Written questions by Holden.

Whether his Department has made an assessment of the potential impact of the Tobacco and Vapes Bill on the risk of vapers returning to traditional cigarettes.

The health advice is clear that whilst vapes are less harmful than smoking and can be an effective quit aid for adult smokers, children and adult non-smokers should never vape. The Tobacco and Vapes Bill has been carefully designed to get this balance right, ensuring we take definitive action to tackle youth vaping, whilst ensuring that vapes, alongside other forms of quit aids, remain accessible to adult smokers.The Government has published a comprehensive impact assessment for the Tobacco and Vapes Bill which includes the health benefits and the impact on people who vape currently. This assessment was reviewed in full by the Regulatory Policy Committee, which deemed it ‘fit for purpose’ in its published opinion on 5 November 2024.Importantly, the bill introduces a progressive age of sale policy for tobacco, the smoke-free generation policy, and also includes policies that further restrict the sale and appeal of tobacco products. This will have a dissuasive effect on consumers considering tobacco products, which will mitigate any potential risks of people that vape returning to tobacco use.Tobacco duty will also be increased alongside the upcoming vaping products duty to maintain the financial incentive to choose vaping over smoking.To support current smokers to quit, we are providing £70 million of additional funding into local stop smoking services and delivering Tobacco Dependency Treatment through National Health Service inpatient and maternity services. These services provide access to a range of medicines, nicotine replacement therapies, and vapes, alongside behavioural support. Vapes are a popular quit aid among adult smokers and we have commissioned guidance from the National Centre for Smoking Cessation and Training to maximise their use and ensure practitioners are trained to deliver the best advice.Our national public health marketing campaigns, such as Stoptober and our annual campaigns, motivate adults to quit smoking. Public health messaging will continue to educate smokers about smoking quit aids and will support the promotion of vapes as a means for adult smokers to quit smoking, as outlined on the Better Health and NHS websites.

What steps his Department plans to take to educate consumers about less harmful alternatives to smoking.

The health advice is clear that whilst vapes are less harmful than smoking and can be an effective quit aid for adult smokers, children and adult non-smokers should never vape. The Tobacco and Vapes Bill has been carefully designed to get this balance right, ensuring we take definitive action to tackle youth vaping, whilst ensuring that vapes, alongside other forms of quit aids, remain accessible to adult smokers.The Government has published a comprehensive impact assessment for the Tobacco and Vapes Bill which includes the health benefits and the impact on people who vape currently. This assessment was reviewed in full by the Regulatory Policy Committee, which deemed it ‘fit for purpose’ in its published opinion on 5 November 2024.Importantly, the bill introduces a progressive age of sale policy for tobacco, the smoke-free generation policy, and also includes policies that further restrict the sale and appeal of tobacco products. This will have a dissuasive effect on consumers considering tobacco products, which will mitigate any potential risks of people that vape returning to tobacco use.Tobacco duty will also be increased alongside the upcoming vaping products duty to maintain the financial incentive to choose vaping over smoking.To support current smokers to quit, we are providing £70 million of additional funding into local stop smoking services and delivering Tobacco Dependency Treatment through National Health Service inpatient and maternity services. These services provide access to a range of medicines, nicotine replacement therapies, and vapes, alongside behavioural support. Vapes are a popular quit aid among adult smokers and we have commissioned guidance from the National Centre for Smoking Cessation and Training to maximise their use and ensure practitioners are trained to deliver the best advice.Our national public health marketing campaigns, such as Stoptober and our annual campaigns, motivate adults to quit smoking. Public health messaging will continue to educate smokers about smoking quit aids and will support the promotion of vapes as a means for adult smokers to quit smoking, as outlined on the Better Health and NHS websites.

Whether his Department has made an assessment of the potential implications for his policies of the BBC Panorama programme The Truth About Baby Food Pouches; and if he will make an assessment of the adequacy of existing regulations on (a) front-of-pack labelling, (b) permitted sugar content, and (c) minimum nutritional standards for commercial baby food.

Children’s early years provide an important foundation for their future health and strongly influence many aspects of wellbeing in later life.The BBC Panorama programme highlighted issues with levels of sugar and misleading labelling and nutrition claims in some commercial baby food products. The Government has recently published voluntary industry guidelines for commercial baby food and drink which challenge manufacturers to reduce levels of sugar and salt in their products. The guidelines also set out actions that businesses should take to improve the labelling and marketing of these products. Businesses have 18 months to deliver the required changes, and we will monitor and publish their progress towards achieving this. The guidelines are available at the following link:https://www.gov.uk/government/publications/commercial-baby-food-and-drink-voluntary-industry-guidelines/commercial-baby-food-and-drink-voluntary-industry-guidelinesWe have regulations in place that set nutritional, compositional and labelling standards for commercial baby food. We continue to keep these regulations under review to ensure that the composition of infant food and drinks reflect the latest scientific advice and dietary guidelines. The voluntary industry baby food guidelines should support improvements in this area.

What recent assessment his Department has made of the availability of ultrasound scans to pregnant women who (a) report reduced foetal movement before 28 weeks’ gestation and (b) present on more than one occasion after 24 weeks' gestation.

The Department has not made a recent assessment of the availability of ultrasound scans to pregnant women who report reduced foetal movement before 28 weeks’ gestation and present on more than one occasion after 24 weeks' gestation. Pregnant women are advised to seek professional help immediately if there is a reduction or change in the pattern of their baby’s movements at any gestation.At any point in the pregnancy, if there is a repeat episode of reduced or changed foetal movements, they should contact their maternity team immediately and a plan for care will be made based on personal circumstances and the number of weeks gestation. Whether further ultrasound scans are recommended will depend on clinical need and be determined on a case-by-case basis.

If he will make an assessment of the potential merits of introducing a duty to refer new mothers experiencing mental distress to appropriate local services.

We recognise that supporting women’s mental health is a crucial aspect of care at all stages of pregnancy and post-partum.General practitioners (GPs) can offer initial support for mild to moderate mental health problems including depression and anxiety. If a pregnant woman needs further support, a range of specialist mental health services have been made available to access during the perinatal period. For women with or at risk of more serious mental health problems, such as severe depression, who are planning a pregnancy, pregnant or have a baby up to two years old, specialist perinatal mental health services provide care in all 42 integrated care system areas of England. As of June 2025, Maternal Mental Health Services are now available across all areas of England. They are available for women experiencing mental health difficulties directly arising from, or related to, their maternity or neonatal experience, such as post-natal depression. Women can be referred to these services, which are often community-based, by any healthcare professional, including midwives, health visitors, GPs, hospital-based teams, mental health services and social workers. Self-referrals are accepted by some services.Additionally, 165 Mother and Baby Unit beds have now been commissioned, with 153 currently operational. These units provide inpatient care to women who experience severe mental health difficulties during and after pregnancy, including postpartum psychosis. A mother could be admitted to a mother and baby unit for treatment of severe depression or an anxiety disorder.NHS England guidance sets out that all women who have given birth should be offered a postnatal check-up with their GP after six to eight weeks. This check-up provides an important opportunity for women to be listened to by their GP in a discreet, supportive environment, and for women to be assessed and supported not just in their physical recovery post-birth but also their mental health. In line with the National Health Service guidance, during this appointment, GPs have a duty to ask every woman about her mental health, and to prioritise identifying and addressing serious mental health concerns such as severe depression. This means any woman needing extra mental health support can be referred to primary care mental health support including Talking Therapies or to a specialist perinatal mental health team, if appropriate.On 17 July 2025, the Prime Minister also announced the launch of Diagnosis Connect, a new service that will better-connect patients to both local and national charities. This will ensure that patients are referred directly to trusted charities and support organisations as soon as they are diagnosed, providing personalised advice, information and guidance to help them manage their condition and feel more in control. This support will include physical and mental wellbeing in the perinatal period.

What steps his Department is taking to ensure that new mothers experiencing (a) anxiety, (b) postnatal depression and (c) other difficulties after birth are routinely referred to local third-sector or community-based support services.

We recognise that supporting women’s mental health is a crucial aspect of care at all stages of pregnancy and post-partum.General practitioners (GPs) can offer initial support for mild to moderate mental health problems including depression and anxiety. If a pregnant woman needs further support, a range of specialist mental health services have been made available to access during the perinatal period. For women with or at risk of more serious mental health problems, such as severe depression, who are planning a pregnancy, pregnant or have a baby up to two years old, specialist perinatal mental health services provide care in all 42 integrated care system areas of England. As of June 2025, Maternal Mental Health Services are now available across all areas of England. They are available for women experiencing mental health difficulties directly arising from, or related to, their maternity or neonatal experience, such as post-natal depression. Women can be referred to these services, which are often community-based, by any healthcare professional, including midwives, health visitors, GPs, hospital-based teams, mental health services and social workers. Self-referrals are accepted by some services.Additionally, 165 Mother and Baby Unit beds have now been commissioned, with 153 currently operational. These units provide inpatient care to women who experience severe mental health difficulties during and after pregnancy, including postpartum psychosis. A mother could be admitted to a mother and baby unit for treatment of severe depression or an anxiety disorder.NHS England guidance sets out that all women who have given birth should be offered a postnatal check-up with their GP after six to eight weeks. This check-up provides an important opportunity for women to be listened to by their GP in a discreet, supportive environment, and for women to be assessed and supported not just in their physical recovery post-birth but also their mental health. In line with the National Health Service guidance, during this appointment, GPs have a duty to ask every woman about her mental health, and to prioritise identifying and addressing serious mental health concerns such as severe depression. This means any woman needing extra mental health support can be referred to primary care mental health support including Talking Therapies or to a specialist perinatal mental health team, if appropriate.On 17 July 2025, the Prime Minister also announced the launch of Diagnosis Connect, a new service that will better-connect patients to both local and national charities. This will ensure that patients are referred directly to trusted charities and support organisations as soon as they are diagnosed, providing personalised advice, information and guidance to help them manage their condition and feel more in control. This support will include physical and mental wellbeing in the perinatal period.

What progress his Department has made on the roll-out of Fracture Liaison Services.

Fracture Liaison Services are commissioned by integrated care boards, which are well-placed to make decisions according to local need.Our 10-Year Health Plan committed to rolling out Fracture Liaison Services across every part of the country by 2030.The Department is working closely with NHS England to consider a range of options to ensure better quality and access to these important preventative services.

Whether his Department has made an assessment of the feasibility of allowing general practitioners to initiate ADHD diagnostic referrals for school-age children.

It is the responsibility of the integrated care boards (ICBs) to make available the appropriate provision to meet the health and care needs of their local population, including decisions on local referral processes for attention deficit hyperactivity disorder (ADHD) assessments, in line with relevant National Institute for Health and Care Excellence (NICE) guidelines. General practitioner teams can already refer patients for an ADHD assessment, both for adults and school-age children, where this is clinically appropriate and indicated according to NICE guidelines.NHS England has established an ADHD taskforce which is bringing together those with lived experience with experts from the National Health Service, education, charity, and justice sectors to get a better understanding of the challenges affecting those with ADHD, including in accessing services and support. An interim report was published on 20 June, with the final report expected to be published later in the year, and we will carefully consider its recommendations.

What steps his Department is taking to reduce the under-diagnosis of ADHD in girls; and what targets have been set for improving identification rates by 2026.

We recognise that diagnosis rates of attention deficit hyperactivity disorder (ADHD) are lower in women and girls and lower than the best evidence on prevalence. This may reflect differences in how ADHD present in males and females, which may make ADHD more difficult to identify in women and girls.ADHD assessments should be undertaken by appropriately skilled clinicians who consider several factors before coming to a clinical decision. Integrated care boards and health professionals should have due regard to National Institute for Health and Care Excellence (NICE) guidelines when commissioning and providing health care services, including ADHD assessment services. NICE guidelines on ADHD set out considerations for clinicians when assessing for ADHD, including highlighting that ADHD may be under-recognised in women and girls.NHS England has established an ADHD taskforce which is bringing together those with lived experience with experts from the National Health Service, education, charity, and justice sectors to get a better understanding of the challenges affecting those with ADHD, including in accessing services and support. An interim report was published on 20 June 2025, with the final report expected to be published later in the year, and we will carefully consider its recommendations.

What steps he is taking to ensure that patients who pursue non-NHS ADHD treatment are not disadvantaged in accessing (a) ongoing and (b) future NHS treatment.

The Department has not issued guidance to integrated care boards (ICBs) or general practices (GPs) on supporting patients with private attention deficit hyperactivity disorder (ADHD) diagnoses to transition into National Health Service care.It is the responsibility of the ICBs in England to make available appropriate provision to meet the health and care needs of their local population, including access to ADHD services, in line with relevant National Institute for Health and Care Excellence guidelines.Shared care with the NHS refers to an arrangement whereby a specialist doctor formally transfers responsibility for all or some aspects of their patient’s care, such as prescription of medication, over to the patient’s GP.The General Medical Council (GMC), which regulates and sets standards for doctors in the United Kingdom, has made it clear that GPs cannot be compelled to enter into a shared care agreement. GPs may decline such requests on clinical or capacity grounds.The GMC has issued guidance on prescribing and managing medicines, which helps GPs decide whether to accept shared care responsibilities. In deciding whether to enter into a shared care agreement, a GP will need to consider a number of factors such as whether the proposed activity is within their sphere of competence, and therefore safe and suitable for their patient’s needs. This includes the GP being satisfied that any prescriptions or referrals for treatment are clinically appropriate.If a shared care arrangement cannot be put in place after the treatment has been initiated, the responsibility for continued prescribing falls upon the specialist clinician, and this applies to both NHS and private medical care.

What recent discussions he has had with NHS England on the adequacy of the consistency of shared care prescribing arrangements for ADHD medication in each Integrated Care Board.

The Department has not issued guidance to integrated care boards (ICBs) or general practices (GPs) on supporting patients with private attention deficit hyperactivity disorder (ADHD) diagnoses to transition into National Health Service care.It is the responsibility of the ICBs in England to make available appropriate provision to meet the health and care needs of their local population, including access to ADHD services, in line with relevant National Institute for Health and Care Excellence guidelines.Shared care with the NHS refers to an arrangement whereby a specialist doctor formally transfers responsibility for all or some aspects of their patient’s care, such as prescription of medication, over to the patient’s GP.The General Medical Council (GMC), which regulates and sets standards for doctors in the United Kingdom, has made it clear that GPs cannot be compelled to enter into a shared care agreement. GPs may decline such requests on clinical or capacity grounds.The GMC has issued guidance on prescribing and managing medicines, which helps GPs decide whether to accept shared care responsibilities. In deciding whether to enter into a shared care agreement, a GP will need to consider a number of factors such as whether the proposed activity is within their sphere of competence, and therefore safe and suitable for their patient’s needs. This includes the GP being satisfied that any prescriptions or referrals for treatment are clinically appropriate.If a shared care arrangement cannot be put in place after the treatment has been initiated, the responsibility for continued prescribing falls upon the specialist clinician, and this applies to both NHS and private medical care.

What guidance his Department has issued to (a) ICBs and (b) GP practices on supporting patients with private ADHD diagnoses to transition into NHS care.

The Department has not issued guidance to integrated care boards (ICBs) or general practices (GPs) on supporting patients with private attention deficit hyperactivity disorder (ADHD) diagnoses to transition into National Health Service care.It is the responsibility of the ICBs in England to make available appropriate provision to meet the health and care needs of their local population, including access to ADHD services, in line with relevant National Institute for Health and Care Excellence guidelines.Shared care with the NHS refers to an arrangement whereby a specialist doctor formally transfers responsibility for all or some aspects of their patient’s care, such as prescription of medication, over to the patient’s GP.The General Medical Council (GMC), which regulates and sets standards for doctors in the United Kingdom, has made it clear that GPs cannot be compelled to enter into a shared care agreement. GPs may decline such requests on clinical or capacity grounds.The GMC has issued guidance on prescribing and managing medicines, which helps GPs decide whether to accept shared care responsibilities. In deciding whether to enter into a shared care agreement, a GP will need to consider a number of factors such as whether the proposed activity is within their sphere of competence, and therefore safe and suitable for their patient’s needs. This includes the GP being satisfied that any prescriptions or referrals for treatment are clinically appropriate.If a shared care arrangement cannot be put in place after the treatment has been initiated, the responsibility for continued prescribing falls upon the specialist clinician, and this applies to both NHS and private medical care.

With reference to Cabinet Office FOI disclosure FOI2025/05753 of 12 June 2025, what assessment his Department has made of the potential impact of cancelling the (a) Antimicrobial resistance (AMR) and (b) Help Us Help You: Cancer the communications campaigns on health outcomes.

The UK Health Security Agency (UKHSA) has not conducted a formal assessment regarding the potential impact of cancelling the Keep Antibiotics Working campaign. UKHSA remains committed to promoting the importance of using antibiotics correctly, and in Spring launched a new pilot campaign to re-engage priority audience groups with the correct behaviors in terms of antibiotic usage. The evaluation of this campaign will support plans to develop the campaign further, if funding becomes available. UKHSA is planning proactive public and system facing activity for World Antimicrobial Awareness Week, from 18 to 24 November 2025, and is using all relevant opportunities to build understanding of antimicrobial resistance and what the public can do to combat it. For these reasons, UKHSA has not conducted a formal assessment regarding the potential impact of cancelling the Keep Antibiotics Working campaign, specifically.NHS England runs Help Us Help You campaigns to increase knowledge of cancer symptoms and address barriers to acting on them, to encourage people to come forward as soon as possible to see their general practitioner. The campaigns focus on a range of symptoms as well as encouraging body awareness to help people spot symptoms across a wide range of cancers at an earlier point. The Department has not made a formal assessment of the potential impact of cancelling the Help Us Help You campaigns.

Whether he plans to install customer experience machines in his Department to measure staff morale.

The Department currently has no plans to install customer experience machines to measure staff morale.The Department does, however, have mechanisms to measure staff engagement. The Department uses the annual Civil Service People Survey to understand staff attitudes to, and their experience of, working in the Department. This provides insight on staff engagement across a range of topics including health and wellbeing, culture, and change management. Business areas will also run their own ad hoc pulse surveys on specific topics when needed. The Department also holds regular all staff calls where staff can feed back their views on various topics.

Pursuant to the Answer of 2 June 2025 to Question 52906 on Department of Health and Social Care: Permanent Secretaries, whether she has been employed under the terms of the model permanent secretary contract; for how long the fixed term period is; and whether she is classified as a (a) temporary or (b) permanent civil servant.

The Department launched a fair and open competition to appoint a Permanent Secretary in January 2025. As a result of this process, Samantha Jones was found to be an appointable candidate for this role. However, during the recruitment process, it was announced that NHS England would be brought back into the Department. This significantly changed the scale and objectives required of this role. In light of these changes the Civil Service Commission agreed a three-year fixed term appointment by exception, on the Senior Civil Service Model contract.

Whether changes have been made to the NHS terms and conditions of service for Agenda for Change in relation to trade unions since 4 July 2024.

Changes to the National Health Service’s Terms and Conditions of Service, also known as the Agenda for Change contract, are agreed via the NHS Staff Council, which is a partnership body made up of employer and trade union representatives.The NHS’s Terms and Conditions of Service were updated in April 2025 to reflect that the Prison Officers Association is now a nationally recognised organisation, for the purposes of the NHS Staff Council and for the collective bargaining of the Agenda for Change contract. No further changes have been made that relate to trade unions.

What declarations of political (a) activity and (b) interests were made by each Health Crown Representative.

The appointments of the Health Crown Representatives, as with all Crown Representatives, were made by the Cabinet Office.The Cabinet Office requires all Crown Representatives to declare any Conflict of Interest both on appointment and at regular intervals thereafter. None of the current Crown Representatives have declared any party-political activity or interests.

What recent steps his Department has taken to improve (a) safety and (b) other standards in maternity services at (i) Southend and (ii) Basildon Hospital.

Following the Care Quality Commission (CQC) rating of maternity services at Southend Hospital as Requires Improvement in January 2025, the trust made several changes to improve the quality of the service. These changes include ensuring qualified midwifery staff are always available to support the maternity telephone triage service, foetal monitoring equipment is regularly checked and available, and triage information is displayed in waiting areas to provide further guidance on waiting times.Basildon Hospital’s maternity services were rated as Requires Improvement by the CQC in March 2024. The trust has made several changes to improve the service, including improvements to staffing, with midwifery vacancies now at their lowest ever, ensuring staff complete training and expanding midwifery support for the birth reflections clinic, and around quality assurance, with regular audits conducted and acted upon.Basildon Hospital maternity services are part of the national Maternity Safety Support Programme, which puts in place oversight from the integrated care board (ICB), NHS England, and the Local Maternity and Neonatal System. This includes support from two Maternity Improvement Advisors, covering all three trust maternity sites. The trust is in the Improvement phase.While improvements have been made, further work is required. The ICB will continue to support the Trust to enhance safety, care quality, and patient experience.

Whether the national investigation into NHS maternity and neonatal services announced on 23 June 2025 will be empowered to recommend (a) regulatory and (b) structural reform of the Care Quality Commission in the context of continued failings in maternity units at (i) Southend Hospital, (ii) Basildon Hospital and (iii) other hospitals rated as Requires Improvement.

My Rt Hon. Friend, the Secretary of State for Health and Social Care announced an independent investigation into National Health Service maternity and neonatal services to understand the systemic issues behind why so many women, babies, and families experience unacceptable care. It will look at up to 10 maternity and neonatal units, international evidence, adoption of best practice, and a system-wide investigation of maternity and neonatal care. This will include bringing together lessons from past reviews. The investigation will produce, by December 2025, one clear set of national actions, that will take primacy over previous recommendations. These actions will drive the improvements needed to ensure high quality, safe care across maternity and neonatal services, and that women and families are listened to.The terms of reference for the investigation are still under development with stakeholders and families, and will be released in due course.

What progress NHS England has made on sharing data about patients who (a) received a blood transfusion before 1996 and (b) have tested positive for (i) HIV and (ii) Hepatitis C with the Independent Contaminated Blood Authority.

NHS England is supporting the Infected Blood Compensation Authority (IBCA) with their engagement with National Health Service organisations for the purposes of sharing data on patients who received a blood transfusion before 1996 and who have tested positive for HIV or hepatitis C, to support compensation claims.This support includes highlighting the requirement to provide information promptly to the IBCA to support claims, conducting workshops to understand how the IBCA can most effectively gather information from NHS organisations, and drafting guidance for patients, clinicians, and information governance professionals so that NHS organisations feel confident about sharing information to support claims.