Written questions by Collins.

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 The draft guidance highlights that people with Down syndrome are likely to have communication needs and sets out support that can be provided, including that people with Down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 her Department is taking to support the hospitality sector in Harpenden and Berkhamsted constituency.

The Government recognises the important role the hospitality sector plays both in terms of its economic contribution but also to our culture.That is why we are delivering a long overdue reform to rebalance the business rates system and support the high street businesses, as promised in our manifesto. We are introducing new permanently lower tax rates for eligible retail, hospitality and leisure (RHL) properties which are worth nearly £900 million per year and will benefit over 750,000 properties.This Government has worked closely with the hospitality sector. We announced the first National Licensing Policy Framework and are working to ensure local authorities apply it consistently to ease licensing decisions ‘on the ground’. We have extended opening hours for Home Nations games in the later stages of the Men’s Football World Cup. We will also legislate to increase the number of Temporary Events Notices venues can hold, helping them screen further national moments and host community and cultural events.In addition, we are more than doubling the Hospitality Support Fund to £10 over three years, ending upward-only rent review clauses and introducing a strong Community Right to Buy.We will continue to work with the hospitality sector to develop a new cross-government High Streets Strategy to help businesses in Harpenden and Berkhamsted, and across the country, to remain the centre of local communities.

How many UK citizens living abroad were making voluntary Class 2 National Insurance contributions in each of the last five years.

A population estimate for the number of individuals who pay voluntary class 2 National Insurance contributions abroad is being published on the 12 March 2026, in the Tax Information and Impact note for the Voluntary National Insurance contributions abroad changes announced at Budget 2025.

Communities and Local Government, what assessment he has made of the potential impact of the grey belt policy on speculative development proposals on village edges in Harpenden and Berkhamsted constituency, while local plans are under examination.

I refer the hon. Member to the answer given to Question UIN 111723 on 24 February 2026.

What assessment he has made of the adequacy of the availability of Government decarbonisation support for medium-sized community buildings that are not classified as public sector bodies.

Eligible community buildings can access support through the Boiler Upgrade Scheme, which provides grants of up to £7,500 towards the installation of low‑carbon heating systems. Landlords and tenants in this sector can search for local grant and advice schemes via the Government’s finance and support for businesses pages at: https://www.gov.uk/business-finance-support. They can also access energy efficiency advice through the Government’s Business Energy Efficiency Campaign at: https://businessenergyefficiency.campaign.gov.uk/

What consideration her Department gave to transition arrangements for UK citizens living abroad who have been making voluntary Class 2 National Insurance contributions but have not yet qualified for a full State Pension.

The changes to voluntary National Insurance contributions policy announced at Budget retain routes for individuals living outside of the UK to fill gaps in their NI records by paying Class 3 NICs, which allows individuals to continue to build entitlement to the UK State Pension. This includes transitional arrangements for existing voluntary Class 2 and 3 customers to not be subject to the new 10-year qualifying conditions. The removal of access to voluntary Class 2 NICs applies for the 2026/27 tax year onwards, and does not affect the ability of any customer to pay voluntary Class 2 NICs for periods abroad prior to 6 April 2026.

Innovation and Technology, what progress the Digital Commercial Centre of Excellence within her Department has made in improving the procurement of digital services, including cloud, since its establishment.

The Digital Commercial Centre of Excellence (DCCOE) is responsible for delivering on the digital procurement recommendations made by the National Audit Office and Public Accounts Committee respectively. Since the establishment of the DCCOE we have made positive progress in addressing those recommendations, including:The DCCOE has recently concluded the successful agreement of an End User Device (EUD) aggregation purchase that allows participating organisations to realise cost efficiencies of approximately 11% versus current procurement arrangements.On cloud specifically the DCCOE is leading on efforts to transform the way we procure cloud services, in line with commitments made in the Blueprint for Modern Digital Government to "negotiate whole-of-public-sector agreements and contracting once for a limited number of high value cases, including platform services such as cloud".

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 steps her Department is taking to help reduce the backlog of medical driving licence applications; whether this includes (a) staffing and (b) other resource changes; and whether target processing times have been set for these applications.

Driving licence applications where a medical condition must be investigated before a licence can be issued can take longer to process as the Driver and Vehicle Licensing Agency (DVLA) is often reliant on receiving information from third parties, including medical professionals. The DVLA is currently experiencing an increase in the volume and complexity of driving licence applications. This has unfortunately led to longer waiting times for some customers. The DVLA keeps applicants informed of key updates on their case, including when medical information is requested or chased. To improve performance, the DVLA is updating its online service, and launching a new casework system. A new digital medical services portal will also launch in April. These enhancements, alongside the recruitment of additional staff to deal with medical applications and answer telephone calls, will deliver real improvements for customers. In 2024/25 the DVLA achieved 85 per cent against its customer service measure to make a licensing decision in 90 days in 90 per cent of medical driving licence cases.

What steps her Department is taking to help (a) reduce the time taken to process medical driving licence applications and (b) ensure applicants receive timely updates on the status of their applications.

Driving licence applications where a medical condition must be investigated before a licence can be issued can take longer to process as the Driver and Vehicle Licensing Agency (DVLA) is often reliant on receiving information from third parties, including medical professionals. The DVLA is currently experiencing an increase in the volume and complexity of driving licence applications. This has unfortunately led to longer waiting times for some customers. The DVLA keeps applicants informed of key updates on their case, including when medical information is requested or chased. To improve performance, the DVLA is updating its online service, and launching a new casework system. A new digital medical services portal will also launch in April. These enhancements, alongside the recruitment of additional staff to deal with medical applications and answer telephone calls, will deliver real improvements for customers. In 2024/25 the DVLA achieved 85 per cent against its customer service measure to make a licensing decision in 90 days in 90 per cent of medical driving licence cases.

How many applications for refugee family reunion submitted before the route was temporarily suspended have been awaiting a decision for longer than the published service standard.

The Home Office temporarily paused the Refugee Family Reunion route from 4 September 2025, with applications submitted before that point continuing to be processed under the previous rules.The number of Refugee Family Reunion applications submitted before the pause and awaiting a decision beyond the service standard is not available in published statistics and could only be collated and verified at disproportionate cost.Official statistics published by the Home Office are kept under review in line with the code of practice for statistics, considering a number of factors including user needs, as well as quality and availability of data.

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 steps the MHRA is taking to address circumstances in which a previously used GMDN Level 2 code has been obsoleted or materially amended at the point of mandatory device registration renewal.

Global Medical Device Nomenclature (GMDN) Codes and Categories are managed by the GMDN Agency. The GMDN Agency may obsolete GMDN Codes within a hierarchy of GMDN Categories. If a GMDN Code is obsoleted, the Medicine and Healthcare products Regulatory Agency (MHRA) will receive a feed notifying it of the GMDN Code obsolescence. When a GMDN Code becomes obsolete, the MHRA notifies all registrants that are impacted by the obsolescence. Applicants are notified within the MHRA Device Online Registration System (DORS). The applicant can then update the obsolete GMDN Code to an active GMDN Code within DORS.If a newly selected active GMDN Code falls within a different GMDN Level 2 Category, or Level 1 Category where no Level 2 Category exists, an annual fee may become payable from 1 April of the following year at the time of renewal. The fee will be charged if the newly selected GMDN Code is the only device within the chargeable category.

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.

What recent steps he has taken to increase access to GP appointments.

This government has invested an extra £1.6 billion into general practice since coming into office, recruited over 2000 GPs, and extended access to online services throughout core hours, delivering 6.8 million more appointments, 46,000 more benefiting your constituents in the last year. Thanks to the steps the government has taken, 75% of patients now say it is easy to contact their GP, up a sizeable 14 percentage points since July 2024, a very positive development that I’m sure the honourable lady would wish to welcome. In our manifesto we pledged to end the 8am scramble - and that is precisely what we are doing.

What assessment she has made of the potential impact of business rates on soft play centres in Harpenden and Berkhamsted constituency.

I refer you to my previous answer to PQ 111499.

With reference to the National Institute for Health and Care Research's news story entitled NIHR launches £13.7 million investment into brain tumour research, published on 19 December 2025, what assessment his Department has made of the potential impact of funding the NIHR Brain Tumour Research Consortium and Brain Tumour Research Centres of Excellence on the level of patient access to tumour tissue freezing within routine NHS neuro-oncology pathways, including access for patients treated outside specialist centres to sequencing, research, and clinical trials.

The Department invests over £1.6 billion each year in research through the National Institute of Health and Care Research (NIHR).In January 2026, the NIHR announced increased investment of over £25 million in the NIHR Brain Tumour Research Consortium. The world-leading consortium aims to transform outcomes for adults and children and their families who are living with brain tumours, ultimately reducing lives lost to cancer. Its activities will include:enrolling patients to a ‘Real World’ study tracking their progress in everyday medical settings, before matching them to new clinical trials based on their cancer subtype;developing pioneering new clinical trials, including platform trials, to test medicines and radiotherapy technologies, immunotherapies, and novel gene therapies. This includes targeted precision medicine; anddeveloping new training programmes for those working in brain cancer research to build capacity and increase skills among the next generation of researchers.It is anticipated that this funding will include costs associated with freezer capacity to house frozen tissue and liquid biopsy samples specifically to support the consortium’s activities. The consortium will also engage with partners on the standardised pathways for tissue storage and whole genome sequencing for all patients for stratification into clinical trials.In addition, the NIHR’s investments for capital equipment, technology, and modular buildings support National Health Service trusts across England to deliver high-quality research to improve the health of the population. This investment includes cutting edge research equipment and fixed assets such as ultra-low and cryogenic freezers, to strengthen research capacity and improve access to samples for research.

What steps his Department is taking to help support people with endometriosis in the workplace in Harpenden and Berkhamsted constituency.

Good work is good for health, so we want everyone to get work and get on in work, whoever they are and wherever they live. Backed by £240 million investment, the Get Britain Working White Paper launched in November 2024 is driving forward approaches to tackling economic inactivity. Disabled people and people with health conditions are a diverse group so access to the right work and health support, in the right place, at the right time, is key. The Government is committed to supporting disabled people and people with health conditions, including women with endometriosis, with their employment journey. We therefore have a range of specialist initiatives to support individuals to stay in work and get back into work, including those that join up employment and health systems. Existing measures include support from Work Coaches and Disability Employment Advisers in Jobcentres and Access to Work grants, as well as joining up health and employment support around the individual through Employment Advisors in NHS Talking Therapies, Individual Placement and Support in Primary Care and WorkWell. WorkWell is part of Pathways to Work and will be rolled out across all of England backed by up to £259 million investment over three years. We are also rolling out Connect to Work, our supported employment programme for anyone who is disabled, has a health condition or is experiencing more complex barriers to work. In November 2025, Sir Charlie Mayfield reported his Keep Britain Working Review, setting out recommendations to support employers to create healthier and more inclusive workplaces and radically reshape the way Government works with employers to improve outcomes. Following publication we have entered the Vanguard phase and, as part of this, we are partnering with Vanguard employers to test how we can better support good health in work, with a focus on women's health as part of this. Women’s health directly impacts economic participation, with health issues being the leading cause of lost working time for women. We have been inputting into the Women’s Health Strategy renewal to ensure women being in work is a positive health outcome. This includes a commitment to adopting a women’s health across the life course lens as part of the partnership with Vanguard employers in the Keep Britain Working Vanguard Phase. The 10 Year Health Plan, published in July, builds on existing work to better integrate health with employment support and incentivise greater cross-system collaboration, recognising good work is good for health. The Plan states our intention to break down barriers to opportunity by delivering the holistic support that people need to access and thrive in employment by ensuring a better health service for everyone, regardless of condition or service area. It outlines how the neighbourhood health service will join up support from across the work, health and skills systems to help address the multiple complex challenges that often stop people finding and staying in work. Individuals unable to work due to endometriosis may be eligible to receive Statutory Sick Pay from their employer which, from April becomes payable from the first full day of sickness absence.