Written questions by Maguire.

How many linear accelerator machines are over (a) 10, (b) 15 and (c) 25 years old by integrated care system.

The number of radiotherapy machines in use which are over the 10-year recommended age is not published by NHS England. The Department also does not hold detailed information about the age of radiotherapy machines, as local systems are responsible for radiotherapy treatment services and since April 2022 the responsibility for investing in new radiotherapy machines has been with local systems.The Government has invested an additional £70 million of central funding into new LINAC radiotherapy machines to replace older, less efficient machines. These machines are now being rolled out across the country, to help boost radiotherapy productivity and reduce waiting times for cancer patients.

What assessment his Department has made of the potential merits of undertaking a National Bladder Cancer Audit.

Improving cancer outcomes, including for bladder cancer, is a priority for the Government. The forthcoming National Cancer Plan will set out further actions to improve earlier diagnosis, expand access to the latest treatments and technologies, and improve survival rates across England.National cancer registry data shows a small but sustained decline in bladder cancer survival rates over recent years. One-year survival fell from approximately 72% to 69.6%, and five-year survival from 51.5% to 47.2% between 2007 to 2011 and 2016 to 2020.To improve treatment times, we have invested £70 million of funding into new radiotherapy treatment machines to replace older, less efficient machines. These new machines are currently being rolled out to trusts throughout the country. These newer machines will reduce treatment times, boost productivity, and allow more patients to be seen over the same period.In addition, non-specific symptom pathways have been introduced to speed up diagnosis for patients whose symptoms may indicate cancer but which do not align clearly with a specific tumour type. This helps ensure that more patients are referred, investigated, and diagnosed earlier, including cases of bladder cancer that present with broader or less specific symptoms.The NHS Cancer Programme has commissioned 10 national clinical audits covering breast, ovarian, pancreatic, lung, prostate, oesophago-gastric, bowel, non-Hodgkin lymphoma, and kidney cancers. These were selected as auditing was expected to have the greatest impact on reducing unwarranted variation in care. For this reason, there are currently no plans to undertake a national clinical audit for bladder cancer, though bladder cancer outcomes continue to be monitored through existing national cancer datasets.

What assessment his Department has made of the adequacy of steps taken by Integrated Care Boards to help tackle regional inequalities in access to eye care services.

No assessment has been made. Integrated care boards, as commissioners of primary and secondary eye care services, are required to work with local authorities to assess the current and future health, care, and wellbeing needs of their local populations. They will then set out, in joint local health and wellbeing strategies, how they will meet those needs, and this could include addressing any identified inequalities in accessing services. Understanding patient demographics is an essential step in identifying and tackling health inequalities. The Elective Reform Plan included a commitment to publish waiting list information broken down by demographics to allow greater visibility of potential health inequalities. The Elective Reform Plan is available at the following link: https://www.england.nhs.uk/publication/reforming-elective-care-for-patients/ This enables local health services to understand the demographics of patients on their waiting list to better tailor services to their needs. Data on demographics of the elective waiting list can be found at the following link for the week ending 26 October 2025: https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/wlmds/ It shows referral to treatment waiting times from the Waiting List Minimum Data Set for Ophthalmology split by age, sex, deprivation, and ethnicity. The Public Health Outcomes Framework Eye Health Indicator also continues to track the rate of sight loss for age-related macular degeneration, glaucoma, and diabetic retinopathy. This information is available to commissioners and can be used to drive improved local outcomes and interventions.

How many ICBs have had to pause NHS services provided by independent healthcare providers during 2024-25.

In January 2025, the National Health Service and the independent sector established a partnership agreement, the first of its kind for 25 years, setting out how we will work together to reduce the elective care waiting list. NHS England manages the Department’s relationships with the integrated care boards (ICBs) and, where appropriate, local systems on the use of independent sector capacity to support delivery of NHS care. Commissioning decisions are for ICBs to make, who have a duty to arrange health services for the patients they are responsible for in a way which promotes the NHS Constitution. ICBs are expected to live within their allocations while continuing to use spare independent sector capacity to meet elective targets. Independent sector providers deliver services agreed in contracts with ICBs, progressing priorities set out in planning guidance, including an improvement in elective waiting time performance. Data on how many ICBs have had to pause NHS services or cancel operations scheduled by independent healthcare providers during 2024/25 is not held centrally by the Department.

What discussions his Department has with ICBs on ensuring delivery of patient care via independent healthcare providers throughout the financial year.

In January 2025, the National Health Service and the independent sector established a partnership agreement, the first of its kind for 25 years, setting out how we will work together to reduce the elective care waiting list. NHS England manages the Department’s relationships with the integrated care boards (ICBs) and, where appropriate, local systems on the use of independent sector capacity to support delivery of NHS care. Commissioning decisions are for ICBs to make, who have a duty to arrange health services for the patients they are responsible for in a way which promotes the NHS Constitution. ICBs are expected to live within their allocations while continuing to use spare independent sector capacity to meet elective targets. Independent sector providers deliver services agreed in contracts with ICBs, progressing priorities set out in planning guidance, including an improvement in elective waiting time performance. Data on how many ICBs have had to pause NHS services or cancel operations scheduled by independent healthcare providers during 2024/25 is not held centrally by the Department.

How many operations scheduled to be carried out by independent healthcare providers were cancelled by ICBs between April 2024 and 2025.

In January 2025, the National Health Service and the independent sector established a partnership agreement, the first of its kind for 25 years, setting out how we will work together to reduce the elective care waiting list. NHS England manages the Department’s relationships with the integrated care boards (ICBs) and, where appropriate, local systems on the use of independent sector capacity to support delivery of NHS care. Commissioning decisions are for ICBs to make, who have a duty to arrange health services for the patients they are responsible for in a way which promotes the NHS Constitution. ICBs are expected to live within their allocations while continuing to use spare independent sector capacity to meet elective targets. Independent sector providers deliver services agreed in contracts with ICBs, progressing priorities set out in planning guidance, including an improvement in elective waiting time performance. Data on how many ICBs have had to pause NHS services or cancel operations scheduled by independent healthcare providers during 2024/25 is not held centrally by the Department.

What steps his Department is taking to create capacity in hospital eye services by expanding the use of optometry-led diagnostic and treatment pathways.

Integrated care boards are responsible for assessing the health needs of their local population and commissioning primary and secondary eye care services to meet them.This can already include the commissioning of enhanced eye care services from high street optical practices, including minor and urgent eye care services and glaucoma referral refinement services.NHS England accelerator pilots have demonstrated that improved IT connectivity and a single point of access can significantly speed up eye care referrals and support more patients to be managed in the community, in line with the ambitions in the 10-Year Health Plan.

What steps his Department is taking to expand the use of community optometry services.

Integrated care boards are responsible for assessing the health needs of their local population and commissioning primary and secondary eye care services to meet them.This can already include the commissioning of enhanced eye care services from high street optical practices, including minor and urgent eye care services and glaucoma referral refinement services.NHS England accelerator pilots have demonstrated that improved IT connectivity and a single point of access can significantly speed up eye care referrals and support more patients to be managed in the community, in line with the ambitions in the 10-Year Health Plan.

What measures the National Cancer Plan will implement to improve ovarian cancer survival in England.

Reducing the number of lives lost to cancer in England, including ovarian cancer, is a key aim of the National Cancer Plan which will be published in the new year. The plan will set out in further detail how the Government will improve outcomes for cancer patients, including ovarian cancer patients, as well as speeding up diagnosis and treatment, ensuring patients have access to the latest treatments and technology, and ultimately driving up this country’s cancer survival rates.The Government knows that many ovarian cancer patients are still left waiting too long for a diagnosis and treatment and so will push to get the National Health Service diagnosing and treating it faster, so that more patients survive the disease and have an improved experience across the system. The Elective Reform Plan, published in January 2025, sets out the productivity and modernisation efforts needed to return to the 18-week constitutional standard by the end of this Parliament. The plan commits to transforming and expanding diagnostic services and speeding up waiting times for tests, a crucial part of reducing overall waiting times and returning to the referral to treatment 18-week standard. This includes expanding existing community diagnostic centres (CDCs), as well as building up to five new ones in 2025/26, to support the NHS to return to meeting the elective waiting time constitutional standard. The plan also commits to CDCs opening 12 hours per day, seven days a week, delivering more same-day tests and consultations and an expanded range of tests, many of which can support the diagnosis of gynaecological cancers, including ovarian cancer.To support early diagnosis, NHS England is taking a wide range of activity to increase awareness of ovarian cancer. NHS England relaunched the Help Us Help You cancer campaign on the 8 January 2024, to encourage people to get in touch with their general practitioner if they notice, or are worried about, symptoms that could be cancer. Previous phases of the campaign have focused on abdominal symptoms which, among other abdominal cancers, can be indicative of ovarian cancer. NHS England and other NHS organisations, nationally and locally, publish information on the signs and symptoms of many different types of cancer, including ovarian cancer. This information can be found at sources including the NHS website, which is available at the following link:https://www.nhs.uk/

What steps his Department is taking to improve public and primary care awareness of ovarian cancer symptoms, in the context of data from the National Ovarian Cancer Audit showing that four in 10 women are admitted as an emergency 28 days prior to diagnosis, often leading to poorer outcomes.

Reducing the number of lives lost to cancer in England, including ovarian cancer, is a key aim of the National Cancer Plan which will be published in the new year. The plan will set out in further detail how the Government will improve outcomes for cancer patients, including ovarian cancer patients, as well as speeding up diagnosis and treatment, ensuring patients have access to the latest treatments and technology, and ultimately driving up this country’s cancer survival rates.The Government knows that many ovarian cancer patients are still left waiting too long for a diagnosis and treatment and so will push to get the National Health Service diagnosing and treating it faster, so that more patients survive the disease and have an improved experience across the system. The Elective Reform Plan, published in January 2025, sets out the productivity and modernisation efforts needed to return to the 18-week constitutional standard by the end of this Parliament. The plan commits to transforming and expanding diagnostic services and speeding up waiting times for tests, a crucial part of reducing overall waiting times and returning to the referral to treatment 18-week standard. This includes expanding existing community diagnostic centres (CDCs), as well as building up to five new ones in 2025/26, to support the NHS to return to meeting the elective waiting time constitutional standard. The plan also commits to CDCs opening 12 hours per day, seven days a week, delivering more same-day tests and consultations and an expanded range of tests, many of which can support the diagnosis of gynaecological cancers, including ovarian cancer.To support early diagnosis, NHS England is taking a wide range of activity to increase awareness of ovarian cancer. NHS England relaunched the Help Us Help You cancer campaign on the 8 January 2024, to encourage people to get in touch with their general practitioner if they notice, or are worried about, symptoms that could be cancer. Previous phases of the campaign have focused on abdominal symptoms which, among other abdominal cancers, can be indicative of ovarian cancer. NHS England and other NHS organisations, nationally and locally, publish information on the signs and symptoms of many different types of cancer, including ovarian cancer. This information can be found at sources including the NHS website, which is available at the following link:https://www.nhs.uk/

What steps the Government is taking to ensure women’s health hubs and community diagnostic centres are utilised to support earlier diagnosis of gynaecological cancers, including ovarian cancer.

Reducing the number of lives lost to cancer in England, including ovarian cancer, is a key aim of the National Cancer Plan which will be published in the new year. The plan will set out in further detail how the Government will improve outcomes for cancer patients, including ovarian cancer patients, as well as speeding up diagnosis and treatment, ensuring patients have access to the latest treatments and technology, and ultimately driving up this country’s cancer survival rates.The Government knows that many ovarian cancer patients are still left waiting too long for a diagnosis and treatment and so will push to get the National Health Service diagnosing and treating it faster, so that more patients survive the disease and have an improved experience across the system. The Elective Reform Plan, published in January 2025, sets out the productivity and modernisation efforts needed to return to the 18-week constitutional standard by the end of this Parliament. The plan commits to transforming and expanding diagnostic services and speeding up waiting times for tests, a crucial part of reducing overall waiting times and returning to the referral to treatment 18-week standard. This includes expanding existing community diagnostic centres (CDCs), as well as building up to five new ones in 2025/26, to support the NHS to return to meeting the elective waiting time constitutional standard. The plan also commits to CDCs opening 12 hours per day, seven days a week, delivering more same-day tests and consultations and an expanded range of tests, many of which can support the diagnosis of gynaecological cancers, including ovarian cancer.To support early diagnosis, NHS England is taking a wide range of activity to increase awareness of ovarian cancer. NHS England relaunched the Help Us Help You cancer campaign on the 8 January 2024, to encourage people to get in touch with their general practitioner if they notice, or are worried about, symptoms that could be cancer. Previous phases of the campaign have focused on abdominal symptoms which, among other abdominal cancers, can be indicative of ovarian cancer. NHS England and other NHS organisations, nationally and locally, publish information on the signs and symptoms of many different types of cancer, including ovarian cancer. This information can be found at sources including the NHS website, which is available at the following link:https://www.nhs.uk/

If his Department will instruct health providers to update outdated or unclear information on hormone replacement therapy treatments for menopause.

Setting guidance for the treatment of individual conditions falls to the National Institute for Health and Care Excellence (NICE), who produce guidance for the National Health Service and wider health and care system. NICE guidelines are evidence-based recommendations for health and care in England and Wales. They help health and social care professionals to prevent ill health, promote good health, and improve the quality of care and services.NICE clinical guidelines are intended for health and social care professionals, commissioners, patients, and carers to help them make informed decisions on the appropriate treatment and care.When put into practice, NICE guidelines have the potential to effectively target health and care resources to significantly improve patient outcomes, in line with the best available evidence of clinical and cost-effectiveness. Although healthcare professionals and commissioners are not legally obliged to follow NICE guidelines, they are expected to take them into full account when making decisions on treatment and care for patients. The most recent guidance, last updated November 2024, is available at the following link:https://www.nice.org.uk/guidance/ng23Generally, providers rely on a range of professional organisations to keep their practice up to date, and they need to work within a scope of practice which includes being up to date and which is assessed through appraisal. In addition to NICE, they would look to the British Menopause Society, the College of Sexual and Reproductive Healthcare, the Royal College of General Practitioners, or the Royal College of Obstetricians and Gynaecologists. Further information on the British Menopause Society is available at the following link:https://thebms.org.uk/

What steps his Department is taking to improve respiratory health and care.

The Government has committed to delivering three big shifts that our National Health Service needs to be fit for the future: from hospital to community; from analogue to digital; and from sickness to prevention. All of these are relevant to improving respiratory health in all parts of the country.Through the community diagnostic centres, we are building capacity for respiratory testing and enabling people to get tested for chronic obstructive pulmonary disease (COPD) closer to home. Earlier diagnosis of conditions will help prevent deterioration and improve survival rates.We are also focused on expanding capacity and improving quality in pulmonary rehabilitation delivery to support patients living with respiratory conditions.We are also taking action to reduce the causes of respiratory conditions such as enabling a smoke free generation and cross Government action to improve air quality.

If his Department will make an assessment of the impact of Surrey ICB suspending ADHD and autism assessments for people using providers under the NHS Right to Choose pathway on support for adults and children with ADHD and autism.

The Government has recognised that, nationally, the demand for assessments for autism and attention deficit hyperactivity disorder (ADHD) has grown significantly in recent years and that people are experiencing severe delays for accessing such assessments. The Government’s 10-Year Health Plan will make the National Health Service fit for the future and recognises the need for early intervention and support.It is the responsibility of integrated care boards (ICBs) in England to make appropriate provision to meet the health and care needs of their local population, including providing access to autism and ADHD assessments, in line with relevant National Institute for Health and Care Excellence guidelines.The Medium-Term Planning Framework, published 24 October, was explicit that ICBs and providers are expected to optimise existing resources to reduce long waits for autism and ADHD assessments and improve the quality of assessments by implementing existing and new guidance, as published.In April 2023, NHS England published a national framework and operational guidance to help ICBs and the NHS to deliver improved outcomes for people referred to an autism assessment service. NHS England has continued to support services to identify challenges and how they might overcome these.  NHS England also established an ADHD taskforce to better understand the challenges affecting those with ADHD, including in accessing timely and equitable access to services and support. We are pleased that the final report was published on 6 November, and we are carefully considering its recommendations.

What steps his Department is taking to improve access to care for menopause treatment across the country.

The Government acknowledges that women suffering from symptoms of menopause have been failed for far too long, and the impact it has on women’s lives, relationships, and participation in the workplace.In October 2025, my Rt Hon. Friend, the Secretary of State for Health and Social Care announced that menopause will be added to the NHS Health Checks from 2026. Local authorities will be asked to include menopause to the check for eligible women aged 40 to 55 years old who attend. This will support up to five million eligible women across England to access high quality information on the menopause, including advice on managing symptoms and where to seek support when they need it the most.We are also renewing the Women’s Health Strategy for England to set out next steps to improving women's healthcare as part of the 10-Year Health Plan. The priority will be to create a system that listens to women's experiences and tackles the inequalities they face. The renewal will look at women’s health as a whole including considering the menopause.

What assessment has been made of the impact of Surrey ICB suspending ADHD and autism assessments for people using providers under the NHS Right to Choose pathway on wait times for adults and children to receive care for their ADHD or autism.

The Government has recognised that, nationally, the demand for assessments for autism and attention deficit hyperactivity disorder (ADHD) has grown significantly in recent years and that people are experiencing severe delays for accessing such assessments. The Government’s 10-Year Health Plan will make the National Health Service fit for the future and recognises the need for early intervention and support.It is the responsibility of integrated care boards (ICBs) in England to make appropriate provision to meet the health and care needs of their local population, including providing access to autism and ADHD assessments, in line with relevant National Institute for Health and Care Excellence guidelines.The Medium-Term Planning Framework, published 24 October, was explicit that ICBs and providers are expected to optimise existing resources to reduce long waits for autism and ADHD assessments and improve the quality of assessments by implementing existing and new guidance, as published.In April 2023, NHS England published a national framework and operational guidance to help ICBs and the NHS to deliver improved outcomes for people referred to an autism assessment service. NHS England has continued to support services to identify challenges and how they might overcome these.  NHS England also established an ADHD taskforce to better understand the challenges affecting those with ADHD, including in accessing timely and equitable access to services and support. We are pleased that the final report was published on 6 November, and we are carefully considering its recommendations.

What steps his Department is taking to reduce the 130,000 Chronic obstructive pulmonary disease hospital admissions made each year.

Smoking is the number one preventable cause of chronic obstructive pulmonary disease (COPD). The Tobacco and Vapes Bill will be the biggest public health intervention since the indoor smoking ban in 2007 and will help deliver our ambition for a smoke-free United Kingdom.Poor air quality can exacerbate COPD. To address this, the Department of Health and Social Care is working across the Government with the Department for Environment, Food and Rural Affairs to tackle air pollution, and the Department for Energy Security and Net Zero to fix housing and reduce damp and mould. Infections can also exacerbate COPD, so the National Health Service is running winter vaccine campaigns against respiratory infections including COVID-19, flu, and pneumococcal disease.To enable faster diagnosis and earlier access to treatment, access to spirometry tests in community diagnostic centres (CDCs) is growing and will continue to do so as more sites come online. The first five months of 2025/26 saw an increase in CDC spirometry testing of approximately 2,000 tests per month more than in the previous year.Pulmonary rehabilitation is a key intervention to improve the health of people with COPD and reduce pressure on NHS hospitals. NHS England has published commissioning standards for pulmonary rehabilitation, setting out the benchmarks that high-quality services should aim for. This includes reducing health inequalities and ensuring equitable access.

If his Department will ensure cleft training is embedded in undergraduate dental education and ongoing professional development.

I refer the Hon. Member to the response I gave to the Hon. Member for Yeovil on 20 November 2025 to Question 90537.

What assessment his Department has made of the potential merits of increasing the use of private high street eye care providers to treat conditions such as glaucoma to relieve pressure from the NHS.

We recognise the vital contribution that high street eye care providers make in maintaining the nation’s eye health.Integrated care boards are responsible for assessing the health needs of their local population and for commissioning primary and secondary eye care services to meet them. This could include the commissioning of community-based glaucoma services, such as glaucoma referral filtering or glaucoma monitoring schemes.The Getting It Right First-Time programme is currently developing best practice guidance for glaucoma services to support the adoption of high standards across the pathway, from detection onwards.

What steps his Department is taking to ensure no one is denied treatment outright because of their cleft.

Patients born with cleft should have care plans tailored to meet their individual needs, with support from multi-disciplinary teams where necessary. Access to dental care is an important part of this and we recognise that some groups of patients may find it difficult to access. We have asked integrated care boards to commission extra urgent dental appointments and are also committed to reforming the dental contract, with a focus on matching resources to need and improving access.