Written questions by Morton.

With reference to HCWS1248, what estimate has been made of the annual cost to the NHS of expanding access to abiraterone; what savings have been achieved through the availability of generic versions of the drug; and how value for money will be assessed over the course of the commissioning policy.

Approximately 2,000 men diagnosed in the last three months with non‑metastatic prostate cancer will now be able to receive abiraterone where it is of clinical benefit, alongside prednisolone. An additional 7,000 men are expected to be diagnosed with prostate cancer each year and will be eligible for the drug. The clinical treatment criteria are available via the Cancer Drugs Fund list at the following link:https://www.england.nhs.uk/publication/national-cancer-drugs-fund-list/These national clinical treatment criteria ensure equity of access for patients across England.NHS England sets national service standards for those elements of cancer care designated as specialised services. Integrated care boards, supported by Cancer Alliances, are expected to plan and organise access to prostate cancer treatment in line with national standards. The integration of specialised and nonspecialised commissioning allows them to join up care and target resources where they can have the greatest impact on outcomes.The National Prostate Cancer Audit (NPCA) assesses the process of care and its outcomes in men diagnosed with prostate cancer in England and Wales. Further information about the NPCA can be found via the National Disease Registration Service at the following link:https://digital.nhs.uk/ndrs/our-work/ncras-partnerships/national-prostate-cancer-audit-npcaInformation regarding the annual cost of expanding access to abiraterone is commercially sensitive. The availability of generic abiraterone means the National Health Service in England can procure the treatment at a lower cost than Zytiga under patent. NHS England has been able to give the green light to the rollout of generic abiraterone for thousands more eligible patients thanks to the health service buying and delivering treatments at better value, following the clinical advice to roll the treatment out last year.

With reference to HCWS1248, what arrangements are in place to monitor patient outcomes following the expanded use of abiraterone at earlier stages of prostate cancer; and whether those outcomes will be published on a national and regional basis.

Approximately 2,000 men diagnosed in the last three months with non‑metastatic prostate cancer will now be able to receive abiraterone where it is of clinical benefit, alongside prednisolone. An additional 7,000 men are expected to be diagnosed with prostate cancer each year and will be eligible for the drug. The clinical treatment criteria are available via the Cancer Drugs Fund list at the following link:https://www.england.nhs.uk/publication/national-cancer-drugs-fund-list/These national clinical treatment criteria ensure equity of access for patients across England.NHS England sets national service standards for those elements of cancer care designated as specialised services. Integrated care boards, supported by Cancer Alliances, are expected to plan and organise access to prostate cancer treatment in line with national standards. The integration of specialised and nonspecialised commissioning allows them to join up care and target resources where they can have the greatest impact on outcomes.The National Prostate Cancer Audit (NPCA) assesses the process of care and its outcomes in men diagnosed with prostate cancer in England and Wales. Further information about the NPCA can be found via the National Disease Registration Service at the following link:https://digital.nhs.uk/ndrs/our-work/ncras-partnerships/national-prostate-cancer-audit-npcaInformation regarding the annual cost of expanding access to abiraterone is commercially sensitive. The availability of generic abiraterone means the National Health Service in England can procure the treatment at a lower cost than Zytiga under patent. NHS England has been able to give the green light to the rollout of generic abiraterone for thousands more eligible patients thanks to the health service buying and delivering treatments at better value, following the clinical advice to roll the treatment out last year.

Pursuant to the Answer of 25 November 2025 to Question 90706, how neighbourhood health services in the West Midlands will be staffed in practice; what steps are being taken to address workforce shortages in general practice, community nursing and district nursing; what role Integrated Care Boards and elected local authorities will play in the design and oversight of neighbourhood health services; and how democratic accountability will be ensured.

The 10 Year Workforce Plan will ensure the National Health Service has the right people in the right places, with the right skills to care for patients, when they need it.Neighbourhood health services will bring together integrated neighbourhood teams of professionals and partners closer to people’s home, including nurses, doctors, social care workers, pharmacists, health visitors, employment support, children’s services, and more, to work together to support people and places to improve their health and wellbeing.Integrated care boards (ICBs) are responsible for commissioning, which includes planning, securing, and monitoring, general practice services within their health systems through delegated responsibility from NHS England. Both ICBs and local health systems will be responsible for designing neighbourhood health services and centres that reflect the needs of their local populations. This will be the case for determining neighbourhood health services and staffing in the West Midlands.The 10-Year Health Plan committed to neighbourhood health plans that will be drawn up in partnership with ICBs, local authorities, and partners.

Pursuant to the Answer of 25 November 2025 to Question 90706, how the Neighbourhood Health Service will improve access to care in rural areas and communities with poor digital connectivity or low digital confidence in the West Midlands; what safeguards are in place to ensure that neighbourhood health centres do not lead to the downgrading or closure of existing GP surgeries or community hospitals; what evaluation he has made of previous neighbourhood care pilots in the region; and what timetable he has set for expanding the programme beyond wave 1, including the inclusion of additional West Midlands areas.

The Neighbourhood Health Service will make it easier for people to access care closer to where they live, including in neighbourhood health centres. Delivery will be locally led, with systems determining how neighbourhood health is designed to meet local population need. This will factor in how services may need to look different across rural and urban areas.The Neighbourhood Health Service will also move us towards a fully digitally enabled health service. We are striving for digital services to improve access, experiences, and outcomes for the widest range of people, based on their preferences, as any digital healthcare benefits will be limited if people remain digitally excluded.Neighbourhood health provides the unifying framework that brings together what is already underway across primary care, community services, urgent care, prevention, digital, estates, and population health, and will build on existing assets and services rather than replacing them. We are intending to publish further guidance that will set-out how areas should work together to design neighbourhood health services around local needs and different population cohorts.In September 2025, we launched the National Neighbourhood Health Implementation Programme (NNHIP) in 43 places across England, including in East Birmingham. Collection of metrics is currently being piloted across all NNHIP sites. Systems are also encouraged to participate in the monthly Community of Practice, that aims to share learning and strengthen collective delivery.Work is underway to consider the future direction of the NNHIP, and we will share an update on this as soon as we can.

Pursuant to the Answer of 25 November 2025 to Question 90706, what funding has been allocated to each West Midlands area participating in wave 1 of the National Neighbourhood Health Implementation Programme; how much of that funding represents new investment rather than existing budgets; what assessment he has made of the programme’s impact on GP access, community nursing capacity and waiting times in Walsall, Coventry, Shropshire, East Birmingham, Solihull and Herefordshire; and what metrics will be used to evaluate success, including whether place-level data will be published.

National Neighbourhood Health Implementation Programme (NNHIP) sites have not been allocated additional funding. NNHIP sites have been provided with expert and peer support to facilitate learning and sharing solutions. This support helps sites tackle challenges, deliver improvements, adapt solutions to their own circumstances, and spread best practices across all sites.Collection of outcome metrics is currently being piloted across NNHIP sites. A measurement guide has been co-produced with NNHIP sites. Data collection for this will begin in early 2026 which will take some time to embed and then analyse. In the interim, sites are producing case studies showcasing what has worked for their populations and the learning from these case studies are shared as part of the improvement programme with the 43 sites, as well as the national community of practice, open to all places. In addition, four deep-dive case studies are planned, providing an in-depth view of the conditions for success across four geographically and demographically different places across the country.

With reference to the Written Statement entitled Mental Health Conditions, Autism and ADHD Prevalence and Support, published on 4 December 2025, HCWS1132, what assessment his Department has made of the wider financial and operational impact on local authorities, schools, criminal justice agencies and employers arising from the increased prevalence of mental health conditions, autism and ADHD; and whether the Independent Review will produce recommendations for cross-government funding mechanisms or reforms to ensure that pressure on non-NHS services does not undermine the sustainability of local support and early-intervention provision.

The Department has not made an assessment. We have commissioned an independent review into prevalence and support for mental health conditions, attention deficit hyperactivity disorder (ADHD), and autism. The review will look to understand the similarities and difference between mental health conditions, ADHD, and autism. It will look at prevalence, early intervention and treatment, and the current challenges facing clinical services. This will include exploring the factors that have contributed to the increase in prevalence and inequalities in access and outcomes. It will also examine the extent to which diagnosis, medicalisation, and treatment improve outcomes for individuals. This will include exploring the evidence around clinical practice and the risks and benefits of medicalisation.The review will appoint an Advisory Working Group which involves a multidisciplinary group of leading academics, clinicians, epidemiological experts, charities, and people with lived experience to directly shape the recommendations and scrutinise the evidence.The chairs will provide a short report within six months setting out conclusions and recommendations for responding to the rising need, both within the Government and across the health system and wider public services.As this is an independent review, it is therefore for the Chair and vice-chairs to explore and consider topics and themes relevant to the terms of reference. It would not be appropriate for the Department to comment or influence further on specific topics, findings, and recommendations. The Government will consider any recommendations and respond accordingly.

With reference to the Written Statement entitled Mental Health Conditions, Autism and ADHD Prevalence and Support, published on 4 December 2025, HCWS1132, what assessment he has made of regional variation in diagnostic practice, referral thresholds and waiting times for autism and ADHD assessments; whether the Independent Review will examine the extent to which inconsistent clinical pathways drive disparities in outcomes; and what steps he plans to take to ensure that adults, young people and children in every Integrated Care Board area receive timely, consistent and clinically robust diagnostic assessment and ongoing support.

The Department has not made an assessment. We have commissioned an independent review into prevalence and support for mental health conditions, attention deficit hyperactivity disorder (ADHD), and autism. The review will look to understand the similarities and difference between mental health conditions, ADHD, and autism. It will look at prevalence, early intervention and treatment, and the current challenges facing clinical services. This will include exploring the factors that have contributed to the increase in prevalence and inequalities in access and outcomes. It will also examine the extent to which diagnosis, medicalisation, and treatment improve outcomes for individuals. This will include exploring the evidence around clinical practice and the risks and benefits of medicalisation.The review will appoint an Advisory Working Group which involves a multidisciplinary group of leading academics, clinicians, epidemiological experts, charities, and people with lived experience to directly shape the recommendations and scrutinise the evidence.The chairs will provide a short report within six months setting out conclusions and recommendations for responding to the rising need, both within the Government and across the health system and wider public services.As this is an independent review, it is therefore for the Chair and vice-chairs to explore and consider topics and themes relevant to the terms of reference. It would not be appropriate for the Department to comment or influence further on specific topics, findings, and recommendations. The Government will consider any recommendations and respond accordingly.

With reference to the Written Statement entitled Mental Health Conditions, Autism and ADHD Prevalence and Support, published on 4 December 2025, HCWS1132, what criteria will be used to appoint members to the Advisory Working Group, how individuals with lived experience will be involved in the development and scrutiny of the Review’s findings, and what steps he plans to take to ensure that any recommendations accepted by the Government are implemented uniformly across Integrated Care Boards and local authorities, with transparent reporting and measurable outcomes.

The Chair and vice-chairs of the independent review into the prevalence of and support for mental health conditions, attention deficit hyperactivity disorder (ADHD), and autism will appoint an Advisory Working Group which involves a multidisciplinary group of leading academics, clinicians, epidemiological experts, charities, and people with lived experience to directly shape the recommendations and scrutinise the evidence. As the review is independent it is for the chairs to determine the process for engaging.The Government has begun to address fundamental problems in National Health Service mental health services and will progress towards a new approach for mental health in 2026. As part of this we are radically enhancing transparency of mental health providers with consequences for poor performance. New league tables are driving improvement in the quality and safety of care, rewarding improvement and success. We are tackling unacceptable failures in care quality through stronger accountability and enhanced support.

With reference to the Written Statement entitled Mental Health Conditions, Autism and ADHD Prevalence and Support, published on 4 December 2025, HCWS1132, what assessment his Department has made of the factors contributing to the reported increase in the prevalence of mental health conditions, autism and ADHD over the past decade; what analysis he has undertaken to differentiate between changes in underlying incidence, improved public awareness, altered diagnostic practice and broader social determinants; and whether he will publish a cross-government strategy setting out how Departments intend to respond to rising prevalence and associated demand on public services.

The Department has not made an assessment. We have commissioned an independent review into prevalence and support for mental health conditions, attention deficit hyperactivity disorder (ADHD), and autism. The review will look to understand the similarities and difference between mental health conditions, ADHD, and autism. It will look at prevalence, early intervention and treatment, and the current challenges facing clinical services. This will include exploring the factors that have contributed to the increase in prevalence and inequalities in access and outcomes. It will also examine the extent to which diagnosis, medicalisation, and treatment improve outcomes for individuals. This will include exploring the evidence around clinical practice and the risks and benefits of medicalisation.The review will appoint an Advisory Working Group which involves a multidisciplinary group of leading academics, clinicians, epidemiological experts, charities, and people with lived experience to directly shape the recommendations and scrutinise the evidence.The chairs will provide a short report within six months setting out conclusions and recommendations for responding to the rising need, both within the Government and across the health system and wider public services.As this is an independent review, it is therefore for the Chair and vice-chairs to explore and consider topics and themes relevant to the terms of reference. It would not be appropriate for the Department to comment or influence further on specific topics, findings, and recommendations. The Government will consider any recommendations and respond accordingly.

What assessment he has made of the potential public health risks arising from the withdrawal of waste collection services in Birmingham following the decision by agency refuse workers to take industrial action from 1 December 2025.

The Director of Public Health for Birmingham continues to monitor the situation locally, including any public health risks from uncollected waste. The UK Health Security Agency, working closely with relevant partner organisations, would contribute to any risk assessment and provide health protection advice and support as requested.

What steps he is taking to increase GP appointment availability in the West Midlands; and what assessment he has made of primary care staffing levels in Walsall.

West Midlands sits within the Black Country Integrated Care Board (ICB) where appointment availability in general practice (GP) has increased by 13.8% in September 2025 compared to the same period last year. In October 2024, we invested £160 million into the Additional Roles Reimbursement Scheme to give additional flexibilities to recruit 2,500 new GPs into primary care networks across England. We have invested an additional £1.1 billion into GPs to reinforce the front door of the National Health Service. This is the biggest increase in over a decade. Additionally, the new £102 million Primary Care Utilisation and Modernisation Fund will create additional clinical space within over 1,000 GPs across England to deliver 8.3 million more appointments each year.As of 30 September 2025, Walsall has seen an increase of 17.4 full-time equivalent GPs compared to September 2024. The responsibility for commissioning primary care services, including NHS dentistry, to meet the needs of the local population has been delegated to the ICBs across England. In 2024/25, there were 57 dentists per 100,000 population in the Black Country ICB, which includes the Walsall constituency. This is above average, compared to a national average of 50 dentists per 100,000 people in England.

What steps he is taking to support the expansion of Pharmacy First services in areas with GP access pressures.

The Government is committed to providing more services in the community, closer to people’s homes. The 10-Year Health Plan is clear that we need to do things differently with more integrated neighbourhood health services, shifting care from hospital to community and from treatment to prevention.Community pharmacies will have a vital role in the Neighbourhood Health Service, as the 10-Year Health Plan brings healthcare to high streets as part of a shift in care to the community. This includes exploring ways to expand the role of pharmacies and to better utilising the skills of pharmacists and pharmacy technicians as we continue to embed the Pharmacy First service.We continue to promote Pharmacy First to increase public awareness and engagement. This has included the recent national media campaign to promote the service, as well as coordinated communications across the healthcare system. Action is also being taken to increase referrals into Pharmacy First, with targeted engagement with integrated care boards, general practice stakeholders, and the community pharmacy sector to encourage and improve the referral pathways to support better access for patients.For 2025/26, funding for the core community pharmacy contractual framework has been increased to £3.073 billion. This represents the largest uplift in funding of any part of the National Health Service, at over 19% across 2024/25 and 2025/26. There is also additional funding available for pharmacies delivering Pharmacy First consultations and flu and COVID-19 vaccinations.

What recent assessment he has made of waiting times for children’s mental health services in the West Midlands; and what steps he is taking to reduce delays.

We know that too many children and young people are waiting too long for mental health support, and through our Plan for Change, we’re determined to give children and young people the best start in life, including in the West Midlands.The Government is expanding access to mental health support teams in all schools and colleges to reach all pupils by 2029, ensuring that every pupil has access to early support services. This expansion will ensure that up to 900,000 more children and young people will have access to support from trained education mental health practitioners in 2025/26.More widely, we are rolling out Young Futures Hubs. The Government’s first 50 Young Futures Hubs will bring together services at a local level to support children and young people, helping to ensure that young people can access early advice and wellbeing intervention. We will work to ensure that there is no wrong door for young people who need support with their mental health.We have also committed to hiring 8,500 more mental health staff to reduce waiting times. Thus far, we have hired almost 7,000 extra mental health workers since July 2024.

What assessment he has made of the potential impact of discharges late on Friday evenings on the safeguarding and wellbeing of patients.

Every acute hospital has access to a multi-disciplinary care transfer hub, where National Health Service and social care professionals manage discharges and arrange appropriate support packages for patients, so they receive the services they need upon their discharge. As set out in the statutory guidance on hospital discharge and community support, these teams should ensure that any safeguarding concerns have been considered alongside other support needs.

What steps he is taking to help prevent industrial action in the NHS.

In May, we accepted the independent pay review bodies’ headline pay recommendations, giving doctors and Agenda for Change staff, including nurses, an above inflation pay rise for the second year in a row.As well as awarding resident doctors in England a pay rise of 28.9% over the last three years, we have listened to their concerns about the state of their training and employment for resident doctors and made proposals to tackle this. We have been clear that we cannot go further on pay but we remain committed to finding a way to end their dispute.We continue to work in partnership with stakeholders, including trade unions and employers, to implement a suite of non-pay measures to improve working conditions such as tackling violence against National Health Service staff, improving career progression for nurses, and improving the process for exception reporting for resident doctors.Our 10 Year Workforce Plan will set out how we will deliver change by making sure that staff are better treated, have better training, and more fulfilling roles.

What recent progress he has made on social care reform.

The Government is progressing towards a National Care Service with a vision that everyone, regardless of their needs, background, or where they live, should have the opportunity to lead healthy, independent, and fulfilling lives.We have made recent progress on key reforms, laying the foundations to turn this vision into reality, underpinned with over £4 billion of additional funding made available for adult social care by 2028. This progress has been aligned with the Government’s three objectives for adult social care, to:- improve the quality of care by valuing and supporting our vital care workforce by legislating for a Fair Pay Agreement backed by £500 million of funding and expanding career opportunities through the Care Workforce Pathway, and investing £12 million in learning, development, and new qualifications. We're also supporting the Care Quality Commission to recover and become a confident, credible force for improvement, supported by their local authority assessments that shine a light on local authority performance;- strengthen the join-up between health and social care services, so that people experience more integrated and person-centred care, by developing neighbourhood health services and reforming the Better Care Fund. This will be underpinned by improved national data and digital infrastructure to ensure health and care staff can access real-time information to improve the safety and quality of care. For example, we have been driving the adoption of Digital Social Care Records (DSCR), with up to 89% of people drawing on care now benefiting from a DSCR; and- enable people to have more choice and control over their care, for instance by promoting greater use of direct payments. We are also expanding care options to boost independent living at home through an additional £172 million for the Disabled Facilities Grant over two years, enabling approximately 15,600 extra home adaptations, and introducing care technology standards to help people choose the right support.

What steps he is taking to increase access to care in the community.

The 10-Year Health Plan sets out our vision for a Neighbourhood Health Service.The Neighbourhood Health Service will embody our new preventative principle that care should happen as locally as it can, digitally by default, in a person’s home if possible, in a neighbourhood health centre when needed, and only in a hospital if necessary.The Neighbourhood Health Service will mean people are treated and cared for closer to their home by new teams of health professionals. It will rebalance our health system so that it fits around peoples’ lives, not the other way round. We expect neighbourhood teams and services to be designed in a way that reflects the specific needs of local populations. This is why we have launched wave 1 of the National Neighbourhood Health Implementation Programme (NNHIP) across 43 places in England. The NNHIP will support systems across the country by driving innovation and integration at a local level, to accelerate improvements in outcomes, satisfaction, and experiences for people by ensuring that care is more joined-up, accessible, and responsive to community needs.

What steps he is taking to increase access to care in the community in the West Midlands.

The 10-Year Health Plan sets out our vision for a Neighbourhood Health Service. The Neighbourhood Health Service will embody our new preventative principle that care should happen as locally as it can, digitally by default, in a person’s home if possible, in a neighbourhood health centre when needed, and only in a hospital if necessary.The Neighbourhood Health Service will mean people are treated and cared for closer to their home by new teams of health professionals. It will rebalance our health system so that it fits around peoples’ lives, not the other way round. We expect neighbourhood teams and services to be designed in a way that reflects the specific needs of local populations. To support this agenda, we have launched wave 1 of the National Neighbourhood Health Implementation Programme (NNHIP) across 43 places in England, including parts of the West Midlands such as: Walsall; Coventry; Shropshire; East Birmingham; Solihull; and Herefordshire.The NNHIP will support systems across the country by driving innovation and integration at a local level, to accelerate improvements in outcomes, satisfaction, and experiences for people by ensuring that care is more joined-up, accessible, and responsive to community needs.

What modelling he undertook during the Spending Review process for funding for the (a) palliative and (b) end of life care sectors for (i) 2025-26, (ii) 2026-27 and (iii) 2027-28.

Department and NHS England officials used a variety of data sources, local examples, and academic research in the modelling for the palliative care and end of life care bids that were made as part of the Spending Review (SR) process.The SR announced that annual National Health Service day-to-day spending will increase by £29 billion in real terms by 2028/29 compared to 2023/24. This will take the NHS resource budget to £226 billion by 2028/29, the equivalent to a 3% average annual real terms growth rate over the SR period.At this stage, it is still too early to say how much funding will be allocated to palliative care and end of life care, which will be worked through in the coming weeks.Whilst the majority of palliative and end of life care is provided by NHS staff and services, we recognise the vital part that voluntary sector organisations, including hospices, also play in providing support to people at the end of life, as well as their loved ones. Integrated care boards are responsible for the commissioning of palliative care and end of life care services to meet the needs of their local populations, and this can include, but does not have to include, services commissioned from hospice providers.We are supporting the hospice sector with a £100 million capital funding boost for adult and children’s hospices in England to ensure they have the best physical environment for care. We are also providing £26 million of revenue funding for children and young people’s hospices for 2025/26.

Pursuant to the Answer of 3 July 2025 to Question 61535 on Palliative Care: Finance, what discussions he plans to have with the hospice sector on the allocation of funding for (a) palliative and (b) end of life care.

Department and NHS England officials used a variety of data sources, local examples, and academic research in the modelling for the palliative care and end of life care bids that were made as part of the Spending Review (SR) process.The SR announced that annual National Health Service day-to-day spending will increase by £29 billion in real terms by 2028/29 compared to 2023/24. This will take the NHS resource budget to £226 billion by 2028/29, the equivalent to a 3% average annual real terms growth rate over the SR period.At this stage, it is still too early to say how much funding will be allocated to palliative care and end of life care, which will be worked through in the coming weeks.Whilst the majority of palliative and end of life care is provided by NHS staff and services, we recognise the vital part that voluntary sector organisations, including hospices, also play in providing support to people at the end of life, as well as their loved ones. Integrated care boards are responsible for the commissioning of palliative care and end of life care services to meet the needs of their local populations, and this can include, but does not have to include, services commissioned from hospice providers.We are supporting the hospice sector with a £100 million capital funding boost for adult and children’s hospices in England to ensure they have the best physical environment for care. We are also providing £26 million of revenue funding for children and young people’s hospices for 2025/26.