Written questions by Ramsay.

What steps his Department is taking to ensure that the new National Inherited Cancer Predisposition Registry is accessible to women at increased risk of breast cancer.

The National Inherited Cancer Predisposition Registry (NICPR), which is part of the National Disease Registration Service (NDRS), records information on individuals who have confirmed pathogenic or likely-pathogenic variants in any of the approximately 120 cancer predisposition genes tested for in the National Health Service. These individuals must be referred to one of the Regional Clinical Genetics Services in England for genetic counselling and management. NDRS works closely with these services and the UK Cancer Genetics Group to ensure that all eligible individuals, including women at increased genetic risk of breast cancer, are captured in the NICPR. To support this, NDRS provides regular feedback to Regional Clinical Genetics Services through quarterly reconciliation audits, to confirm that all relevant individuals are included and have access to appropriate clinical support.NICPR also supports referrals into the Very High Risk Breast Screening Programme, where relevant. In addition to those with confirmed genetic variants, NDRS also supports referral of women in the risk-equivalent category, for example those with a strong family history of breast cancer but who have not undertaken a definitive genetic test. Information on these women is submitted using a similar portal as for NICPR referrals.

What steps his Department is taking to ensure that changes to NICE’s cost effectiveness thresholds results in improved and equitable access to new and effective treatments for people with incurable secondary breast cancer.

The Government intends to increase the standard cost-effectiveness threshold that the National Institute for Health and Care Excellence (NICE) uses in its evaluations of medicines in line with the commitment in the United Kingdon and United States’ trade deal. The new threshold is expected to mean that NICE is able to recommend some medicines for use on the National Health Service that it would not have otherwise been able to recommend. Decisions on whether an individual medicine can be recommended as a clinically and cost-effective use of NHS resources once the new threshold is applied will be taken by NICE in line with its established processes.

What assessment he has made of the potential impact of financial barriers on graduate entry medical students in England.

No specific assessment has been made. 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 socio-economic backgrounds, so that they are able to thrive at medical school. We will set out next steps in due course.

What assessment he has made of the potential impact of the proposed Nursing and Midwifery Council registration fee increase on recruitment, retention and workforce morale within the NHS.

The Nursing and Midwifery Council (NMC) is independent of the Government, is directly accountable to Parliament, and is responsible for operational matters concerning the discharge of its statutory duties. As the NMC set out in its consultation, registrant fees, which account for 97% of organisational income, have remained at the same level for over 10 years. The NMC has deemed it necessary to propose a fee increase to ensure that the organisation can carry out its statutory functions. We understand that the proposed increase would equate to an annual increase of £23 per registrant, the equivalent of an additional £1.92 a month. The NMC’s registrant fee remains one of the lowest across all of the health and care professional regulators. United Kingdom taxpayers can claim tax relief on their registration fees, helping to reduce the overall cost. Professionals can also apply to spread the cost of registration by paying in four instalments each year. We are working closely with employers and leaders across the National Health Service to improve staff retention. There are many issues that can influence staff retention, so this requires a multi-faceted approach. The 10 Year Workforce Plan due to be published in the spring will have a big focus on making the NHS a better employer. This includes the development of a new set of staff standards which will focus on improving staff experience and health and wellbeing.NHS England is already leading work nationally through its retention programme to drive a consistent, system-wide approach to staff retention across NHS trusts. This ensures trusts have access to proven retention strategies, data-driven monitoring, and can foster a more stable, engaged, productive, and supported workforce.

What steps his Department is taking to help ensure that professional regulatory costs do not act as a disincentive to entering or remaining in the nursing, midwifery and nursing associate professions.

The Nursing and Midwifery Council (NMC) is independent of the Government, is directly accountable to Parliament, and is responsible for operational matters concerning the discharge of its statutory duties. As the NMC set out in its consultation, registrant fees, which account for 97% of organisational income, have remained at the same level for over 10 years. The NMC has deemed it necessary to propose a fee increase to ensure that the organisation can carry out its statutory functions. We understand that the proposed increase would equate to an annual increase of £23 per registrant, the equivalent of an additional £1.92 a month. The NMC’s registrant fee remains one of the lowest across all of the health and care professional regulators. United Kingdom taxpayers can claim tax relief on their registration fees, helping to reduce the overall cost. Professionals can also apply to spread the cost of registration by paying in four instalments each year. We are working closely with employers and leaders across the National Health Service to improve staff retention. There are many issues that can influence staff retention, so this requires a multi-faceted approach. The 10 Year Workforce Plan due to be published in the spring will have a big focus on making the NHS a better employer. This includes the development of a new set of staff standards which will focus on improving staff experience and health and wellbeing.NHS England is already leading work nationally through its retention programme to drive a consistent, system-wide approach to staff retention across NHS trusts. This ensures trusts have access to proven retention strategies, data-driven monitoring, and can foster a more stable, engaged, productive, and supported workforce.

What steps his Department is taking to ensure patients with brain tumours treated at NHS trusts that are not members of the National Institute for Health and Care Research's Brain Tumour Research Consortium are able to access equivalent a) tumour tissue freezing, b) whole genome sequencing and c) clinical trial stratification pathways.

The Department invests over £1.6 billion each year in research through the National Institute for Health and Care Research (NIHR).The Department is committed to ensuring that all patients, including those with brain tumours, have access to cutting-edge clinical trials and innovative, lifesaving treatments. The NIHR funds research and research infrastructure across England which supports patients and the public to participate in high-quality research, including brain cancer trials. The NIHR also provides an online service called Be Part of Research which promotes participation in health and care research, by allowing users to search for relevant studies and register their interest.In addition, the Government will implement the Rare Cancers Act 2026. The act will make it easier for clinical trials on brain tumours to take place in England, by ensuring the patient population can be more easily contacted by researchers.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. These investments include 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.Genomic testing in the NHS in England is delivered through the NHS Genomic Medicine Service (GMS) via seven regional Genomic Laboratory Hubs (GLHs). All seven GLHs deliver testing based on the National Genomic Test Directory, which outlines eligibility criteria for genomic testing. The Test Directory includes over 200 cancer indications for a range of genomic tests, including whole genome sequencing for neurological tumours, for both diagnostic and treatment purposes. Seven NHS GMS Alliances also work to embed genomics into clinical pathways, raise awareness among clinicians and the public, and ensure equitable access to whole genome sequencing across all regions.

Whether his Department has (a) set and (b) considered setting a national standard for the maximum timeframe within which brain tumour tissue should be placed into a fresh-frozen state following surgical excision.

The Department has neither set nor considered setting a national standard for the maximum timeframe within which brain tumour tissue should be placed into a fresh-frozen state following surgical excision.Fresh-freezing, also referred to as snap-freezing, is a standard technique used by pathology networks to preserve tissue architecture without chemical fixatives, allowing for subsequent molecular or histological analysis, typically supporting research or advanced diagnostic applications.Pathology services in England are delivered through 27 regional pathology networks, and offer a comprehensive range of tests, including the analysis of brain tissues. Individual pathology services in England maintain their own standard operating procedures (SOPs) for fresh, or the snap-freezing, of tissue samples. These SOPs outline local capabilities and practices. While NHS England does not routinely set detailed technical standards for specific laboratory processes, relevant professional bodies, such as Royal College of Pathologists, may develop guidance to support consistent practice across services.

What assessment his Department has made of the adequacy of access to medication, paediatric support, and Child and Adolescent Mental Health Services follow-up for children diagnosed with ADHD through the Right to Choose pathway.

It is the responsibility of integrated care boards (ICBs) in England to make available appropriate provision to meet the health and care needs of their local population, including providing access to attention deficit hyperactivity disorder (ADHD) assessment and support, in line with relevant National Institute for Health and Care Excellence (NICE) guidelines.NICE guidelines recommend that all medication for ADHD should only be initiated by a healthcare professional with training and expertise in diagnosing and managing ADHD and after titration and dose stabilisation. Prescribing and monitoring of ADHD medication should be carried out under shared care protocol arrangements with primary care.NHS England established an ADHD taskforce which brought together those with lived experience with experts from the National Health Service, education, charity, and justice sectors to get a better understanding of the challenges affecting those with ADHD, including in accessing services and support. The final report was published on 6 November 2025. The work of the independent ADHD taskforce highlighted the need for coordinated action across health, education and public services to reform ADHD services and support.On 4 December, my Rt. Hon. Friend, the Secretary of State for Health and Social Care, announced the launch of an Independent Review into Prevalence and Support for Mental Health Conditions, ADHD and Autism. The independent review will build directly on the evidence and recommendations of the ADHD taskforce. The taskforce’s report provides a strong, evidence‑based foundation, and the review will consider its findings in full to ensure conclusions are aligned and complementary. In the meantime, we are working with NHS England to deliver some of the taskforce’s recommendations such as on data improvement, enhancing mental health support teams in schools, improved commissioning and better collaboration between mental health and primary care services.

Whether he plans to provide additional funding and workforce planning support to Integrated Care Boards to reduce waiting times for children with ADHD assessments and treatment.

NHS England is responsible for determining allocations of financial resources to integrated care boards (ICBs). Funding for attention deficit hyperactivity disorder (ADHD) and autism assessment services are included within NHS England’s financial allocations to ICBs. The Government has recognised that, nationally in England, demand for assessments for ADHD has grown significantly in recent years and that people of all ages, including children and young people, are experiencing delays accessing such assessments. The Government’s 10-Year Health Plan for England will make the National Health Service fit for the future, recognising the need for early intervention and support, including for children and young people, such as those with special educational needs and disabilities. Through the NHS Medium Term Planning Framework, published 24 October, NHS England has set clear expectations for local ICBs and trusts to improve access, experience, and outcomes for autism and ADHD services over the next three years, focusing on improving quality and productivity. NHS England established an ADHD taskforce which brought together those with lived experience with experts from the NHS, education, charity, and justice sectors to get a better understanding of the challenges affecting those with ADHD, including in accessing services and support. The final report was published on 6 November 2025, and we are carefully considering its recommendations. Building on the work of the Independent ADHD Taskforce, on 4 December 2025, my Rt. Hon. Friend, the Secretary of State for Health and Social Care, announced the launch of an Independent Review into Prevalence and Support for Mental Health Conditions, ADHD and Autism. The review will inform our approach so that people with ADHD and autistic people have the right support in place to enable them to live well in their communities.

What data his Department holds on the number of children removed from local NHS ADHD waiting lists after accessing the Right to Choose pathway.

The Department does not collect data on the number of children removed from local National Health Service attention deficit hyperactivity disorder (ADHD) waiting lists after accessing the Right to Choose pathway.NHS England has worked with stakeholders to develop a national ADHD data improvement plan, which was published in May 2025. The plan highlights the need to make use of and publish existing NHS England data in this area and to improve data quality, with further information available at the following link:https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/neurodevelopmental-data-hub/adhd-data-improvement-planFor the first time, NHS England published management information on ADHD prevalence and waits at a national level on 29 May 2025 as part of its ADHD data improvement plan. This management data publication will be published quarterly going forward. Further information is available at the following link:https://digital.nhs.uk/data-and-information/publications/statistical/mi-adhd/november-2025NHS England also issued technical guidance on 3 June 2025 for those who submit ADHD data, to improve recording of ADHD data with a view to improving the quality of data on ADHD waiting times and for publishing more localised data in the future.NHS England issued advice to systems on ADHD service delivery and prioritisation on 7 October 2025. This advice includes guidance on managing service provision, reviewing waiting lists and providing patient support.NHS England has also captured examples from ICBs who are trialling innovative ways of delivering ADHD services and is using this information to support systems to tackle ADHD waiting lists and provide support to address people’s needs.

What guidance his Department has issued to Integrated Care Boards on how Right to Choose providers should integrate with local NHS paediatric and mental health services for children with ADHD, including for young children with complex or multiple needs.

It is the responsibility of integrated care boards (ICBs) in England to make available appropriate provision to meet the health and care needs of their local population, including providing access to attention deficit hyperactivity disorder (ADHD) and autism services and support, in line with relevant National Institute for Health and Care Excellence (NICE) guidelines.NHS England established an ADHD taskforce which brought together those with lived experience with experts from the NHS, education, charity, and justice sectors to get a better understanding of the challenges affecting those with ADHD, including in accessing services and support. The final report was published on 6 November 2025. The work of the independent ADHD Taskforce highlighted the need for coordinated action across health, education and public services to reform ADHD services and support.On 4 December 2025, my Rt. Hon. Friend, the Secretary of State for Health and Social Care, announced the launch of an Independent Review into Prevalence and Support for Mental Health Conditions, ADHD and Autism. This will build on the work of the Independent ADHD Taskforce.

Whether he has modelled the projected level of demand for consultant‑level cancer specialists in rural, coastal and remote regions over the next 10 years.

The Department will use training more directly as a lever to support improvements in operational performance, prioritising training places in trusts, often those in rural or coastal areas, where vacancy rates are higher and performance is lower. This also includes targeting grants to train cancer nurse specialists in high-need areas.The development of the National Cancer Plan has highlighted areas where there are higher vacancy rates in some areas of the country. The Department and NHS England will work with the royal colleges to encourage resident doctors and internal medicine trainees to specialise in clinical and medical oncology to address these pressures.The Government will publish the 10 Year Workforce Plan in spring 2026. This plan will set out action to create a workforce able to deliver the transformed service set out in the 10-Year Health Plan.

With reference to action 25 of the National Cancer Plan, what factors will be used to prioritise locations for new training places; and if he will consider the potential merits of using a formula to identify areas of greatest need for this purpose.

The Department will use training more directly as a lever to support improvements in operational performance, prioritising training places in trusts, often those in rural or coastal areas, where vacancy rates are higher and performance is lower. This also includes targeting grants to train cancer nurse specialists in high-need areas.The development of the National Cancer Plan has highlighted areas where there are higher vacancy rates in some areas of the country. The Department and NHS England will work with the royal colleges to encourage resident doctors and internal medicine trainees to specialise in clinical and medical oncology to address these pressures.The Government will publish the 10 Year Workforce Plan in spring 2026. This plan will set out action to create a workforce able to deliver the transformed service set out in the 10-Year Health Plan.

With reference to Action 25 of the National Cancer Plan, what steps he will take to incentivise medical graduates to accept specialty training posts in rural, coastal and remote areas.

The Department will use training more directly as a lever to support improvements in operational performance, prioritising training places in trusts, often those in rural or coastal areas, where vacancy rates are higher and performance is lower. This also includes targeting grants to train cancer nurse specialists in high-need areas.The development of the National Cancer Plan has highlighted areas where there are higher vacancy rates in some areas of the country. The Department and NHS England will work with the royal colleges to encourage resident doctors and internal medicine trainees to specialise in clinical and medical oncology to address these pressures.The Government will publish the 10 Year Workforce Plan in spring 2026. This plan will set out action to create a workforce able to deliver the transformed service set out in the 10-Year Health Plan.

What steps he plans to take following the internal review of the upper limit for Disabled Facilities Grants; and what his planned timetable is for further action.

In England, we continue to fund the Disabled Facilities Grant (DFG) which is delivered by local authorities. This grant helps eligible older and disabled people on low incomes to adapt their homes to make them safe and suitable for their needs.The upper limit for DFG grant awards is currently set at £30,000, however local authorities have a high degree of flexibility to fund adaptations above this amount where they judge it is appropriate. Following an internal review of the upper limit, we have been working closely with the Ministry of Housing, Communities and Local Government on next steps and hope to provide an update in the spring.We have recently announced an additional £50 million for the DFG in 2025/26. This could fund approximately 5,000 additional home adaptations supporting older and disabled people to live more independently in their homes, and brings the total DFG amount this year to £761 million.

What discussions he has had with the Secretary of State for Housing, Communities and Local Government following the internal review of the upper limit for Disabled Facilities Grants.

In England, we continue to fund the Disabled Facilities Grant (DFG) which is delivered by local authorities. This grant helps eligible older and disabled people on low incomes to adapt their homes to make them safe and suitable for their needs.The upper limit for DFG grant awards is currently set at £30,000, however local authorities have a high degree of flexibility to fund adaptations above this amount where they judge it is appropriate. Following an internal review of the upper limit, we have been working closely with the Ministry of Housing, Communities and Local Government on next steps and hope to provide an update in the spring.We have recently announced an additional £50 million for the DFG in 2025/26. This could fund approximately 5,000 additional home adaptations supporting older and disabled people to live more independently in their homes, and brings the total DFG amount this year to £761 million.

What measures are being taken to manage pressure on NHS services by improving outcomes for patients with chronic musculoskeletal conditions.

Improving the health and work outcomes for people with musculoskeletal (MSK) conditions will help deliver the Government's mission to build a National Health Service that is fit for the future.To manage pressure on NHS services, we are working to deliver the Getting It Right First Time (GIRFT) MSK Community Delivery Programme. GIRFT teams are working with health system leaders to further reduce MSK community waiting times, which are the highest of all community waits, and improve data, metrics, and referral pathways to wider support services.Patients with MSK conditions will also soon be able to bypass their general practitioners (GPs) and directly access community services, including physiotherapy, pain management, and orthopaedics, in the NHS App. The landmark change will deliver faster treatment for the flare up of existing conditions including arthritis, backpain, and joint pain, while enabling GPs to focus on more complex cases, reducing pressure on hospitals and freeing up GPs.

When will he announce the next phase of Modern Service Frameworks, and what consideration has been given to including musculoskeletal conditions in the next phase of the Modern Service Frameworks.

As announced in the 10-Year Health Plan, as well as an overall quality strategy, the National Quality Board will oversee the development of a new series of service frameworks. These modern service frameworks will define an aspirational, long-term outcome goal for a major condition and will then identify the best evidenced interventions and the support for delivery.Early priorities will include cardiovascular disease, sepsis, severe mental illness, and the first ever service framework for frailty and dementia. As advised by the National Quality Board, the Government will consider other conditions for future phases of modern service frameworks, and has recently announced a Modern Service Framework on Palliative and End of Life Care.We are advancing modern service frameworks for those conditions where we can swiftly and significantly raise the quality of care and productivity. Future phases will address conditions that carry substantial health and economic consequences.To support people with musculoskeletal (MSK) conditions, we are working to deliver the Getting It Right First Time (GIRFT) MSK Community Delivery Programme. GIRFT teams are working with health system leaders to reduce MSK community waiting times, which are the highest of all community waits, and improve data and metrics and referral pathways to wider support services.

What steps he is taking to ensure capital investment in NHS estate and infrastructure supports improvements in climate resilience.

We recognise the importance of increasing the climate resilience of the National Health Service estate and infrastructure. NHS trusts are responsible for maintaining their estate, including adapting premises to reduce the risks associated with climate change, as set out in the NHS Standard Contract.The Department is supporting the improvement of NHS sites by investing £30 billion over the next five years in day-to-day maintenance and repair, with £5 billion allocated specifically to address the most critical building issues. NHS trusts will be able to direct some of this funding towards improving the climate resilience of their estate where this is locally appropriate. Additionally, the Department is making sure all new hospitals are fit for the future. The Department’s New Hospital Programme requires schemes to achieve a minimum rating of BREEAM ‘Excellent’ for new builds, and ‘Very Good’ for refurbishments. All NHS investments in new buildings and upgrades to existing facilities that are subject to HM Treasury business case approval process must align with the NHS Net Zero Building Standard, which includes a focus on overheating risks.

What assessment he has made of the potential implications for his policies of the Adult Oral Health Survey 2023, published 9 December 2025.

The Adult Oral Health Survey 2023 provides the first picture of adult oral health in England for more than a decade. It provides further evidence of the need for dental contract reform.We are taking forward significant changes to the National Health Service dental contract. The reforms will prioritise patients with urgent dental needs and those requiring complex treatments and will come in from April 2026. More information is available at the following link:https://www.gov.uk/government/consultations/nhs-dentistry-contract-quality-and-payment-reforms/outcome/government-response-to-consultation-on-nhs-dentistry-contract-quality-and-payment-reformsWe are committed to fundamental reform of the NHS dental contract by the end of this Parliament, with a focus on improving access, promoting prevention and rewarding dentists fairly.The Government is also focussed on prevention of poor dental health through our supervised toothbrushing programme to reach up to 600,000 children in the 20% most deprived areas of England, and by expanding community water fluoridation to the North East of England. This intervention will reach an additional 1.6 million people and will reduce tooth decay and inequalities in dental health, particularly in children and vulnerable adults.