Written questions by Anderson.

What steps he is taking to increase the long-term sustainability of the hospice sector.

Palliative care services are included in the list of services an Integrated Care Board (ICB) must commission. This promotes a more consistent national approach and supports commissioners in prioritising palliative and end of life care. To support ICBs in this duty, NHS England has published statutory guidance and service specifications.Whilst the majority of palliative and end of life care is provided by National Health Service staff and services, we recognise the vital part that voluntary sector organisations, including hospices, also play in providing support to people at the end of life and their loved ones.In recognition of this, we are supporting the hospice sector with a £100 million capital funding boost for adult and children’s hospices in England for 2024/25 and 2025/26, to ensure they have the best physical environment for care.Additionally, children and young people’s hospices will receive £26 million in revenue funding for 2025/26. This is a continuation of the funding which until recently was known as the Children and Young People’s Hospice Grant.  As part of the work to develop the 10-Year Health Plan, we will be carefully considering policies, including those that impact people with palliative and end of life care needs, with input from the public, patients, health staff, and our partners, including those in the hospice sector.In February, I met with key palliative and end of life care and hospice stakeholders, in a roundtable format, with a focus on long-term sector sustainability within the context of our 10-Year Health Plan.

What assessment he has made of the adequacy of the capacity of the National Health Service in helping local authorities to improve the social care sector.

The National Health Service plays an important role by working collaboratively with local authorities to deliver social care.Integrated care partnerships bring integrated care boards and partner local authorities together, alongside wider system partners, to agree priorities and take collaborative action to address cross-system challenges, improve outcomes, and reduce inequalities.The Better Care Fund (BCF) is a framework for integrated care boards and local authorities to make joint plans and pool budgets for the purposes of delivering better joined-up care. The NHS makes a minimum contribution of approximately £5.6 billion to the BCF, which includes funding for social care. This supports local authorities to provide timely and joined-up support for people with more complex health and care needs.

What assessment he has made of the adequacy of the numbers of GPs in South Shropshire.

In January 2025, there were 57.8 full time equivalent doctors in general practice (GP) working in the South Shropshire constituency.The Government is recruiting over 1,000 recently qualified GPs through an £82 million boost to the Additional Roles Reimbursement Scheme (ARRS) over 2024/25, as part of an initiative to address GP unemployment and secure the future pipeline of GPs. Newly qualified GPs employed under the ARRS will continue to receive support under the scheme in the coming year as part of the 2025/26 contract.We have committed to training thousands more GPs across the country which will increase capacity and take the pressure off those currently working in the system.

What steps he is taking to ensure that medical students remain in the (a) UK and (b) medical profession after graduation.

We are committed to listening to the concerns of resident doctors, and to enhancing and improving their working lives.We are undertaking a range of work to tackle the issues that resident doctors are facing, including improving working conditions and reforming the current system of rotations and placements, working in partnership with the British Medical Association and other partners, as agreed as part of the pay deal last year.NHS England’s Enhancing Resident Doctors Working Lives programme continues to implement a number of measures to support resident doctors, encouraging them to stay in training and the National Health Service. This includes measures such as less than full time training options, to allow trainees to continue to work in the service and progress with their training on a reduced working pattern, where this benefits their personal circumstances.

What assessment she has made of the adequacy of training pathways to GP registration in (a) rural areas and (b) general.

The Targeted Enhanced Recruitment Scheme was an initiative that formerly offered a one-off payment of £20,000 to General Practice Specialty Trainees committed to working in a select number of training locations in England that either had a history of under-recruitment or were in under-doctored or deprived areas. It is, however, no longer needed as currently all general practice training places are oversubscribed and, therefore, filled. We will keep the distribution of the workforce, particularly in rural areas, under review.On 18 February 2025, the Chief Medical Officer and the National Medical Director of NHS England jointly launched a review of postgraduate medical training. The review will cover placement options, the flexibility of training, difficulties with rotas, control and autonomy in training, and the balance between developing specialist knowledge and gaining a broad range of skills. The review will be based on feedback from current resident doctors and students, and locally employed doctors and medical educators, with a series of engagement events around the country starting from this March.

What steps he is taking to improve mental health support for residents in rural areas.

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 of accessing high quality mental health support when they need it.Nationally, we plan to recruit an additional 8,500 mental health workers across children 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 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 integrated care boards (ICB) to commission care to meet the needs of their local population.

What steps she is taking to support unpaid carers in rural areas.

Local authorities are best placed to understand and plan for the needs of their population, which is why, under the Care Act 2014, they are tasked with the duty to shape their care market to meet the diverse needs of all local people.The Government is committed to giving families the support that they need. I recently met with the Parliamentary Under-Secretary of State for Employment Rights, Competition and Markets in the Department for Business and Trade, and the Minister of State for Social Security and Disability in the Department for Work and Pensions to look at how we can work together more closely to support unpaid carers.The Government has already taken steps to support unpaid carers. From April 2025 we are increasing the Carer's Allowance weekly earnings limit from £151 a week to £196. This means carers can earn up to £10,000 a year whilst still retaining Carer's Allowance; this is approximately an additional £2,000 a year.The Accelerating Reform Fund’s (ARF) second tranche of funding worth £22.6 million for 2024/25 has also been released. More than half of the ARF projects, and at least one in each integrated care system area are focussed on identifying, recognising and supporting unpaid carers.The Government recognises the challenges facing the adult social care system. That is why we are launching an independent commission into adult social care as part of our critical first steps towards delivering a National Care Service.The Commission will start a national conversation about what working age adults, older people, and their families expect from adult social care, including exploring the needs of unpaid carers who provide vital care and support.

How many local authorities reported an (a) underspend and (b) overspend on public health grants in the last five financial years.

Local authorities must account for the full allocated Public Health Grant and must accrue any money that is not committed to a ring-fenced reserve. These reserves serve an important purpose, for example to support strategic changes which may involve a one-off change in spending patterns, or as provision against future spending plans. The following table shows the movement of public health reserve levels as reported by each local authority from 2019/20 to 2023/24: Movement of reserve levels2019/202020/212021/222022/232023/24Decreased reserves7311215883Increased reserves501101016945Source: local authority revenue outturn data, available at the following link: https://www.gov.uk/government/collections/local-authority-revenue-expenditure-and-financingNotes:the data for 2020/21 and 2021/22 includes the impact of the Contain Outbreak Management Fund on Grants and the impact of COVID-19 on services, the information published for 2023/24 does not include any reserve outturn data for two local authorities, Birmingham and Westmorland and Furness, and the data for Barking and Dagenham was only partially completed.the reserve outturn data refers to the whole of the Department’s local authority Public Health Spend, not just the Public Health Grant.the total number of local authorities may vary across years due to local government structural changes.Local authorities do not report underspends on the Public Health Grant.

What steps he is taking to support local authorities with the impact of changes to employer National Insurance contributions on public health contracts.

In determining Public Health Grant allocations for 2025/26, we considered a range of cost pressures affecting local authority commissioned or provided health services, including increased operational costs. 2025/26 Public Health Grant allocations have been increased by an average of 5.4% relative to 2024/25.

What assessment he has made of the potential merits of providing local authorities longer-term public health funding.

Following the upcoming Spending Review, we will aim to issue multi-year public health grant allocations to local authorities from 2026/27. We recognise that multi-year funding settlements for councils provide several benefits, enabling them to focus on delivering outcomes in a stable environment rather than managing budget uncertainties. In addition, 93% of respondents in a Society of Local Authority Chief Executives and Senior Managers (Solace) survey stated that they believe multi-year settlements would support economic prosperity.

What steps his Department is taking to innovate the delivery of public health services in rural areas.

Upper tier local authorities have a statutory duty to take steps to improve the health of local people. Under this duty, local authorities commission a range of public health services and are responsible for determining the most effective approaches to the delivery of these services taking account of different local needs, including the needs of rural areas.In 2025/26, we will provide funding of £3.858 billion to local authorities for their public health duty, through the Public Health Grant and the 100% retained business rate arrangement for local authorities in Greater Manchester. This is a cash increase of £198 million, an average 5.4% cash increase and 3.0% real-terms increase compared to 2024/25.NHS England is responsible for commissioning further specified public health services, including national immunisation and screening programmes, under a statutory delegation from the Secretary of State for Health and Social Care and informed by the recommendations of the UK National Screening Committee and the Joint Committee on Vaccination and Immunisation. Working with NHS Integrated Care Boards, commissioning of these services should also take account of local needs, including the different urban and rural characteristics of communities.

What assessment he has made of the adequacy of Public Health Grants in rural areas.

In line with the Government’s Health Mission, our goal is to create a more equitable healthcare system that leaves no person or community behind.The government recognises the health inequalities faced by rural communities in England, particularly around access to healthcare services.In response, we are working closely across the department, with NHS England (NHSE), and regional Directors of Public Health (DPHs) to develop approaches that address these inequalities. The Department supports statutory Integrated Care Systems (ICSs) in delivering National Health Services across England. ICSs are partnerships of organisations which come together to plan and deliver joined up health and care services, this includes considering adequate healthcare provision for populations in rural and remote areas.The local authority Public Health Grant, including funding for the ten Greater Manchester authorities through a business rate retention arrangement is £3.858 billion in 2025/26. This is an increase of 5.4% in cash terms, 3% in real terms, compared to 2024/25. On average, funding for the most deprived local authorities is more than two times greater than that for the least deprived.

What steps he is taking to ensure the long-term sustainability of air ambulance charities.

The Government supports the longstanding independent air ambulance charities model for the successful operation of helicopter emergency medical services in England, including through the training and provision of National Health Service clinicians.

What steps he is taking to help to improve training in the use of automated external defibrillators in rural areas.

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 September 2023, the Government approved a further £500,000 in August 2024 to fulfil existing applications to the fund.The Department selected a joint bid from Smarter Society as its independent partners to manage grant applications. Smarter Society has reviewed funding applications, against requirements specified by the Department. These requirements were to ensure that resources are allocated where there is the greatest need, for instance remote communities with extended ambulance response times, places with high footfall and high population densities, hotspots for cardiac arrest, including sporting venues and venues with vulnerable people, and deprived areas.As part of the Department’s requirements, the defibrillators are suitable for use by untrained persons. The Mindray C1A Defibrillator, a fully automated device suitable for use by untrained persons, are the AEDs provided by Smarter Society in partnership with London Hearts charity.The Department has continued its partnership with Smarter Society, who managed the grant applications on our behalf, with London Hearts supplying the AEDs. London Hearts is the leading heart defibrillator charity in the United Kingdom, supporting communities with the provision of life saving heart defibrillators and teaching cardiopulmonary resuscitation and defibrillator skills.NHS England has partnered with St John Ambulance to co-ordinate skills development to significantly increase the use of AEDs by individuals in community settings. This includes a national network of Community Advocates to champion the importance of first aid, training 60,000 people that will help save up to 4,000 lives each year by 2028.

What steps he is taking to improve (a) physical, (b) emotional and (c) financial support for people diagnosed with (i) Pulmonary Fibrosis and (ii) Interstitial Lung Disease.

NHS England is responsible for the commissioning of interstitial lung disease (ILD) services, and funds the anti-fibrotic treatments that are part of the treatment pathway for ILD. The national service specification describes the standards required of clinical teams to support patients physically and emotionally with the diagnosis and management of ILD. Further information on the national service specification is available at the following link:https://www.england.nhs.uk/publication/interstitial-lung-disease-adults-service-specification/NHS England is also supporting systems to improve outcomes for people with a range of respiratory conditions, for example through enabling access to pulmonary rehabilitation through the publication of commissioning standards together with the provision of funding. NHS England has also extended the scope of the National Respiratory Audit Programme’s pulmonary rehabilitation audit so that all patients who participate in pulmonary rehabilitation are captured in the audit, irrespective of their condition. Along with providing a more complete picture of participation, the decision to extend was made to recognise and reinforce the value of pulmonary rehabilitation to all who are eligible with chronic respiratory conditions other than chronic obstructive pulmonary disease, including ILD.The energy costs associated with using oxygen concentrators at home are reimbursed, however no decision has been made to extend this to other medical devices such as complex home ventilation, syringe drivers, electric wheelchairs, or other disability aids.

What steps he is taking to ensure that veterans in rural areas have access to mental health support services.

NHS England commissions Op COURAGE, the integrated mental health and wellbeing service for veterans. Veterans can self-refer to Op COURAGE. The service has been designed to support veterans from all areas, including rural areas, and is delivered from a range of locations, including National Health Service trusts, general practices, Poppy Shops, veteran hubs, and drop-in centres. Elements of the service may also be provided online if this is clinically appropriate.As set out in the NHS Priorities and Operational Planning Guidance for 2024/25, NHS England is continuing to expand access to mental health services to increase the number of people accessing mental health support. Integrated care boards are responsible for providing health and care services to meet the needs of their local populations, taking into account local considerations such as access to services in rural areas. The Government recognises that too many people are not receiving the mental health care they need, and that waits for mental health services are too long. The Government is determined to change that, and ensure that mental health has the same focus as physical health, to help people in rural areas to access high quality mental health support when they need it.In addition, people of all ages who are in crisis or who are concerned about a family or loved one can now call 111, select the mental health option, and speak to a trained mental health professional. NHS 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.

What steps he is taking to increase the number of community diagnostic hubs in rural areas.

We have committed to getting back to the 18-week standard by the end of this Parliament, addressing the unacceptably long waits experienced by too many people. The Department is working with NHS England on a reform plan for elective care, which will be published in the coming weeks, and will set out more detail on the plans for more timely, accessible, and accurate diagnostic testing.Approximately £1.5 billion of additional capital funding has been allocated in the Budget for 2025/26 to support National Health Service performance across secondary and emergency care. This investment includes the purchasing of new diagnostic scanners, which will reduce waiting times and increase diagnostic capacity outside of hospitals, in communities and primary care, including in Community Diagnostic Centres (CDC). Details of how this investment will be spent are currently being developed with NHS England.All existing CDC locations have been chosen based on robust guidance to ensure that they meet certain specifications in order to reduce health inequalities, and integrated care boards were responsible for making recommendations on where there was the greatest need across their areas, including in rural areas. This includes ensuring that they have good transport links to improve access to diagnostic tests for the communities where the need is greatest.

What steps his Department is taking to improve mental health facilities in rural areas.

Integrated care boards are responsible for providing health and care services to meet the needs of their local populations. We plan to recruit an additional 8,500 mental health workers across children and adult mental health services in England to reduce delays and provide faster treatment.The Suicide Prevention Strategy for England 2023-2028, published September 2023, sets out an ambition to conduct and commission research and data linkage projects, including supporting the Department for Environment, Food and Rural Affairs to look at agricultural workers to understand the unique challenges in that occupational group and respond appropriately.In addition, people of all ages who are in crisis or who are concerned about a family or loved one can now call 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.

What steps his Department is taking to improve local healthcare provision in rural communities.

Rural populations increasingly include people who are most likely to need care. South Shropshire is facing particular challenges. The waiting list for Shropshire, Telford and Wrekin ICB has increased by 12,000 compared to 2023. This is why we must continue to focus on patient access, including in rural areas, as part of plans to build an NHS fit for the future.

What steps he is taking to increase the availability of automated external defibrillators in rural areas.

The treatment and prevention of cardiovascular disease is a priority for the Government. We want people to have the best chance of survival from cardiac arrest, and rapid intervention is central to improving outcomes. This is why the Government increased the number of publicly accessible automated external defibrillators (AEDs).The Government is committed to improving access to AEDs in public spaces, and reducing inequalities in access to these life saving devices. We made a further £500,000 available from August 2024 to fulfil existing applications to the Department’s Community AED Fund. The criteria specified for the original grant continues to apply and will go to applications for AEDs in areas where there is the greatest need, including in areas of high footfall, hot spots for cardiac arrest, and areas that already have low access to AEDs, which could include rural areas.