Written questions by Andrew.

What assessment his Department has made of trends in the level of diagnostic overshadowing for people with Down syndrome; and whether that issue will be included in the final statutory guidance under the Down Syndrome Act 2022.

In 2023, NHS England produced a guide for frontline staff to support people with learning disabilities which asks staff to be aware of diagnostic overshadowing. NHS England does not hold data on the extent of diagnostic overshadowing for people with Down syndrome, nor is the data held centrally. This guide is available at the following link:https://www.england.nhs.uk/long-read/clinical-guide-for-front-line-staff-to-support-the-management-of-patients-with-a-learning-disability-and-autistic-people-relevant-to-all-clinical-specialties/Through the implementation of the Down Syndrome Act 2022, the Government is striving to improve life outcomes for people with Down syndrome, raise awareness and understanding of their needs, and break down barriers to opportunity that they, and other disabled people, face.Under the Down Syndrome Act, the Secretary of State for Health and Social Care is required to give guidance to relevant authorities in health, social care, education and housing services on what they should be doing to support the needs of people with Down syndrome. The draft guidance, which was published for public consultation on 5 November 2025, acknowledges that many people with Down syndrome may experience diagnostic overshadowing and recognises its impact on the care and treatment that people receive.The Department welcomes specific suggestions of other topics for inclusion or additional detail on those already covered through the consultation. Once the consultation has closed, the Government will consider all consultation responses to inform the final guidance to be published.

What steps his Department has taken to ensure that references to learning disability and support needs in the draft statutory guidance under the Down Syndrome Act 2022 reflect the needs profile of people with Down syndrome.

Under the Down Syndrome Act, my Rt Hon. Friend, the Secretary of State for Health and Social Care, is required to give statutory guidance to relevant authorities in health, social care, education, and housing services on what they should be doing to meet the needs of people with Down syndrome. The consultation on the draft guidance was launched on 5 November 2025 and will remain open until 30 March 2026.The draft guidance has been informed by over 1,500 responses to the call for evidence in 2022. A summary of these findings was published on 5 November 2025. In developing the draft guidance, the Department for Health and Social Care engaged with NHS England and all relevant Government departments, including the Department for Education. Officials also engaged with people with Down syndrome and those with other conditions and/or a learning disability who have similar needs, and their parents and carers, as well as experts and practitioners from multiple sectors, to ensure the guidance is robust, evidence-based and fit for purpose.Based on what we were told during the call for evidence and subsequent engagement, a needs profile paper has also been developed which sets out the specific needs of people with Down syndrome. The needs paper, which has been published alongside the consultation, was used to inform the development of the draft guidance.

Whether Integrated Care Boards will be required to designate a named lead for the implementation of statutory guidance issued under the Down Syndrome Act 2022.

Under the Down Syndrome Act 2022, my Rt Hon. Friend, the Secretary of State for Health and Social Care, is required to give guidance to relevant authorities in health, social care, education, and housing services on what they should be doing to meet the needs of people with Down syndrome. Relevant authorities, as defined in the schedule to the act, have a duty to have due regard to the final guidance once it is published. The act does not create any new functions beyond this duty. Rather, it brings together existing statutory requirements and guidance that relevant authorities must and/or should already be complying with to support people with Down syndrome and people with other conditions and/or a learning disability who have similar needs.NHS England published statutory guidance on 9 May 2023 which says that every integrated care board (ICB) should identify a member of its board to lead on supporting the ICB to perform its functions effectively in the interest of people with Down syndrome. The statutory guidance sets out NHS England’s expectations about fulfilling executive lead functions and outlines the responsibilities of these roles in more detail, and is available at the following link: https://www.england.nhs.uk/publication/executive-lead-roles-within-integrated-care-boards/

What mechanisms will be used to monitor compliance by public bodies with statutory guidance issued under the Down Syndrome Act 2022.

Under the Down Syndrome Act 2022, my Rt Hon. Friend, the Secretary of State for Health and Social Care, is required to give guidance to relevant authorities in health, social care, education, and housing services on what they should be doing to meet the needs of people with Down syndrome. Relevant authorities, as defined in the schedule to the act, have a duty to have due regard to the final guidance once it is published. The act does not create any new functions beyond this duty. Rather, it brings together existing statutory requirements and guidance that relevant authorities must and/or should already be complying with to support people with Down syndrome and people with other conditions and/or a learning disability who have similar needs.NHS England published statutory guidance on 9 May 2023 which says that every integrated care board (ICB) should identify a member of its board to lead on supporting the ICB to perform its functions effectively in the interest of people with Down syndrome. The statutory guidance sets out NHS England’s expectations about fulfilling executive lead functions and outlines the responsibilities of these roles in more detail, and is available at the following link: https://www.england.nhs.uk/publication/executive-lead-roles-within-integrated-care-boards/

What assessment his Department has made of the role of community-based diagnostic services and AI-supported electrocardiogram interpretation in the early detection of inherited cardiac conditions in young people.

A number of diagnostics are used to detect inherited cardiac conditions in young people at an early stage, including electrocardiograms (ECGs) and imaging. National Health Service artificial intelligence-supported ECG interpretation helps detect inherited cardiac conditions in young people by identifying subtle, subclinical patterns in heart electrical activity that are invisible to the human eye.12-lead ECGs and ambulatory ECG monitoring are core cardiac science diagnostic tests for any community diagnostic centre (CDC). Currently, electrocardiography services are provided in 108 of the 170 CDCs across England, helping to expand community based diagnostic provision for all patients, including young people.NHS England’s Physiological Sciences strategic framework clearly positions AI as a key enabler of community-based diagnostics, supporting faster and more standardised analysis of ECG tests. We are actively working to expand access to AI enabled ECG investigations.

With reference to the National Cancer Plan’s commitment to provide £70 million more in local authority Stop Smoking Services, whether that funding will be provided on an annual basis until 2030.

To help people quit, the Government has invested an additional £70 million in both 2024/25 and 2025/26 to support local authority led Stop Smoking Services in England. We are already seeing the impact this has made, as the first year of additional funding, 2024/25, resulted in a 23% increase in the number of people supported to quit compared to the previous year, 2023/24.From April, we are investing an additional £260 million over three years, from 2026/27 to 2028/29, in Stop Smoking Services within the Public Health Grant, meaning at least £150 million per year will be ringfenced for these services. This will give local authorities greater certainty on their funding for the next three years.

What the planned level of funding per post is for the additional 1,000 medical specialty training posts referred to in the 10 Year Workforce Plan; and how this compares with the current level of funding per post for existing medical specialty training posts.

NHS England is currently in discussions with local National Health Service providers on proposals to expand specialty training posts, with a view to introducing these through an additional recruitment round in 2026.NHS England has written to NHS Providers on the 30 January setting out an offer of funding. There are a range of funding models used for postgraduate medical training posts in the NHS and NHS England is currently considering the contribution that central and local funding should make for these additional posts, which will be finalised shortly in discussions with providers.

Whether the additional 1,000 medical specialty training posts referred to in the 10 Year Workforce Plan will be allocated in the current calendar year or phased over multiple years.

NHS England is currently in discussions with local National Health Service providers on proposals to expand specialty training posts, with a view to introducing these through an additional recruitment round in 2026.NHS England has written to NHS Providers on the 30 January setting out an offer of funding. There are a range of funding models used for postgraduate medical training posts in the NHS and NHS England is currently considering the contribution that central and local funding should make for these additional posts, which will be finalised shortly in discussions with providers.

What assessment he has made of the potential impact of block contract arrangements on elective care performance by NHS trusts.

Integrated care boards (ICBs) are responsible for the commissioning of elective care services, based on the needs of their population.The NHS Payment Scheme is the set of rules, prices, and guidance that determine how providers of National Health Service-funded healthcare are paid for the services they provide. It is designed to ensure that funding flows fairly and efficiently across the healthcare system. Under the NHS Payment Scheme 2025/26, NHS trusts should not be paid under a block contract basis for elective care. NHS trusts should be paid on the basis of the elective care they deliver.The only exception is where the value of patient activity between a commissioner and an NHS trust is less than £1.5 million, and in these circumstances the trust is paid a fixed amount for all the activity that they deliver for that commissioner, including both elective and non-elective, to minimise the number of low value transactions between NHS organisations.NHS England expects each ICB and provider to meet the requirements of the 2025/26 Planning Guidance, including delivering the necessary elective recovery targets. Where systems and providers are failing to meet their plans, NHS England will work with them to ensure appropriate mitigations are in place. This can include escalation into the national tiering programme, and the provision of improvement support. The National Oversight Framework describes how NHS England assesses ICBs and NHS providers, ensuring public accountability for performance. These processes are the same for all providers and systems, regardless of the commissioning arrangements in place.Details of the 2025/26 NHS Payment Scheme are published at the following link:https://www.england.nhs.uk/long-read/25-26-nhs-payment-scheme/

What his Department’s policy is on NHS trusts delivering elective care under block contract arrangements.

Integrated care boards (ICBs) are responsible for the commissioning of elective care services, based on the needs of their population.The NHS Payment Scheme is the set of rules, prices, and guidance that determine how providers of National Health Service-funded healthcare are paid for the services they provide. It is designed to ensure that funding flows fairly and efficiently across the healthcare system. Under the NHS Payment Scheme 2025/26, NHS trusts should not be paid under a block contract basis for elective care. NHS trusts should be paid on the basis of the elective care they deliver.The only exception is where the value of patient activity between a commissioner and an NHS trust is less than £1.5 million, and in these circumstances the trust is paid a fixed amount for all the activity that they deliver for that commissioner, including both elective and non-elective, to minimise the number of low value transactions between NHS organisations.NHS England expects each ICB and provider to meet the requirements of the 2025/26 Planning Guidance, including delivering the necessary elective recovery targets. Where systems and providers are failing to meet their plans, NHS England will work with them to ensure appropriate mitigations are in place. This can include escalation into the national tiering programme, and the provision of improvement support. The National Oversight Framework describes how NHS England assesses ICBs and NHS providers, ensuring public accountability for performance. These processes are the same for all providers and systems, regardless of the commissioning arrangements in place.Details of the 2025/26 NHS Payment Scheme are published at the following link:https://www.england.nhs.uk/long-read/25-26-nhs-payment-scheme/

How many NHS trusts are paid for the delivery of elective treatment through block contract arrangements.

Integrated care boards (ICBs) are responsible for the commissioning of elective care services, based on the needs of their population.The NHS Payment Scheme is the set of rules, prices, and guidance that determine how providers of National Health Service-funded healthcare are paid for the services they provide. It is designed to ensure that funding flows fairly and efficiently across the healthcare system. Under the NHS Payment Scheme 2025/26, NHS trusts should not be paid under a block contract basis for elective care. NHS trusts should be paid on the basis of the elective care they deliver.The only exception is where the value of patient activity between a commissioner and an NHS trust is less than £1.5 million, and in these circumstances the trust is paid a fixed amount for all the activity that they deliver for that commissioner, including both elective and non-elective, to minimise the number of low value transactions between NHS organisations.NHS England expects each ICB and provider to meet the requirements of the 2025/26 Planning Guidance, including delivering the necessary elective recovery targets. Where systems and providers are failing to meet their plans, NHS England will work with them to ensure appropriate mitigations are in place. This can include escalation into the national tiering programme, and the provision of improvement support. The National Oversight Framework describes how NHS England assesses ICBs and NHS providers, ensuring public accountability for performance. These processes are the same for all providers and systems, regardless of the commissioning arrangements in place.Details of the 2025/26 NHS Payment Scheme are published at the following link:https://www.england.nhs.uk/long-read/25-26-nhs-payment-scheme/

What his Department’s policy is on managing NHS trusts that are not meeting elective recovery targets where services are delivered under block contract arrangements.

Integrated care boards (ICBs) are responsible for the commissioning of elective care services, based on the needs of their population.The NHS Payment Scheme is the set of rules, prices, and guidance that determine how providers of National Health Service-funded healthcare are paid for the services they provide. It is designed to ensure that funding flows fairly and efficiently across the healthcare system. Under the NHS Payment Scheme 2025/26, NHS trusts should not be paid under a block contract basis for elective care. NHS trusts should be paid on the basis of the elective care they deliver.The only exception is where the value of patient activity between a commissioner and an NHS trust is less than £1.5 million, and in these circumstances the trust is paid a fixed amount for all the activity that they deliver for that commissioner, including both elective and non-elective, to minimise the number of low value transactions between NHS organisations.NHS England expects each ICB and provider to meet the requirements of the 2025/26 Planning Guidance, including delivering the necessary elective recovery targets. Where systems and providers are failing to meet their plans, NHS England will work with them to ensure appropriate mitigations are in place. This can include escalation into the national tiering programme, and the provision of improvement support. The National Oversight Framework describes how NHS England assesses ICBs and NHS providers, ensuring public accountability for performance. These processes are the same for all providers and systems, regardless of the commissioning arrangements in place.Details of the 2025/26 NHS Payment Scheme are published at the following link:https://www.england.nhs.uk/long-read/25-26-nhs-payment-scheme/

What assessment his Department has made of the potential impact of block contract arrangements on the level of NHS productivity.

No formal assessment of the impact of block contract arrangements on National Health Service productivity has been made. However, the 10‑Year Health Plan sets out the Government’s intention to move away from block contracts, paid irrespective of how many patients are seen or the quality of care, and to realign funding with activity and performance.Under these reforms, payment for poor‑quality care will be withheld, high‑quality care will attract additional reward, and new incentives will be introduced for the most effective NHS leaders, clinicians, and teams. These changes are designed to support clearer accountability, improve productivity over time, and ensure that NHS resources are targeted where they deliver the greatest value for patients.

Pursuant to the Answer to Question UIN 82954, answered on 15 January 2026, what activities the £18,818,566 paid by NHS England for validation exercises (April to September 2025) funded; whether those payments were made on the basis of a per-patient or per-pathway “RTT clock stop” rate (or any other unit rate); and if he will make a statement.

NHS England has provided funding to increase validation of waiting lists in 2025/26, as part of the Government's plans for a more productive and improved approach to elective care which is better for patients. A £33 fee is provided for each additional referral to treatment clock stop per patient pathway above a provider’s agreed baseline.Validation is a clinically supported process and forms a long-standing part of trusts’ routine management of their waiting lists. National guidance from NHS England provides further information about the validation process and is available at the following link:https://www.england.nhs.uk/wp-content/uploads/2022/12/B2121ii-validation-toolkit-and-guidance-december-2022.pdf

What payments NHS South Yorkshire Integrated Care Board made to its former Chief Executive in connection with his departure in October 2025; and what the amounts were for (a) redundancy and (b) pay in lieu of notice.

It has not proved possible to respond to the hon. Member in the time available before Prorogation.

How many exit payments of £150,000 and more were made by integrated care boards in the 2024-25 financial year.

Data reported in the Department’s Annual Report and Accounts for 2024/25 is limited to providing high-level data on the total number and cost of exit payments, including non-contractual severance payments. This data is not broken down to identify the name or type of specific organisations or payment types. The data provided in the Department’s accounts use consolidated data from NHS England.NHS England has confirmed that during 2024/25, there were 33 exit payment cases disclosed by integrated care boards which were of a value of £150,001 or more. This means that an exit package might be agreed, approved, and accrued in one financial year, and so disclosed in that year, but the actual payment may, in some cases, fall into the next financial year. NHS England does not hold information to identify where this is the case.

What steps his Department is taking to ensure that Integrated Care Boards do not (a) implement minimum waiting times and (b) make reductions to Indicative Action Plans in ways that could risk patient harm.

Integrated care boards (ICBs) have existing contractual powers to manage activity by providers, which were enhanced in 2025/26 with central support for setting and managing activity. The NHS Standard Contract includes the ability to set indicative activity plans (IAPs) to help providers and commissioners plan demand, capacity and expenditure. Activity management plans (AMPs) allow commissioners and providers to work together to manage elective activity within agreed performance and financial targets.The setting of IAPs and AMPs must be appropriate, and the designated process needs to be followed. Commissioners’ use of IAPs and AMPs support systems to live within their means and deploy better financial discipline than previous years where systems have overspent.The provision and use of IAPs and AMPs is designed to deliver the demand and activity levels modelled to achieve the goal of at least 65% of patients waiting no longer than 18 weeks for treatment by March 2026 whilst living within financial budgets set for 2025/26.Any planning assumptions based on waiting times need to support commissioners’ overall duties to the populations they serve and our waiting time targets, including our commitment to return to the 18-week standard. NHS England have worked with commissioners to ensure services are not planned on the basis of waiting times above this standard.While IAPs and AMPs are implemented to ensure this financial balance, all providers are expected to have their own safeguards to ensure that patients waiting for planned care are triaged, and that appointments take place according to clinical priority and the length of time patients have waited, avoiding risk of serious complications.

Whether (a) his Department and (b) NHS England has issued guidance to Integrated Care Boards on the use of minimum waiting times for elective care.

Integrated care boards (ICBs) have existing contractual powers to manage activity by providers, which were enhanced in 2025/26 with central support for setting and managing activity. The NHS Standard Contract includes the ability to set indicative activity plans (IAPs) to help providers and commissioners plan demand, capacity and expenditure. Activity management plans (AMPs) allow commissioners and providers to work together to manage elective activity within agreed performance and financial targets.The setting of IAPs and AMPs must be appropriate, and the designated process needs to be followed. Commissioners’ use of IAPs and AMPs support systems to live within their means and deploy better financial discipline than previous years where systems have overspent.The provision and use of IAPs and AMPs is designed to deliver the demand and activity levels modelled to achieve the goal of at least 65% of patients waiting no longer than 18 weeks for treatment by March 2026 whilst living within financial budgets set for 2025/26.Any planning assumptions based on waiting times need to support commissioners’ overall duties to the populations they serve and our waiting time targets, including our commitment to return to the 18-week standard. NHS England have worked with commissioners to ensure services are not planned on the basis of waiting times above this standard.While IAPs and AMPs are implemented to ensure this financial balance, all providers are expected to have their own safeguards to ensure that patients waiting for planned care are triaged, and that appointments take place according to clinical priority and the length of time patients have waited, avoiding risk of serious complications.

What assessment his Department has made of the potential impact of changes to Indicative Action Plans and the introduction of minimum waiting times on patients with ongoing care needs, including those at risk of serious complications such as irreversible sight loss.

Integrated care boards (ICBs) have existing contractual powers to manage activity by providers, which were enhanced in 2025/26 with central support for setting and managing activity. The NHS Standard Contract includes the ability to set indicative activity plans (IAPs) to help providers and commissioners plan demand, capacity and expenditure. Activity management plans (AMPs) allow commissioners and providers to work together to manage elective activity within agreed performance and financial targets.The setting of IAPs and AMPs must be appropriate, and the designated process needs to be followed. Commissioners’ use of IAPs and AMPs support systems to live within their means and deploy better financial discipline than previous years where systems have overspent.The provision and use of IAPs and AMPs is designed to deliver the demand and activity levels modelled to achieve the goal of at least 65% of patients waiting no longer than 18 weeks for treatment by March 2026 whilst living within financial budgets set for 2025/26.Any planning assumptions based on waiting times need to support commissioners’ overall duties to the populations they serve and our waiting time targets, including our commitment to return to the 18-week standard. NHS England have worked with commissioners to ensure services are not planned on the basis of waiting times above this standard.While IAPs and AMPs are implemented to ensure this financial balance, all providers are expected to have their own safeguards to ensure that patients waiting for planned care are triaged, and that appointments take place according to clinical priority and the length of time patients have waited, avoiding risk of serious complications.

What recent engagement his Department has had with the devolved Administrations in relation to the recommendations of The Hughes Report, published on 7 February 2024; and whether any Ministerial-level discussions are planned with the governments of Scotland, Wales and Northern Ireland.

While health is predominantly devolved, the Department holds some reserved functions and working together across the United Kingdom on health and social care is ingrained in the values of our National Health Service and social care sector.The Patient Safety Commissioner’s report covered England-only, however, any response by the Government to the recommendations of the Hughes Report in England will likely have implications for the devolved administrations and their constituents. Engagement between officials across the UK occurs regularly and during an Inter-Ministerial Group meeting on 11 December 2025, the Hughes report was discussed and ministers across the four nations agreed to meet in January 2026 for further engagement.