Written questions by Paul.

Whether his Department has identified service gaps in the provision of primary care, mental health, dentistry and substance misuse services at HMP/YOI Downview.

Primary care, mental health, dentistry, and substance misuse services at HMP/YOI Downview are delivered under the national specification for integrated healthcare. As part of the commissioning monitoring processes outlined in the NHS Strategic Commissioning Framework, which covers all National Health Service commissioned services, including health and justice, providers are measured against the mandatory performance indicators within the national specification and any potential inconsistencies in service delivery are identified. Independent processes are also embedded within service delivery monitoring. These include annual healthcare needs assessments, equality impact assessments, Independent Monitoring Board reports, Care Quality Commission reports and inspections, and user experience consultations. An annual user experience has also been carried out across all prisons in the South East.

What assessment his Department has made of the potential impact of the requirement to obtain a medical exemption certificate before being eligible to claim free prescriptions on people with chronic illnesses.

The Department has made no assessment.The exemption certificate provides the patient with evidence to demonstrate to dispensers that they are entitled to have the National Health Service cover the cost of their prescriptions. The exemption certificate requirement also allows for the verification of claims for exemption, and for fraud to be identified and pursued.It is straightforward to apply for a medical exemption certificate; the patient should ask their doctor for form FP92A. The form includes guidance on how to complete it and who can authorise it. A healthcare professional (HCP), e.g. a hospital doctor or general practitioner (GP), or at the GP’s discretion a member of the GP’s practice who can access medical records, must authorise the application to confirm the patient has the qualifying condition. If a patient is unable to complete the form themselves then a relative or HCP can complete it on their behalf and insert their name in the signature box.

How many NHS penalty charges for incorrectly claimed free prescriptions have been issued to individuals who qualified for but did not hold NHS medical exemption certificates in the last 12 months.

From November 2024 to October 2025, the NHS Business Service Authority issued 47,058 penalty charge notices (PCNs) to people who claimed a medical exemption but were found to have no exemption in place when checked. Of these, 21,328 were eased, for various reasons including the patient subsequently applying for an exemption successfully. The number of easements in this category cannot be confirmed. Of the 47,058 PCNs issued 3,583 people received multiple PCNs.Although the Department has made no formal assessment of the effectiveness of issuing PCNs as a deterrent against improper claims, the fact that the vast majority who receive one PCN do not go on to receive another would, in my opinion, suggest a potential deterrent effect.

What assessment his Department has made of the effectiveness of issuing penalty charge notices as a deterrent against improper claims of free NHS prescriptions.

From November 2024 to October 2025, the NHS Business Service Authority issued 47,058 penalty charge notices (PCNs) to people who claimed a medical exemption but were found to have no exemption in place when checked. Of these, 21,328 were eased, for various reasons including the patient subsequently applying for an exemption successfully. The number of easements in this category cannot be confirmed. Of the 47,058 PCNs issued 3,583 people received multiple PCNs.Although the Department has made no formal assessment of the effectiveness of issuing PCNs as a deterrent against improper claims, the fact that the vast majority who receive one PCN do not go on to receive another would, in my opinion, suggest a potential deterrent effect.

With reference to the Independent Monitoring Board's report entitled Annual report of the Independent Monitoring Board at HMP/YOI Downview, published on 3 September 2025, what steps he is taking to ensure acutely mentally unwell prisoners are swiftly (a) identified and (b) given care in an appropriate facility at (a) HMP/YOI Downview, (b) other prisons and (c) other young offenders institutions.

NHS England commissions prison health care services for HMP/YOI Downview and every other prison and young offenders institution in England. Every prison has onsite health care services including primary care, mental health, dentistry, and substance misuse teams. The National Service Specification for integrated mental health sets out how patients within secure settings, who require support for their mental wellbeing, should receive the same level of healthcare as people in the community, both in terms of the range of interventions available to them, in order to meet their needs, and the quality and standards of those interventions. This includes access to crisis intervention and crisis prevention for those at high risk of self-harm and suicide, where such behaviours relate to poor emotional wellbeing and/or minor psychiatric morbidity. Access to mental health provision is available to every person in prison at any stage of their sentence, beginning at the point of entry. NHS England commissions first night reception screening to have a registered nurse/practitioner review patients’ medical history to address any immediate health needs and risks and to ensure medication is made available as soon as possible and that onward referrals to onsite healthcare teams, including mental health services, for both urgent face to face appointments, within 24 hours, and routine face to face appointments, within five working days, are made. Outside of reception screening, people in prison can be referred or can self-refer to mental health services, within those timeframes. When someone is acutely unwell, they can be transferred from prisons and other places of detention to hospital for treatment, under the Mental Health Act, within the target transfer period of 28 days. The Mental Health Bill, currently going through Parliament, introduces a statutory 28-day time limit within which agencies must seek to ensure individuals who meet the criteria for detention under the act are transferred to hospital for treatment. NHS England’s South East Health and Justice team is funding a transfer and remissions co-ordinator from January 2025, to improve, where possible, safe, effective, and efficient transfers to hospital level treatment and interventions. NHS England is reviewing the National Integrated Prison Service Specification to ensure it continues to meet the needs of the prison population.

Whether his Department plans to provide additional support for women who face additional prescription costs due to (a) menorrhagia and (b) other menstrual issues caused by (i) miscarriage and (ii) other significant traumas.

There are no plans to review the support available to women facing these issues.A maternity exemption certificate can be applied for as soon as a healthcare professional has confirmed that the patient is pregnant or has given birth, including still-birth, in the previous twelve months, and this provides exemption from prescription costs until 12 months after the due date. The certificate remains valid if the patient has a miscarriage. The certificate is automatically backdated one month from the date the application is received by the NHS Business Services Authority.If a patient is not entitled to the maternity exemption, they can purchase a prescription prepayment certificate (PPC), which allows them to claim as many prescriptions as they need for a set cost. A three-monthly PPC, costing £32.05, or an annual PPC, costing £114.50, will save people money if they need four or more items in three months or 12 or more items in 12 months. To help spread the cost, people can pay for an annual PPC by ten monthly direct debits. A holder of a 12-month certificate can get all the prescriptions they need for just over £2 per week.Approximately 40% of the population are currently liable to pay the prescription charge though approximately 89% of the items dispensed in the community are dispensed free of charge.

What information his Department holds on the status of the proposed PATHWAYS clinical trial.

Better quality evidence is critical if the NHS is to support young people suffering from gender incongruence, so we are supporting a programme of research, recommended by the Cass Review, including the PATHWAYS study. The health and wellbeing of the children and young people involved is our primary concern.Ethical and regulatory approvals have been received for the observational element of the study. Approval processes and site set-up are well underway for the clinical trial and we will provide an update when the study moves to the next stage.

What assessment he has made of the potential implications for his policies of the recommendations on surrogacy in the report by the UN Special Rapporteur for Violence Against Women and Girls entitled Report of the Special Rapporteur on violence against women and girls, its causes and consequences: The different manifestations of violence against women and girls in the context of surrogacy, published on 14 July 2025.

The UN Special Rapporteur’s report is framed within the context of Violence Against Women and Girls and recommends banning surrogacy in all forms.The United Kingdom Government supports surrogacy as an option for family formation, for people unable to carry their own children. For this option, we recommend the use of UK not-for-profit surrogacy organisations.For those considering surrogacy overseas, we recommend taking specialist legal advice and consulting the advice published by the Foreign, Commonwealth and Development Office, which is available at the following link:https://www.gov.uk/government/publications/surrogacy-overseas/surrogacy-overseas

What assessment his Department has made of the potential impact of £985 per cycle payments to egg donors on the level of incentive to women from the poorest backgrounds to donate eggs because of financial need.

The compensation rate for egg donation is set by the Human Fertilisation and Embryology Authority (HFEA), as provided for in the Human Fertilisation and Embryology Act 1990. The HFEA has advised that the donor compensation levels originally set in 2011 followed a thorough ethical review, which identified a set of principles that ensured altruism remained at the heart of donation and that there were not any unjustifiable barriers to donation. The HFEA has advised that the increase in donor compensation from 1 October 2024 to £985 per cycle reflects the rise in inflation since the compensation rates were first introduced in 2011.Academic research in the United Kingdom has consistently found that donating eggs and sperm is driven by altruism, and HFEA published data shows that egg and sperm donors in England from 2011 to 2020 lived in similar or more affluent socio-economic areas than the general population.

If he will make an assessment of the potential merits of running long term studies in to the impact on women's bodies of egg retrieval.

The Human Fertilisation and Embryology Authority (HFEA)’s Scientific and Clinical Advances Advisory Committee (SCAAC) recently reviewed the published evidence of health outcomes for those having fertility treatment, including egg donors. The last 10 years of evidence were reviewed and the HFEA will update relevant information on its website as needed.The HFEA also set out strict requirements in its Licence Conditions and Code of Practice relating to the information that must be given before egg retrieval takes place in United Kingdom licensed fertility clinics, whether for the patient’s own use or to donate to others. This includes information about the potential immediate or longer-term health risks and the psychological consequences of being a donor, as well as offering counselling to everyone involved.

Whether his Department has made an assessment of the potential impact of allowing young women to be solicited for egg donations by for-profit fertility clinics utilising adverts which do not list known health risks on their safety.

No such assessment has been made. The Human Fertilisation and Embryology Authority (HFEA), the United Kingdom’s fertility sector regulator, sets out strict requirements in its Licence Conditions and Code of Practice in relation to the recruitment of donors and the information that must be given to egg donors in advance of donating at United Kingdom licensed fertility clinics, which includes information about the potential immediate or longer-term health risks and the psychological consequences of being a donor, as well as offering counselling to everyone involved.The HFEA’s Code of Practice states that advertising should be designed with regard to the sensitive issues involved in recruiting donors and should follow the Advertising Standards Authority (ASA) codes. This includes that advertising or publicity aimed at recruiting gamete or embryo donors, or encouraging donation, should not refer to the possibility of financial gain or similar advantage, although it may refer to compensation permitted under relevant HFEA Directions.The ASA and HFEA issued a joint enforcement notice in 2021 to ensure fertility clinics and others were aware of the advertising rules, which remains in place.

What recent assessment he has made of the reason that over 4,100 women from the poorest backgrounds in the UK have donated their eggs since 2011.

The Department has not undertaken an assessment, however, academic research in the United Kingdom has consistently found that donating eggs and sperm is driven by altruism.The Human Fertilisation and Embryology Authority (HFEA) published data shows that egg and sperm donors in England from 2011 to 2020 lived in similar or more affluent socio-economic areas than the general population.The following table shows the number of egg donors living in each of the multiple deprivation deciles in England at time of registration, between 2011 and 2020:Multiple deprivation decileNumber of egg donors11,11721,48831,54241,36051,31061,21471,11481,09791,05010860Source: the HFEA report, Trends in egg, sperm and embryo donation 2020.Notes:this data includes donors with a postcode in England only;multiple deprivation deciles were calculated using 2015 data from the Ministry of Housing, Communities and Local Government, and post code information from the HFEA register; anddata provided is from a live register and may not match data published elsewhere.

What steps his Department is taking to ensure newly qualified nurses are not prevented from accessing band 5 roles within the NHS due to (a) experience requirements and (b) such roles only being advertised internally.

Decisions about recruitment are a matter for individual National Health Service employers, who manage this at a local level to ensure they have the staff they need to deliver safe and effective care.NHS England is working with employers, universities, and regional nursing leads to ensure support is in place to help graduating nurses find a role as soon as possible after qualification, aiding their transition into the workplace.

How much the average cost of healthcare was for (a) male prisoners and (b) female prisoners in HMP Downview in the last 12 months.

HMP Downview is a women’s prison. The average cost of healthcare per female prisoner at HMP Downview for 2024/25 was £11,765.

What steps he is taking to help support GP practices to acquire larger premises.

General practice (GP) contractors are responsible for securing the premises from which to deliver their contracted services. Should practice premises be deemed too small, GPs may make an application to integrated care boards for capital funding grants for repurposing existing underutilised space, or expansion of the existing site, or seek agreement for the GP practice to relocate to a different building.One of the core objectives of the 10-Year Health Plan is enabling people to access care closer to home and in the community. In autumn 2024, we announced £102 million of additional capital funding for GP estates upgrades in 2025/26. This will support improved use of existing buildings and space, boosting productivity and enabling practices to deliver more patient appointments.There may be revenue solutions to premises needs, dependent on the budgetary capacity of the local commissioner. Commissioners can work closely with local authorities, other system providers, and the One Public Estate Programme to identify existing premises for the potential delivery of healthcare services.

What steps he is taking to help improve the capacity of sexual health (a) drop in clinics and (b) services in Reigate constituency.

Local authorities in England, including East Sussex County Council which covers Reigate, are funded through a ring-fenced Public Health Grant to commission comprehensive, open access sexual health services. Therefore, it is the responsibility of local authorities to decide on spending priorities, such as drop-in clinics and general services, based on the blend of services that best suits the needs of their population.For 2025/26, we are increasing funding through the grant to £3.858 billion. This is a cash increase of £198 million compared to 2024/25, providing local authorities with an average 5.4% cash increase and 3.0% real terms increase. This represents a significant turning point for local public health services, marking the biggest real-terms increase after a period of reduced spending between 2016 and 2024.

With reference to his Department's response to the consultation on hub and spoke dispensing, last updated on 13 May 2024, what his planned timetable is for introducing the legislative amendments outlined in his Department's response.

The policy proposals, consultation, and response were published under the previous administration. Following the General Election, the Government has reviewed the proposals. The Department is working towards introducing legislation to enable hub and spoke dispensing between different legal entities this year. This change will be enabled via amendments to both primary and secondary legislation, and is subject to the usual Parliamentary processes.

Pursuant to the Answer of 15 October 2024 to Question 7682 on Cancer: Medical Treatments, when he plans to publish the updated NHS Commercial Framework for New Medicines.

NHS England published its updated Commercial Framework for New Medicines on 29 January 2025. The publication can be found here: NHS England » NHS commercial framework for new medicines

If his Department will take steps to ensure that all defibrillators installed at train stations are (a) registered and (b) visible on The Circuit national defibrillator network website.

The Government is committed to improving access to automated external defibrillators (AEDs) in public spaces and reducing inequalities in access to these life saving devices. Following the depletion of the existing AED fund, launched in in September 2023, the Government approved a further £500,000 in August 2024 to fulfil existing applications to the fund.The Department does not hold data on AEDs installed in train stations or whether those AEDs are registered on The Circuit, a national defibrillator and ambulance service database, operated independently by the British Heart Foundation in collaboration with the National Health Service.However, AEDs procured through the Department’s AED fund, once installed, are required to be registered on The Circuit. Upon registration, contact details are provided for the nominated AED guardian or guardians who are local to the defibrillator’s location and conduct checks when required. The registered guardian receives an automatic email or SMS text message notification if the defibrillator has potentially been used, therefore prompting the guardian to conduct a check. The Circuit records the potential use of each registered defibrillator. The registered guardian of the defibrillator will automatically be contacted if their AED is potentially used, and may therefore require replacement pads. In addition, The Circuit will also send out an automatic notification to the guardian approximately three months before the AED battery or pads expire.

If his Department will take steps to help ensure that emergency services are provided with up to date information on the (a) location and (b) status of defibrillators installed at train stations.

The Government is committed to improving access to automated external defibrillators (AEDs) in public spaces and reducing inequalities in access to these life saving devices. Following the depletion of the existing AED fund, launched in in September 2023, the Government approved a further £500,000 in August 2024 to fulfil existing applications to the fund.The Department does not hold data on AEDs installed in train stations or whether those AEDs are registered on The Circuit, a national defibrillator and ambulance service database, operated independently by the British Heart Foundation in collaboration with the National Health Service.However, AEDs procured through the Department’s AED fund, once installed, are required to be registered on The Circuit. Upon registration, contact details are provided for the nominated AED guardian or guardians who are local to the defibrillator’s location and conduct checks when required. The registered guardian receives an automatic email or SMS text message notification if the defibrillator has potentially been used, therefore prompting the guardian to conduct a check. The Circuit records the potential use of each registered defibrillator. The registered guardian of the defibrillator will automatically be contacted if their AED is potentially used, and may therefore require replacement pads. In addition, The Circuit will also send out an automatic notification to the guardian approximately three months before the AED battery or pads expire.