Written questions by Buckley.

What steps his Department is taking to increase the rate of early diagnosis of chronic kidney disease for (a) people with (i) diabetes, (ii) cardiovascular disease and (iii) other associated risk conditions and (b) all people.

NHS England is working to detect people at risk of kidney disease through the NHS Health Check Programme. The programme, which is available for everyone between the ages of 40 and 74 years old who is not already on a chronic disease register, assesses people’s health and risk of developing certain health problems. Using this information, patients are supported to make behavioural changes and access treatment which helps to prevent and detect kidney disease earlier.The NHS Long Term Plan has committed to a number of key ambitions to improve care and outcomes for individuals with cardiovascular disease (CVD), including enhanced diagnostic support in the community, better personalised planning, and increasing access to cardiac rehabilitation. These ambitions will support the delivery of the aim to help prevent 150,000 heart attacks, strokes, and dementia cases by 2029. Specific priorities include the management of CVD risk factors, such as hypertension, or high blood pressure, atrial fibrillation, or an abnormal, fast irregular heartbeat, and high cholesterol, ensuring early and rapid access to diagnostic tests and treatment. NHS England is working to identify opportunities for improved integration of CVD management across clinical specialities.The UK National Screening Committee (UK NSC) reviewed chronic kidney disease (CKD) and glomerulonephritis in 2011, concluding that a population-wide screening programme would not be recommended. Although the UK NSC has not since looked at the evidence for a targeted programme, it can be alerted to any new published peer-reviewed evidence which may suggest the case for a new screening programme. Further information is available at the following link:https://www.gov.uk/government/publications/uk-nsc-annual-call-submitting-a-screening-proposal/uk-nsc-annual-call-how-to-submit-a-proposalThe National Health Service provides access to tests and therapies to diagnose, code, and treat patients with early-stage CKD. NHS England, through the Renal Services Transformation Programme and regional renal networks, is implementing initiatives to provide better, integrated care, reduce health inequalities, and focus on prevention and timely intervention for kidney disease within both primary and secondary care. Regional renal clinical networks prioritise CKD diagnosis and prevention within their transformation ambitions, facilitating earlier treatment. This includes considerations to develop a unified approach to testing populations at risk of developing CKD, and includes raising awareness of diagnostic tools like urine albumin creatinine tests, enabling CKD diagnosis at stages 1 and 2. NHS England aims to improve awareness and access to these important urine and blood tests across primary and secondary care. In addition, the transformation programme launched a renal toolkit last year for use by systems, that outlines principles to support better management of patients identified with CKD throughout their patient journey.The National Institute for Health and Care Excellence (NICE) guidance, Chronic kidney disease: Assessment and management [NG203], updated in November 2021, sets out best practice for clinicians in the diagnosis and management of CKD. The guidance covers the care and treatment of patients at risk of CKD. It includes recommendations on the monitoring of patients at risk of CKD and aims to prevent or delay the progression of the disease. The guidance is available at the following link:https://www.nice.org.uk/guidance/ng203The management of CKD has evolved over the last two decades. Increasingly, there are drug interventions to slow the progression of kidney disease, mitigate the risk of cardiovascular events associated with CKD, and reduce the additional risk of acute kidney injury. NICE guidance continues to be updated as evidence accumulates, and NHS England, through the Renal Clinical Reference Group, supports that process through advice and horizon scanning, as therapeutic interventions are introduced. The renal clinical networks have all established work examining the management of CKD, including diagnosis and intervention.

Whether the NHS Ten Year Plan will prioritise action to combat kidney disease to reduce healthcare inequalities.

The Government is committed to building a fairer Britain by tackling the structural inequalities that contribute to poor health, particularly for disadvantaged groups. We are dedicated to ensuring that people live well for longer and spend less time in ill health, regardless of where they are born or their financial circumstances.Our Health Mission in England will focus on addressing the social determinants of health, with the goal of halving the gap in healthy life expectancy between the richest and poorest regions. We will work across Government to address the root causes of health inequalities, including barriers of access to health and care services. We will prioritise prevention, shift more care into the community, and intervene earlier in life to raise the healthiest generation of children in our history.The 10-Year Health Plan will ensure a better health service for everyone, regardless of condition or service area. On 21 October 2024, we launched a national conversation on the future of the National Health Service, inviting views from across the country on how to deliver a health service fit for the future. Patients, staff, and organisations, including those with experience of, or expertise in, kidney disease, can make themselves heard by logging onto the online portal, which is available at the following link:http://change.nhs.ukNo formal assessment has been made of the potential impact of healthcare inequalities in kidney disease on NHS waiting lists.We recognise that patients have been let down for too long whilst they wait for the care they need, including for kidney disease. Currently, the overall waiting list stands at 7.64 million patient pathways, with over six million people waiting. The Government is committed to putting patients first. This means making sure that patients are seen on time and ensuring that people have the best possible experience during their care.Today, fewer than 60% of patients are being seen within 18 weeks. We will ensure 92% of patients return to waiting no longer than 18 weeks from Referral to Treatment within our first term, a standard which has not been met consistently since September 2015.Tackling waiting lists is a key part of our Health Mission. We will start by delivering an extra 40,000 operations, scans, and appointments each week, as the first step in our commitment to ensuring patients are treated within 18 weeks. We will also address the challenges in diagnostic waiting times, providing the number of computed tomography, magnetic resonance imaging, and other tests that are needed to reduce elective waits.NHS England has established the Renal Services Transformation Programme (RSTP), which aims to reduce unwarranted variation in the quality and accessibility of renal care, to improve outcomes and services for those with kidney disease. NHS England, through the RSTP and regional renal clinical networks, is implementing initiatives to provide better, integrated care, to reduce health inequalities, and to focus on prevention and timely intervention for kidney disease.Working in collaboration with the NHS RightCare Programme and the renal community, the RSTP has developed a renal toolkit to provide integrated care boards, regional renal clinical networks, and providers with tools, case studies, and principles to support the transformation of services at a local level. The toolkit outlines principles to support better management of patients identified with chronic kidney disease (CKD) throughout their patient journey. The RSTP is working closely with NHS England’s regional renal clinical networks to review this toolkit, to work with local partners to develop transformation programmes that will focus on the early identification and management of kidney disease, and which will seek to reduce the number of patients progressing through the various stages of CKD and reduce the number of patients requiring dialysis. By supporting prevention and early intervention, the need for late-stage treatments will be reduced.

What support his Department provides to local NHS Integrated Care Systems to tackle chronic kidney disease through delivering person-centred care.

The National Institute for Health and Care Excellence (NICE) guidance, Chronic kidney disease: Assessment and management [NG203], updated in November 2021, sets out best practice for clinicians in the diagnosis and management of chronic kidney disease (CKD). The guidance covers the care and treatment of patients at risk of CKD. It includes recommendations on the monitoring of patients at risk of CKD and aims to prevent or delay the progression of the disease. The guidance is available at the following link: https://www.nice.org.uk/guidance/ng203 NHS England, through the Renal Services Transformation Programme and regional renal networks, is implementing initiatives to provide better, integrated care, reduce health inequalities, and focus on the prevention and timely intervention for kidney disease. Regional renal clinical networks have already prioritised CKD diagnosis and the prevention of disease progression within their core function. This includes assessing the concordance with NICE guidance around the use of drugs to mitigate the consequences of CKD. Regional renal clinical networks also prioritise CKD diagnosis and prevention within their transformation ambitions, facilitating earlier treatment. This includes considerations to develop a unified approach to testing populations at risk of developing CKD, and includes raising awareness of diagnostic tools like urine albumin creatinine tests, enabling CKD diagnosis at stages 1 and 2. NHS England aims to improve awareness and access to these important urine and blood tests across primary and secondary care. In addition, the transformation programme launched a renal toolkit earlier last year, for use by systems, that outlines principles to support better management of patients identified with CKD throughout their patient journey.No assessment has been made of the adequacy of the implementation of NHS England’s Renal Services Transformation Programme by local National Health Service integrated care systems.

Food and Rural Affairs, what steps his Department plans to take to help family-run farms with any increased costs associated with the Carbon Border Adjustment Mechanism.

Overall, the Government expects any impact on UK farmers to be modest. The level of the Carbon Border Adjustment Mechanism (CBAM) and impact on fertiliser prices is a function of the effective carbon price under the Emission Trading Scheme (ETS) for fertiliser producers, after accounting for Free Allowances. Currently, fertiliser producers have high coverage by Free Allowances. What happens to Free Allowance allocations in the coming years is a matter for the UK ETS Authority.

If she will make an assessment of the potential (a) impact of green levies on electricity bills on electric vehicle drivers who charge their vehicles at home and (b) merits of imposing green levies on gas only.

The government keeps all taxes, including those levied through energy bills, under review.

If she will make an assessment of the potential merits of granting a presumptive right to install electric vehicle chargers at their own cost to people living in rented accommodation.

The Government already provides support for people living in rented accommodation to install chargepoints, through its Electric Vehicle Chargepoint Grant. This provides up to £350 toward the costs of purchasing and installing an electric vehicle chargepoint. We will continue to review whether further steps are needed.

What assessment she has made of the (a) adequacy of schemes offered by the Government to encourage more people to buy electric vehicles and (b) effectiveness of those schemes in helping the UK reach its net zero targets.

This Government is committed to the transition to electric vehicles (EV) and is encouraging uptake through a range of taxation incentives and grants. Drivers of zero emission vehicles (ZEVs) will continue to benefit from favourable tax rates, such as generous company car tax incentives, which have been set until March 2030. ZEVs remain exempt from vehicle excise duty (VED) until April 2025, after which they will still have preferential first year rates. In addition, the Government has announced £120m for next financial year to support the purchase of new electric vans and manufacturing of wheelchair accessible vehicles. The Government is also committed to accelerating the rollout of charging infrastructure so that everyone, no matter where they live or work, can make the transition to an EV. As of 1 November, there are over 71,000 publicly available charging devices in the UK, alongside 680,000 private chargepoints in England alone, supporting drivers to switch to EVs.

Whether his Department is taking steps to raise public awareness of the potential health risks of open (a) coal and (b) wood fires for cooking and heating in the home.

The Government recognises the importance of raising awareness of air pollution and the associated health impacts. The Department of Health and Social Care is supporting the Department for Environment, Food and Rural Affairs on their comprehensive Clean Air Strategy, which will include consideration of interventions to reduce emissions so that everyone’s exposure to air pollution is reduced. In addition, the Department for Environment, Food and Rural Affairs is undertaking a review of how we communicate air quality information to ensure members of the public, and vulnerable groups in particular, have what they need to protect themselves. The Government will also continue to raise awareness about the impact of domestic solid fuel burning.

If he will make an assessment of the potential impact of removing the exemption of care homes from the Smoke and Carbon Monoxide Alarm (England) Regulations 2015 on public health.

We have no current plans to assess the impact of removing this exemption. The Smoke and Carbon Monoxide Alarm (England) Regulations 2015, later amended by the Carbon Monoxide Regulations 2022, are for rented residential premises in England. The regulations exclude a range of settings, including care homes.

What steps he is taking to help ensure long-term funding for hospices.

The Government is determined to shift more healthcare out of hospitals and into the community, to ensure that patients and their families receive personalised care in the most appropriate setting, and palliative and end of life care, including hospices, will have a big role to play in that shift.Palliative care services are included in the list of services an integrated care board (ICB) must commission. This promotes a more consistent national approach and supports commissioners in prioritising palliative and end of life care. To support ICBs in this duty, NHS England has published statutory guidance and service specifications.Whilst the majority of palliative and end of life care is provided by National Health Service staff and services, we recognise the vital part that voluntary sector organisations, including hospices, also play in providing support to people at end of life and their loved ones.Most hospices are charitable, independent organisations which receive some statutory funding for providing NHS services. The amount of funding charitable hospices receive varies by ICB area, and will, in part, be dependent on the breadth of a range of palliative and end of life care provision within their ICB footprint.I recently met with NHS England, and discussions have begun on how to reduce inequalities and variation in access to, and quality of, palliative and end of life care.  We will consider next steps on palliative and end of life care, including funding, in the coming months.

What recent assessment his Department has made of the adequacy of the level of funding for hospices.

We want a society where every person receives high-quality, compassionate care, including at the end of their life. I know that hospices provide fantastic services to many people. The government is going to shift the focus of healthcare out of the hospital and into the community. We recognise the value of the voluntary sector, including hospices, and we will continue to work closely with the sector to understand the pressures they are under.