Written questions by Braverman.

Whether his Department is considering reform of the residential care funding framework to prevent older people being displaced from long‑standing care home placements for purely financial reasons.

The Department has no current plans to reform the residential care funding framework. The responsibility for meeting eligible needs rests with local authorities under the Care Act 2014. The Government is making over £4.6 billion of additional funding available for adult social care in 2028/29 compared to 2025/26. In terms of an assessment of the impact of involuntary care home moves on older people with dementia, the Care Act places a duty on local authorities to promote wellbeing when arranging social care for an individual, and this provides individuals and their carers with more control over the way in which care and support is provided. The Care Quality Commission (CQC) is assessing how local authorities in England are meeting the full range of their duties under Part 1 of the Care Act 2014. If the CQC identifies that a local authority has failed or is failing to discharge its duties under the Care Act to an acceptable standard, my Rt Hon. Friend, the Secretary of State for Health and Social Care, has powers to intervene. The Independent Commission into adult social care, chaired by Baroness Louise Casey, is looking at the medium and long-term reforms needed in adult social care to deliver a fair and affordable system that is fit for the future, including looking at what long-term and sustainable funding solutions should look like.

What assessment his Department has made of the potential impact of removing long‑term residents from care homes once they become local‑authority funded on provider financial sustainability and the stability of the residential care market.

Local authorities are best placed to understand and plan for the needs of their population, which is why, under the Care Act 2014, they are tasked with the duty to shape their care markets to meet the diverse needs of all local people. In doing so, they should use local population and market data to inform commissioning decisions, involve people and providers in the commissioning process, and encourage a wide range of service provision to ensure that people have a choice of appropriate and high-quality care services in their local area. Local authorities also have a duty to provide continuity of care to minimise disruption and to ensure that people continue to receive the care and support they need and do not suffer a gap in their care service when care arrangements change. The Care Quality Commission (CQC) is assessing how local authorities in England are meeting the full range of their duties under Part 1 of the Care Act 2014, including those related to commissioning. The CQC is under a duty to inform my Rt Hon. Friend, the Secretary of State for Health and Social Care, if they consider an authority is failing to discharge its functions. My Rt Hon. Friend, the Secretary of State for Health and Social Care, has powers to intervene where he is satisfied that authorities have failed or are failing to discharge Care Act functions to an acceptable standard. All reports are made available on CQC’s website and can be found at the following link: https://www.cqc.org.uk/care-services/local-authority-assessment-reports

What steps his Department is taking to ensure that local authorities comply with their statutory duties under section 1 of the Care Act 2014 to promote individual wellbeing when making decisions about residential care placements.

The relevant guidance issued by the Department is the Care and Support Statutory Guidance, issued under the Care Act 2014. This makes clear that local authorities must take into account a person’s circumstances and preferences when arranging care, including when reviewing existing care home placements. They must promote the wellbeing of those drawing on care, beginning with an assumption that the individual drawing on care is best placed to judge what they require for their own wellbeing. This applies equally to those entering care for the first time and to those who have been self-funders but, because of diminishing resources, are on the verge of needing local authority support.Where an individual is assessed as requiring support in a residential care home and they are eligible for means tested support from their local authority, the local authority must ensure that the individual drawing on care is offered a genuine choice of accommodation. This must include at least one option which is affordable within the person’s personal budget, and should include more than one option. If suitable accommodation is not available at the amount identified in a personal budget, the local authority must arrange care in a more expensive setting and adjust the budget accordingly to ensure that needs are met.The Care Quality Commission (CQC) is assessing how local authorities in England are meeting the full range of their duties under Part 1 of the Care Act 2014. The assessments identify local authorities’ strengths and areas for improvement, facilitating the sharing of good practice and helping us to target support where it is most needed. The CQC is under a duty to inform my Rt Hon. Friend, the Secretary of State for Health and Social Care, if they consider an authority is failing to discharge its functions. My Rt Hon. Friend, the Secretary of State for Health and Social Care, has powers to intervene where he is satisfied that authorities have failed or are failing to discharge Care Act functions to an acceptable standard. Reports are made available on the CQC’s website at the following link:https://www.cqc.org.uk/

Whether his Department has assessed the extent to which residents and families are presented with a genuine choice when a care home placement becomes local‑authority funded, as opposed to being offered relocation as the only viable option.

Local authorities are best placed to understand and plan for the needs of their population, which is why, under the Care Act 2014, they are tasked with the duty to shape their care markets to meet the diverse needs of all local people. In doing so, they should use local population and market data to inform commissioning decisions, involve people and providers in the commissioning process, and encourage a wide range of service provision to ensure that people have a choice of appropriate and high-quality care services in their local area. Local authorities also have a duty to provide continuity of care to minimise disruption and to ensure that people continue to receive the care and support they need and do not suffer a gap in their care service when care arrangements change. The Care Quality Commission (CQC) is assessing how local authorities in England are meeting the full range of their duties under Part 1 of the Care Act 2014, including those related to commissioning. The CQC is under a duty to inform my Rt Hon. Friend, the Secretary of State for Health and Social Care, if they consider an authority is failing to discharge its functions. My Rt Hon. Friend, the Secretary of State for Health and Social Care, has powers to intervene where he is satisfied that authorities have failed or are failing to discharge Care Act functions to an acceptable standard. All reports are made available on CQC’s website and can be found at the following link: https://www.cqc.org.uk/care-services/local-authority-assessment-reports

Whether his Department has issued guidance to Integrated Care Boards on maximum acceptable waiting times for ADHD and autism assessments for children.

The waiting time standard recommended by the National Institute for Health and Care Excellence (NICE) is for a maximum waiting time of 13 weeks between a referral for an autism assessment and a first appointment. NICE guidelines on attention deficit hyperactivity disorder (ADHD) do not recommend a maximum waiting time standard from referral for an assessment of ADHD to assessment.The Government has recognised that, nationally, demand for assessments for autism and ADHD has grown significantly in recent years and that people, including children, are experiencing severe delays for accessing such assessments. The Government’s 10-Year Health Plan will make the National Health Service fit for the future, and reforms to the Special Educational Needs and Disabilities (SEND) focus will improve early intervention and support.It is the responsibility of integrated care boards (ICBs) to make available appropriate provision to meet the health and care needs of their local population, including provision of autism and ADHD services, in line with relevant NICE guidelines.Through the NHS Medium-Term Planning Framework, published 24 October 2025, NHS England has set clear expectations for local ICBs and trusts to improve access, experience, and outcomes for autism and ADHD services over the next three years, focusing on improving quality and productivity. The framework was explicit that ICBs and providers are expected to optimise existing resources to reduce long waits for ADHD and autism assessments and improve the quality of assessments by implementing existing and new guidance, as published.In December 2025, my Rt Hon. Friend, the Secretary of State for Health and Social Care, launched the independent review into the Prevalence and Support for mental health conditions, ADHD, and autism. The review is chaired by Professor Peter Fonagy, with Vice Chairs Professor Sir Simon Wessely and Professor Gillian Baird.The review’s interim report, published at the end of March, sets out the evidence reviewed so far on prevalence, describes the impact of rising demand for diagnosis and support, identifies where the evidence is uncertain, and outlines the key questions for the next phase. It does not offer final conclusions or recommendations.The final report, due in the summer, will make recommendations on how the Government, the health system and wider public services can respond to increasing demand for support more fairly and effectively so that people receive the right support, at the right time, in the right place.

What information his Department holds on the trends in the level of older people being required to move from established care home placements to alternative homes solely on cost grounds once they become local‑authority funded.

The Department does not hold this information.Where an individual is assessed as requiring support in a residential care home, and they are eligible for means tested support from their local authority, the local authority must ensure that the individual drawing on care is offered a genuine choice of accommodation. This must include at least one option which is affordable within the person’s personal budget.Where an individual wishes to remain in their current accommodation, and this accommodation is more expensive than their personal budget, the local authority is under a duty to arrange for the person to be placed in the preferred accommodation where it is satisfied that another person on their behalf, or in some limited circumstances the person receiving care, is willing and able to cover the difference in cost for the expected duration of the care arrangement, and other conditions set out in regulations are met.

If he will make an assessment of the potential merits of extending Jess’s Rule, or establishing a similar national protocol, to ensure that recurrent presentations automatically trigger a clinical review.

Jess’s Rule was published in September 2024 as formal clinical guidance, developed with the Royal College of General Practitioners and NHS England, to support and strengthen general practitioners’ (GPs’) clinical judgement. It encourages GPs to pause, review recurrent presentations, and consider whether anything may have been missed.Jess’s Rule formalises best practice, helping to embed a more consistent approach and reduce harmful inequalities in care. However, the guidance is intended to support, not replace, clinical decision-making. It does not mandate automatic referrals or investigations, as the GP remains responsible for deciding what action is clinically appropriate for the individual patient, in line with local pathways, and to avoid unnecessary pressure on services.We will continue to keep Jess’s Rule under review, including the case for any future updates to national guidance.

If he will consider requiring Jess’s Rule to be applied across all primary care contact points, including A&E and Child Assessment Units.

Jess’s Rule is an NHS England patient safety initiative for primary care. It is designed for general practitioners and supports them to reconsider a patient’s presentation and/or diagnosis where the patient has attended general practice three or more times and symptoms have escalated, or the diagnosis is uncertain.Martha’s Rule is an NHS England patient safety initiative for secondary care. It enables patients, families, and carers to request an urgent, independent review if they believe a hospital inpatient’s condition is deteriorating and is not being adequately addressed. This includes all acute hospitals in England, including paediatric acute inpatient service.

Whether his Department has made an assessment of the potential merits of introducing a mandatory national screening programme for prostate cancer to help improve early detection and reduce mortality.

On 28 November 2025, the UK National Screening Committee (UK NSC) opened a 12-week public consultation on a draft recommendation to offer targeted screening for prostate cancer in men with variants of BRCA1 and BRCA2 genes, every two years from the age of 45 to 61 years old. This consultation has now closed, and the committee is considering the responses.We welcome the UK NSC’s consideration of the evidence and robust consultation process. We expect the UK NSC to make a final recommendation soon. My Rt Hon. Friend, the Secretary of State for Health and Social Care, will then consider the advice, make a decision, and determine the next steps.

Whether his Department has issued guidance to integrated care boards on local commissioning in the context of patients’ legal right to choose under the NHS Choice Framework.

The Government is committed to patients having the right to choose their provider when referred to consultant-led treatment, or to a mental health professional, for their first appointment as an outpatient. Patients’ right to choose is set out in legislation and integrated care boards remain responsible for ensuring their own processes comply with the Right to Choose, including clinical appropriateness, eligibility criteria, and qualifying contract requirements. NHS England has issued national Patient Choice Guidance, available at the following link: https://www.england.nhs.uk/long-read/patient-choice-guidance/ This sets out an overview of the choices available to patients and the rules that underpin those rights. The guidance explains how commissioners can meet their statutory duties in relation to patient choice, supports greater consistency in the application of those rights across the National Health Service, and describes how NHS England manages enquiries and complaints relating to patient choice. NHS England has also published, as part of its Enforcement Guidance, further material explaining how it exercises its enforcement powers in relation to patient choice. Further information on the choices available for patients can be found on the NHS Choice framework, available at the following link: https://www.gov.uk/government/publications/the-nhs-choice-framework

What steps he is taking to reduce NHS waiting times for ADHD assessments; and what role he expects the independent sector capacity to have in meeting demand.

The Government has recognised that, nationally in England, demand for assessments for attention deficit hyperactivity disorder (ADHD) has grown significantly in recent years and that people are experiencing severe delays accessing such assessments. The Government’s 10-Year Health Plan for England will make the National Health Service fit for the future, recognising the need for early intervention and support.It is the responsibility of integrated care boards (ICBs) in England to make appropriate provision to meet the health and care needs of their local population, including providing access to ADHD assessment and treatment, in line with relevant National Institute for Health and Care Excellence guidelines.The independent sector provides important service capacity within ADHD services. We are committed to ensuring patients have equitable access to safe, effective, and high-quality services, irrespective of their service provider. Patients being referred for consultant-led elective care, or to a mental health professional, have the right to be treated by any clinically appropriate provider who holds a contract for the provision of NHS services.This includes the independent sector, which holds contracts with ICBs across the country to deliver services for the NHS. By working with the independent sector, we are making sure patients have greater choice in their local areas.NHS England established an ADHD taskforce which brought together those with lived experience with experts from the NHS, education, charity, and justice sectors to get a better understanding of the challenges affecting those with ADHD, including in accessing timely and equitable access to services and support. My Rt Hon. Friend, the Secretary of State for Health and Social Care, announced on 4 December 2025 the launch of an Independent Review into Prevalence and Support for Mental Health Conditions, ADHD and Autism. This independent review will inform our approach to enabling people with ADHD and autistic people to have the right support in place to enable them to live well in their communities.

What assessment he has made of the potential impact of Integrated Care Boards placing (a) activity caps and (b) other restrictions on NHS Right to Choose ADHD providers on patient (i) access, (ii) waiting times and (iii) clinical risk.

No specific assessment has been made on the potential impact of integrated care boards (ICBs) placing activity caps and other restrictions on NHS Right to Choose ADHD providers on patient access, waiting times or clinical risk.Patients have a legal Right to Choose their provider when referred for NHS-funded eligible care. ICBs are responsible for ensuring that their processes comply with the legal Right to Choose.NHS England issued advice to systems on ADHD service delivery and prioritisation on 7 October 2025. This advice includes guidance on managing service provisions, reviewing waiting lists and providing patient support. The advice is available at the following link:https://www.england.nhs.uk/long-read/adhd-service-delivery-and-prioritisation-advice-to-systems/

What action the Government is taking to end regional disparities in access to insulin pumps and continuous glucose monitors.

To reduce variation and health inequalities, data on the uptake of continuous glucose monitors (CGM) for diabetics is collected as part of the National Diabetes Audit (NDA).NHS England plans to routinely publish this data in the NDA Core Quarterly dashboard in 2025/26, which will provide the data insights integrated care boards require to deliver CGM to their populations.

What assessment his Department has made of the potential merits of piloting a national early-detection scheme for Type 1 Diabetes, in the context of seeking to deliver long-term savings and reducing unplanned hospital admissions.

NHS England has published a RightCare toolkit which sets out what good quality diabetes care looks like for children and young adults and which includes guidance on timely and accurate diagnosis.The National Institute for Health and Care Excellence has published clinical guidelines for the diagnosis, treatment, and care of children and young people with type 1 diabetes.Through our National Institute for Health and Care Research, we have supported the establishment of the Early Surveillance for Autoimmune diabetes, or the “ELSA” study. This study is exploring the feasibility and benefits of screening for type 1 diabetes.

What assessment he has made of the implementation of national early-detection programmes for Type 1 Diabetes in England compared to other countries such as Italy, in the context of around a third of people experiencing life-threatening diabetic ketoacidosis at diagnosis.

A national Task and Finish Group has been established by NHS England which brings together key experts from across the health system, including academia/research and leading national clinicians, to jointly assess the opportunities and challenges that are associated with a national screening programme for diabetes and to inform the national direction of travel with regard to the development of national policy in this area.

If he will make an assessment of the cost-effectiveness of a Type 1 Diabetes screening programme.

In the United Kingdom, new screening programmes and modifications to existing screening programmes are recommended by the UK National Screening Committee (UK NSC), an independent scientific advisory committee.The UK NSC received a submission via its 2024 open call process to consider screening for autoimmune type 1 diabetes through blood testing. Once the National Institute for Health and Care Excellence has published its recommendation on the drug teplizumab, the UK NSC will look again at this open call submission and consider whether a fresh review of the evidence for type 1 diabetes screening should be undertaken.

What steps he is taking to prevent the misdiagnosis of adults over 30 with Type 1 Diabetes as Type 2 within the NHS.

To coincide with World Diabetes Day on 14 November 2025, NHS England, in partnership with other key national stakeholders, launched a national awareness campaign to promote health care professionals in their identification and diagnosis of type 1 diabetes and reduce the risk of misdiagnosis.This included a call to action to healthcare professionals, signposting to information, and action to take if a person is displaying any of the symptoms of type 1 diabetes, as well as supportive resources.

What guidance his Department issues to GPs on immediate blood glucose testing when symptoms of Type 1 diabetes are reported.

The National Health Service has publicly accessible information on its website about the signs and symptoms of type 1 diabetes, available at the following link:https://www.nhs.uk/conditions/type-1-diabetes/symptoms/The DigiBete app, launched in June 2020, provides a wide range of clinically approved, age-appropriate resources to help with the self-management and awareness of type 1 diabetes, with further information available at the following link:https://www.digibete.org/type-1-awareness/It is the responsibility of the National Institute for Health and Care Excellence (NICE) to provide guidance and quality standards for the treatment and care of diabetes in England. The NICE NG18 guideline for type 1 and 2 diabetes provides clinical guidelines for the diagnosis, treatment, and care of children and young people.NG18 recommends that children and young people with suspected type 1 diabetes are referred immediately, on the same day, to a multidisciplinary paediatric diabetes team with the competencies needed to confirm diagnosis and provide immediate care.

What plans his Department has to improve public awareness of the early signs of Type 1 diabetes.

The National Health Service has publicly accessible information on its website about the signs and symptoms of type 1 diabetes, available at the following link:https://www.nhs.uk/conditions/type-1-diabetes/symptoms/The DigiBete app, launched in June 2020, provides a wide range of clinically approved, age-appropriate resources to help with the self-management and awareness of type 1 diabetes, with further information available at the following link:https://www.digibete.org/type-1-awareness/It is the responsibility of the National Institute for Health and Care Excellence (NICE) to provide guidance and quality standards for the treatment and care of diabetes in England. The NICE NG18 guideline for type 1 and 2 diabetes provides clinical guidelines for the diagnosis, treatment, and care of children and young people.NG18 recommends that children and young people with suspected type 1 diabetes are referred immediately, on the same day, to a multidisciplinary paediatric diabetes team with the competencies needed to confirm diagnosis and provide immediate care.

What steps his Department is taking to ensure that general practitioners receive training on recognising symptoms of Type 1 diabetes in children and young people.

The National Health Service has publicly accessible information on its website about the signs and symptoms of type 1 diabetes, available at the following link:https://www.nhs.uk/conditions/type-1-diabetes/symptoms/The DigiBete app, launched in June 2020, provides a wide range of clinically approved, age-appropriate resources to help with the self-management and awareness of type 1 diabetes, with further information available at the following link:https://www.digibete.org/type-1-awareness/It is the responsibility of the National Institute for Health and Care Excellence (NICE) to provide guidance and quality standards for the treatment and care of diabetes in England. The NICE NG18 guideline for type 1 and 2 diabetes provides clinical guidelines for the diagnosis, treatment, and care of children and young people.NG18 recommends that children and young people with suspected type 1 diabetes are referred immediately, on the same day, to a multidisciplinary paediatric diabetes team with the competencies needed to confirm diagnosis and provide immediate care.