Written questions by Andrew.

What assessment he has made of the potential implications for his policies of responses to the consultation on the draft statutory guidance under the Down Syndrome Act 2022.

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.The Down Syndrome Act 2022 requires my Rt Hon. Friend, the Secretary of State for Health and Social Care, to give guidance to relevant authorities in health, social care, education, and housing services on the actions they should be taking to support the needs of people with Down syndrome. The public consultation on the draft guidance was launched on 5 November 2025 and will remain open until 30 March 2026. Once the consultation has closed, the Government will consider all consultation responses to inform the final guidance to be published.

If he will set out the timetable for the UK National Screening Committee’s review of screening for sudden cardiac death in young people; and whether the large-scale screening audit data due for publication in February 2026 will be considered as part of that review.

The UK National Screening Committee (UK NSC) is currently re-examining the evidence for sudden cardiac death screening in young people and will open a public consultation on this in the spring. The UK NSC secretariat is not aware of the audit referred to in this question. However, as the literature review needs to be completed and analysed before a consultation is published, any evidence published in February of this year will not be part of the UK NSC consultation.

What assessment his Department has made of the potential impact of electrocardiogram screening for young people engaged in organised sport, including the clinical effectiveness and cost effectiveness of such screening.

The Government is guided by the independent scientific advice of the UK National Screening Committee (UK NSC). It is only where the offer to screen provides more good than harm that a screening programme is recommended. The UK NSC makes its recommendations based on internationally recognised criteria and a rigorous evidence review and consultation process.Every sudden cardiac death of a young person is a tragedy. The UK National Screening Committee (UK NSC) is currently re-examining the evidence for sudden cardiac death screening in young people, including those involved in organised sports, and will open a public consultation on this in the spring.The Government welcome the UK NSC’s robust and rigorous approach to evaluating the benefits and harms of screening, as it is vital that screening policy is based on scientific evidence.

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 the final statutory guidance issued under the Down Syndrome Act 2022 will include Down syndrome-specific training for health, education and social care professionals.

I refer the Rt Hon. Member to the answer I gave to the Hon. Member for Maidenhead on 5 January 2026 to Question 103131.

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/

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 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.

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 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.

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/

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.

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/

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/

Whether he has made an assessment of the potential merits of uprating Pension Protection Fund compensation for members who lost indexation from April 1997, to reflect the value their pensions would have held if index-linking had been preserved.

Indexation in the Pension Protection Fund (PPF) on pensions built up on or after 6 April 1997 (post-1997 indexation) broadly reflects the statutory requirements for Defined Benefit schemes more generally, which are in line with the consumer prices index, capped at 2.5%. This may be different to the increases that would have been provided under the rules of the original scheme. The PPF is a compensation scheme and, as such, was never intended to replicate the benefits of schemes which were unable to secure their liabilities.

What steps her Department is taking to ensure that Plan 2 student loan borrowers are informed of the changes to repayment thresholds due to take effect in April 2027.

The government announced on 26 November 2025, as part of Autumn Budget 2025, the repayment threshold to apply to English Plan 2 student loans from April 2027 to April 2030. The Student Loans Company (SLC) publish confirmation of the repayment threshold to apply in the upcoming financial year annually on GOV.UK. Further, SLC have extensive guidance on the operation of the student loan repayments system available on GOV.UK, including confirmation of the current repayment threshold.

What assessment her Department has made of the potential impact of freezing the Plan 2 student loan repayment threshold from April 2027 on existing student loan borrowers.

It was announced at the Autumn Budget that the repayment and interest thresholds for Plan 2 student loans will be frozen from the 2026/27 financial year until April 2030, when they will increase annually by inflation.The department has produced the attached analysis regarding the impact of freezing the repayment and interest thresholds.If a borrower is earning above the repayment threshold and their income stays the same, then their repayments will remain the same. If a borrower is not earning above the repayment threshold and their income remains the same, they will continue to not be required to make any repayments.