Written questions by Allin-Khan.

What steps his Department is taking to (a) develop and (b) improve Fracture Liaison Services.

The Government and NHS England support the clinical case for services which help to prevent fragility fractures, and support the patients who sustain them. The Government is committed to ending the postcode lottery for access to Fracture Liaison Services.Officials continue to work closely with NHS England to explore a range of options to provide better quality and access to these important preventative services.

What steps his Department is taking to support people diagnosed with osteoporosis.

On 6 January 2025, NHS England published the new Elective Reform Plan, which sets out a whole system approach to hitting the 18-week Referral to Treatment target by the end of this Parliament. Further information on the Elective Reform Plan is available at the following link: https://www.england.nhs.uk/publication/reforming-elective-care-for-patients/ Part of the plan sets out funding to boost bone density scanning capacity, to support improvements in early diagnosis and bone health for conditions such as osteoporosis. This will provide an estimated 29,000 extra scans per year. As announced in the Get Britain Working white paper, we are delivering the joint Department for Work and Pensions, Department of Health and Social Care, and NHS England Getting It Right First-Time (GIRFT) Musculoskeletal (MSK) Community Delivery Programme. With a £3.5 million funding boost, GIRFT teams will deploy their proven Further Faster model to work with integrated care board leaders to further reduce MSK community waiting times, including for those with osteoporosis, and improve data, metrics, and referral pathways to wider support services.

Whether he has made an assessment of the (a) efficacy and (b) efficiency of NHS Pathways.

The Government is taking action to improve the efficacy and efficiency of NHS Pathways across the health system.The NHS Pathways clinical content and assessment protocols are consistent with the latest advice from the respected bodies that provide evidence and guidance for medical practice. In particular, NHS Pathways is concordant with the latest guidelines from the National Institute for Health and Clinical Excellence, the UK Resuscitation Council, and the UK Sepsis Trust.The NHS Pathways Clinical Decision Support System (CDSS) is a triage product used to support urgent and emergency care in England, and is embedded in NHS 111 and 999 telephony service, and NHS 111 online. It is continuously reviewed to ensure it remains safe, effective, and efficient. The system is developed and maintained by a group of experienced National Health Service clinicians with an urgent and emergency care background. The safety of the clinical triage process is overseen by the Academy of Medical Royal Colleges and the relevant royal colleges, and clinical professional groups endorse and approve the CDSS.The NHS triages patients waiting for elective care, including surgeries, through clinical prioritisation, ensuring the order in which patients are seen reflects clinical judgement on need as well as taking into account overall wait time.The Government is taking action to improve efficacy and efficiency of NHS Pathways across the health system. The recently published Elective Reform Plan commits to reforming outpatient care through clinical pathway transformation. Reform will include doing more activity in the community and increasing the opportunities for patients to be referred straight to diagnostic tests without the need to first see a consultant, reducing unnecessary follow-up appointments and freeing up clinical time for those who need it most. The Elective Reform Plan also makes changes to advice and guidance to support more patients being cared for outside of hospitals, avoiding 800,000 unnecessary referrals each year.

What steps his Department is taking to make dentistry more affordable.

The Government is committed to National Health Service dental services being available for all those who need them. Free NHS dental care is available to people who meet one of the following criteria:under 18 years old, or under 19 years old and in full-time education;pregnant or had a baby in the previous 12 months;being treated in an NHS hospital and the treatment is carried out by the hospital dentist, although patients may have to pay for any dentures or bridges; andreceiving low-income benefits, or under 20 years old and a dependant of someone receiving low-income benefits. Support is also available through the NHS Low Income Scheme for those patients who are not eligible for exemption or full remission of dental patient charges. Further information is available at the following link:https://www.nhs.uk/nhs-services/dentists/who-is-entitled-to-free-nhs-dental-treatment-in-england/

What assessment he has made of the potential merits of increasing the regulation of private dental charges.

The National Health Service contracts independent dental providers to deliver NHS dental treatment. Dentists must make clear which treatments can be provided on the NHS and which can only be provided on a private basis, and the costs associated for each. If a patient decides to choose alternative private options, this should be included in their treatment plan.The Department and NHS England do not control the cost of private dental or orthodontic treatment.

If he will make an assessment of the potential merits of including breast density in medical data collection, in the context of diagnosing breast cancer.

The UK National Screening Committee is currently reviewing the evidence surrounding breast density in screening.Improving early diagnosis of cancer, including breast cancer, is a priority for NHS England. To support early detection and diagnosis, the National Health Service carries out approximately 2.1 million breast cancer screens each year in hospitals and mobile screening vans, usually in convenient community locations.

What steps his Department is taking to improve the rate of breast cancer diagnoses for women with asymptomatic breast density.

The UK National Screening Committee is currently reviewing the evidence surrounding breast density in screening.Improving early diagnosis of cancer, including breast cancer, is a priority for NHS England. To support early detection and diagnosis, the National Health Service carries out approximately 2.1 million breast cancer screens each year in hospitals and mobile screening vans, usually in convenient community locations.

What steps his Department is taking to improve the quality of healthcare provision across the prison estate.

NHS England’s Health and Justice Oversight Delivery Group is responsible for governance and oversight of delivery and continuous improvement in health and justice commissioned services. NHS England, via the regional health and justice teams, has regular meetings with prison healthcare providers to ensure the quality of the services that are provided.  These are also supplemented with local partnership boards, where governors, commissioners, and providers meet to discuss any issues, risks, and areas of concern. NHS England also works closely with the Prisons and Probation Ombudsman to identify themes, trends, and learning from recommendations made as part of the investigations into deaths in custody, and also takes learning and insights around preventable events from preventing future deaths reports and commissioner-led complaints. NHS England is undertaking a review of health and justice service specifications to ensure they remain fit for purpose in relation to patient needs, developments in health and justice, and the wider National Health Service. This review includes engagement with lived experience, commissioners, providers, clinical leads, partner organisations, and stakeholders, along with NHS England directorates. This review of service specifications may also provide opportunities for the improvement of the provision of services. It is expected that publication of the refreshed specifications will start in 2025, and will be fully complete by the end of March 2026.

What assessment he has made with Cabinet colleagues of the adequacy of healthcare provision in HMP Wandsworth.

Healthcare services at HMP Wandsworth underwent inspection, jointly undertaken by His Majesty’s Inspectorate of Prisons and the Care Quality Commission, in May 2024. The joint inspectorate noted that improvements had been made across the provision of healthcare since the last inspection. The full report is available at the following link: https://hmiprisons.justiceinspectorates.gov.uk/hmipris_reports/hmp-wandsworth-3/ NHS England continues to monitor service provision and the quality of the healthcare service, meeting with the healthcare provider on a quarterly basis to discuss quality and assurance matters. Quality and assurance visits to the service are also taking place, attended by the Lead Commissioner and Clinical Quality Lead.

What assessment he has made of the potential merits of increasing the (a) acceptable and (b) achievable levels of S07b incident screenings for mammograms.

As part of the NHS Breast Screening Programme, S07b is the ‘screening standard’ whereby ‘incident screens’, that is any subsequent breast screen after first screen, are referred for further assessment.NHS England has advised that there is expected to be an initial light touch review of the breast screening standards by the end of March 2025, with a full review of all standards in screening year 2025/6. During the full review in 2025/26, the programme performance in ‘percentage referrals to assessment’ will be reviewed to determine whether the acceptable and achievable limits should be changed.However, increasing the thresholds for this standard, will mean that the number of women referred for follow up tests, namely biopsy, mammograms, and ultrasound, will increase, many of whom will have no cancer. Screening programmes must continue to maximise benefit while minimising harm.

What steps his Department is taking to improve the number of breast cancer diagnoses at mammogram or other early stages.

Lord Darzi’s report has set out the scale of the challenges we face in fixing the National Health Service and the need to improve cancer waiting time performance and cancer survival, including for breast cancer. In particular, he has highlighted the need to improve the number of patients starting their treatment within 62 days of referral and to increase the number of patients diagnosed at an earlier stage.The Government is committed to meeting all three NHS cancer waiting time standards across England within the next five years. Meeting these will ensure no patient waits longer than they should for diagnosis or treatment.The NHS Breast Screening Programme offers all women in England from 50 years old up to their 71st birthday the opportunity to be screened every three years for breast cancer, to help detect abnormalities and intervene early to reduce the number of lives lost to invasive breast cancer.NHS England has also developed a national plan in collaboration with key stakeholders such as cancer alliances to improve uptake within the breast screening programme. The plan sets out the priorities, interventions and monitoring of impact and outcomes to be achieved to improve uptake through: Expanding access, data and analytics, reducing inequalities, contracting, communication and IT developments.

What assessment he has made of the adequacy of the UK Health Security Agency's response to the recent fire at the recycling centre on Weir Road.

The UK Heath Security Agency (UKHSA) provided expertise in local health protection and environmental hazards to support the response to this incident.UKHSA engaged with other stakeholders, including the London Fire Brigade and the Environment Agency, as well as the Directors of Public Health for both the London Borough of Wandsworth and the London Borough of Merton. UKHSA assessed the impacts on air quality to inform health advice for residents, and remained involved with the incident until the fire was extinguished.

What steps his Department is taking to improve the supply of methylphenidate hydrochloride in pharmacies.

The Department has been working hard with industry and NHS England to help resolve supply issues with some attention deficit hyperactivity disorder (ADHD) medicines, which are affecting the United Kingdom and other countries around the world. As a result of intensive work, some issues have been resolved. All strengths of lisdexamfetamine, atomoxetine capsules, and guanfacine prolonged-release tablets are now available.We are continuing to work to resolve medicine supply issues, where they remain, for some strengths of methylphenidate. We are engaging with all suppliers of methylphenidate prolonged-release tablets to assess the challenges faced, and their actions to address them. We are also directing suppliers to secure additional stocks, expedite deliveries where possible, and review plans to further build capacity to support continued growth in demand for the short and long-term. It is anticipated the methylphenidate supply issues will be resolved by October 2024.In parallel, the Department has worked with specialist clinicians, including those within the National Health Service, to develop management advice for the NHS clinicians to consider prescribing available alternative brands of methylphenidate prolonged release tablets. We would expect ADHD service providers and specialists to follow our guidance to offer rapid response to primary care teams seeking urgent advice or opinion for the management of patients, including those known to be at a higher risk of adverse impact because of these shortages.To aid ADHD service providers and prescribers further, we have widely disseminated our communications and continually update a list of currently available and unavailable ADHD products on the Specialist Pharmacy Service website, helping ensure that those involved in the prescribing and dispensing of ADHD medications can make informed decisions with patients. Further information is available at the following link:https://www.sps.nhs.uk/articles/prescribing-available-medicines-to-treat-adhd/

When he plans to respond to the correspondence of 7 August 2024 from the hon. Member for Tooting on children's cancer services in the South East.

We replied to the hon. Member’s letter on 16 September 2024. We apologise for the delay in replying, as this was due to Conference.