Written questions by Andrew.

With reference to his Department’s press release entitled Patients treated more quickly as NHS productivity rises over year, published on 22 September 2025, how the growth in costs used to measure NHS productivity was calculated.

National Health Service productivity is measured by comparing the amount of healthcare activity delivered, otherwise known as outputs, against the resources used, otherwise known as inputs, over time. To estimate the growth in costs, data is drawn from financial returns submitted by NHS trusts, known as Provider Financial Returns. These returns capture spending across the system. However, certain items that are not directly related to patient care activity, such as one-off or exceptional costs, are excluded to ensure the analysis reflects core service delivery.To allow for a fair comparison between years, the figures are adjusted to remove the effects of inflation and NHS pay awards. This process, known as “deflation”, ensures that any changes in cost reflect real changes in resource use rather than price increases. This is standard practice in productivity analysis.Following these adjustments, the estimated increase in acute sector costs between 2023/24 and 2024/25 is £3.0 billion. This figure reflects the additional resources used to support increased activity in acute care settings, such as hospitals.

How many NHS trusts are providing Tofersen through the Early Access to Medicines Scheme.

The Early Access to Medicines Scheme (EAMS) is a programme led by the Medicines and Healthcare products Regulatory Agency (MHRA) which aims to give patients with life threatening or seriously debilitating conditions early access to medicines that show early signs of having a major advantage over existing therapeutics. Tofersen is not available via EAMS. Some National Health Service hospitals may sign an agreement with the manufacturer of tofersen, Biogen, to provide pre-license access. NHS England does not have any involvement in non-EAMS early access programmes. NHS England does not hold any data on the number of NHS trusts or patients accessing tofersen through company led early access programmes.

Whether his Department has made an assessment of regional variations in patient access to Tofersen.

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for developing authoritative, evidence-based recommendations for the National Health Service on whether new medicines represent a clinically and cost-effective use of resources. The NHS in England is legally required to fund medicines recommended by NICE, normally within three months of the publication of final guidance.NICE has selected tofersen for treating amyotrophic lateral sclerosis caused by the superoxide dismutase – 1 (SOD1) gene mutations as a topic for guidance development through its Highly Specialised Technology (HST) programme. The HST programme appraises medicines for the treatment of very rare, and often very severe diseases, and evaluates whether they can be considered a clinically and cost-effective use of NHS resources. NICE has not yet been able to start the evaluation of tofersen as it is unable to issue guidance on the use of the technology without receiving an evidence submission about the technology’s clinical and cost-effectiveness from the marketing authorisation holder. Therefore, NICE is ready to review tofersen via its HST programme, as soon as Biogen indicates that it is ready to start the NICE evaluation.I am aware that the marketing authorisation holder has established early access programmes (EAPs) through which some patients are currently accessing tofersen. Participation in company-led schemes is decided at an individual NHS trust level and under these programmes, the cost of the drug is free to both patients taking part in it, and to the NHS, but NHS trusts must still cover the administration costs and must provide clinical resources to deliver the EAP. No assessment has been made of regional variation in access to tofersen through the programme.NHS England has published guidance for integrated care systems (ICS) on free of charge medicines schemes, providing advice on potential financial, resourcing, and clinical risks. ICSs should use the guidance to help determine whether to implement any of these schemes, including assessing suitability and any risks in the short, medium, and long term. The guidance is available at the following link:https://www.england.nhs.uk/long-read/free-of-charge-foc-medicines-schemes-national-policy-recommendations-for-local-systems/

What steps his Department is taking to ensure equitable access to Tofersen for motor neurone disease patients.

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for developing authoritative, evidence-based recommendations for the National Health Service on whether new medicines represent a clinically and cost-effective use of resources. The NHS in England is legally required to fund medicines recommended by NICE, normally within three months of the publication of final guidance.NICE has selected tofersen for treating amyotrophic lateral sclerosis caused by the superoxide dismutase – 1 (SOD1) gene mutations as a topic for guidance development through its Highly Specialised Technology (HST) programme. The HST programme appraises medicines for the treatment of very rare, and often very severe diseases, and evaluates whether they can be considered a clinically and cost-effective use of NHS resources. NICE has not yet been able to start the evaluation of tofersen as it is unable to issue guidance on the use of the technology without receiving an evidence submission about the technology’s clinical and cost-effectiveness from the marketing authorisation holder. Therefore, NICE is ready to review tofersen via its HST programme, as soon as Biogen indicates that it is ready to start the NICE evaluation.I am aware that the marketing authorisation holder has established early access programmes (EAPs) through which some patients are currently accessing tofersen. Participation in company-led schemes is decided at an individual NHS trust level and under these programmes, the cost of the drug is free to both patients taking part in it, and to the NHS, but NHS trusts must still cover the administration costs and must provide clinical resources to deliver the EAP. No assessment has been made of regional variation in access to tofersen through the programme.NHS England has published guidance for integrated care systems (ICS) on free of charge medicines schemes, providing advice on potential financial, resourcing, and clinical risks. ICSs should use the guidance to help determine whether to implement any of these schemes, including assessing suitability and any risks in the short, medium, and long term. The guidance is available at the following link:https://www.england.nhs.uk/long-read/free-of-charge-foc-medicines-schemes-national-policy-recommendations-for-local-systems/

Whether his Department plans to publish data on the number of patients receiving Tofersen through NHS services.

I am aware that the marketing authorisation holder has established an early access programme (EAP) through which some NHS patients are currently accessing tofersen. This is a company-led EAP and therefore the Department nor NHS England centrally hold prospective information regarding the exact number of patients receiving tofersen.

What discussions his Department has had with the Motor Neurone Disease Association on patient access to Tofersen.

Department officials recently met with the Motor Neurone Disease Association to discuss a range of issues, including patient access to tofersen.

What assessment he has made of the potential impact of deliberately imposed minimum waiting times for elective care on the NHS’s compliance with its constitutional access standards.

As set out in the Plan for Change, we are committed to returning to the NHS constitutional standard that 92% of patients wait no longer than 18 weeks from referral to consultant-led treatment by March 2029. As of August 2025, the waiting list had reduced by over 206,000 compared to the start of July 2024 despite over 24.5 million referrals onto the list over this period. Performance against the standard for 92% of patients to start first treatment within 18 weeks of referral was 61.0%, 2.7 percentage points higher than a year earlier.There is no formal national policy supporting minimum waits in the National Health Service and no national assessment has been made on the potential impact of minimum waiting. However, the NHS standard contract technical guidance for 2025/26 states that commissioners may choose to include minimum waiting times in Activity Planning Assumptions to ensure delivery of targets within agreed financial allocations. The guidance requires commissioners to consider the equality and quality impacts of their plans on patients and to plan to deliver their wait time targets as set out in the annual Planning Guidance.Improving value for money and ensuring we are using resources in the most effective manner is a priority for this government. This provision was added to support commissioners in managing activity to ensure they can sustainably manage within their budgets alongside the other requirements set out in the operational planning guidance for 2025/26.Integrated care boards (ICBs) hold the responsibility and budget for commissioning and delivering elective activity through providers in their local area, they have discretion to design bespoke services that work best for and meet the needs of their local community. The specific information requested on which NHS ICBs use minimum waiting times for elective care; and for what reasons, is not held by the Department.We will work closely with all systems to ensure they deliver the expected level of improvement in waiting times set out in 2025/26 Planning Guidance.

What assessment he has made of the potential impact of minimum waiting times for elective care on patients; and if he will publish clinical advice his Department has received on those waiting times.

As set out in the Plan for Change, we are committed to returning to the NHS constitutional standard that 92% of patients wait no longer than 18 weeks from referral to consultant-led treatment by March 2029. As of August 2025, the waiting list had reduced by over 206,000 compared to the start of July 2024 despite over 24.5 million referrals onto the list over this period. Performance against the standard for 92% of patients to start first treatment within 18 weeks of referral was 61.0%, 2.7 percentage points higher than a year earlier.There is no formal national policy supporting minimum waits in the National Health Service and no national assessment has been made on the potential impact of minimum waiting. However, the NHS standard contract technical guidance for 2025/26 states that commissioners may choose to include minimum waiting times in Activity Planning Assumptions to ensure delivery of targets within agreed financial allocations. The guidance requires commissioners to consider the equality and quality impacts of their plans on patients and to plan to deliver their wait time targets as set out in the annual Planning Guidance.Improving value for money and ensuring we are using resources in the most effective manner is a priority for this government. This provision was added to support commissioners in managing activity to ensure they can sustainably manage within their budgets alongside the other requirements set out in the operational planning guidance for 2025/26.Integrated care boards (ICBs) hold the responsibility and budget for commissioning and delivering elective activity through providers in their local area, they have discretion to design bespoke services that work best for and meet the needs of their local community. The specific information requested on which NHS ICBs use minimum waiting times for elective care; and for what reasons, is not held by the Department.We will work closely with all systems to ensure they deliver the expected level of improvement in waiting times set out in 2025/26 Planning Guidance.

Which NHS Integrated Care Boards use minimum waiting times for elective care; and for what reasons.

As set out in the Plan for Change, we are committed to returning to the NHS constitutional standard that 92% of patients wait no longer than 18 weeks from referral to consultant-led treatment by March 2029. As of August 2025, the waiting list had reduced by over 206,000 compared to the start of July 2024 despite over 24.5 million referrals onto the list over this period. Performance against the standard for 92% of patients to start first treatment within 18 weeks of referral was 61.0%, 2.7 percentage points higher than a year earlier.There is no formal national policy supporting minimum waits in the National Health Service and no national assessment has been made on the potential impact of minimum waiting. However, the NHS standard contract technical guidance for 2025/26 states that commissioners may choose to include minimum waiting times in Activity Planning Assumptions to ensure delivery of targets within agreed financial allocations. The guidance requires commissioners to consider the equality and quality impacts of their plans on patients and to plan to deliver their wait time targets as set out in the annual Planning Guidance.Improving value for money and ensuring we are using resources in the most effective manner is a priority for this government. This provision was added to support commissioners in managing activity to ensure they can sustainably manage within their budgets alongside the other requirements set out in the operational planning guidance for 2025/26.Integrated care boards (ICBs) hold the responsibility and budget for commissioning and delivering elective activity through providers in their local area, they have discretion to design bespoke services that work best for and meet the needs of their local community. The specific information requested on which NHS ICBs use minimum waiting times for elective care; and for what reasons, is not held by the Department.We will work closely with all systems to ensure they deliver the expected level of improvement in waiting times set out in 2025/26 Planning Guidance.

What his Department’s policy is on the use of minimum waiting times for elective NHS care; and whether he has considered prohibiting the use of such waiting times less than 18 weeks.

As set out in the Plan for Change, we are committed to returning to the NHS constitutional standard that 92% of patients wait no longer than 18 weeks from referral to consultant-led treatment by March 2029. As of August 2025, the waiting list had reduced by over 206,000 compared to the start of July 2024 despite over 24.5 million referrals onto the list over this period. Performance against the standard for 92% of patients to start first treatment within 18 weeks of referral was 61.0%, 2.7 percentage points higher than a year earlier.There is no formal national policy supporting minimum waits in the National Health Service and no national assessment has been made on the potential impact of minimum waiting. However, the NHS standard contract technical guidance for 2025/26 states that commissioners may choose to include minimum waiting times in Activity Planning Assumptions to ensure delivery of targets within agreed financial allocations. The guidance requires commissioners to consider the equality and quality impacts of their plans on patients and to plan to deliver their wait time targets as set out in the annual Planning Guidance.Improving value for money and ensuring we are using resources in the most effective manner is a priority for this government. This provision was added to support commissioners in managing activity to ensure they can sustainably manage within their budgets alongside the other requirements set out in the operational planning guidance for 2025/26.Integrated care boards (ICBs) hold the responsibility and budget for commissioning and delivering elective activity through providers in their local area, they have discretion to design bespoke services that work best for and meet the needs of their local community. The specific information requested on which NHS ICBs use minimum waiting times for elective care; and for what reasons, is not held by the Department.We will work closely with all systems to ensure they deliver the expected level of improvement in waiting times set out in 2025/26 Planning Guidance.

What assessment he has made of the potential impact of the 2025/26 NHS Payment Scheme Consultation on the ability of patients to access medication for ADHD.

As required by law, NHS England has assessed the impact of the proposed NHS Payment Scheme. This is available at the following link:https://www.england.nhs.uk/wp-content/uploads/2025/01/25-26-NHSPS-Consultation-notice-C-impact-assessment.pdfThis impact assessment includes consideration of the impact on patient choice, as well as an assessment of the impact on patients, in line with NHS England’s public sector equality duty.Attention deficit hyperactivity disorder (ADHD) patients will continue to benefit from the Right to Choose their provider at the point of referral. None of the proposed changes to the NHS Payment Scheme included in the consultation would change this.Local integrated care boards (ICBs) are responsible for planning service provision in their local area, including for ADHD assessments and medication. In doing so, ICBs should take account of waiting lists, considering how local funding can be deployed to best meet the needs of their local population.

What assessment he has made of the potential impact of the 2025/26 NHS Payment Scheme Consultation on existing waiting times for an ADHD diagnosis.

As required by law, NHS England has assessed the impact of the proposed NHS Payment Scheme. This is available at the following link:https://www.england.nhs.uk/wp-content/uploads/2025/01/25-26-NHSPS-Consultation-notice-C-impact-assessment.pdfThis impact assessment includes consideration of the impact on patient choice, as well as an assessment of the impact on patients, in line with NHS England’s public sector equality duty.Attention deficit hyperactivity disorder (ADHD) patients will continue to benefit from the Right to Choose their provider at the point of referral. None of the proposed changes to the NHS Payment Scheme included in the consultation would change this.Local integrated care boards (ICBs) are responsible for planning service provision in their local area, including for ADHD assessments and medication. In doing so, ICBs should take account of waiting lists, considering how local funding can be deployed to best meet the needs of their local population.

What steps he is taking to ensure that the Mental Health Bill will (a) protect and (b) enhance the rights of (i) children and (ii) young people who are (A) detained in and (B) admitted informally to mental health hospitals.

The forthcoming Mental Health Bill will strengthen the rights of children and young people, to ensure they are involved in decisions about their care, that they can challenge these decisions and, above all, ensure that they are only detained for treatment in hospital when it is absolutely necessary. NHS England is working to minimise the number of children and young people informally admitted to inpatient mental health care.Subject to the passage of the Bill through Parliament, it is proposed that children and young people formally detained under the Mental Health Act will have statutory Care and Treatment Plans, the right to choose a ‘Nominated Person’ to look after their interests and expanded access to Independent Mental Health Advocates. The latter will also apply to voluntary patients who are not detained under the Act.

Whether he plans to increase investment into the children's mental health system to (a) reduce waiting times for and (b) increase access to support.

It is unacceptable that too many children and young people are not receiving the mental health care they need, and we know that waits for mental health services are far too long. That is why we will recruit 8,500 additional mental health workers across both adult and children and young people’s mental health services. We are discussing our future investment in children and young people’s mental health services.The Department of Health and Social Care is working with the Department for Education to consider how to deliver our manifesto commitment of accessing a specialist mental health professional in every school. We need to ensure any support meets the needs of young people, teachers, parents, and carers. This includes considering the role of existing programmes of support with evidence of a positive impact, such as Mental Health Support Teams in schools and colleges.Alongside this we are working toward rolling out Young Futures hubs in every community, offering open access mental health services for young people.The Mental Health Bill currently before Parliament will deliver the Government’s commitment to modernise the Mental Health Act 1983, so that it is fit for the 21st century. The Bill will amend the Act, which applies to England and Wales, and give patients detained under the Act greater choice, autonomy, rights, and support.