Written questions by Mierlo.

When the document entitled Guidance to support local authorities in the design and delivery of active travel routes will be published; and whether this guidance will include the use of Compulsory Purchase Order powers for active travel routes.

ATE is developing specific guidance for good practice application in rural areas and expects to publish this later this year. Officers in ATE are currently seeking the input of stakeholders on the document, and the current draft includes case studies on the use of Compulsory Purchase Orders for active travel routes. Compulsory purchase orders has a high bar with a requirement for public authorities to demonstrate a compelling case in the public interest. An alternative approach to creating new active travel routes is public path creation under the Highways Act 1980, rather than outright purchase of the land through a CPO.

What assessment he has made of the adequacy of (a) funding and (b) the availability of trained staff for GP practices to perform blood tests for children.

Overall, ensuring adequate general practice (GP) provision is the responsibility of the integrated care boards (ICBs).GPs are independent businesses, providing primary care services, based on a National Health Service GP Contract, to their local populations. Most commonly, GPs are run by GP partners who, alongside other GPs and healthcare staff, are responsible for running their own practice. This allows them to have relative autonomy in deciding how to provide contracted services, and provides opportunities for innovation.Local enhanced services, such as blood tests, are negotiated and agreed locally, and are commissioned by ICBs to fit the needs of the local population. GPs can choose whether or not they would like to participate in providing these services. These services can vary in scope and funding across the country.

What assessment he has made of the adequacy of the availability of phlebotomy services to perform blood tests for children in (a) Oxfordshire and (b) nationally.

The Government is committed to putting patients first. This means making sure that patients are seen on time and ensuring that patients have the best possible experience during their care.Community diagnostic centres (CDCs) offer local populations a wide range of diagnostic tests closer to home as well as greater choice on where and how they are undertaken. This reduces the need for hospital visits, reduces pressure on hospitals, and speeds up diagnosis. CDCs are expected to offer their services to children and young people where it is safe and appropriate to do so. The Oxfordshire, Oxford CDC in Cowley delivers a range of diagnostic services, including phlebotomy services.Phlebotomy services are also provided by general practices (GPs). Where services are provided by GP, they are commissioned locally by integrated care boards (ICBs), based on local population need, and are funded as part of their annual funding allocations.In Oxfordshire, the Buckinghamshire, Oxfordshire and Berkshire West ICB has commissioned GPs to deliver phlebotomy services for all ages, including children. Services must be led by suitably trained professionals.Guidance communicated to GPs from the Berks, Bucks and Oxon Local Medical Committee, the body representing all NHS GPs practising in the Buckinghamshire, Oxfordshire, and Berkshire area, is that GPs should not perform blood tests for patients under 12 years old and instead that these should be performed by specialist paediatric trained staff. Where GPs have clinical staff with the training, competence, and experience to perform blood tests on patients under 12 years old, these services may be available. However, at practices that do not have these staff, they will instead refer the child to alternative providers, such as in a children’s hospital clinic.

Food and Rural Affairs, when he plans to respond to the correspondence from the hon. Member for Henley and Thame dated 7 May 2025 on lock keepers' safety concerns.

A reply to the hon. Member is being prepared and will be issued as soon as possible.

What discussions he has had with the Medicines and Healthcare products Regulatory Agency on encouraging manufacturers to apply for UK licenses for Hormone Replacement Therapy implants.

The Medicines and Healthcare products Regulatory Agency (MHRA) and the Department have kept ministers informed of the ongoing issues in the manufacturing of unlicenced products used as medicines for hormone replacement therapy (HRT) implants. Regular discussions have been held with the importer of the unlicenced medicines, and the Medicines Supply team in the Department are actively looking at licenced alternatives to ensure ongoing supply.A medicine can only become licensed if an application is made for such a licence, usually by the manufacturer, and the MHRA is only able to grant a marketing authorisation after the supporting data has been assessed to demonstrate its quality, safety, and efficacy for the conditions it is intended to treat, and to confirm that it has an acceptable balance of risk and benefit. In our role as the medicines regulator, we are not in a position to solicit for new product licence applications.However, the MHRA welcomes marketing authorisation applications for HRT implants and has processes in place to review applications as soon as they are received. In addition, manufacturers can seek scientific advice on their product from the MHRA at any stage of development.

Food and Rural Affairs, pursuant to the Answer of 14 May 2025 to Question 51082 on National Landscapes: Chilterns, if she will make an assessment of the potential merits of reviewing changes to the budget of Natural England in the context of the cancellation of the project to expand the Chilterns Area of Outstanding Beauty; and if she will publish the technical review completed by LUC.

For year 2025/26 the direct funding for National Landscape designation work was not continued. Natural England is using baseline budget to fund a reduced programme of landscape designation work. Decisions on future funding for Natural England will be made as part of the 2025 multi-year Spending Review and through finance settlement processes. Natural England are considering how the evidence base which has been gathered so far through their designation work can best be shared and used.

What steps he is taking to ensure access to licenced Hormone Replacement Therapy implants for women.

There are currently no licensed United Kingdom suppliers of oestrogen and testosterone hormone replacement therapy (HRT) implants in the UK, and companies are free to decide what they market.The Department is working closely with the Medicines and Healthcare products Regulatory Agency to ensure safe access to these products. As part of this, we have also reached out to specialist importers who can source unlicensed medicines in order to find HRT implants for UK patients.

What steps he is taking to encourage Hormone Replacement Therapy implant manufacturers to apply for UK licenses.

The Medicines and Healthcare products Regulatory Agency (MHRA) and the Department have kept ministers informed of the ongoing issues in the manufacturing of unlicenced products used as medicines for hormone replacement therapy (HRT) implants.Regular discussions with the importer of the unlicenced medicines have been held, and the Medicines Supply team in the Department are actively looking at both licenced and other sources, to ensure an ongoing supply of appropriate products.The MHRA welcomes these applications and has processes in place to review applications for HRT implants, as soon as they are received.

If he will make an assessment of the potential merits of expanding the criteria for medical exemption certificates to include everyone with a (a) disability and (b) chronic illness.

The Department has no plans to expand the criteria for medical exemption certificates.Individuals with qualifying medical conditions or with a continuing physical disability which prevents them from leaving their residence without the help of another person are entitled to apply for a medical exemption certificate.People may also be exempt from prescription charges depending on their age, whether they are in qualifying full-time education, whether they are pregnant or have recently given birth, or whether they are in receipt of certain benefits or a war pension.People who do not qualify for an exemption and who need many prescription items could save money with a prescription prepayment certificate, which allows people to claim as many prescriptions as they need for a set cost. People on a low income can seek help under the NHS Low Income Scheme.

Media and Sport, what discussions she has had with local authorities on the availability of books in public libraries which feature (a) characters, (b) storylines, (c) lives and (d) the history of the LGBTQ+ community.

The Public Libraries and Museums Act 1964 requires all local authorities to provide a comprehensive and efficient library service. Public libraries are funded by local authorities and each local authority is responsible for assessing the needs of their local communities and designing a library service to meet those needs within available resources.It is for each local authority to determine its stock management policy, including which books and other materials are made available for the benefit of its residents. We expect library collections to represent a variety of perspectives and topics.

What recent assessment she has made of the effectiveness of the service provided by the (a) probate service and (b) probate service contractors.

Official statistics published by the Ministry of Justice show that despite continued high levels of receipts, the effectiveness of the service being provided continues to improve. Average waiting times are reducing and was 6 weeks, from receipt of the documentation needed across all types of grants, for grants issued during October to December 2024, down from 13 weeks for the same period in 2023 and the open caseload has reduced to 39,142 as at the end of December 2024, down from 77,904 at the end of 2023.HMCTS administers the probate service with civil servants. When a third party provides a service, such as document scanning, HMCTS regularly meets with them to review performance against Service Level Agreements and has no concerns.Average waiting times and open caseload for probate grants are routinely published on gov.uk via the Family Court Statistics: Family Court Statistics Quarterly - GOV.UK.

What funding is available for the (a) repair and (b) maintenance of (i) sports facilities and (ii) swimming pools at schools.

​Schools provide important opportunities for all pupils to be physically active, with sports facilities being key to the provision of high quality physical education lessons and extra-curricular sport.The department supports academy trusts, local authorities and voluntary-aided bodies, who are responsible for managing the safety and maintenance of their estates, with capital funding, rebuilding programmes and guidance on effective estate management.We recently confirmed details of £2.1 billion of capital funding for the 2025/26 financial year to improve the condition of the school estate, including sports facilities and school swimming pools, up from £1.8 billion committed for the 2024/25 financial year. Capital funding is not ring-fenced for sports facilities, and decisions on capital projects to improve the estate are primarily taken at a local level. Details of funding are published on GOV.UK.​Capital funding for schools beyond 2025/26 will be confirmed following the next phase of the spending review.

If he will make it his policy to review the adequacy of the earnings criteria for free prescriptions.

No discussions have been held between my Rt Hon. Friend, the Secretary of State for Health and Social Care and my Rt Hon. Friend, the Secretary of State for Work and Pensions on expanding eligibility to all claimants in receipt of Universal Credit. The Department keeps the earnings thresholds for free prescriptions under review on an annual basis.Approximately 89% of prescription items dispensed in community pharmacy in England are free of charge, and for the first time in three years prescription charges have been frozen, meaning around 40% of the population will save money on their prescriptions.

What discussions he has had with the Secretary of State for Work and Pensions on the potential merits of expanding eligibility for free prescriptions to include everyone in receipt of Universal Credit.

No discussions have been held between my Rt Hon. Friend, the Secretary of State for Health and Social Care and my Rt Hon. Friend, the Secretary of State for Work and Pensions on expanding eligibility to all claimants in receipt of Universal Credit. The Department keeps the earnings thresholds for free prescriptions under review on an annual basis.Approximately 89% of prescription items dispensed in community pharmacy in England are free of charge, and for the first time in three years prescription charges have been frozen, meaning around 40% of the population will save money on their prescriptions.

If he will make an assessment of the potential merits of using (a) PET scans, (b) cerebrospinal fluid testing and (c) other bio-marker led tests to confirm Alzheimer's disease.

The Department delivers dementia research through the National Institute for Health and Care Research (NIHR). The NIHR funds a range of research into dementia, for example investing almost £11 million to develop new digital approaches for the early detection and diagnosis of dementia.The Government’s Dame Barbara Windsor Dementia Goals programme has already invested £13 million into a range of biomarker innovation projects which include biomarker technologies, ranging from an artificial intelligence tool designed to improve the accuracy of blood tests for dementia, to using retinal scans to detect early-onset dementia decades before symptoms. Some of these innovations could support improved diagnosis in the future, if validated for clinical use.

What steps he is taking to help support UK-based research into new forms of treatment for dementia.

The Department delivers dementia research via the National Institute for Health and Care Research (NIHR). Government funders are investing in dementia research across all areas, from causes, diagnosis and prevention to treatment, care and support, including for carers.The NIHR is investing almost £50 million to the UK Dementia Trials Network, which will deliver a coordinated network of early phase dementia trial sites. This will be complemented by the £20 million Dementia Clinical Trials Accelerator, designed to position the United Kingdom as the destination of choice for late phase clinical trials in dementia and neurodegenerative diseases.The NIHR welcomes funding applications for research into any aspect of human health and care, including dementia. These applications are subject to peer review and judged in open competition, with awards being made based on the importance of the topic to patients and health and care services, value for money and scientific quality. Welcoming applications on dementia to all NIHR programmes enables maximum flexibility both in terms of amount of research funding a particular area can be awarded, and the type of research which can be funded.The Government’s Dame Barbara Windsor Dementia Goals programme, with almost £150 million expected to be allocated to, or aligned with it, aims to speed up the development of new treatments for dementia by accelerating innovations in biomarkers, clinical trials and implementation. Some of this will be delivered through the Neurodegeneration Initiative which the programme is establishing, which will be a globally unique, not-for-profit, industry led public-private partnership that will work together across government, industry, academia, the National Health Service and third sector to deliver its objectives, including UK research organisations.So far, the programme has invested £13 million into a range of biomarker innovation projects, many of which are being delivered by UK small and medium enterprises and UK research organisations.

What steps he is taking to increase the proportion of Alzheimer's disease specialists compared to other G7 countries.

The provision of dementia health care services is the responsibility of local integrated care boards (ICBs). We expect ICBs to commission services based on local population needs, taking account of National Institute for Health and Care Excellence guidelines.We want all health and care staff to have received appropriate training to provide high quality care to people with dementia. Employers in the health system are responsible for ensuring that their staff are trained to the required standards to deliver appropriate care for patients. The required training needs are set out in the Dementia Training Standards Framework, which is available through Skills For Health at the following link:https://www.skillsforhealth.org.uk/wp-content/uploads/2021/01/Dementia-Core-Skills-Education-and-Training-Framework.pdf

What steps he is taking to return the dementia diagnosis rate to its target level.

To support recovery of the dementia diagnosis rates, we have developed a memory service dashboard to support commissioners and providers with appropriate data and enable targeted support where needed.We have funded an evidence-based improvement project to fund two trusts in each region, totalling 14 sites, to pilot the Diagnosing Advanced Dementia Mandate protocol. Learning is currently being shared and promoted with regional and local partners following an impact assessment of the pilots.The Office for Health Improvement and Disparities’ Dementia Intelligence Network has developed a tool for local systems to enable investigation into local variation in diagnosis and take informed action to enhance diagnosis rates.We have also published the D100: Assessment Tool Pathway programme, which brings together multiple resources into a single, consolidated tool. The tool continues the work of the Dementia Care Pathway, covering all elements of the Well Pathway, including Diagnosing Well.The D100: Pathway Assessment Tool launched in April 2025 and is available at the following link:https://www.rcpsych.ac.uk/improving-care/nccmh/service-design-and-development/dementia-100-pathway-assessment-tool

Food and Rural Affairs, what progress he has made on achieving (a) Good Chemical Status and (b) Good Ecological Status for waterways in Henley and Thame constituency.

The major waterbodies in the Henley & Thames constituency are the Thames (Wallingford to Caversham), Thames (Caversham to Cookham) and the Thame. These waterbodies do not achieve Good Ecological Status due to their Phosphate Status. All the other elements are at Good Status or above. The Environment Act (2021) puts obligations on water companies to reduce their Phosphorous loading from STWs by 80% using a 2020 base. This needs to be achieved by 2038. It is anticipated that once these improvements have been made, most waterbodies will be at or close to Good Status for Phosphate. Any additional reductions to get Phosphate to meet Good Status will need to be done with other sectors, particularly the agricultural sector. The tributaries within the Thame catchment have various reasons for Not Achieving Good Status. During Asset Management Period 8 (which covers 2025-30), 8 Sewage Treatment Works (STW) overflows will be improved to meet Environment Act targets, and a further 7 will have storm overflow investigations, alongside Phosphorus reduction. It is expected that these measures will form part of the pathway to getting the waterbodies to Good Ecological Status.

Food and Rural Affairs, whether he plans to amend the Water Environment (Water Framework Directive) (England and Wales) Regulations 2017.

In October 2024 the UK and Welsh Government launched an Independent Commission into the water sector regulatory system, this is the third stage of the Government’s water strategy and is the largest review of the industry since privatisation.The Commission will publish an interim report soon and final report later this summer with recommendations to the Government on how to tackle inherited systemic issues in the water sector. The Water Environment (Water Framework Directive) (England and Wales) and River Basin Management Plans are in scope of the Commission.The UK and Welsh Government will respond to the report and consult on proposals they intend to take forward to fundamentally transform how the nation’s water system operates to tackle pollution and deliver a resilient water supply, turbocharge investment, and speed up the delivery of infrastructure upgrades to clean up the nation’s waterways.The Corry Review into Defra’s regulatory landscape, published in April this year, has identified the Water Environment (Water Framework Directive) (England and Wales) Regulations 2017 along with other regulations as a priority for reform. The review recommends modernising these regulations to ensure they are outcome-focused, proportionate and fit for the future- supporting both nature recovery and sustainable growth. Defra is actively considering implementation of the recommendations from the review.