Written questions by Barker.

What steps his Department is taking to improve access to home dialysis for patients with kidney failure.

NHS England is delivering a comprehensive programme to improve the diagnosis, treatment, and outcomes of people with kidney disease, through its renal services transformation programme. This includes a specification for renal services which sets out the scope for the work of the renal clinical networks commissioned across England, with further information available at the following link: https://www.england.nhs.uk/wp-content/uploads/2024/05/PRN231110-renal-clinical-network-specification-2023-.pdf The goals of the specification include reducing variation across the renal care pathway by developing, agreeing, and implementing standardised pathways of care, including dialysis and home therapy services for adult and paediatric services. The eight regional kidney networks in England, working with providers, are implementing this toolkit with a clear focus on improving early diagnosis, slowing disease progression, and reducing the number of patients reaching advanced stages of kidney disease. This work is supported nationally by the Renal Clinical Reference Group.NHS England is also supporting the Department and key kidney organisations to identify further opportunities to enhance prevention, diagnosis, treatment, and long‑term outcomes for people living with kidney disease, including improved access to home dialysis.

When the updated Renal Service Specification is expected to be published.

The specification is being worked on by NHS England in line with their national service specification methods process, which is available at the following link:https://www.england.nhs.uk/publication/methods-national-service-specifications/Stakeholder testing was recently undertaken. The timing of full publication has yet to be decided upon as the feedback from stakeholders is being considered, alongside any changes required. NHS England will set out the expected date of publication as soon as this is available.

If he will consider commissioning a standalone Modern Service Framework for chronic kidney disease, including dialysis, transplantation, paediatrics, frailty, rare kidney disease and genetic kidney conditions.

The Government will consider long-term conditions for future waves of modern service frameworks (MSFs). The criteria for determining other conditions for future MSFs will be based on where there is potential for rapid and significant improvements in the quality of care and productivity. After the initial wave of MSFs is complete, the National Quality Board will determine the conditions to prioritise for any new MSFs as part of its work programme.

What assessment his Department has made of the role of home dialysis in supporting the shift from hospital to community care set out in the NHS 10-Year Health Plan.

NHS England is delivering a comprehensive programme to improve the diagnosis, treatment, and outcomes of people with kidney disease, through its renal services transformation programme. This includes a specification for renal services which sets out the scope for the work of the renal clinical networks commissioned across England, with further information available at the following link: https://www.england.nhs.uk/wp-content/uploads/2024/05/PRN231110-renal-clinical-network-specification-2023-.pdf The goals of the specification include reducing variation across the renal care pathway by developing, agreeing, and implementing standardised pathways of care, including dialysis and home therapy services for adult and paediatric services. The eight regional kidney networks in England, working with providers, are implementing this toolkit with a clear focus on improving early diagnosis, slowing disease progression, and reducing the number of patients reaching advanced stages of kidney disease. This work is supported nationally by the Renal Clinical Reference Group.NHS England is also supporting the Department and key kidney organisations to identify further opportunities to enhance prevention, diagnosis, treatment, and long‑term outcomes for people living with kidney disease, including improved access to home dialysis.

Whether he intends to take steps through the fair pay agreement process for the adult social care sector to reduce the take-home pay gap between social care support workers and equivalent NHS Band 3 roles.

We plan to introduce the first ever Fair Pay Agreement in 2028, backed by £500 million of funding to improve pay and conditions for the adult social care workforce.The Fair Pay Agreement process will see a new body formed to negotiate changes to pay and terms and conditions for care workers, improving recruitment and retention, and giving staff better recognition for their vital work. Both employers and trade unions will sit on the body, and this initial investment will mean that by 2028, care workers will expect to see a boost in their yearly wages.The details of individual Fair Pay Agreements for the care sector, including who it applies to, and the resultant impacts on an individual’s pay in a given social care role, will be subject to this negotiation process, and is for the negotiating body to decide.

What assessment his Department has made of (a) the effectiveness of the monitoring of early foetal development in patients by trusts and (b) trends in the level of variations in that monitoring by those trusts.

Monitoring and reviewing Foetal Growth Restriction is a key safety component of the Saving Babies Lives Care Bundle (Care Bundle) which includes the Foetal Growth standard. NHS Resolution monitors this through the Maternity Incentive Scheme as part of the financial incentive for National Health Service trusts to improve safety in maternity and neonatal services. We are expecting the final evaluation of Maternity Incentive Scheme this year.In December 2025, NHS England wrote to NHS trusts advising them to stop using intergrowth growth charts to estimate foetal weight and move to other alternatives by 31 March 2026. This is supported in guidance from the Royal College of Gynaecologists and implementation of this change will be monitored locally.

What national guidance is in place for cases of aspirin-allergic women at high risk of placental complications.

NHS England’s guidance states that there are a few absolute contraindications, that being, conditions that mean a certain treatment should not be used, to aspirin therapy. Pregnant women with a history of aspirin allergy, for example urticaria, or hypersensitivity to other salicylates are at risk of anaphylaxis and should not receive aspirin. Clinicians should undertake a personalised risk assessment and agree appropriate care and surveillance of maternal and foetal health in line with national guidance, local protocols, and the woman’s circumstances. NHS England’s guidance is available at the following link:https://www.england.nhs.uk/long-read/saving-babies-lives-version-3-2/#appendix-b-medication-to-reduce-the-risk-of-pregnancy-complications:~:text=There%20are%20a%20few,case%2Dby%2Dcase%20basis

What information his Department holds on the proportion of boys and men aged between 10 and 50 that have suffered from mental health issues.

The following table shows the percentage of male children and young people with a probable disorder, sorted by age group: Age group in years8 to 1617 to 1920 to 25Male children and young people with a probable disorder20.8%15.4%13.4%Source: Mental Health of Children and Young People in England Survey 2023. In addition, the following table shows the percentage of male adults with a common mental health condition, sorted by age group: Age group in years16 to 2425 to 3435 to 4445 to 55Male adults with a common mental health condition13.5%20.8%14.9%18.4%Source: Adult Psychiatric Morbidity Survey 2023/24.

What estimate he has made of the proportion of children aged 12-16 who are vaping.

NHS England publishes estimates of the prevalence of vaping in children in the Smoking, Drinking and Drug Use among Young People in England Survey. This survey covers children in years 7 to 11 in secondary school, the majority of whom will be aged 12 to 16 years old, although some 11 year olds will also be included.The latest figures for England are from the 2023 survey, which showed that 5% of children were regular vapers, 4% were occasional vapers, and 25% reported having ever tried vaping. The report is available at the following link: https://digital.nhs.uk/data-and-information/publications/statistical/smoking-drinking-and-drug-use-among-young-people-in-england/2023

What estimate his Department has made of the number of children aged between 12 and 16 years inclusive that have taken illegal drugs.

There are two official national surveys on illicit drug use among children. NHS England’s Smoking, Drinking and Drug Use among Young People surveys pupils aged between 11 and 15 years old in England. In 2023, 13% of pupils reported that they had taken drugs.The Crime Survey for England and Wales, published by the Office for National Statistics, reported that in the year ending March 2024, 15% of young people aged 16 to 19 years old reported using any drugs in the past 12 months.

With reference to the Answer of 7 May 2024 to Question 24352 on Dietetics: Prescriptions, if he will make an assessment of the potential implications for his policies of the findings of the report by the University of Surrey entitled Innovation in the Allied Health Professions: Evaluation of supplementary prescribing by dietitians and independent prescribing by therapeutic radiographers, published in December 2024, on the (a) safety and (b) efficacy of dietitians prescribing; and whether he plans to extend independent prescribing rights to dietitians.

The Department remains committed to exploring the extension of medicines responsibilities for non-medical professionals. This will support the aim that patients are cared for, and treated by, the most appropriate healthcare professional to meet their needs, where it is safe and appropriate to do so. Many regulated healthcare professionals have already received extended medicines responsibilities and prescribing rights, and the Department is committed to assessing the impact that these changes have had on patient care.Regarding the extension of prescribing rights to dietitians, there is a process in place for making changes to prescribing responsibilities to ensure proposals are safe and beneficial for patients. Officials are carefully considering proposals relating to a range of healthcare professionals, including dietitians, as part of wider work concerning non-medical prescribing. This will include consideration of literature relevant to the profession being assessed.

What steps his Department is taking to ensure that mental health patients who could pose a risk to the wider public have their cases managed appropriately.

The Mental Health Act 1983, now and when reformed, has the necessary powers to enable clinicians to manage high risk mental health patients. The planned reforms will not change the fundamental powers and purpose of the Act, which is to detain and treat people when they are so unwell they become a risk to themselves or others. However, when the very serious decision is taken to detain someone, the reforms will ensure there is a modern framework for the use of these powers, to ensure patients are treated with dignity and respect and that they receive care and treatment which supports recovery.The Mental Health Bill will seek to improve the management of risk within the Act. This Government has made additional changes to the bill published in draft in 2022 to achieve this, including the introduction of a new requirement for the patient’s responsible clinician to consult another person who has been professionally concerned with the patient’s care when they are deciding about whether to discharge a patient.NHS England included a requirement in the 2024/25 NHS Priorities and Operational Planning Guidance that all integrated care boards (ICBs) “review their community services by Q2 2024/25 to ensure that they have clear policies and practice in place for patients with serious mental illness, who require intensive community treatment and follow-up but where engagement is a challenge”.The outcome of these reviews and local action plans will be presented at ICB’s public boards to ensure the outcome of the review is transparent and locally led.

What steps his Department is taking to ensure that (a) NHS England and (b) Berkshire Healthcare NHS Trust respond to Sir Adrian Fulford's prevention of future deaths report following the Forbury Garden terrorist incident in June 2020.

It is the responsibility of the individual organisations named within a Report to Prevent Future Deaths to take action to address any identified failures. Following Sir Adrian Fulford's report, each organisation, including NHS England and the trusts, has written to the Judge Coroner, setting out what action they have taken to address the points he has made.As a first step, NHS England included a requirement in the National Health Services’ 2024/25 priorities and operational planning guidance that all integrated care boards (ICBs) ‘review their community services by Q2 2024/25 to ensure that they have clear policies and practice in place for patients with serious mental illness, who require intensive community treatment and follow-up but where engagement is a challenge’. Further information on the 2024/25 priorities and operational planning guidance is available at the following link:https://www.england.nhs.uk/operational-planning-and-contracting/The outcome of these reviews and local action plans will be presented at the ICBs’ Public Boards, to ensure the outcome of the review is transparent and locally led.

What he is taking to ensure effective intelligence sharing between mental health services and (a) the police and (b) other relevant services when a patient is deemed to pose a risk to the wider public.

Mental health services work and engage with a range of services to manage patients identified as a potential risk. The nature of this engagement will vary depending on the nature and level of the risk. For example, this may be through formal processes such as multi-agency public protection arrangements.In matters of national security, health services work with Counter Terrorism policing and the wider security sector to ensure that information is shared appropriately, to provide a complete picture of any risk, and to provide the right interventions and care for patients.Local level arrangements will also be in place, as police forces are operationally independent. Whilst the roll out of the Right Care, Right Person approach has reduced the involvement of police in mental health incidents, they will continue to engage where there is a serious risk of harm, and local level arrangements have been put in place to support safe roll out between police, and health and social care services.We intend to use the Code of Practice following the Mental Health Bill to further underline good practice for how mental health services should work with other services, including the police, to keep people safe, particularly regarding consideration of discharge.

With reference to the guidance by the National Institute for Health and Care Excellence entitled Integrated health and social care for people experiencing homelessness, published on 16 March 2022, what steps his Department is taking to implement these guidelines in health and social care settings.

The Department recognises the importance of the National Institute for Health and Care Excellence’s guidelines, and is working across the Government and the health system, and with local government, commissioners, and the voluntary sector, to continue to review and support implementation of the guidance Integrated health and social care for people experience homelessness (NG214), both nationally and locally. With the aim to include setting priority areas of focus and identifying and sharing best practice for implementation.

What steps his Department is taking to ensure that home care workers are paid correctly for their travel time.

All workers, including social care workers, must be paid at least the National Minimum Wage or National Living Wage for the work that they do. Time spent travelling between appointments counts as working time for minimum wage purposes. If anyone thinks they are not receiving at least the minimum wage, they can contact the Advisory, Conciliation and Arbitration Service or submit a query directly to HM Revenue and Customs.On 10 October 2024, recognising the central role of our amazing care workforce, we took a critical step, introducing the legislation that will establish the first ever Fair Pay Agreement for care professionals. Fair Pay Agreements will empower worker, employer, and other sector representatives to negotiate pay and terms and conditions in a regulated and responsible manner and will help to address the recruitment and retention crisis in the sector, in turn supporting the continued delivery of high-quality care.

How many Integrated Care Systems across England have policies targeted to better health outcomes for those that experience homelessness.

Integrated care systems and integrated care boards (ICBs) are expected to have a dedicated focus on tackling health inequalities. The Health and Care Act 2022 mandates that ICBs reduce inequalities in access to and outcomes from healthcare for the population they serve. This includes groups experiencing the poorest health outcomes, often referred to as inclusion health populations, such as people experiencing homelessness, vulnerable migrants, sex workers, and people with substance use issues. In addition, the Department has supported the development of National Institute for Health and Care Excellence guidance which provides recommendations on ways to improve access to, and engagement with, health and social care services for people experiencing homelessness, and the Department is working across the health system to promote this guidance.

What steps his Department is taking to help prevent street discharge from hospital settings for people rough sleeping.

The Department is committed to promoting safe and timely discharge for people experiencing, or at risk of, homelessness to appropriate accommodation. Every acute hospital has access to a care transfer hub to manage discharge for people with more complex needs, who need extra support.The Department of Health and Social Care and the Ministry of Housing, Communities and Local Government have published guidance and supporting materials for health and care staff on discharging people at risk of or experiencing homelessness. This guidance is available at the following link:https://www.gov.uk/government/publications/discharging-people-at-risk-of-or-experiencing-homelessness/discharging-people-at-risk-of-or-experiencing-homelessnessThis ensures that every health and care interaction with a homeless person acts as an opportunity to provide support and signposting, with the aim of ending rough sleeping. The Department of Health and Social Care continues to work with the Ministry of Housing, Communities and Local Government on the development of the Government’s plans for social and affordable housing.

What steps his Department is taking to provide Belzutifan to patients with von Hippel-Lindau disease.

The National Institute for Health and Care Excellence (NICE) makes recommendations for the National Health Service on whether new medicines should be routinely funded by the NHS, based on an assessment of their costs and benefits. The NICE has published final draft guidance that recommends belzutifan for treating tumours associated with von Hippel-Lindau disease subject to a managed access agreement. Belzutifan is now available to eligible patients through the Cancer Drugs Fund in line with the NICE’s final draft recommendations, ahead of the publication of the NICE’s final guidance.

What steps he is taking to improve the integration of (a) dietitians and (b) allied health professionals in the delivery of (i) public health and (ii) primary care.

The Department is leading a collaboration between the nations of the United Kingdom, as well as 14 Allied Health Professional (AHP) bodies, including the British Dietetic Association, to refresh the UK Allied Health Professions Public Health Strategic Framework, which is available at the following link:https://www.ahpf.org.uk/files/UK%20AHP%20Public%20Health%20Strategic%20Framework%202019-2024.pdfPublication of the new strategic framework is planned for early 2025. It will include goals to increase the profile, capability, and leadership of AHPs, including dietitians, in public health, including how they integrate into the wider public health workforce.The Department has also worked with the Council of Deans of Health to publish Public Health Curricula Guidance for Pre-Registration Education of AHPs, including dietitians, and with the Health and Care Professions Council to promote their revised standards of proficiency for public health.The Network Contract Directed Enhanced Service (DES) was developed to support the establishment of primary care networks which would provide greater resilience for practices, and is available at the following link:https://www.england.nhs.uk/wp-content/uploads/2024/03/PRN01583-network-contract-des-spec-24-25-pcn-requirements-entitlements.pdfThe Network Contract DES details that primary care networks are entitled to funding to support the recruitment of additional staff to deliver health services, which is referred to as the Additional Roles Reimbursement Scheme (ARRS). The ARRS includes first contact physiotherapists and paramedics and also dietitians, podiatrists, and occupational therapists. The inclusion of these AHP roles within primary care creates capacity within the system for the timely assessment and management of patients within the community, reducing the need for general practice (GP) intervention.Together with existing GP staff, the new roles can help form a multidisciplinary team who can provide new services, better care for patients, and improve integration. GPs can refer to other AHPs not included in the ARRS as clinically indicated within the community.