Written questions by Wrigley.

If he will make an assessment of the potential impact of the removal of the dementia diagnosis rate target on the adequacy of dementia care.

We remain committed to increasing dementia diagnosis rates and agree that early diagnosis is vital to ensure people with dementia can access the treatment and support they need.We have taken a new approach to NHS Planning Guidance this year, reducing the number of national directives from 32 to 18. We will only turn the National Health Service around by doing things differently. These are the first steps on our journey for long-term reform of the NHS.NHS Planning Guidance is not an exhaustive list of everything the NHS does, and the absence of a target does not mean it is not an area of focus. The Darzi Investigation found that there are too many targets set for the NHS, which made it hard for local systems to prioritise their actions or to be held properly accountable.Our aim is to give more power to local systems and let them decide how they use local funding to best meet the needs of their local population. This approach signals our ambition for reform, recognises the role of the NHS in driving economic growth, and enshrines our commitment to financial rigour in the system.Through our extensive public engagement as part of the 10-Year Health Plan, we will continue to listen to patients’ priorities and keep focused on what matters most to the public.Lord Darzi’s independent review showed that a timely diagnosis is vital to ensuring 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 10-Year Health Plan will address the challenges diagnosed by Lord Darzi and set the vision for what good joined-up care looks like for people with a combination of complex health and care needs. It will set out how we support and enable health and social care services to work together better to provide that joined-up care.

Commonwealth and Development Affairs, what recent discussions he has had with his Canadian counterparts on recent tariffs applied to that country by the US.

The Foreign Secretary speaks regularly with Canadian Foreign Minister Joly, most recently on 28 January, where they discussed a range of bilateral and global issues. Canada is one of our closest allies, underpinned by a broad trade and investment relationship which we are committed to deepening further.

With reference to NHS England's guidance entitled 2025/26 priorities and operational planning guidance, published on 30 January 2025, if he will make an assessment of the potential impact of the removal of the dementia diagnosis target rate on (a) support and (b) treatment for non-diagnosis dementia patients.

We remain committed to increasing dementia diagnosis rates and agree that early diagnosis is vital to ensure people with dementia can access the treatment and support they need.We have taken a new approach to NHS Planning Guidance this year, reducing the number of national directives from 32 to 18. We will only turn the National Health Service around by doing things differently. These are the first steps on our journey for long-term reform of the NHS.NHS Planning Guidance is not an exhaustive list of everything the NHS does, and the absence of a target does not mean it is not an area of focus. The Darzi Investigation found that there are too many targets set for the NHS, which made it hard for local systems to prioritise their actions or to be held properly accountable.Our aim is to give more power to local systems and let them decide how they use local funding to best meet the needs of their local population. This approach signals our ambition for reform, recognises the role of the NHS in driving economic growth, and enshrines our commitment to financial rigour in the system.Through our extensive public engagement as part of the 10-Year Health Plan, we will continue to listen to patients’ priorities and keep focused on what matters most to the public.Lord Darzi’s independent review showed that a timely diagnosis is vital to ensuring 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 10-Year Health Plan will address the challenges diagnosed by Lord Darzi and set the vision for what good joined-up care looks like for people with a combination of complex health and care needs. It will set out how we support and enable health and social care services to work together better to provide that joined-up care.

With reference to NHS England's guidance entitled 2025/26 priorities and operational planning guidance, published on 30 January 2025, if he will make an assessment of the potential impact of the removal of the dementia diagnosis target rate on the number of patients at risk of going into urgent care.

We remain committed to increasing dementia diagnosis rates and agree that early diagnosis is vital to ensure people with dementia can access the treatment and support they need.We have taken a new approach to NHS Planning Guidance this year, reducing the number of national directives from 32 to 18. We will only turn the National Health Service around by doing things differently. These are the first steps on our journey for long-term reform of the NHS.NHS Planning Guidance is not an exhaustive list of everything the NHS does, and the absence of a target does not mean it is not an area of focus. The Darzi Investigation found that there are too many targets set for the NHS, which made it hard for local systems to prioritise their actions or to be held properly accountable.Our aim is to give more power to local systems and let them decide how they use local funding to best meet the needs of their local population. This approach signals our ambition for reform, recognises the role of the NHS in driving economic growth, and enshrines our commitment to financial rigour in the system.Through our extensive public engagement as part of the 10-Year Health Plan, we will continue to listen to patients’ priorities and keep focused on what matters most to the public.Lord Darzi’s independent review showed that a timely diagnosis is vital to ensuring 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 10-Year Health Plan will address the challenges diagnosed by Lord Darzi and set the vision for what good joined-up care looks like for people with a combination of complex health and care needs. It will set out how we support and enable health and social care services to work together better to provide that joined-up care.

With reference to NHS England's guidance entitled 2025/26 priorities and operational planning guidance, published on 30 January 2025, if he will make an assessment of the potential impact of the removal of the dementia diagnosis target rate on local health service accountability.

We remain committed to increasing dementia diagnosis rates and agree that early diagnosis is vital to ensure people with dementia can access the treatment and support they need.We have taken a new approach to NHS Planning Guidance this year, reducing the number of national directives from 32 to 18. We will only turn the National Health Service around by doing things differently. These are the first steps on our journey for long-term reform of the NHS.NHS Planning Guidance is not an exhaustive list of everything the NHS does, and the absence of a target does not mean it is not an area of focus. The Darzi Investigation found that there are too many targets set for the NHS, which made it hard for local systems to prioritise their actions or to be held properly accountable.Our aim is to give more power to local systems and let them decide how they use local funding to best meet the needs of their local population. This approach signals our ambition for reform, recognises the role of the NHS in driving economic growth, and enshrines our commitment to financial rigour in the system.Through our extensive public engagement as part of the 10-Year Health Plan, we will continue to listen to patients’ priorities and keep focused on what matters most to the public.Lord Darzi’s independent review showed that a timely diagnosis is vital to ensuring 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 10-Year Health Plan will address the challenges diagnosed by Lord Darzi and set the vision for what good joined-up care looks like for people with a combination of complex health and care needs. It will set out how we support and enable health and social care services to work together better to provide that joined-up care.

With reference to NHS England's guidance entitled 2025/26 priorities and operational planning guidance, published on 30 January 2025, if he will make an assessment of the potential impact of the removal of the dementia diagnosis target rate on the NHS.

We remain committed to increasing dementia diagnosis rates and agree that early diagnosis is vital to ensure people with dementia can access the treatment and support they need.We have taken a new approach to NHS Planning Guidance this year, reducing the number of national directives from 32 to 18. We will only turn the National Health Service around by doing things differently. These are the first steps on our journey for long-term reform of the NHS.NHS Planning Guidance is not an exhaustive list of everything the NHS does, and the absence of a target does not mean it is not an area of focus. The Darzi Investigation found that there are too many targets set for the NHS, which made it hard for local systems to prioritise their actions or to be held properly accountable.Our aim is to give more power to local systems and let them decide how they use local funding to best meet the needs of their local population. This approach signals our ambition for reform, recognises the role of the NHS in driving economic growth, and enshrines our commitment to financial rigour in the system.Through our extensive public engagement as part of the 10-Year Health Plan, we will continue to listen to patients’ priorities and keep focused on what matters most to the public.Lord Darzi’s independent review showed that a timely diagnosis is vital to ensuring 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 10-Year Health Plan will address the challenges diagnosed by Lord Darzi and set the vision for what good joined-up care looks like for people with a combination of complex health and care needs. It will set out how we support and enable health and social care services to work together better to provide that joined-up care.

If he will take steps to improve access to the NHS for transgender adults.

The Government wants all patients, including transgender adults, to feel safe and confident in accessing National Health Service health services. This is part of our mission to ensure that the NHS is there for everyone when they need it, providing equal access to health care which promotes choice and inclusivity. Transgender adults may seek access to NHS gender services specifically and these should be available when needed. NHS England has increased the number of adult Gender Dysphoria Clinics in England from seven to 12. The rollout of these new clinics is helping to tackle long waiting times, which had increased due to a shortage of specialist clinical staff to meet the rapidly rising demand. NHS England is currently undertaking a review of adult gender services, chaired by Dr David Levy. The review will examine the model of care and operating procedures of each service, and will carefully consider experiences, feedback, and outcomes from clinicians and patients, with the aim of producing an updated service specification.

What recent discussions he has had with the NHS on the dementia diagnosis target rate.

We remain committed to increasing dementia diagnosis rates and agree that early diagnosis is vital to ensure people with dementia can access the treatment and support they need. NHS Planning Guidance is not an exhaustive list of everything the National Health Service does, and the absence of a target does not mean it is not an area of focus. Lord Darzi’s independent review showed that a timely diagnosis is vital to ensuring 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 dementia diagnosis target has not been met for half a decade.We have taken a new approach to NHS Planning Guidance this year, reducing the number of national directives from 32 to 18. We will only turn the NHS around by doing things differently. These are the first steps on our journey for long-term reform of the NHS.The Darzi investigation found that there are too many targets set for the NHS, which made it hard for local systems to prioritise their actions or to be held properly accountable. Our aim is to give more power to local systems and let them decide how they use local funding to best meet the needs of their local population. This approach signals our ambition for reform and putting patients at the centre of care.Through our extensive public engagement as part of the 10-Year Health Plan, we will continue to listen to patients’ priorities and keep focused on what matters most to the public. The 10-Year Health Plan will address the challenges diagnosed by Lord Darzi and set the vision for what good joined-up care looks like for people with a combination of complex health and care needs. It will set out how we support and enable health and social care services to work together better to provide that joined-up care.

What steps his Department is taking with NHS England to ensure that eligible patients have access to Givinostat employee assistance programmes.

ITF Pharma UK, the United Kingdom marketing authorisation holder for givinostat, is providing access to givinostat through a type of compassionate use scheme called an Early Access Programme (EAP). Under the EAP, givinostat is free to both patients taking part in it and to the National Health Service, but the trusts must still cover the cost of administering it to patients. Only Duchenne muscular dystrophy clinicians can make requests for givinostat for their patients. Decisions are made on a case-by-case basis for individual named patients, aligned to eligibility criteria.NHS England does not have any initiatives to encourage participation in compassionate use schemes, which are the responsibility of individual pharmaceutical companies. Participation in the EAP for givinostat, which must be through one of the 23 NorthStar Centres in the UK, is decided at an individual NHS trust level, although there is general advice that trusts should engage with the relevant commissioner if they choose to participate, so that any impacts on the wider service can be taken into account. A NorthStar Centre will not be able to provide givinostat if its local trust has not approved participation.NHS England has published guidance for integrated care systems (ICS) on free of charge medicines schemes such as EAPs, including providing advice on potential financial, administrative, and clinical risks. The guidance aims to support the NHS to drive value from the medicines and ensure consistent and equitable access to medicines across England. ICSs should follow the recommendations to determine whether to implement any free of charge scheme, including assessing suitability and any risks in the short, medium, and long term. The guidance is available at the following link:https://www.england.nhs.uk/long-read/free-of-charge-foc-medicines-schemes-national-policy-recommendations-for-local-systems/

What steps his Department is taking to ensure that NHS Trusts are (a) aware of and (b) encouraged to participate in the Givinostat Early Access Programme.

ITF Pharma UK, the United Kingdom marketing authorisation holder for givinostat, is providing access to givinostat through a type of compassionate use scheme called an Early Access Programme (EAP). Under the EAP, givinostat is free to both patients taking part in it and to the National Health Service, but the trusts must still cover the cost of administering it to patients. Only Duchenne muscular dystrophy clinicians can make requests for givinostat for their patients. Decisions are made on a case-by-case basis for individual named patients, aligned to eligibility criteria.NHS England does not have any initiatives to encourage participation in compassionate use schemes, which are the responsibility of individual pharmaceutical companies. Participation in the EAP for givinostat, which must be through one of the 23 NorthStar Centres in the UK, is decided at an individual NHS trust level, although there is general advice that trusts should engage with the relevant commissioner if they choose to participate, so that any impacts on the wider service can be taken into account. A NorthStar Centre will not be able to provide givinostat if its local trust has not approved participation.NHS England has published guidance for integrated care systems (ICS) on free of charge medicines schemes such as EAPs, including providing advice on potential financial, administrative, and clinical risks. The guidance aims to support the NHS to drive value from the medicines and ensure consistent and equitable access to medicines across England. ICSs should follow the recommendations to determine whether to implement any free of charge scheme, including assessing suitability and any risks in the short, medium, and long term. The guidance is available at the following link:https://www.england.nhs.uk/long-read/free-of-charge-foc-medicines-schemes-national-policy-recommendations-for-local-systems/

What guidance his Department has issued to NHS Trusts on tackling administrative barriers to access to Givinostat treatment.

ITF Pharma UK, the United Kingdom marketing authorisation holder for givinostat, is providing access to givinostat through a type of compassionate use scheme called an Early Access Programme (EAP). Under the EAP, givinostat is free to both patients taking part in it and to the National Health Service, but the trusts must still cover the cost of administering it to patients. Only Duchenne muscular dystrophy clinicians can make requests for givinostat for their patients. Decisions are made on a case-by-case basis for individual named patients, aligned to eligibility criteria.NHS England does not have any initiatives to encourage participation in compassionate use schemes, which are the responsibility of individual pharmaceutical companies. Participation in the EAP for givinostat, which must be through one of the 23 NorthStar Centres in the UK, is decided at an individual NHS trust level, although there is general advice that trusts should engage with the relevant commissioner if they choose to participate, so that any impacts on the wider service can be taken into account. A NorthStar Centre will not be able to provide givinostat if its local trust has not approved participation.NHS England has published guidance for integrated care systems (ICS) on free of charge medicines schemes such as EAPs, including providing advice on potential financial, administrative, and clinical risks. The guidance aims to support the NHS to drive value from the medicines and ensure consistent and equitable access to medicines across England. ICSs should follow the recommendations to determine whether to implement any free of charge scheme, including assessing suitability and any risks in the short, medium, and long term. The guidance is available at the following link:https://www.england.nhs.uk/long-read/free-of-charge-foc-medicines-schemes-national-policy-recommendations-for-local-systems/

What steps he is taking to ensure access to Givinostat for families of children with Duchenne muscular dystrophy.

ITF Pharma UK, the United Kingdom marketing authorisation holder for givinostat, is providing access to givinostat through a type of compassionate use scheme called an Early Access Programme (EAP). Under the EAP, givinostat is free to both patients taking part in it and to the National Health Service, but the trusts must still cover the cost of administering it to patients. Only Duchenne muscular dystrophy clinicians can make requests for givinostat for their patients. Decisions are made on a case-by-case basis for individual named patients, aligned to eligibility criteria.NHS England does not have any initiatives to encourage participation in compassionate use schemes, which are the responsibility of individual pharmaceutical companies. Participation in the EAP for givinostat, which must be through one of the 23 NorthStar Centres in the UK, is decided at an individual NHS trust level, although there is general advice that trusts should engage with the relevant commissioner if they choose to participate, so that any impacts on the wider service can be taken into account. A NorthStar Centre will not be able to provide givinostat if its local trust has not approved participation.NHS England has published guidance for integrated care systems (ICS) on free of charge medicines schemes such as EAPs, including providing advice on potential financial, administrative, and clinical risks. The guidance aims to support the NHS to drive value from the medicines and ensure consistent and equitable access to medicines across England. ICSs should follow the recommendations to determine whether to implement any free of charge scheme, including assessing suitability and any risks in the short, medium, and long term. The guidance is available at the following link:https://www.england.nhs.uk/long-read/free-of-charge-foc-medicines-schemes-national-policy-recommendations-for-local-systems/

Food and Rural Affairs, if he will make an assessment of the potential merits of replacing combined sewerage systems with segregated sewerage in Devon.

For too long, water companies have discharged unacceptable levels of sewage into our rivers, lakes and seas. Storm overflows are safety valves within our combined sewage system to protect properties from flooding. The Storm Overflow Discharge Reduction Plan sets stretching targets to reduce the harms from storm overflows. This ambitious plan is guiding future investment in sector. Water companies are investing around £12 billion between 2025-2030, a record amount, to improve nearly 3,000 storm overflows across England and Wales, and reduce spills by 45% compared to 2021 levels. In Devon, a large spill reduction programme of works will be undertaken by South West Water, in the next 5 years to improve overflows in the Exe river & estuary catchments. This will see improvements to Combined Storm Overflows, pumping stations & sewage treatment works. We are also carrying out a full review of the water sector to shape further legislation that will transform how our water system works and clean up rivers, lakes and seas for good.

Which Department is responsible for ensuring the mandatory installation of post boxes.

The government is not responsible for ensuring the mandatory installation of post boxes.Section 29(6) of the Postal Services Act 2011 requires Ofcom, as the independent regulator, to “secure the provision of sufficient access points to meet the reasonable needs of users of the universal postal service”.Royal Mail is currently required by Ofcom’s Designated Universal Service Provider (DUSP) condition 1.8.1 to provide a post box within half a mile, by straight line distance, of the premises of at least 98% of users of postal services.

Food and Rural Affairs, what recent discussions he has had with water companies on the use of water butts to prevent sewage overflow in Devon.

Defra have had no recent discussions with water companies about the use of water butts to prevent sewage overflow in Devon. However, as part of a well-designed sustainable drainage system (SuDS), water butts can help in reducing pressure on sewerage. This Government is strongly committed to requiring standardised SuDS in new developments. These should be to designs that cope with changing climatic conditions as well as delivering wider water infrastructure benefits, reduce run off and help to improve water quality, amenity and biodiversity. It is also important to ensure appropriate adoption and maintenance arrangements are in place.

Food and Rural Affairs, if he will make an assessment of the potential implications for his policies of the number of cracks in sewerage systems in Devon.

For too long, water companies have discharged unacceptable levels of sewage into our rivers, lakes and seas. Regulators are working with South West Water on their Drainage and Wastewater Management Plans and will be ensuring they look at the investment needs for the issues raised relating to reducing infiltration in their sewerage system, leaks from the system, and removing surface water. As part of its Waterfit programme, South West Water is carrying out surface water separation programmes within the catchments of Dawlish, Goodrington, Mothecombe, Millandreath & Ilfracombe, with the purpose of spill reduction and bathing water protection.

Food and Rural Affairs, what assessment his Department has made of the potential impact of combined sewerage systems on untreated sewage overflow in Devon.

For too long, water companies have discharged unacceptable levels of sewage into our rivers, lakes and seas. Storm overflows are safety valves within our combined sewage system to protect properties from flooding. The Storm Overflow Discharge Reduction Plan sets stretching targets to reduce the harms from storm overflows. This ambitious plan is guiding future investment in sector. Water companies are investing around £12 billion between 2025-2030, a record amount, to improve nearly 3,000 storm overflows across England and Wales, and reduce spills by 45% compared to 2021 levels. In Devon, a large spill reduction programme of works will be undertaken by South West Water, in the next 5 years to improve overflows in the Exe river & estuary catchments. This will see improvements to Combined Storm Overflows, pumping stations & sewage treatment works. We are also carrying out a full review of the water sector to shape further legislation that will transform how our water system works and clean up rivers, lakes and seas for good.

Food and Rural Affairs, what recent discussions he has had with water companies on replacing combined sewerage systems with segregated sewerage systems in Devon.

For too long, water companies have discharged unacceptable levels of sewage into our rivers, lakes and seas. Storm overflows are safety valves within our combined sewage system to protect properties from flooding. The Storm Overflow Discharge Reduction Plan sets stretching targets to reduce the harms from storm overflows. This ambitious plan is guiding future investment in sector. Water companies are investing around £12 billion between 2025-2030, a record amount, to improve nearly 3,000 storm overflows across England and Wales, and reduce spills by 45% compared to 2021 levels. In Devon, a large spill reduction programme of works will be undertaken by South West Water, in the next 5 years to improve overflows in the Exe river & estuary catchments. This will see improvements to Combined Storm Overflows, pumping stations & sewage treatment works. We are also carrying out a full review of the water sector to shape further legislation that will transform how our water system works and clean up rivers, lakes and seas for good.

Food and Rural Affairs, if he will take steps to reduce sewage infiltration in Devon.

For too long, water companies have discharged unacceptable levels of sewage into our rivers, lakes and seas. Regulators are working with South West Water on their Drainage and Wastewater Management Plans and will be ensuring they look at the investment needs for the issues raised relating to reducing infiltration in their sewerage system, leaks from the system, and removing surface water. As part of its Waterfit programme, South West Water is carrying out surface water separation programmes within the catchments of Dawlish, Goodrington, Mothecombe, Millandreath & Ilfracombe, with the purpose of spill reduction and bathing water protection.

Food and Rural Affairs, what information his Department holds on the number and proportion of homes that use a (a) combined and (b) segregated sewerage system in Devon.

Defra does not hold the specific information on sewerage operations in different regions. It is the responsibility of the sewerage undertaker to manage its own operation, in this case South West Water.