Written questions by Andrew.

Pursuant to the Answer of 21 October 2025 to Question 76564 on Surgery: Waiting Lists, what discussions he had with NHS England on (a) the introduction of NHS standard contract technical guidance for 2025-26 and (b) provisions for minimum waiting times before publication.

Following consultation, NHS England publishes the NHS Standard Contract annually for use by commissioners in contracting for National Health Service-funded healthcare services. The Department is involved in the consultation process on the Standard Contract. Technical guidance is published for information alongside the Standard Contract consultation. Its purpose is to advise commissioners and providers on how to apply the contract.NHS England develops the standard contract technical guidance in collaboration with the system to ensure it provides the support required for both commissioners and providers to apply the contract requirements and to deliver on Operational Planning Guidance.The Department has ongoing discussions with NHS England on 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. Planning Guidance for 2025/26 sets a target that 65% of patients wait no longer than 18 weeks by March 2026, with every trust expected to deliver a minimum 5% improvement on current performance over that period.Integrated care boards (ICBs) are required to hit those targets and providers are working hard to deliver this commitment.

Pursuant to the Answer of 21 October 2025 to Question 76564 on Surgery: Waiting Lists, whether NHS England holds information on which ICBs use minimum waiting times for elective care.

Following consultation, NHS England publishes the NHS Standard Contract annually for use by commissioners in contracting for National Health Service-funded healthcare services. The Department is involved in the consultation process on the Standard Contract. Technical guidance is published for information alongside the Standard Contract consultation. Its purpose is to advise commissioners and providers on how to apply the contract.NHS England develops the standard contract technical guidance in collaboration with the system to ensure it provides the support required for both commissioners and providers to apply the contract requirements and to deliver on Operational Planning Guidance.The Department has ongoing discussions with NHS England on 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. Planning Guidance for 2025/26 sets a target that 65% of patients wait no longer than 18 weeks by March 2026, with every trust expected to deliver a minimum 5% improvement on current performance over that period.Integrated care boards (ICBs) are required to hit those targets and providers are working hard to deliver this commitment.

What assessment his Department has made of the potential impact on (a) diver safety and (b) emergency access for people in the West Midlands of the proposed closure of the Midland Dive Chamber in Rugby.

NHS England has no immediate plans to decommission the hyperbaric oxygen therapy services in the Midlands. The responsibility for the delivery, implementation, and funding decisions for services ultimately rests with the appropriate National Health Service commissioning body, and hyperbaric oxygen therapy is a specialised service commissioned by NHS England.

How many removals from elective waiting lists there have been as a result of data validation exercises in 2025-26; and what the cost to his Department has been of those exercises.

Validation is a well-established component for the effective management of waiting lists, ensuring that the patients who are on the list should still be there. While we have significantly reduced the size of the total elective waiting list by over 206,000 since the Government took office, a large list requires consistent validation in order to ensure that all patients on the list still require care, and all appointments are of optimum value for patients and clinicians.The Department does not hold data centrally on the number of patient pathways removed from the elective waiting list as a result of data validation.NHS England has paid the system £18,818,566 for validation exercises from April to September 2025. Payments for the most recent validation exercises have not yet been issued to providers. We know validation provides significant benefits for patients by reducing missed appointments, making effective use of clinical time, and ensuring patients are on the best care pathway for their needs.

How many new general practice premises projects are awaiting a valuation by the district valuer; and what the average time taken is to complete such valuations.

For context, the Valuation Office Agency’s (VOA) District Valuer Services (DVS) provide property advice to NHS bodies in England, including Current Market Rent (CMR) assessments for GP practice premises, under the NHS (General Medical Services - Premises Costs) Directions. DVS is instructed in accordance with the Directions, to assess the financial value for money aspect of proposed new lease terms including rent for both existing premises and for third-party development schemes. DVS then provide advice to the Integrated Care Board (ICB) who will utilise our advice to consider their wider Value for Money approval including affordability. The length of time taken to complete a case varies depending on case type and complexity, and negotiations with GPs and their advisors. Instructions of this nature vary considerably. DVS may be asked to provide advice on the CMR based on initial project proposals or alternatively may be asked to review the scheme, seek further details of the proposal and enter into discussions with the parties prior to providing an opinion of CMR. Therefore, the time taken to provide the valuation will vary. As projects progress and are subject to amendment DVS may provide a number of valuations during the instruction period and instructions may be paused at the request of the ICB, depending on wider circumstances. Instructions are commenced within a short period from date of receipt and progressed in line with client requirements.

How many and what proportion of new general practice premises projects have appealed the valuation by the district valuer service; and how many of those appeals were upheld.

For context, the Valuation Office Agency’s (VOA) District Valuer Services (DVS) provide property advice to NHS bodies in England, including Current Market Rent (CMR) assessments for GP practice premises, under the NHS (General Medical Services - Premises Costs) Directions. DVS is instructed in accordance with the Directions, to assess the financial value for money aspect of proposed new lease terms including rent for both existing premises and for third-party development schemes. DVS then provide advice to the Integrated Care Board (ICB). The ICB is responsible for the decision on approval of the project reflecting all Value for Money considerations including the DVS advice and their own budgetary targets. The VOA are not aware of any appeals to NHS Resolution in relation to an ICB Value for Money decision relating to new premises development.

Food and Rural Affairs, what assessment she has made of the potential impact of the ban on poultry shows on the conservation of rare and traditional poultry breeds.

Regulation 6 of the Avian Influenza (Preventive Measures) (England) Regulations 2006, as amended, sets out the legal basis for permitting gatherings of poultry or other captive birds. In England, a licence to hold a bird gathering may be granted by Defra if a veterinary risk assessment has been carried out, and if the gathering, including the movement of birds to and from it, would not significantly increase the risk of the transmission of avian influenza virus. Detailed risk assessments can be found on GOV.UK. A licence for a poultry gathering, such as a show, may be granted if the gathering and the transport of birds to and from it would not significantly increase the risk of the spread of bird flu. For each application to hold a gathering of poultry, such as a small poultry show, an individual risk assessment will be completed, and mitigating conditions will be set out in the licence. Defra, through the annual UK Farm Animal Genetic Resources (FAnGR) breed inventory, updates the Breeds at Risk (BAR) list which contains native breeds that are considered to be at particular risk, for example in the event of an outbreak of exotic animal disease. The BAR list provides a potential derogation from culling during an outbreak, which is dependent on veterinary risk assessment.

Food and Rural Affairs, with reference to the Animal and Plant Health Agency’s Epidemiology Report: Highly Pathogenic Avian Influenza H5N1 outbreaks in Great Britain, October 2022 to March 2023, published on 30 March 2023, what assessment she has made of the potential merits of ending the blanket ban on poultry shows in England and Wales.

This is a devolved matter and the information provided therefore relates to England only. Regulation 6 of the Avian Influenza (Preventive Measures) (England) Regulations 2006, as amended, sets out the legal basis for permitting gatherings (such as shows) of poultry or other captive birds. In England, a licence to hold a bird gathering may be granted by Defra if a veterinary risk assessment has been carried out, and if the gathering, including the movement of birds to and from it, would not significantly increase the risk of the transmission of avian influenza virus. Detailed risk assessments can be found on GOV.UK. A licence for a poultry gathering, such as a show, may be granted if the gathering and the transport of birds to and from it would not significantly increase the risk of the spread of bird flu. For each application for a licence to hold a gathering of poultry, an individual risk assessment will be completed, and mitigating conditions will be set out in the licence.

Food and Rural Affairs, what assessment she has made of the potential impact of reductions in poultry biodiversity on the food chain.

The UK has a highly resilient poultry meat supply chain which has coped well in responding to the unprecedented challenges it has faced in the recent years. Conservation of animal genetic resources including poultry breeds contributes to biodiversity. These resources provide genetic traits which can contribute to a sustainable increase in food productivity and help the agriculture sector adapt to climate change. Defra receives independent expert advice from the UK Genetics for Livestock and Equines Committee which is used to inform approaches to conservation of native breeds including poultry.

Food and Rural Affairs, what assessment she has made of the potential merits of consulting stakeholders on a proportionate approach to managing avian influenza risks in relation to poultry shows.

Defra officials have engaged with stakeholders to better understand achievable conditions for poultry shows. This process helped to shape a set of template conditions which could mitigate the disease risk associated with some poultry gatherings (for example shows). Applicants can apply to the Animal and Plant Health Agency for a specific licence for a poultry gathering. An individual risk assessment will be competed for each application to determine if a licence can be granted for that specific event.

Food and Rural Affairs, what assessment she has made of the potential implications for her policies of the UK Health Security Agency’s conclusion that the risk to the general public from avian influenza remains very low when determining policy on poultry shows.

Regulation 6 of the Avian Influenza (Preventive Measures) (England) Regulations 2006, as amended, sets out the legal basis for permitting gatherings of poultry or other captive birds. In England, a licence to hold a bird gathering may be granted by Defra if a veterinary risk assessment has been carried out, and if the gathering, including the movement of birds to and from it, would not significantly increase the risk of the transmission of avian influenza virus. These risk assessments focus on the risk as it relates to birds. Detailed risk assessments can be found on GOV.UK.

What recent discussions she has had with the Secretary of State for Health and Social Care on the potential impact of district valuer assessments on the opening of new GP surgeries.

The Chancellor has regular conversations with the Health Secretary on range of issues. The Spending Review 2025 announced the largest ever health capital budget, with a £2.3 billion real terms increase in capital spending over the SR period. The £102 million Primary Care Utilisation and Modernisation Fund announced earlier this year will upgrade more than a thousand GP surgeries across England, which will create space to deliver more appointments and improve access for patients. With respect to the opening of new GP surgeries, this is a matter for the Department of Health and Social Care and the NHS, who may consult the district valuer when the value for money of premises development proposals is assessed.

What the (a) average and (b) longest waiting times were for district valuer assessments of GP premises proposals in the most recent 12-month period for which data are available.

For context, the Valuation Office Agency’s (VOA) District Valuer Services (DVS) provide property advice to NHS bodies in England, including Current Market Rent (CMR) assessments for GP practice premises, under the NHS (General Medical Services - Premises Costs) Directions. DVS is instructed in accordance with the Directions, to assess the financial value for money aspect of proposed new lease terms including rent for both existing premises and for third-party development schemes. DVS then provide advice to the Integrated Care Board (ICB) who will utilise our advice to consider their wider Value for Money approval including affordability. The length of time taken to complete a case varies depending on case type and complexity, and negotiations with GPs and their advisors. Instructions of this nature vary considerably. DVS may be asked to provide advice on the CMR based on initial project proposals or alternatively may be asked to review the scheme, seek further details of the proposal and enter into discussions with the parties prior to providing an opinion of CMR. Therefore, the time taken to provide the valuation will vary. As projects progress and are subject to amendment, DVS may provide a number of valuations during the instruction period and instructions may be paused at the request of the ICB, depending on wider circumstances. For the above reasons it is not possible to provide average and longest waiting times for DV assessments of GP proposals. Instructions are commenced within a short period from date of receipt and progressed in line with client requirements.

With reference to his Department’s press release entitled Patients treated more quickly as NHS productivity rises over year, published on 22 September 2025, what estimate he has made of the monetary value of the increased acute sector costs referred to; and if he will provide a breakdown of that expenditure.

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.

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.

Food and Rural Affairs, what assessment she has made of the potential implications for her policies of other countries permitting poultry shows under biosecure conditions.

Regulation 6 of the Avian Influenza (Preventive Measures) (England) Regulations 2006, as amended, sets out the legal basis for permitting gatherings of poultry or other captive birds. In England, a licence to hold a bird gathering may be granted by Defra if a veterinary risk assessment has been carried out, and if the gathering, including the movement of birds to and from it, would not significantly increase the risk of the transmission of avian influenza virus. Detailed risk assessments can be found on GOV.UK. Gatherings risk assessments focus on the risk as it relates to birds within Great Britain at the time of assessment. The policies and risk management decisions of other countries do not directly impact our assessment of risk. Context is important as there are differences in industry structure between Great British poultry and poultry in other countries; as well as differences in biosecurity requirements, disease prevalence, migratory pathways and disease control measures. Each competent authority will need to assess the risk to animal health in their own administrations based on local risk assessments.

With reference to his Department’s press release entitled Patients treated more quickly as NHS productivity rises over year, published on 22 September 2025, whether NHS pay awards were included in the calculation of cost growth used to measure NHS productivity.

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.

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 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/