Written questions by Collins.

What steps his Department is taking to encourage early diagnosis of bowel cancer in Harpenden and Berkhamsted constituency.

Awaiting answer.

What steps his Department is taking to introduce a realistic and responsive price‑concession mechanism to for pharmacies.

Awaiting answer.

What recent steps his Department has taken to support unpaid carers of family members living with dementia in Harpenden and Berkhamsted constituency; and what recent assessment he has made of the adequacy of that support.

Awaiting answer.

What assessment he has made of whether the NHS target of treating 85% of cancer patients within 62 days is being met in Harpenden and Berkhamsted constituency.

The Department does not collect this data. The data collected by NHS England is not collected at a constituency level. Data on what proportion of cancer patients in the Hertfordshire and West Essex Integrated Care Board received a first treatment within the 62-day cancer waiting time standard can be found on the NHS England website at the following link:https://www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting-times/In March 2026, the Hertfordshire and West Essex Integrated Care Board performed at 75.4% on the 62-day cancer waiting time standard. This exceeds the Operational Planning Guidance for NHS systems to perform at 75% by March 2026. We have committed in the recently published National Cancer Plan to improve performance against the 62-day standard by the end of this Parliament.

What steps his Department is taking to increase public participation in the bowel cancer screening programme in Harpenden and Berkhamsted constituency.

Bowel screening uptake in Berkhamsted and Harpenden is currently between 84% and 87%. The NHS Central East Integrated Care Board (ICB) works closely with general practices (GPs) to encourage promotion of bowel screening through a ‘making every contact count’ approach when they are informed which of their patients have not returned their faecal immunochemical test (FIT).The ICB has also used regional innovation screening funding to support cancer screening projects in Hertfordshire, including some specifically for bowel cancer. In 2025/26, the programme included:delivering outreach to people on the Serious Mental Illness Register who face barriers to screening because of their mental ill health;targeting non-responders from communities who find National Health Services hard-to-reach, including traveller and asylum seeker communities;supporting screening uptake within the learning disability population, with a particular focus on bowel screening;providing public education on cancer awareness to specific postcodes with low uptake of screening, delivered by the patient-led ‘Cancel out Cancer’ group;reviewing 130,000 bowel screening non-responders to identify themes in order to understand potential barriers; andreaching out to patients who are eligible for screening but who haven’t taken up the opportunity to answer any questions they have and book in appointments for people as needed, via Cancer Care Co-ordinators who form part of the GP teams across Hertfordshire.In England, coverage of bowel cancer screening has been increasing in recent years. In 2019, 60.5% of people took the offer up, while now it is 71.8%. To further increase coverage across England, NHS England is doing the following:delivering new approaches to communicating with people about screening through the NHS App;incorporating the reasonable adjustment flag into screening to ensure that people get information in the way they want, and that adjustments are made to support people at appointments;has recently updated the bowel cancer screening leaflets and is updating the bowel cancer screening letters to improve accessibility; andhas made the bowel cancer screening FIT kit more accessible for people who are blind or partially sighted.

What support his Department is providing to people living with Multiple Sclerosis in Harpenden and Berkhamsted constituency.

At the national level, initiatives such as NHS England’s Getting It Right First Time programme and the NHS RightCare Progressive Neurological Conditions toolkit both aim to reduce unwarranted variation in services and improve equity of care for people with multiple sclerosis (MS).At the local level, the West Hertfordshire Teaching Hospitals NHS Trust’s neurology department provides care to patients with MS in the Harpenden and Berkhamsted constituency. The team consists of consultant neurologists, a consultant neurophysiologist, and two specialist nurses. All consultants hold joint appointments with University College London Hospitals or the Royal Free Hospital, giving access to specialised neurological care. The Central London Community Healthcare NHS Trust provides the community neurological rehabilitation service for adults in the Harpenden and Berkhamsted constituency. The service provides specialist therapy to patients with long term neurological conditions, including those with MS. Specialist advice and oversight is available from a consultant neurologist where clinically appropriate. The service offers complex care, needs-led intervention, specialist equipment, and self-management support according to intensity of clinical needs.

What assessment his Department has made of (a) the prevalence of respiratory disease and (b) the number of emergency hospital admissions for respiratory conditions in Harpenden and Berkhamsted constituency compared with national averages; and what steps he is taking to ensure respiratory health is prioritised nationally.

Data is available for emergency Finished Admission Episodes (FAEs) where there was a primary diagnosis of 'respiratory conditions’. The following table shows the number of FAEs where there was a primary diagnosis of 'respiratory conditions’ for Harpenden and Berkhamsted and England, for activity in English National Health Service hospitals and English NHS commissioned activity in the independent sector, for 2024/25 and provisionally for 2025/26:Westminster Parliamentary Constituency of Residence2024/25 (August 2024 to March 2025)2025/26 (April 2025 to December 2025)Harpenden and Berkhamsted845595England612,855511,558Source: Hospital Episode Statistics, NHS England. Available data on trends in respiratory conditions can be found on the Department’s Fingertips dataset. Data is not available by parliamentary constituency. Data is available at regional, county, unitary authority, and integrated care board level. Information for Hertfordshire can be found at the following link: https://fingertips.phe.org.uk/search/Respiratory#page/1/gid/1/pat/15/ati/502/are/E10000015/iid/90933/age/314/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1 The Government has committed to delivering three big shifts that our National Health Service needs to be fit for the future: from hospital to community; from analogue to digital; and from sickness to prevention. All of these are relevant to improving respiratory health in all parts of the country. Through our community diagnostic centres, we are building capacity for respiratory testing and enabling people to get diagnosed closer to home. 101 community diagnostic centres across the country now offer out of hours services, 12 hours a day, seven days a week, meaning patients can access vital diagnostic tests around busy working lives. This is alongside action being taken to expand capacity and improve the quality of pulmonary rehabilitation services to support patients living with respiratory condition.

What lessons his Department has learned of the effectiveness of the legal duty to provide free period products under the Period Products (Free Provision) (Scotland) Act 2021.

The Government recognises the importance of women and girls being able to access the care they need for their reproductive health, including period products. That is why there are several Government schemes across England which ensure that those who are most vulnerable can access the products they need. The Department for Education’s period products scheme launched in 2020 and provides free period products to girls and women in their place of study so that nobody misses out on education because of their period. Similarly, all women and girls being cared for by the National Health Service are entitled to be given, on request, appropriate period products free of charge. All women in prison have access to menstrual products, which are typically stored in locations that allow women to collect items themselves as needed.We are also taking steps to ensure that products are as affordable as possible. The tax on period products has been zero-rated since 2021 and, in 2023, this was extended to include reusable period underwear.The Department of Health and Social Care will be exploring the effectiveness of the legal duty to provide free period products under the Period Products (Free Provision) (Scotland) Act 2021.

Whether his Department is taking steps to develop a national plan for a sudden unexplained death in childhood plan.

We recognise the devastating impact of Sudden Unexplained Death in Childhood (SUDC) on affected families and communities. There are currently no plans to develop a national plan for SUDC. However, during a recent Westminster Hall Debate on this issue, I highlighted the Government’s commitment to strengthening pathology services, ensuring high-quality bereavement support, and growing the evidence base.A national programme to strengthen National Health Service perinatal and paediatric pathology services was launched in 2022 to help reduce waitlists for death certification and access to screening, alongside additional funding to expand training posts.We are encouraging research applications on any aspect of SUDC through the National Institute for Health and Care Research, alongside supporting the National Child Mortality Database which is improving our understanding of deaths in children over the age of one years old. Continued support and information for bereaved families is provided through the When a Child Dies leaflet, which is available at the following link:https://www.ncmd.info/publications/when-a-child-dies-a-guide-for-parents-and-carers/The When a Child Dies leaflet was updated in 2025 to include refreshed bereavement guidance and links to organisations such as SUDC UK and the Lullaby Trust. Families are also assigned a key worker to guide them through the child death review process and to help them access appropriate support and services. Further bereavement support can be found on the NHS help page, Get help with grief after bereavement or loss, and the GOV.UK page, What to do after someone dies: Bereavement help and support, which are available, respectively, at the following two links:https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/feelings-and-symptoms/grief-bereavement-loss/https://www.gov.uk/after-a-death/bereavement-help-and-supportNHS Bereavement support is commissioned locally to help ensure services are shaped around the needs of their community. Anyone affected by SUDC is encouraged to contact their general practice, who can offer advice and refer them to local bereavement support services. We are also exploring options to ensure parents and professionals can access appropriate information and signposting, including via the NHS website.

What assessment his Department has made of the potential to scale up investment in dementia clinical trials, including through the Dementia Goals Programme.

Government responsibility for delivering dementia research is shared between the Department for Health and Social Care, with research delivered by the National Institute for Health and Care Research (NIHR), and the Department for Science, Innovation and Technology, with research delivered via UK Research and Innovation (UKRI).The Department for Health and Social Care is committed to ensuring that all patients, including those with dementia, have access to cutting-edge clinical trials and innovative, lifesaving treatments. Government funding is already enabling the dementia clinical trials landscape to become more efficient and accessible.The Dame Barbara Windsor Dementia Goals programme, with up to £150 million expected to be allocated to, or aligned with it, aims to speed up the development of new treatments for dementia and neurodegenerative conditions by accelerating innovations in biomarkers, clinical trials, and implementation. Closely aligned to the programme, the NIHR has invested up to £50 million into the UK Demetia Trials Network (UKDTN). UKDTN aims to expand the United Kingdom’s early phase clinical trial capabilities in dementia by addressing industry challenges around trial recruitment and fragmented research infrastructure. The UKDTN will establish a coordinated network of over 20 trial sites, with a real-time database to enable efficient identification of trial sites for industry collaboration. The network will also build a skilled workforce of dementia trial specialists, including early-career researchers, and embedded research nurses to support trial set-up and delivery.In addition, the Medical Research Council’s £20 million investment into a Dementia Trials Accelerator aims to embed more innovation in how clinical trials are designed and delivered in order to increase the speed and quality, while driving down the cost of large-scale trials.In partnership with Alzheimer’s Society, Alzheimer’s Research UK, and Alzheimer Scotland, the NIHR also delivers Join Dementia Research, an online platform which enables the involvement of people with and without a dementia diagnosis, as well as carers, to take part in a range of important research, including studies evaluating potential treatments for dementia. As of March 2026, over 110,000 participants have joined dementia research through the service, with 112 studies currently open.

What recent steps his Department has taken to increase the number and capacity of dementia trials.

Government responsibility for delivering dementia research is shared between the Department for Health and Social Care, with research delivered by the National Institute for Health and Care Research (NIHR), and the Department for Science, Innovation and Technology, with research delivered via UK Research and Innovation (UKRI).The Department for Health and Social Care is committed to ensuring that all patients, including those with dementia, have access to cutting-edge clinical trials and innovative, lifesaving treatments. Government funding is already enabling the dementia clinical trials landscape to become more efficient and accessible.The Dame Barbara Windsor Dementia Goals programme, with up to £150 million expected to be allocated to, or aligned with it, aims to speed up the development of new treatments for dementia and neurodegenerative conditions by accelerating innovations in biomarkers, clinical trials, and implementation. Closely aligned to the programme, the NIHR has invested up to £50 million into the UK Demetia Trials Network (UKDTN). UKDTN aims to expand the United Kingdom’s early phase clinical trial capabilities in dementia by addressing industry challenges around trial recruitment and fragmented research infrastructure. The UKDTN will establish a coordinated network of over 20 trial sites, with a real-time database to enable efficient identification of trial sites for industry collaboration. The network will also build a skilled workforce of dementia trial specialists, including early-career researchers, and embedded research nurses to support trial set-up and delivery.In addition, the Medical Research Council’s £20 million investment into a Dementia Trials Accelerator aims to embed more innovation in how clinical trials are designed and delivered in order to increase the speed and quality, while driving down the cost of large-scale trials.In partnership with Alzheimer’s Society, Alzheimer’s Research UK, and Alzheimer Scotland, the NIHR also delivers Join Dementia Research, an online platform which enables the involvement of people with and without a dementia diagnosis, as well as carers, to take part in a range of important research, including studies evaluating potential treatments for dementia. As of March 2026, over 110,000 participants have joined dementia research through the service, with 112 studies currently open.

What assessment he has made of the potential impact of private parking enforcement practices at hospital sites on patients attending medical treatment; and whether additional protections are being considered for those who overstay due to clinical circumstances.

No assessment has been made of the potential impact of private parking enforcement practices at hospital sites on patients attending medical treatment and protections are being considered for those who overstay due to clinical circumstances.National Health Service organisation make decisions locally on how they provide their car parking for patients, visitors, and staff. This will include whether parking services are provided in-house or outsourced. Where outsourced, the NHS car parking guidance 2022 for NHS trusts and NHS foundation trusts states that:- NHS organisations are responsible for the actions of private contractors who run car parks on their behalf; and- NHS organisations should act against rogue contractors in line with the relevant codes of practice where applicable Further information is available at the following link:https://www.gov.uk/government/publications/nhs-patient-visitor-and-staff-car-parking-principles/nhs-patient-visitor-and-staff-car-parking-principlesIt is recognised that the attendance at hospitals cannot be predicted in advance and therefore, the NHS parking guidance states that trusts should consider installing ‘pay on exit’ or similar schemes so that drivers pay only for the time that they have used. Additional charges should only be imposed where reasonable and should be waived when overstaying is beyond the driver’s control, such as when treatment takes longer than planned, or when staff are required to work beyond their scheduled shift.

If her Department will make an assessment of the potential impact of the transition from student loan funding to NHS bursary support on the cost of living for medical students in the later years of their degree.

The Government reviews the funding arrangements for medical students annually. This includes the NHS Bursary Scheme and Student Finance England support.The 10-Year Health Plan, published in July 2025, recognises the need to improve access to the medical profession for those from disadvantaged backgrounds and commits to a range of actions to achieve this. This includes exploring options to improve financial support for students from the lowest socioeconomic backgrounds, so that they are able to thrive at medical school. We will set out next steps in due course.

Whether his Department has taken recent steps to develop a modern service framework for frailty and dementia; and if he will take steps to ensure that it includes national standards for diagnostic pathways.

The Modern Service Framework for Frailty and Dementia will reduce unwarranted variation and narrow inequality in diagnosis and care for those living with dementia. It will set national standards and redirect National Health Service priorities to provide the best care and support.Central to this modern service framework will be improved care and support and access to a timely and accurate diagnosis.We are still developing plans for the Modern Service Framework for Frailty and Dementia and, in doing so, we are engaging with a wide group of partners to understand what should be included to ensure the best outcomes for people living with dementia.As part of this exercise, we are considering all options to help reduce variation, including reviewing existing guidance and pathways. This will include the D100: Pathway Assessment Tool and the Dementia Care Pathway, covering all elements of the Well Pathway from Prevention through to Dying Well.We are working to develop the content as soon as possible and we will keep partners updated on progress and timings as this work unfolds.

If he will take steps to ensure that the final guidance under the Down Syndrome Act 2022 provides direction on required provision, including speech and language support and transition to adulthood; and how implementation will be monitored.

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. We considered a range of evidence from our Call for Evidence and engagement when developing the draft Down syndrome guidance, currently out for public consultation, including research on speech and language therapy (SLT). The draft guidance highlights that people with Down syndrome are likely to have communication needs and sets out support that can be provided, including that people with Down syndrome should be able to access speech and language assessment and support in a timely manner. The guidance is also clear that NHS commissioners and providers may offer people with Down syndrome, and their families and carers, a range of SLT services and interventions to support their communication, tailored to their specific needs. This should include early intervention services starting from birth, continuing through early years to support a good start in life, and then into primary and secondary school and transition to adulthood, including transitions from child to adult care and support. 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 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 potential impact of diagnostic overshadowing on people with Down syndrome; and if he will take steps to include expectations on condition-specific training for relevant professionals within guidance under the Down Syndrome Act 2022.

In 2023, NHS England produced a guide for frontline staff as they support people with a learning disability which asks staff to be aware of diagnostic overshadowing, and which 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/NHS England does not hold data on the extent of diagnostic overshadowing for people with Down syndrome, nor is the data held centrally.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, 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 support the needs of people with Down syndrome. The draft guidance, which was published for public consultation on 5 November 2025, acknowledges that the care of people with Down syndrome may be affected by diagnostic overshadowing and recognises its impact on the care and treatment that people receive. Once the consultation has closed on 30 March 2026, the Government will consider all consultation responses to inform the final guidance to be published.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.Under existing legislation, Care Quality Comision registered providers must ensure that staff receive appropriate professional development which is necessary for them to carry out their duties and must receive specific training on learning disability and autism appropriate to their role, as per Section 20 of the Health and Social Care Act 2008, Section 181(7) of the Health and Care Act 2022 and Regulation 18 of the Health and Social Care Act 2008 Regulated Activities) Regulations 2014. We expect that providers should be considering whether specific training on Down syndrome is required for their staff, and the draft guidance under the Down Syndrome Act sets out that some staff who work frequently with people with Down syndrome may require additional training on Down syndrome.

What steps are being taken to ensure dementia diagnosis pathways align with NHS access standards for timely assessment and treatment.

We recognise the importance of a timely diagnosis and remain committed to increasing diagnosis rates and ensuring people can access any treatment licensed or recommended by the National Institute for Health and Care Excellence, and support they need.We will deliver the first ever Modern Service Framework for Frailty and Dementia to deliver rapid and significant improvements in quality of care and productivity. This will be informed by phase one of the independent commission into adult social care, which is expected this year.As part of this exercise, we are considering all options to help reduce variation, including reviewing metrics and targets.

What assessment his Department has made of the potential implications for his policies of the impact of breast density on the reliability of mammogram screening for breast cancer; and what steps his Department is taking to help ensure that women with high breast density receive appropriate (a) information and (b) access to supplementary screening methods.

The Government is guided by the UK National Screening Committee (UK NSC), an independent scientific advisory committee which makes its recommendations based on internationally recognised criteria and a rigorous evidence review and consultation process. It is only where the UK NSC is confident that to screen would provide more good than harm that a screening programme is recommended, as all medical interventions carry an inherent risk.A review by the UK NSC of the evidence in 2019 of supplementary ultrasound for women with dense breasts and negative mammograms showed insufficient evidence to balance the risks, benefits, and costs. In the field, there are concerns that undertaking notification of increased density without provision of any modification of screening may increase inequity and capacity issues, as well as leading to increased anxiety and confusion.The UK NSC is considering the best approach for women with dense breast tissue. It reviewed the evidence relating to the provision of additional breast screening for women who have dense breast tissue and invited stakeholders’ feedback on the findings to inform future work. The consultation closed in August 2025. Further work is needed to understand the clinical impact and costs of adding breast density to the screening pathways in the United Kingdom.In the meantime, the Breast Screening Risk Adaptive Imaging for Density (BRAID) trial is looking into the use of supplementary imaging techniques for women within the standard breast screening programme who are found to have radiographically dense breast tissue. The different tests include magnetic resonance imaging and ultrasound. The UK NSC is in contact with the researchers and is reviewing this evidence as it becomes available. It will make recommendations to ministers in light of this.The NHS Breast Screening Programme advises all women, as part of its literature, that cancer may be missed and that breast symptoms should be reported even if they have recently had a negative screening mammogram.

What process is available to manufacturers to seek reassignment or review of a GMDN Level 2 classification used by the MHRA where the published description no longer reflects the device’s intended purpose.

Global Medical Device Nomenclature (GMDN®) codes and categories are managed and determined by the GMDN Agency. The structure is managed independently of the Medicines and Healthcare products Regulatory Agency (MHRA) who is not involved in assigning GMDN® codes to categories. Questions regarding GMDN® code allocations to categories should therefore be directed to the GMDN Agency.

What oversight his Department exercises over the MHRA’s use of GMDN Level 2 classifications in the registration and regulation of medical devices in the UK.

The Medicines and Healthcare products Regulatory Agency (MHRA) derives most of its income from charging statutory fees for its services. Generally, wherever the MHRA provides a service for regulatory work, a statutory fee is set to recover the cost of the work involved.This means the regulated bear the cost of regulation, and Government bodies do not make a loss which must be subsidised by wider Government and ultimately the taxpayer, including patients themselves.This is in line with the HM Treasury guidance “Managing Public Money” which states that ‘the standard approach is to set charges to recover full costs’. The MHRA does not make any profit from statutory fees.In 2024, the MHRA consulted on proposals regarding ongoing cost recovery, and a Government response was published in March 2025. This is available at the following link:https://www.gov.uk/government/consultations/mhra-consultation-on-statutory-fees-proposals-on-ongoing-cost-recoveryGoing forward, the MHRA intends to update its fees every two years as regularity provides more certainty to customers and enables financial planning. This is standard practice amongst government bodies operating on a cost recovery basis.The modified Medical Device Registration Fee will be calculated by relating staff costs for post-market work to the number of Global Medical Device Nomenclature (GMDN®) codes registered to each manufacturer. The GMDN® is a comprehensive set of terms that name and group all medical device products. The Department has an agreement with the GMDN Agency for the use of the GMDN® Codes and Categories. However, these Codes and Categories are managed by the GMDN Agency.The MHRA, as an executive agency of the Department, may use the GMDN® Codes and Categories. It does so for the purposes of devices registration and vigilance reporting, which is essential for the MHRA’s work to implement the regulations for medical devices and in-vitro diagnostics.There will be an annual fee for each of the GMDN® codes under which a manufacturer registers.