Written questions by Niblett.

What steps his Department is taking to ensure the availability of (a) Levetiracetam and (b) other medications in the supply chain.

The Department is aware that some manufacturers of levetiracetam tablets are facing supply issues. However, alternative suppliers can fully support the market during this time.Medicine supply chains are complex, global, and highly regulated, and there are a number of reasons why supply can be disrupted, many of which are not specific to the United Kingdom and outside of Government control, including manufacturing difficulties, access to raw materials, sudden demand spikes or distribution issues, and regulatory issues. There are approximately 14,000 licensed medicines, and the overwhelming majority are in good supply.While we can’t always prevent supply issues from occurring, we have a range of well-established processes and tools to manage them when they arise, to mitigate risks to patients. These include close and regular engagement with suppliers, use of alternative strengths or forms of a medicine to allow patients to remain on the same product, expediting regulatory procedures, sourcing unlicensed imports from abroad, adding products to the restricted exports and hoarding list, use of Serious Shortage Protocols, and issuing National Health Service communications to provide management advice and information on issues to healthcare professionals including pharmacists, so they can advise and support their patients.

Whether his Department plans to ensure a multi-year funding agreement for social care to cover the full cost of care and enable care providers to plan long term.

From 2026/27, we want to fundamentally improve the way we fund councils and direct funding to where it is most needed through the first multi-year settlement in 10 years. This will provide greater long-term certainty for local authorities and will enable local government to focus on its priorities, delivering for residents and providing vital front-line services that people rely on every day.

What support is available to patients where tapering off of Mirtazapine has been unsuccessful and subsequently they find themselves taking a drug that they know is causing them harm.

NHS England encourages integrated care boards (ICBs) to address inappropriate antidepressant prescribing and to consider commissioning services for patients wishing to reduce or stop prescribed medicines that can cause dependence and withdrawal.In March 2023, NHS England published Optimising personalised care for adults prescribed medicines associated with dependence or withdrawal symptoms: Framework for action for ICBs and primary care. The framework includes actions, resources and case studies to help systems develop plans that can support people who are taking medicines associated with dependence and withdrawal symptoms. The framework is available at the following link:https://www.england.nhs.uk/long-read/optimising-personalised-care-for-adults-prescribed-medicines-associated-with-dependence-or-withdrawal-symptoms/ICBs are responsible for planning health services for their local population. This includes consideration of services for patients taking medicines associated with dependence and withdrawal symptoms based on local population needs.An increasing number of non-pharmacological alternatives have become available on the National Health Service, including significant investment in NHS Talking Therapies for common conditions like anxiety and depression, with 1.26 million referrals starting a course of treatment in 2023/24. There has also been considerable investment in social prescribing, which can help people with mental health problems, and there are now over 3700 full-time equivalent trained social prescribing link workers, and over 2.5 million people have been referred to a social prescribing link worker.Additionally, the National Institute for Health and Care Excellence has published guidelines, Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults, which is available at the following link:https://www.nice.org.uk/guidance/NG215The Medicines and Healthcare products Regulatory Agency is currently leading a project to improve the information supplied with dependency-forming medicines. The project aims to improve risk minimisation measures and better inform and educate healthcare professionals and patients about the risk of dependence, addiction, tolerance and withdrawal related to a wide range of medicines including antidepressants in the United Kingdom.

What plans he has to encourage Integrated Care Boards to commission Referral Management Systems to reduce the significant time taken by primary care in chasing secondary care referrals and appointments.

The Government is committed to cutting waiting times for secondary care appointments, which in turn should minimise the time that general practitioners spend chasing referrals. As a first step, we have seen the waiting list reduce by over 190,000 and have provided 2.5 million extra appointments since July 2024. The Government is also committed to optimising referrals through more effective models of triage which allow patients with the most urgent health needs to be prioritised and can be used to redirect referrals to an alternative service better suited to the patient’s needs (including in primary or community services where that is best for the patient). Referral management systems are one model of triage. The Elective Reform Plan (ERP), published in January 2025, commits to developing an implementation toolkit for triage services, by March 2026, and to working with integrated care boards to put in place clinical triage standard operating procedures for high-volume specialties. The NHS Electronic Referral System (e-RS) is a national digital platform for referring patients from primary care into elective secondary care service. The ERP commits to improving e-RS throughout 2025/26 and beyond, to enhance information sharing between primary and secondary care and will help referrers in general practice know sooner what care their patient will receive and where, including whether their referral has been accepted in hospital.

What progress his Department has made on the The Getting It Right First Time programme.

The Getting It Right First Time (GIRFT) programme is a national NHS England programme designed to improve treatment and care by reviewing health services in England.The GIRFT team is working with systems and regions to help the National Health Service embed best practice in elective care, to reduce waiting times, improve patient outcomes and, ultimately, to support delivery of the commitment to return to the NHS constitutional standard that 92% of all patients will wait no longer than 18 weeks from referral-to-treatment, by March 2029.Surgical hubs are part of the GIRFT High Volume Low Complexity programme and mainly focus on driving improvement in six high volume specialties. With GIRFT support, there are currently 114 elective surgical hubs that are operational across England as of March 2025. These surgical hubs help separate elective care facilities from urgent and emergency care, improving outcomes for patients and reducing pressures on hospitals. GIRFT’s role also includes delivering an accreditation scheme for surgical hubs. To date, 44 surgical hubs have been accredited for clinical and operational excellence.Within the Elective Reform Plan, the Government has committed to providing quicker access for patients to common surgical hub procedures by opening 17 new and expanded surgical hubs by June 2025 and ramping up the number of hubs over the next three years, so more operations can be carried out. Through the GIRFT Further Faster programme, a cohort of 20 trusts, and their integrated care systems (ICS), chosen in areas of the greatest economic inactivity, are being given support to improve and streamline pathways for patients and spread good practice in areas with high levels of economic inactivity. All 20 trusts are working to deliver ‘High Flow Theatre’ lists and super clinics, not only to deliver rapid impact, but also to build into ‘business as usual’ pathways.

Whether his Department has issued guidance on the adequate travel distance for accessing out of hours pharmacy provision.

Local authorities are required to undertake a pharmaceutical needs assessment every three years, to assess whether their population is adequately served, and keep these assessments under review. These assessments inform integrated care boards (ICBs) when reviewing applications from prospective National Health Service pharmacy contactors. In addition, ICBs have powers to direct and fund pharmacies to open for longer than their core contractual hours if there is an unmet need. Patients can also choose to access medicines and pharmacy services through any of the over 400 NHS online pharmacies that are contractually required to deliver prescription medicines free of charge to patients.

Whether the 2025/26 NHS Payment Scheme Consultation removes the right to choose for families with ADHD.

The proposed 2025/26 NHS Payment Scheme does not remove a patient’s right to choose. The Government is committed to patients having the right to choose their provider when referred to consultant-led treatment, or to a mental health professional, for their first appointment as an outpatient.

With reference to his Department's press release GP reforms to cut red tape and bring back family doctor, published on 20 December 2024, whether GPs will be able to determine how to spend the additional funding to best meet local needs.

On 20 December 2024, we announced a proposed £889 million uplift for general practice (GP) in 2025/26 and set out the proposed areas of reform which will help us to deliver on our commitments. This is the largest uplift to GP funding in years and means we are reversing the recent trend with a rising share of total National Health Service resources going to GPs.Details on how funding will be allocated is subject to the ongoing GP Contract consultation with the General Practitioners Committee England, and will be announced ahead of April.

Pursuant to the Answer of 3 February 2025 to Question 27349 on Vaccination, what steps his Department is taking to ensure contemporaneous vaccine delivery across all regions.

NHS England is responsible for the operational delivery of the vaccination programmes, including the respiratory syncytial virus programme, in line with recommendations from the Joint Committee on Vaccination and Immunisation (JCVI), and considering local population needs.General practices (GPs) are commissioned as a component of essential services, with practices required to offer and provide vaccinations to eligible patients, including their registered patients residing in care homes. NHS England’s regional teams monitor operational data to ensure that all providers are vaccinating those eligible.Routine and seasonal vaccination programmes are commissioned in a nationally consistent way across all regions through inclusion in the GP Contract, GP and community pharmacy advanced and enhanced services, and National Health Service standard contracts. Regional commissioners are also able to stand up vaccination programmes in response to local pressures and outbreaks to supplement this core offer.

What assessment his Department has made of the adequacy of waiting times for mental health services in South Derbyshire constituency; and what steps he is taking to reduce those times.

Waiting times for those referred to mental health services are too high all across England, including in the South Derbyshire constituency.Too many people with mental health issues are not getting the support or care they need, which is why we will fix the broken system to ensure we give mental health the same attention and focus as physical health and that people can be confident in accessing high quality mental health support when they need it.Nationally, we plan to recruit an additional 8,500 mental health workers across child and adult mental health services in England to reduce delays and provide faster treatment. We will also introduce access to a specialist mental health professional in every school and roll out Young Futures hubs in every community.In addition, people of all ages who are in crisis or who are concerned about a family or loved one can now call NHS 111, select the mental health option, and speak to a trained mental health professional. National Health Service staff can guide callers with next steps such as organising face-to-face community support or facilitating access to alternative services, like crisis cafés or safe havens, which provide a place for people to stay as an alternative to accident and emergency or a hospital admission.It is the responsibility of the integrated care boards to commission care to meet the needs of their local population.

What steps his Department is taking to (a) modernise NHS IT infrastructure and (b) ensure value for money in upgrading IT systems.

Through the Frontline Digitisation programme, we will work to level up National Health Service trusts to a baseline level of digital capability. Our investment in digitising the frontline will ensure value for money and that health and care staff have access to health-related information when and where it is needed, supporting them to deliver care efficiently, effectively, and safely, thereby reducing variation and improving outcomes. Currently 91%, or 187 out of 206, of Secondary Care Trusts have an Electronic Patient Record (EPR) in place, with work underway to provide tailored support to the remaining 19 trusts that do not yet have an EPR. Our ambition is for all trusts to meet our stated core digitisation standards, including having EPRs in place by March 2026. The programme is forecasting to achieve 96% EPR coverage by its end in March 2026, with the remaining 4% of trusts having advanced in their plans for an EPR.

What additional (a) funding and (b) other resources his Department plans to provide to primary care providers to support preventative healthcare in South Derbyshire constituency.

The 10-Year Health Plan will describe a shared vision for the health and care system in 2035, drawing directly from the extensive engagement underway with the public, patients, and staff. It will set out how the National Health Service will deliver the shift from sickness to prevention, which will be one of the central tenets of the plan. This includes a working group focused on the preventative healthcare model for the future.We have announced a proposed £889 million uplift for general practices (GPs) in 2025/26 and set out the proposed areas of reform which will help us to deliver on our commitments. This is the largest uplift to GP funding since the beginning of the five-year framework and means that we are reversing the recent trend, with a rising share of total NHS resources going to GPs.To shift care from sickness to prevention, the Government has also proposed providing financial incentives to reward GPs who go above and beyond to prevent the most common killers, like heart disease, for the next contract year. This is subject to the contract consultation currently underway with the General Practitioners Committee England.We have already started hiring an extra 1,000 GPs into the NHS and uplifted a monthly payment to practices by 7.4%. We will also be resuming our consultation with Community Pharmacy England regarding funding arrangements.The most common reason children aged five to nine are admitted to hospital is for tooth decay. We will work with local authorities and the NHS to introduce supervised tooth brushing for children aged between three and five years old in the most deprived communities. These programmes are proven to reduce tooth decay and to boost good practices at home.Integrated care boards have delegated responsibility for planning and commissioning healthcare services to meet the reasonable needs of the people for whom they are responsible. In South Derbyshire, our Regional Director of Public Health is working with local government and the Joined Up Care Derbyshire Integrated Care System to support the shift to prevention.

What steps his Department is taking to shift towards a preventative healthcare model in South Derbyshire constituency; and if he will make an assessment of the potential impact of the preventative healthcare model on primary care providers nearby.

The Health Mission sets out our plan to shift the National Health Service away from a model geared towards late diagnosis and treatment, to one where the NHS focuses on prevention, and where more services are delivered in local communities. Our core objective is to shorten the amount of time spent in ill-health and prevent premature deaths, which will in turn reduce pressure on the NHS, boost the economy, and prevent the vicious cycle of ill health and poverty.We are taking action across the Government to tackle the biggest drivers of ill health, including legislation to make this country smoke-free and to protect future generations from the harms of addiction, as well as working closely with local government to address the underlying social determinants of health.Within the health and care system, the 10-Year Health Plan will describe a shared vision for the health and care system in 2035, drawing directly from the extensive engagement underway with the public, patients, and staff. It will set out how the NHS will deliver the shift from sickness to prevention, which will be one of the central tenets of the plan. This includes a working group focused on the preventative healthcare model for the future.To support the shift to prevention within primary care, we have proposed providing financial incentives to reward general practitioners who go above and beyond to prevent the most common killers, like heart disease, for the next contract year. This is subject to the contract consultation currently underway with the General Practitioners Committee England. NHS England has published NHS Planning Guidance for 2025/26, setting out the first steps for reform and the immediate actions we are asking systems to take to deliver, including on the shift from sickness to prevention. In South Derbyshire our Regional Director of Public Health is working with local government and the Joined Up Care Derbyshire Integrated Care Board (ICB) to support the shift to prevention. The Joined Up Care Derbyshire ICB is responsible for considering the impact of its preventative healthcare model on local primary care providers.

What steps he is taking to coordinate the roll out of (a) the Respiratory Syncytial Virus vaccine and (b) other vaccines across all English regions to maximise effectiveness.

Respiratory syncytial virus (RSV) vaccination programmes for pregnant women, to protect newborns, and adults aged 75 to 79 years old began in England on 1 September 2024. The programmes are being delivered by general practices and commissioned maternity services, as well as a small number of community pharmacies in the East of England. General practices are responsible for proactively inviting aged-based eligible patients for vaccination, and for providing the vaccine to eligible patients from 28 weeks of pregnancy, either opportunistically or on request. RSV vaccinations are offered to eligible individuals year-round, rather than seasonally, though vaccination should be undertaken at the earliest opportunity to maximise protection against RSV.NHS England continues to focus on maximising vaccine uptake across both seasonal and routine vaccination programmes, including by improving access to vaccinations through outreach services, improving the National Booking Service, and working across the system to ensure coadministration of vaccines wherever possible and advisable. This approach supports the healthcare system to take every opportunity to vaccinate those who are eligible and to maximise the uptake of all vaccines.For older adults, whilst the RSV vaccine is not routinely given at the same appointment or on the same day as seasonal flu or COVID-19 vaccines, if the individual is unlikely to return for a second appointment or immediate protection is necessary then the RSV vaccine can be administered at the same time as the COVID-19 and/or flu vaccine. Older adults can get the RSV vaccine at the same time as the shingles and pneumococcal vaccines where eligible.The RSV and pertussis vaccines are not routinely scheduled at the same time during pregnancy. However, if a pertussis-containing vaccine has not been given to pregnant women by the time of attendance for an RSV vaccine, both vaccines can and should be given at the same appointment to ensure prompt development of immune response. The seasonal flu and COVID-19 vaccines can be given at any time in pregnancy when the campaigns are running, and at the same time as the pertussis and RSV vaccines.Healthcare professionals should take the opportunity to check immunisation status and offer or signpost vaccination where possible. Maternity services commissioned to deliver the maternal RSV programme are also encouraged to have vaccination discussions with pregnant women early in pregnancy.

What assessment his Department has made of the effectiveness of (a) public health and (b) adult social care services in reducing the demand on (i) primary and (ii) acute services in South Derbyshire constituency.

The NHS Derby and Derbyshire Integrated Care Board (ICB) is responsible for meeting the healthcare needs and demands of South Derbyshire's population.There is evidence that public health and adult social care interventions of different kinds can be effective, and cost-effective, in preventing or delaying the onset of ill health, which in turn supports better use of health and care resources. A shift from treatment to prevention and from acute hospital services to community services are part of the three strategic shifts underpinning our 10-Year Health Plan.We also recognise the need to alleviate pressures through increasing supply and reducing demand.We will make sure the future of general practice (GP) is sustainable by training thousands more GPs, guaranteeing a face-to-face appointment for all those who want one, and delivering a modern booking system.The Government will publish a plan setting out how urgent and emergency care services across England will be supported to deliver improvements.

Pursuant to the Answer of 17 January 2025 to Question 23992 on Primary Health Care: Standards, what steps his Department is taking to help support (a) elderly and (b) digitally-challenged people to use technology to access healthcare.

Digital health tools should be part of a wider offering that includes face-to-face support, with appropriate help for people who struggle to access digital services. NHS England has successfully run a number of programmes to support patients, carers, and health service staff with their digital skills. These include: - the NHS App Spoken Word Pilot project, designed to test the efficacy of promoting National Health Service digital health products and services in languages other than English;- the Digital Health Champions programme, a proof of concept to support citizens who have no or low digital skills with understanding how to access health services online; and- the Widening Digital Participation programme, aimed to ensure that more people have the digital skills, motivation, and means to access health information and services online. NHS England has also published a framework for NHS action on digital inclusion and is developing further resources to support practical actions. All digital programmes are actively considering how they can contribute to improvements in healthcare inequalities and digital inclusion.

What steps he is taking to support people with long term physical disabilities to access secondary care including (a) hydrotherapy, (b) physiotherapy and (c) acupuncture without re-referrals.

The Government is committed to championing the rights of disabled people. Under the Equality Act (2010), health and social care organisations must make reasonable adjustments to ensure that disabled people are not disadvantaged. NHS England has developed a Reasonable Adjustment Digital Flag, which enables the recording of key information about a patient and their reasonable adjustment needs in their patient record, to ensure support can be tailored appropriately. Health and social care staff can also access free training to implement the Reasonable Adjustment Digital Flag, helping it to become part of a standard approach to care and treatment for all disabled people.Across England, community health services, including therapies, are locally commissioned to enable systems to best meet the needs of their communities. We are working closely with NHS England to improve access to community health services and on actions to reduce long waits.We have launched a 10-Year Health Plan to reform the National Health Service. The plan will set out a bold agenda to deliver on the three big shifts needed, to move healthcare from hospital to the community, analogue to digital, and sickness to prevention. We will ensure the NHS has the right people, in the right places, with the right skills to deliver the care patients need when they need it.The engagement process for the 10-Year Health Plan has been launched, and as we work to develop and finalise the plan, we are encouraging those concerned about care for people with long term physical disabilities to engage with that process so we can identify what the potential solutions are. Further information is available at the following link:https://change.nhs.uk/en-GB/

What plans he has to support primary care to reduce the time it takes to receive (a) results and (b) appointments from secondary care services.

The Elective Reform Plan, launched as part of the Government’s Plan for Change, sets out plans to improve patients’ experience, so that it is as smooth, supportive, and convenient as possible. This includes giving them more control and flexibility, and designing care around their needs.Effective integration of primary and secondary care will be essential to helping ensure results and appointments are communicated quickly to both general practitioners and patients. We have set out improvements to digital tools, including a revolutionised NHS App, to help patients to contact their treatment provider more easily and conveniently, to receive clear information, regular updates, and test results.By March 2025, patients at over 85% of acute trusts will be able to view appointment information via the NHS App. By December 2025, we will build on the success of digitising appointment letters by making more types of content about patients’ treatment available on the NHS App, such as discharge letters and results.

What steps he plans to take to reduce waiting times for Tier 3 weight management services in Derbyshire.

Local authorities and the National Health Service provide weight management services to support their communities to achieve and maintain a healthier weight. These range from behavioural weight management programmes to specialist services for those living with obesity and the associated co-morbidities.Integrated care boards (ICBs) are responsible for commissioning NHS specialist weight management services and should consider local population need and the relevant guidance when commissioning these services.The NHS Derby and Derbyshire ICB commissions the Derbyshire Community Health Services NHS Foundation Trust to deliver a Tier 3 specialist weight management service. Patients are offered weight management, lifestyle, and behaviour change advice on a one-to-one and group basis for up to 12 months.The ICB is aware that there is currently limited prescribing capacity within the service, and there is work underway to re-design the weight management service pathway within Derbyshire.

If he plans to extend the assurances provided on funding for the increase in employer National Insurance costs to NHS Trusts to general practice.

We have made necessary decisions to fix the foundations of the public finances in the Autumn Budget. Resource spending for the Department will be £22.6 billion more in 2025/26 than in 2023/24, as part of the Spending Review settlement. The employers’ National Insurance contribution (NIC) rise will be implemented in April 2025.The definition of who is in scope is based on the Office for National Statistics classification of the entity paying employer NICs. This applies to employees who are directly employed by the public sector, but not, for example, where services are contracted out. Any other approach would result in differential treatment between private sector employers. General practices (GPs) are independent contractors and do not fall within this remit. This is consistent with the approach taken by previous Governments.We recently announced a proposed funding uplift to the GP contract for 2025/26 of £889 million, representing a 7.2% cash growth, estimated at approximately 4.8% real terms growth. This is the largest uplift to GP funding since the beginning of the five-year framework and means we are reversing the recent trend with a rising share of total National Health Service resources going to GPs. We are currently consulting the profession on the annual GP contract.