Written questions by Mierlo.

Pursuant to the Answer of 22 January 2025 to Question 24061 on Rolling Stock, whether the Rolling Stock Strategy will include branch lines.

The Government is committed to ending years of poor service and fragmentation on the railways, by creating a unified and simplified system through public ownership of train operations and by establishing Great British Railways (GBR). The forthcoming Railways Bill will enable the biggest overhaul of the rail sector in a generation. It will create stronger leadership by establishing GBR as a new ‘directing mind’ for the industry, bringing together the management of the rail network and the delivery of passenger services into a single public body. GBR will have the tools and operational independence it needs to plan and run the rail system effectively on a long-term basis, driving up performance and reliability. The Government is working at pace to develop the framework for a rolling stock strategy which will include considerations around the timelines for new build, refurbishments, and potential cascades. Once established, GBR will take the strategy forward providing a long-term approach to future rolling stock needs across the entire network including branch lines.

Pursuant to the Answer of 22 January 2025 to Question 24061 on Rolling Stock, whether new builds will ensure sufficient capacity is procured in the future for the Henley Branch Line to cover moments of peak demand.

The Government is committed to ending years of poor service and fragmentation on the railways, by creating a unified and simplified system through public ownership of train operations and by establishing Great British Railways (GBR). The forthcoming Railways Bill will enable the biggest overhaul of the rail sector in a generation. It will create stronger leadership by establishing GBR as a new ‘directing mind’ for the industry, bringing together the management of the rail network and the delivery of passenger services into a single public body. GBR will have the tools and operational independence it needs to plan and run the rail system effectively on a long-term basis, driving up performance and reliability. The Government is working at pace to develop the framework for a rolling stock strategy which will include considerations around the timelines for new build, refurbishments, and potential cascades. Once established, GBR will take the strategy forward providing a long-term approach to future rolling stock needs across the entire network including branch lines.

Whether he plans to retain the 66.7% national dementia diagnosis rate target for the 2025-26 financial year.

The Government and NHS England remain committed to recovering the dementia diagnosis rate to the national ambition of 66.7% The new approach to planning guidance will improve the operating model, giving local leaders the freedom and autonomy they need to provide the best services to their local community, including for those with dementia. Planning guidance is not a catalogue of everything the National Health Service does, and the absence of a target does not mean it has been deprioritised. Lord Darzi’s independent review showed that a timely diagnosis is vital to ensure that a person with dementia can access the advice, information, care and support that can help them to live well and remain independent for as long as possible. The review also highlighted that there were too many targets set for the NHS which made it hard for local systems to prioritise their actions or be held properly accountable.We are therefore reducing the number of national priorities from 32 last year to 18 this year. This will allow local NHS leaders to make the best choices to meet the needs of their local population.

Food and Rural Affairs, if he will make an assessment of the potential merits of making it mandatory for insurers participating in the Flood Re scheme to provide insurance to properties at risk of flooding.

Flood Re is a joint government and industry flood reinsurance scheme established specifically to help UK households at high risk of flooding to access affordable insurance through their insurance provider. In 2023/24, Flood Re provided cover for over 280,000 household policies, and report that 99% of householders at high risk of flooding can now obtain quotes from 15 or more insurers. All insurance companies providing home insurance policies in the UK are required to pay the Flood Re Levy irrelevant of whether they cede policies to Flood Re or not. It is for individual companies to decide the policies they offer, and when to cede a policy to Flood Re. Householders are encouraged to always shop around for the most suitable policy for their needs, including flood cover. For anyone struggling to find appropriate insurance we advise them to look at BIBA’s Flood Insurance Directory, which can be accessed online via www.biba.org.uk/find-insurance. Alternatively, BIBA’s Find an insurance service can be contacted on 0370 950 1790, Monday to Friday between 9:00am and 5:30pm. Consumers must ensure the cover they choose provides appropriate cover for their circumstances.

If he will make an assessment of the potential merits of expediting a NICE appraisal for Givinostat.

The National Institute for Health and Care Excellence (NICE) works with companies on timelines for its evaluations of new medicines, and aims, wherever possible, to issue guidance close to the point of licensing to support rapid access for National Health Service patients to clinically and cost-effective medicines. The NICE’s timeline for its evaluation of givinostat was rescheduled at the request of the company, to facilitate a suitably comprehensive and robust submission. The NICE’s Appraisal Committee is due to meet to consider its recommendations on givinostat in May 2025.

What assessment he has made of adequacy of the diagnostic capacity of memory clinics in Oxfordshire.

Cutting waiting lists, including for diagnostic tests, is a key priority for the Government. We are committed to transforming diagnostic services, and will support the National Health Service to increase diagnostic capacity to meet the demand for diagnostic services through investment in new capacity, including magnetic resonance imaging and computed tomography scanners.Our Elective Reform Plan, published in January 2025, builds on the investments already made with an ambitious vision for the future of diagnostic testing. This will include more straight-to-test pathways, increasing and expanding Community Diagnostic Centres (CDCs), and better use of technology.With 170 CDCs due to be up and running by the end of March 2025, CDCs can take on more of the growing diagnostic demand within elective care. We will also deliver additional CDC capacity in 2025/26 by expanding a number of existing CDCs and building up to five new ones.In Oxfordshire, we are currently working with the local population, including patients, carers, Age UK, and clinicians in primary care, mental health services, and acute hospital services, to develop a new strategy, Living Well with Dementia, to be implemented from April 2025. Within this work we are seeking to increase the rate of diagnosis by streamlining the referral processes into diagnostic and memory clinics, as well as the alignment with the other services that might be needed.

If he will take steps to (a) increase diagnostic capacity at memory clinics, (b) prepare primary care, (c) increase numbers of specialists capable of prescribing new medicines, (d) adopt new diagnostic technology including blood biomarkers, (e) ensure adequate CT scanning capacity and (f) raise awareness among patients of new medications for Alzheimer's Disease.

The Government is committed to transforming diagnostic services and will support the National Health Service to increase diagnostic capacity to meet the demand for diagnostic services through investment in new capacity, including magnetic resonance imaging and computed tomography scanners.Our Elective Reform Plan, published in January 2025, builds on the investments already made with an ambitious vision for the future of diagnostic testing. This will include more straight-to-test pathways, increasing and expanding Community Diagnostic Centres (CDCs), and better use of technology. With 170 CDCs due to be up and running by the end of March 2025, CDCs can take on more of the growing diagnostic demand within elective care. We will also deliver additional CDC capacity in 2025/26 by expanding a number of existing CDCs and building up to five new ones.Alongside Alzheimer’s Research UK, the Alzheimer’s Society, Gates Ventures, and the People’s Postcode Lottery, the National Institute for Health Research is funding the Blood Biomarker Challenge, which seeks to produce the clinical and economic data that could make the case for the use of a blood test in the NHS to support the diagnosis of dementia.New disease modifying drugs for Alzheimer’s disease are in development. NHS England is working closely with system partners to ensure that arrangements are in place to support the adoption of any new licensed and National Institute for Health and Care Excellence-recommended treatments as soon as possible.

Pursuant to the Answer of 22 January 2025 to Question 24596 on Caesarean Sections, what steps he is taking with NHS England to ensure that women are not unnecessarily discouraged from having elective caesarean sections.

NHS England’s three-year delivery plan for maternity and neonatal services recognises the importance of listening to women and families. It aims to ensure that women have clear choices, supported by unbiased information and evidence-based guidelines, and that all women are offered personalised care and support plans.Personalised care and support plans take account of physical health, mental health, social complexities, and choices. Personalised care includes open, honest, and ongoing dialogue between a woman, her midwife, and other clinicians, to understand the care she wants.If a woman would prefer a caesarean for non-medical reasons, they can ask their midwife or doctor, who will explain the overall benefits and risks of a caesarean to the woman and their baby compared with a vaginal birth. If, after discussing all the risks and hearing about all the support on offer, a woman feels that a vaginal birth is not an acceptable option, they should be offered a planned caesarean.

What steps the Government if taking to reach an agreement to end collective action by GPs.

The Government has accepted and implemented the independent pay review body recommendation of a 6% uplift in general practitioner (GP) pay, and has committed to hiring an extra 1,000 GPs.We have announced a proposed £889 million uplift for GPs in 2025/26 and set out the proposed areas of reform. This is the largest uplift to GP funding since the beginning of the five-year framework and means that we are reversing the recent trend with a rising share of total National Health Service resources going to GPs.The Department and NHS England started consultation with the General Practitioners Committee in England, of the British Medical Association, on the 2025/26 GP Contract on 19 December 2024, and will consider all proposed policy changes. An announcement will be made before April 2025.

When he plans to respond to the letter of 6 November 2024 from the Hon. Member for Henley and Thame on a constituent's concern over confectionary VAT added to his product designed to be a healthier option.

We have received the Hon. Member’s correspondence of 6 November 2024, and responded on 23 January 2025, with the reference PO-1545237.

If he will have discussions with (a) Eisai Co., Ltd and Biogen Inc. and (b) Eli Lilly and Company on the production of disease-modifying treatments for Alzheimer's disease in the UK.

The Government deeply values its relationships with life science companies and is committed to getting treatments to National Health Service patients through our 10 Year Plan for the NHS. This will include a plan for procurement, giving a clearer route to getting products into the NHS, coupled with reformed incentive structures to drive innovation and faster regulatory approval for new technology and medicines. The Government engages regularly with companies on the production of disease-modifying treatments for Alzheimer's disease in the United Kingdom, such as those developed by Eisai, Biogen, and Eli Lilly, and where appropriate, ministers may be involved in this engagement.

What criteria he plans to use to evaluate the respiratory syncytial virus immunisation method to protect infants in the June 2025 review.

The respiratory syncytial virus (RSV) antenatal maternal vaccination programme for infant protection began in England on 1 September 2024. The first uptake data will be published on 30 January 2025.The UK Health Security Agency (UKHSA) undertakes evaluations of national immunisation programmes, and will be evaluating the impact and effectiveness of the RSV maternal vaccination programme for infant protection once sufficient data is available. Immunisation programme effectiveness against hospital admissions is typically assessed using the test-negative case-control method.To raise awareness of the potential vaccination benefits and increase awareness of the programmes amongst health professionals, parents, carers, and the wider public, the UKHSA provides a comprehensive suite of public facing resources and assets. This includes information leaflets in multiple languages and accessible formats, like easy read, British Sign Language, and braille. The UKHSA also provides comprehensive clinical guidance, including e-learning programmes and training for healthcare professionals.

What the uptake rate was of the RSV vaccine by pregnant people in each of the last three years; and if he will make an assessment of the potential implications for his policies of trends in the uptake rate of the RSV vaccine by pregnant people in that time.

The respiratory syncytial virus (RSV) antenatal maternal vaccination programme for infant protection began in England on 1 September 2024. The first uptake data will be published on 30 January 2025.The UK Health Security Agency (UKHSA) undertakes evaluations of national immunisation programmes, and will be evaluating the impact and effectiveness of the RSV maternal vaccination programme for infant protection once sufficient data is available. Immunisation programme effectiveness against hospital admissions is typically assessed using the test-negative case-control method.To raise awareness of the potential vaccination benefits and increase awareness of the programmes amongst health professionals, parents, carers, and the wider public, the UKHSA provides a comprehensive suite of public facing resources and assets. This includes information leaflets in multiple languages and accessible formats, like easy read, British Sign Language, and braille. The UKHSA also provides comprehensive clinical guidance, including e-learning programmes and training for healthcare professionals.

If she will make an assessment of the potential merits of taking legislative steps to provide VAT relief on the rethatching of listed buildings.

To preserve heritage, restorative work carried out on listed buildings previously benefited from a zero rate of VAT. However, this relief was abolished in 2012, as it was primarily used to carry out extension work unnecessary for heritage purposes. Withdrawing this relief simplified VAT rules and removed the scope for error when categorising construction work as either alteration or repair. VAT is a broad-based tax on consumption and the 20 per cent standard rate applies to most goods and services. VAT is the UK’s second largest tax forecast to raise £171 billion in 2024/25. Taxation is a vital source of revenue that helps to fund vital public services. Evidence suggests that businesses only partially pass on any savings from lower VAT rates. In some cases, reliefs do not represent good value for money, as there is no guarantee that savings will be passed on to consumers. The Government therefore has no current plans to reduce the VAT charged on work to maintain and repair listed properties, but we keep all taxes under review.

Pursuant to the Answer of 24 October to Question 9576 on Methylphenidate: Shortages, if he will make an assessment of the adequacy of the supply of methylphenidate for ADHD since October 2024.

The Department continues to work hard with industry and NHS England to help resolve the supply issues with some attention deficit hyperactivity disorder (ADHD) medicines, which are affecting the United Kingdom and other countries around the world. As a result of intensive work, some issues have been resolved. All strengths of lisdexamfetamine, atomoxetine capsules, atomoxetine oral solution, and guanfacine prolonged-release tablets are now available.However, whilst the supply of methylphenidate prolonged-release tablets has improved since October 2024, issues persist. We are continuing to work to resolve these remaining issues by engaging with all suppliers of methylphenidate prolonged-release tablets to assess the challenges faced and their actions to address them. We are also directing suppliers to secure additional stocks, expedite deliveries where possible, and review plans to further build capacity to support continued growth in demand for the short and long-term. The Department is also working with new suppliers of methylphenidate prolonged-release tablets to improve supply and resiliency for the UK market.We are supporting an ADHD taskforce that NHS England has established to examine ADHD service provision. The taskforce will bring together expertise from across a broad range of sectors, including the National Health Service, education, and justice, to help provide a joined-up approach in response to concerns around rising demand. In collaboration with NHS England’s national ADHD data improvement plan, we plan to combine modelling for future growth forecasts, which will be shared with industry to improve demand forecasting for ADHD medicines.

What steps he is taking to help increase the uptake rate of the RSV vaccine during pregnancy.

The maternal respiratory syncytial virus (RSV) vaccination programme launched on 1 September 2024, and is being delivered by general practices and commissioned maternity services. NHS England has been working with systems, stakeholders, and partners to increase awareness and uptake of the RSV vaccine amongst pregnant women.A system letter setting out the role of providers in advising pregnant women of their eligibility for vaccination was sent from the Chief Midwifery Officer for England, the National Clinical Director for Maternity, and the Chief Delivery Officer and National Director for Vaccination and Screening in August 2024.NHS England has held webinars for health professionals on vaccination in pregnancy and with the midwifery and nursing teams delivering the RSV vaccine, to provide information on eligibility, outreach, and how to administer the vaccine before the programme started. Resources and information have been shared with maternity leads since the programme began, to increase awareness of the vaccine and ensure more women are booking their vaccination for when they become eligible at 28 weeks. Commissioned maternity services are also encouraged to have vaccination discussions with pregnant women early in pregnancy.A range of communication materials have been produced by NHS England and the UK Health Security Agency, who are working with stakeholders, including parenting clubs, to disseminate information on vaccination in pregnancy through their channels.RSV vaccination event data from all commissioned providers is made available to NHS England regional commissioning teams and their partner integrated care boards in a timely way. NHS operational vaccination data is being monitored closely at a local and national level, and is being used to drive further development of the programme.

Food and Rural Affairs, what the funding settlement is for National Trails UK for 2025-26.

The Government recognises the value of the Trails and the benefits they bring. We understand the uncertainty around resourcing remains a challenge for National Trails UK. Defra business planning is ongoing, and we will communicate the outcome of the settlements for National Trails UK as soon as possible.

What assessment she has made of the adequacy of provisions for registration of deaths to ensure that (a) bereaved people are able to meet the requirement to notify a death within five days of the statutory relevant date and (b) the burden on the recently bereaved is minimised as far as possible.

Since the implementation of the death certification reforms in September 2024, the 5-day statutory time period for an informant to register a death commences when the registrar receives a completed Medical Certificate of Cause of Death (MCCD) from a Medical Examiner, or notification from a Coroner.Monitoring by the General Register Office for England and Wales confirms that current appointment availability for the bereaved with registrars in Local Authorities to be available to register deaths is adequate, but the Government is continuing to work towards the electronic registration of deaths to minimise the burden on bereaved family members at a difficult time, as set out by the Secretary of State for Science, Innovation and Technology.

What assessment he has made of the impact of the statutory two week paternity leave on the economy.

Paternity Leave supports working people. Access to family-friendly rights means that working people can enjoy a better work-life balance that benefits wellbeing, morale, productivity and retention. The Government has committed to conduct a review of the whole parental leave system. This review will focus on ensuring that parental leave, including Paternity Leave, offers the best possible support to working families. Work is already underway on planning for its delivery.

If he will make an assessment of the potential merits of extending paternity leave.

Paternity Leave supports working people. Access to family-friendly rights means that working people can enjoy a better work-life balance that benefits wellbeing, morale, productivity and retention. The Government has committed to conduct a review of the whole parental leave system. This review will focus on ensuring that parental leave, including Paternity Leave, offers the best possible support to working families. Work is already underway on planning for its delivery.