rating in July 2025, indicating that the FDP is on track. In line with Government commercial function standards and contract management best practice, we shall be reviewing the FDP and Associated Services (FDP-AS) contract with a decision anticipated to be made this year on extension. As part of ongoing and regular contract reviews of the FDP-AS, due consideration is given as to how benefits and outcomes are protected, and whether there is an extension or not. In the event of the contract ending, there are clear Exit Management provisions which would take effect. As with any change programme, there are many aspects that require planning and resource, including delivery of associated procurement activity, mobilising the replacement solutions, managing business change, in particularly supporting users, and managing the exit from existing contracts, the latter inclusive of service continuity during change activity. The contract has a number of measures built in to facilitate exit and transition, including clear intellectual property rights in NHS build products or components.

What steps his Department is taking to help (a) ensure that the BREAKWATER treatment protocol for patients with BRAF‑mutated bowel cancer is evaluated and funded as a matter of urgency, and (b) secure equal access to this protocol for patients across the UK.

The National Institute for Health and Care Excellence (NICE) makes recommendations for the National Health Service on whether new licensed medicines and licence extensions for existing medicines should be routinely funded by the NHS based on an assessment of clinical and cost effectiveness. NICE aims wherever possible to issue guidance for the NHS on new medicines close to the time of licensing, and cancer drugs are eligible for funding from the point of a positive draft NICE recommendation.The BREAKWATER study is investigating encorafenib, a BRAF inhibitor, in combination with cetuximab and fluorouracil-based chemotherapy for the potential treatment of colorectal cancer. This regimen does not currently have a United Kingdom marketing authorisation for use in the treatment of previously untreated BRAF V600E mutation positive metastatic colorectal cancer. NICE has prioritised an appraisal of encorafenib for this indication in anticipation of it being granted a UK marketing authorisation and will schedule the appraisal so that guidance can be published as close as possible to the expected licensing date. Further information on the appraisal’s status is publicly available on NICE’s website at the following link:https://www.nice.org.uk/guidance/awaiting-development/gid-ta11961The clinical trial was assessed and approved in the UK and is currently active, with further information available at the following link:https://clinicaltrials.gov/study/NCT04607421?term=BREAKWATER&viewType=Card&rank=1

What steps his Department is taking to support the safety and appropriate care of patients with suspected craniocervical instability; what plans he has to improve access to appropriate imaging and specialist clinical review for such patients, including those with Ehlers-Danlos syndrome; and what assessment he has made of the potential merits of using patients’ lived experience to inform future policy development and service provision in this area.

Decisions on the assessment, diagnosis, and management of suspected craniocervical instability (CCI) are made by National Health Service clinicians on a case‑by‑case basis, drawing on established neurological, neurosurgical, rheumatology, and pain pathways. The Department has not issued specific national guidance on CCI, including in patients with Ehlers–Danlos syndromes (EDS). Responsibility for designing and commissioning pathways for rare or complex conditions rests with integrated care boards (ICBs), which are best placed to plan services that reflect local needs and available specialist expertise.Patients with symptoms suggestive of CCI may be referred for appropriate diagnostic imaging, such as magnetic resonance imaging or computed tomography scanning, where clinically indicated. Access to imaging continues to expand through the Government’s programme of community diagnostic centres, which is increasing diagnostic capacity and supporting earlier identification of complex conditions as part of the wider 10‑Year Health Plan.Where specialist clinical review is required, referral decisions are made by NHS clinicians, who can access expertise across neurology, neurosurgery, and associated sub-specialties. ICBs are responsible for ensuring that local pathways support timely referral to the most appropriate service.The Department recognises the value of patients’ lived experience in improving the design of services for complex conditions. Department officials are working with patient groups to identify service gaps, improve equity of access, and inform future service development. This approach helps ensure that the needs and experiences of patients with suspected CCI, including those with EDS, are reflected in wider policy work.

If his Department will make an assessment of the potential merits of including international medical graduates who are GMC-registered and who have at least two years’ NHS experience by 5 March 2026 in the prioritisation for specialty training.

The Medical Training (Prioritisation) Act 2026, which received Royal Assent on 5 March 2026, prioritises United Kingdom medical graduates and other doctors with significant National Health Service experience for specialty training places.For specialty training places starting in 2026, immigration statuses are being used as a practical proxy to capture applicants who are most likely to have significant experience working in the health service in the UK.From 2027, immigration status will no longer automatically determine priority for specialty training. Instead, we are able to make regulations to specify any additional groups who will be prioritised by reference to criteria indicating significant experience as a doctor in the health service, or by reference to immigration status. The Department will work with NHS England, the devolved administrations, and other partners on how best to define and evidence significant NHS experience as part of the development of those regulations.

What steps he is taking to ensure that people with substance use issues can access specialist inpatient detox treatment.

Local authorities are responsible for commissioning drug and alcohol treatment services according to local need as part of their public health responsibilities, and this includes the provision of inpatient detoxification services.In line with recommendations in Dame Carol Black’s independent review of drug treatment and recovery, the Department created a distinct grant to support and expand inpatient detoxification for people who use drugs and alcohol. The £10 million a year grant ran between 2022/23 and 2024/25, before being consolidated into the Drug and Alcohol Treatment and Recovery Improvement Grant in 2025/26. Investment in inpatient detoxification services will continue beyond 2026. The Government has committed over £13.45 billion across three years through the Public Health Grant, including £3.4 billion ringfenced for drug and alcohol prevention, treatment, and recovery, which includes funding for inpatient detoxification. This multi-year funding provides greater certainty for local areas as they plan and sustain services.

What steps he is taking to ensure that patient experience data and intelligence is independently aggregated and analysed following the abolition of local Healthwatch.

Following the abolition of local Healthwatch, our proposals are that integrated care boards (ICBs) and local authorities (LAs) will have the responsibility for gathering views, and feedback from local people about health and social care services respectively in their area. ICBs and LAs will be required to take these views into account when looking at their commissioning strategies to ensure these meet the needs of local people. They will also be required to demonstrate that they have done so. However, these proposals require primary legislation. The timing of this is subject to the will of Parliament and will happen when parliamentary time allows.

If he will ensure that human, qualitative patient insight is not displaced by digital, survey-based and institution-led feedback once local Healthwatch is abolished.

As set out in the Dash Review of the patient safety landscape published in July 2025, and in the 10-Year Health Plan, the statutory functions of local Healthwatch bodies will be transferred to integrated care boards (ICBs) for health, and to local authorities (LAs) for social care.Both ICBs and LAs will be required to demonstrate how they have gathered patient and user feedback from local people including those who do not have access to digital platforms, those who are less proficient with technology, and people for whom English is a second language.

What assessment he has made of the potential benefits of including inflammatory bowel disease on the list of medical conditions which are entitled to a medical exemption certificate.

There are currently no plans to add inflammatory bowel disease to the list of medical conditions that entitle someone to apply for a medical exemption certificate which exempts the holder from paying the National Health Service prescription charge.

What assessment his Department has made of the potential impact of the availability of NHS provision on the number of patients with Cranio-Cervical Instability who are seeking (a) diagnosis and (b) surgical treatment overseas.

The Department recognises that Ehlers–Danlos syndromes (EDS) and associated cranio‑cervical instability (CCI) are complex conditions that can be challenging to diagnose and manage, and we acknowledge the concerns raised by patients and clinicians about variation in expertise and access to appropriate care.Care for CCI is managed within existing specialised neurology and spinal pathways, delivered in centres with the appropriate expertise. NHS England works with clinical experts and integrated care boards to ensure that provision reflects the best available evidence and supports patients with complex connective‑tissue and neurological presentations. Decisions on surgical interventions for CCI must be based on individual clinical assessment, the strength of available evidence for benefit, and consideration of potential risks.Once qualified, healthcare professionals are responsible for ensuring their own clinical knowledge remains up to date, and for identifying learning needs as part of their continuing professional development. Clinical teams are expected to use the best available evidence and follow national guidance when assessing and managing patients with complex connective tissue disorders.The Department continues to engage with patient groups, charities, and Members of Parliament on the issues facing people with EDS and CCI. Insights from this engagement, including on the barriers patients encounter in accessing National Health Services, are informing our ongoing consideration of what further action may be needed to strengthen referral routes, support the dissemination of clinical resources, and consider where further system support may improve diagnostic confidence and care coordination.The Department is aware of a number of individual cases where patients with suspected CCI have travelled overseas for imaging or surgery not routinely available in the NHS.

What steps his Department is taking to improve a) (a) the diagnosis of, (b) clinician training on and (c) access to treatment for patients with Ehlers-Danlos Syndromes and associated Cranio-Cervical Instability.

The Department recognises that Ehlers–Danlos syndromes (EDS) and associated cranio‑cervical instability (CCI) are complex conditions that can be challenging to diagnose and manage, and we acknowledge the concerns raised by patients and clinicians about variation in expertise and access to appropriate care.Care for CCI is managed within existing specialised neurology and spinal pathways, delivered in centres with the appropriate expertise. NHS England works with clinical experts and integrated care boards to ensure that provision reflects the best available evidence and supports patients with complex connective‑tissue and neurological presentations. Decisions on surgical interventions for CCI must be based on individual clinical assessment, the strength of available evidence for benefit, and consideration of potential risks.Once qualified, healthcare professionals are responsible for ensuring their own clinical knowledge remains up to date, and for identifying learning needs as part of their continuing professional development. Clinical teams are expected to use the best available evidence and follow national guidance when assessing and managing patients with complex connective tissue disorders.The Department continues to engage with patient groups, charities, and Members of Parliament on the issues facing people with EDS and CCI. Insights from this engagement, including on the barriers patients encounter in accessing National Health Services, are informing our ongoing consideration of what further action may be needed to strengthen referral routes, support the dissemination of clinical resources, and consider where further system support may improve diagnostic confidence and care coordination.The Department is aware of a number of individual cases where patients with suspected CCI have travelled overseas for imaging or surgery not routinely available in the NHS.

What consideration his Department has given to introducing transitional arrangements for the implementation of UK graduate prioritisation in medical specialty recruitment for the 2025–26 recruitment cycle; and whether he will review the decision to assess applicants’ immigration or settlement status at the point of application rather than at the point of job offer, in cases where applicants will have Indefinite Leave to Remain by the time offers are made.

The Government does not plan to introduce transitional arrangements for the implementation of the Medical Training (Prioritisation) Bill.For 2026 specialty training posts we have used immigration status as a reasonable proxy for National Health Service experience. Subject to parliamentary passage, the bill prioritises applicants at offer stage based on their immigration status at that point. Applicants will be able to update their application status where it has changed since they made their application. For specialty training posts starting from 2027 onwards, the immigration status category will not apply automatically. Instead, we will be able to make regulations to specify any additional groups who will be prioritised by reference to criteria indicating significant experience as a doctor in the health service, or by reference to immigration status. We will set out next steps on these regulations in due course.

What assessment his Department has made of the potential impact of the Medical Training (Prioritisation) Bill on British citizens who have already commenced undergraduate medical degrees overseas on the understanding that they would be able to return to the UK to complete their Foundation Programme; and what plans he has to implement transitional protections and assurances to safeguard their training prospects and future careers in the NHS.

Subject to the parliamentary passage of the bill, British citizens who have graduated from medical schools outside of the United Kingdom will not be prioritised for foundation training places if they spent the majority of their time studying outside the British Islands.The Government does not plan to implement transitional protections or assurances in relation to these applicants. Prioritisation does not mean exclusion. Non-prioritised graduates will still be able to apply for foundation training places, and they will be offered places if vacancies remain after prioritised applicants have received offers.

What assessment he has made of the adequacy of redundancy arrangements for NHS staff who take partial retirement.

This specific assessment has not been made. Where National Health Service staff have taken partial retirement, they retain continuous service. As a result, some staff may be entitled to receive a statutory redundancy payment that exceeds their contractual redundancy entitlement, in which case, the statutory payment will apply. Entitlement to redundancy payments ultimately depends on what is set out in an employee’s employment contract and whether their contract refers to Section 16 of the Agenda for Change terms. Different rules may apply to NHS staff who are not employed on Agenda for Change terms in England.Contractual redundancy provisions for staff covered by the NHS Terms and Conditions of Service handbook, also referred to as Agenda for Change, were agreed and ratified in partnership by the NHS Staff Council, the collective bargaining structure made up of trade union and employer representatives. Any future changes to the handbook, including this section, would require the Department to issue a mandate to allow negotiations to be undertaken by the NHS Staff Council.

What assessment he has made of the potential impact of long working hours and workforce burnout on staff wellbeing, retention and safe staffing levels within the NHS.

We know from engagement on the 10-Year Health Plan that many National Health Service staff feel disempowered and overwhelmed. Tackling this and providing proper support for staff is a top priority. NHS organisations have a responsibility to create supportive working environments for staff, ensuring they have the conditions they need to thrive, including access to high quality health and wellbeing support.The Government is committed to publishing a 10 Year Workforce Plan which will have a focus on supporting and retaining our hardworking and dedicated healthcare professionals. This includes the development of a new set of staff standards for modern employment, which will reaffirm our commitment to improving retention and are likely to focus on flexible working, improving staff health and wellbeing and dealing with violence, racism, and sexual harassment in the NHS workplace. Additionally, we will roll out Staff Treatment Hubs that will ensure staff have access to high quality support for occupational health, including support for mental health and back conditions.

What assessment he has made of the potential merits of a) waiving and b) subsidising the cost of the first six to eight (i) preliminary and (ii) core examinations for junior doctors.

The Department has not made a specific assessment of the potential merits of waiving or subsidising the cost of the first six to eight preliminary and/or core examinations for resident, previously “junior”, doctors.My Rt Hon. Friend, the Secretary of State for Health and Social Care, made two offers to the British Medical Association (BMA) Resident Doctors Committee in 2025 to try to resolve its ongoing industrial disputes. These including provisions to reimburse fees for mandatory royal college examinations to resident doctors in England. However, the BMA rejected these offers.The Government remains determined to put an end to the damaging cycles of disruption caused by strike action and is holding talks with the BMA to resolve the disputes.

What steps he is taking to reduce diagnostic waiting times for gynaecological conditions in Nottingham; and if he will make additional funding available to support gynaecological services.

Reducing diagnostic waiting times, including for gynaecology, is a key part of the Government’s health mission. That is why we are transforming diagnostic services and are taking steps to support the National Health Service to increase diagnostic capacity, including those tests typically used in gynaecology services such as magnetic resonance imaging (MRI) and ultrasound.As set out in the Elective Reform Plan, we plan to build up to five more community diagnostic centres (CDCs), as part of £600 million capital funding for diagnostics in 2025/26. The plan also commits to CDCs opening 12 hours per day, seven days a week, delivering more same-day tests and consultations. In August 2025, we confirmed that 100 CDCs were delivering these extended services.There are already two CDCs located within the NHS Nottingham and Nottinghamshire Integrated Care Board. These are Broad Marsh CDC in Nottingham and Mansfield CDC in Mansfield, which offer patients across Nottingham and Nottinghamshire key diagnostic tests, including MRI and ultrasound.More generally, to support gynaecological services, we are prioritising gynaecology pathways as part of the launch of NHS online. This will give people on certain pathways, such as those with severe menopause symptoms and menstrual problems, the choice of getting specialist case from their home and provide additional capacity to cut waiting times.

What steps his Department is taking to encourage trainee doctors to take up rehabilitation as a specialism.

We are committed to training the staff we need, including rehabilitation specialists, to ensure patients are cared for by the right professional, when and where they need it.As of September 2025, there are 490 full-time equivalent (FTE) doctors working in the speciality of rehabilitation medicine in National Health Service trusts and other core organisations in England. This is 24, or 5%, more than last year, 116, or 31.2%, more than 2020, and 232, or 90.2%, more than in 2010. This includes over 164 FTE consultants. This is seven, or 4.3%, more than last year, 15, or 10%, more than in 2020, and 50, or 43.8%, more than in 2010. Fill rates for ST3 level rehabilitation medicine have been increasing. 94% of training posts were filled in 2025 compared to 54% in 2023 and 60% in 2024.

What assessment his Department has made of the potential impact of partial retirement for NHS staff on redundancy entitlements; and what discussions his Department has had with NHS representatives on ensuring staff were informed of the employment and redundancy implications of partial retirement.

Partial retirement does not mean that National Health Service staff are ineligible for redundancy payments. However, taking partial retirement may change the way in which contractual redundancy payments are calculated.The rules concerning the calculation of redundancy payments for NHS staff who have previously taken pension benefits, are determined in accordance with their contracts of employment, and statutory redundancy entitlements.Redundancy terms for NHS staff on the Agenda for Change contract are set out under section 16 of the NHS Staff Terms and Conditions of Service handbook. This also applies to NHS staff whose redundancy terms refer to section 16. This section states that service used for the purposes of calculating previous pension benefits will not count for the calculation of a contractual redundancy payment. Statutory redundancy entitlements are unaffected.The Department commissions NHS Employers to provide guidance for employers on a range of topics, including NHS redundancy arrangements and retirement options for NHS staff.

What steps his department is taking to increase access to specialist wheelchairs for children in Nottingham East constituency.

Integrated care boards (ICBs) are responsible for the provision and commissioning of local wheelchair services, and responsibility for providing disabled children’s equipment would typically fall to the National Health Service and local authorities.NHS England supports ICBs to commission effective, efficient, and personalised wheelchair services. Since July 2015, NHS England has collected quarterly data from clinical commissioning groups, now ICBs, on wheelchair provision, including waiting times, with the aim of supporting improvements where required. Further information can be found at the following link:www.england.nhs.uk/statistics/statistical-work-areas/national-wheelchairNHS England is taking steps to reduce regional variation in the quality and provision of NHS wheelchairs, and to support ICBs to reduce delays in people receiving intervention and equipment. This includes publishing a Wheelchair Quality Framework on 9 April 2025 which sets out quality standards and statutory requirements for ICBs, such as offering personal wheelchair budgets. The framework is available at the following link:https://www.england.nhs.uk/long-read/wheelchair-quality-framework/The Nottingham and Nottinghamshire ICB is actively working to ensure equitable access to specialist wheelchair services across the region, including Nottingham City and South Nottinghamshire. This is being pursued through:the procurement of a unified long-term wheelchair service for Mid-Nottinghamshire and Bassetlaw and aligning service specifications and reporting with Nottingham University Hospitals, the provider for South Nottinghamshire and Nottingham City; anda plan to introduce Key Performance Indicators, which will include monthly reporting to monitor access, equipment, and service delivery timescales for children and adults across different localities. This work is planned to start in Nottingham University Hospitals in the third quarter of the 2025/26 financial year.