Written questions by Vickers.

What steps he is taking to share best practice between (a) Integrated Care Boards that continue to provide gluten-free staple foods on prescription and (b) those that do not.

Decisions about the commissioning and funding of local health services are the responsibility of local integrated care boards (ICBs). It is the responsibility of ICBs, working with clinicians, service users, and patient groups, to develop local services and care pathways that meet patients’ needs. The Government expects ICBs to take account of relevant guidelines and best practice in designing their local services, to ensure consistency of approaches between ICBs. NHS England’s guidance should be taken into account when ICBs formulate local policies, and prescribers are expected to reflect local policies in their prescribing practices.NHS England’s guidance on Prescribing Gluten-Free Foods in Primary Care states that commissioners restrict the prescribing of gluten free (GF) foods to bread and mixes only. Under the current legislation, ICBs may choose to further restrict product choice, or end the prescribing of GF foods altogether, if they feel this is appropriate for their population, whilst taking account of their legal duties to advance equality and having regard to reducing health inequalities.The national prescribing position in England remains that GF bread and mixes can be provided to coeliac patients on a National Health Service prescription, and a wide range of these items continue to be listed in part XV of the Drug Tariff. This means that prescribers can issue NHS prescriptions, based on a shared decision between prescriber and patient, while also being mindful of local and national guidance.

What steps he is taking to ensure that people diagnosed with coeliac disease have equitable regional access to gluten-free staple foods.

Decisions about the commissioning and funding of local health services are the responsibility of local integrated care boards (ICBs). It is the responsibility of ICBs, working with clinicians, service users, and patient groups, to develop local services and care pathways that meet patients’ needs. The Government expects ICBs to take account of relevant guidelines and best practice in designing their local services, to ensure consistency of approaches between ICBs. NHS England’s guidance should be taken into account when ICBs formulate local policies, and prescribers are expected to reflect local policies in their prescribing practices.NHS England’s guidance on Prescribing Gluten-Free Foods in Primary Care states that commissioners restrict the prescribing of gluten free (GF) foods to bread and mixes only. Under the current legislation, ICBs may choose to further restrict product choice, or end the prescribing of GF foods altogether, if they feel this is appropriate for their population, whilst taking account of their legal duties to advance equality and having regard to reducing health inequalities.The national prescribing position in England remains that GF bread and mixes can be provided to coeliac patients on a National Health Service prescription, and a wide range of these items continue to be listed in part XV of the Drug Tariff. This means that prescribers can issue NHS prescriptions, based on a shared decision between prescriber and patient, while also being mindful of local and national guidance.

What support is available for people with coeliac disease in areas where gluten-free prescriptions have been reduced or withdrawn.

Decisions about the commissioning and funding of local health services are the responsibility of local integrated care boards (ICBs). It is the responsibility of ICBs, working with clinicians, service users, and patient groups, to develop local services and care pathways that meet patients’ needs. The Government expects ICBs to take account of relevant guidelines and best practice in designing their local services, to ensure consistency of approaches between ICBs. NHS England’s guidance should be taken into account when ICBs formulate local policies, and prescribers are expected to reflect local policies in their prescribing practices.NHS England’s guidance on Prescribing Gluten-Free Foods in Primary Care states that commissioners restrict the prescribing of gluten free (GF) foods to bread and mixes only. Under the current legislation, ICBs may choose to further restrict product choice, or end the prescribing of GF foods altogether, if they feel this is appropriate for their population, whilst taking account of their legal duties to advance equality and having regard to reducing health inequalities.The national prescribing position in England remains that GF bread and mixes can be provided to coeliac patients on a National Health Service prescription, and a wide range of these items continue to be listed in part XV of the Drug Tariff. This means that prescribers can issue NHS prescriptions, based on a shared decision between prescriber and patient, while also being mindful of local and national guidance.

What recent assessment he has made of cancer (a) referral and (b) diagnosis rates in Tees Valley.

Cancer patients are waiting too long for diagnosis and treatment on the NHS, including in Tees Valley. It is crucial that patients with cancer have access to treatment as quickly as possible after their diagnosis.The NHS is working with local providers to identify opportunities in both community diagnostic centres and hospital based diagnostic services to improve performance against the Faster Diagnosis Standard, to reduce the number of patients waiting too long for a confirmed diagnosis of cancer.

What steps he is taking to monitor the affordability of gluten-free staple foods for people with coeliac disease.

The Department carried out an analysis of this issue as part of its Equalities Impact Assessment, which was published as part of the consultation on the availability of gluten-free (GF) foods on prescription in primary care, launched in March 2017. A copy of the Equality Impact Assessment following this consultation is available on the consultation page, at the following link:https://www.gov.uk/government/consultations/availability-of-gluten-free-foods-on-nhs-prescriptionWe looked at the equality impact assessment and the consultation responses, and as a result made the decision to retain GF bread and mixes on National Health Service prescription services. This will help coeliacs to obtain their basic food needs and will mitigate the risk that those on lower incomes are not able to purchase their own GF foods from retail outlets, where evidence shows that the price is often higher and availability more limited.In England, NHS prescription charge exemptions are in place to help those with the greatest need. Eligibility depends on the patient’s age, whether they are in qualifying full-time education, whether they are pregnant or have recently given birth, whether they have a qualifying medical condition, or whether they are in receipt of certain benefits or a war pension.We have frozen NHS prescription charges in England for the first time in three years, keeping the cost of a prescription below £10. This decision will help with the cost of living for millions of patients who regularly pay for prescriptions.Consumer food prices depend on a range of factors, including import prices, domestic agricultural prices, domestic labour and manufacturing costs, and exchange rates. The Department for Environment, Food and Rural Affairs regularly engages with supermarkets and producers on a range of food supply matters. However, it is not for the Government to set retail food prices or to comment on day-to-day commercial decisions taken by businesses.

What steps eh has taken to ensure that Integrated Care Boards comply with national guidance on prescribing gluten-free products to patients with coeliac disease.

Decisions about the commissioning and funding of local health services are the responsibility of local integrated care boards (ICBs). It is the responsibility of ICBs, working with clinicians, service users, and patient groups, to develop local services and care pathways that meet patients’ needs. The Government expects ICBs to take account of relevant guidelines and best practice in designing their local services, to ensure consistency of approaches between ICBs. NHS England’s guidance should be taken into account when ICBs formulate local policies, and prescribers are expected to reflect local policies in their prescribing practices.NHS England’s guidance on Prescribing Gluten-Free Foods in Primary Care states that commissioners restrict the prescribing of gluten free (GF) foods to bread and mixes only. Under the current legislation, ICBs may choose to further restrict product choice, or end the prescribing of GF foods altogether, if they feel this is appropriate for their population, whilst taking account of their legal duties to advance equality and having regard to reducing health inequalities.The national prescribing position in England remains that GF bread and mixes can be provided to coeliac patients on a National Health Service prescription, and a wide range of these items continue to be listed in part XV of the Drug Tariff. This means that prescribers can issue NHS prescriptions, based on a shared decision between prescriber and patient, while also being mindful of local and national guidance.

What recent estimate he has made of the number of unfilled NHS roles in the North East.

NHS England publishes a compendium of NHS Vacancy Statistics each quarter. The information currently provides four measures of the level of vacancies in the National Health Service, one of which presents management information collected by NHS England from NHS trusts on full time equivalent vacancies reported, which is the most commonly used measure. NHS England collects and publishes vacancies in the North East and Yorkshire as a single region, which is available in this publication.Published vacancy data, including information on the definition of the collected data and the available timeseries, along with the measure’s strengths and weaknesses, is available at the following link:https://digital.nhs.uk/data-and-information/publications/statistical/nhs-vacancies-survey

What assessment he has made of the potential impact of increases to the cost-of-living on the ability of people with coeliac disease to maintain a medically required gluten-free diet.

The Department carried out an analysis of this issue as part of its Equalities Impact Assessment, which was published as part of the consultation on the availability of gluten-free (GF) foods on prescription in primary care, launched in March 2017. A copy of the Equality Impact Assessment following this consultation is available on the consultation page, at the following link:https://www.gov.uk/government/consultations/availability-of-gluten-free-foods-on-nhs-prescriptionWe looked at the equality impact assessment and the consultation responses, and as a result made the decision to retain GF bread and mixes on National Health Service prescription services. This will help coeliacs to obtain their basic food needs and will mitigate the risk that those on lower incomes are not able to purchase their own GF foods from retail outlets, where evidence shows that the price is often higher and availability more limited.In England, NHS prescription charge exemptions are in place to help those with the greatest need. Eligibility depends on the patient’s age, whether they are in qualifying full-time education, whether they are pregnant or have recently given birth, whether they have a qualifying medical condition, or whether they are in receipt of certain benefits or a war pension.We have frozen NHS prescription charges in England for the first time in three years, keeping the cost of a prescription below £10. This decision will help with the cost of living for millions of patients who regularly pay for prescriptions.Consumer food prices depend on a range of factors, including import prices, domestic agricultural prices, domestic labour and manufacturing costs, and exchange rates. The Department for Environment, Food and Rural Affairs regularly engages with supermarkets and producers on a range of food supply matters. However, it is not for the Government to set retail food prices or to comment on day-to-day commercial decisions taken by businesses.

What assessment he has made of the potential impact of workforce shortages on ambulance response times in rural areas of the North East.

North East Ambulance Service (NEAS) is fully staffed at present across their patient-facing roles in emergency care. When vacancies arise, recruitment is targeted in those areas. The NEAS works closely with universities to support the 3-year education programme for paramedics so when jobs are available, they are encouraged to apply. NEAS will also, if required, use overtime, additional hours, bank shifts or local third-party providers should they have any short-term or unplanned shifts not covered to ensure response times and therefore patient care is not affected.The latest figures show that Category 2 response times in the North East were 20 minutes 51 seconds on average, the fastest in the country.

What steps he is taking to increase training placements for (a) nurses and (b) allied health professionals in the North East.

Clinical practice placements are mandatory for healthcare education and training, in order to support and embed the skills, values, and behaviours for the future National Health Service workforce. Financial support is currently available to placement providers in the form of a placement tariff for nurses and allied health professionals.As part of our 10-Yeah Health Plan, we have committed to reforming the clinical placement tariff system to ensure it drives clinical placement activity in the right professions and settings.The Professional Strategy for Nursing and Midwifery, being developed by the Chief Nursing Officer for England, will build on this to ensure that every nursing student spends sufficient time across a range of clinical settings, and will include a requirement for all students to have a high-quality experience in neighbourhood and community settings and social care.

What recent progress he has made in digitising patient records in NHS trusts in Teesside.

University Hospitals Tees (UHT), comprising of the North Tees and Hartlepool and South Tees Hospitals NHS Foundation Trusts, continues to progress its ambitions in digitising patient records across Teesside, North Yorkshire, and County Durham.A recent digital patient record success for UHT was the achievement of the BSI0008:2020 accreditation. This means that the scanning bureau at the North Tees and Hartlepool NHS Foundation Trust now holds the accreditation equivalent to that of major national and international organisations for storing patient information electronically.

What steps he is taking to help support Integrated Care Boards to improve patient access in areas with high levels of deprivation.

Ensuring that funding for core services, provided via integrated care boards, are fairly allocated across practices nationwide is crucial and we recognise the importance of prioritising areas with high levels of deprivation. This is why we have committed to reviewing the general practice (GP) funding formula, so that resources are directed where they are needed most to improve patient access.Through our 10-Year Health Plan, it will be easier and faster to see a GP. We will end the 8:00am scramble for appointments, train more doctors, and will guarantee consultations within 24 hours for those who need one. In October 2024, we invested £82 million into the Additional Roles Reimbursement Scheme to support the recruitment of 2,000 individual GPs into primary care networks across England, helping to increase appointment availability and improve care for thousands of patients. The new £102 million Primary Care Utilisation and Modernisation Fund will create additional clinical space within over 1,000 practices across England. This investment will deliver more appointments and improve patient care.

How many and what proportion of NHS estates are in need of (a) major repairs and (b) replacement in the North East.

National Health Service trusts are legally responsible for managing and maintaining their estates using their operational capital allocations, and as part of this, they regularly assess the physical condition of their estate.The NHS England Estates Related Information Collection (ERIC) survey collects data from trusts on the condition of their estate annually, including backlog maintenance, and the projected cost of bringing all the buildings on each NHS site into acceptable condition. The latest ERIC data, from 2023/24 and including trusts in the North East, is available at the following link:https://digital.nhs.uk/data-and-information/publications/statistical/estates-returns-information-collection/management-information---provisional-summary-figures-for-2023-24Repairing and rebuilding our NHS estate is a vital part of our ambition to create an NHS that is fit for the future through our 10-Year Health Plan. The Government’s recently published 10 Year Infrastructure Strategy set out ten-year maintenance budgets for the public estate, confirming £6 billion per year for the maintenance and repair of the NHS estate up to 2034/35.

What discussions he has had with (a) Coeliac UK and (b) other patient representative groups on access to gluten-free staple products in England.

My Rt Hon. Friend, the Secretary of State for Health and Social Care has not held any meetings with integrated care boards (ICBs) or patient groups on the provision of gluten free (GF) bread and flour mixes for patients diagnosed with coeliac disease.Following consultation, the legislation restricting the prescribing of GF foods to bread and mixes came into force in December 2018, and NHS England’s guidance on prescribing GF foods in primary care was subsequently issued to clinical commissioning groups, now ICBs. Following a review in 2019, the position in England remains that GF bread and mixes can be provided to all eligible coeliac patients on a National Health Service prescription, and a wide range of these items continue to be listed in Part XV of the Drug Tariff. NHS England currently has no plans to update the guidance.

Whether he plans to include specialist assessments by dementia nurses as standard evidence in NHS Continuing Healthcare eligibility decisions.

There are no plans to update NHS Continuing Healthcare (CHC) guidance regarding mobility assessments or specialist assessments by dementia nurses. The CHC assessment process is supported by the Decision Support Tool. This provides practitioners with a way to bring together and record an individual’s needs in the twelve ‘care domains’, including mobility. The assessment should consider the ways in which an individual’s needs interact with one another, for example how cognition impacts on mobility.Eligibility for CHC is not determined by diagnosis or condition but is assessed on a case-by-case basis considering the totality of an individual’s needs, ensuring a person-centred approach. Someone with specialist knowledge of an individual’s condition, for example dementia, should be involved in the process. Assessments should take into account evidence from a comprehensive range of assessments relating to the individual. For individuals with dementia, this could include specialist assessments by dementia nurses.

What steps his Department is taking to improve access to NHS Continuing Healthcare for people with (a) young onset dementia and (b) other forms of dementia.

Our national statutory guidance, the National framework for NHS Continuing Healthcare and NHS-funded Nursing Care, outlines that access to NHS Continuing Healthcare (CHC) assessment, care provision, and support should be fair, consistent, and free from discrimination. This national statutory guidance is available at the following link:https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-careEligibility for CHC is not determined by diagnosis or condition. Individuals can be identified and referred for CHC assessments by a variety of health or social care practitioners who have been trained and are known to the individual. Individuals and families can also request a CHC assessment from a health and care practitioner.Integrated care boards should make the CHC Public Information Leaflet available to members of the public, for example through local National Health Service websites, hard copies on hospital wards, through primary care outlets, local care homes, and local voluntary sector organisations. This Public Information Leaflet containing further information on CHC is available at the following link:https://www.gov.uk/government/publications/nhs-continuing-healthcare-and-nhs-funded-nursing-care-public-information-leaflet/public-information-leaflet-nhs-continuing-healthcare-and-nhs-funded-nursing-care--2NHS England has also commissioned an information and advice service for CHC, supplied by Beacon, which individuals and their families might find helpful, and which is available at the following link:https://beaconchc.co.uk/how-we-can-help/free-information-and-advice-on-nhs-continuing-healthcare/

What recent discussions he has had with Integrated Care Boards on the provision of gluten-free bread and flour mixes for patients diagnosed with coeliac disease.

My Rt Hon. Friend, the Secretary of State for Health and Social Care has not held any meetings with integrated care boards (ICBs) or patient groups on the provision of gluten free (GF) bread and flour mixes for patients diagnosed with coeliac disease.Following consultation, the legislation restricting the prescribing of GF foods to bread and mixes came into force in December 2018, and NHS England’s guidance on prescribing GF foods in primary care was subsequently issued to clinical commissioning groups, now ICBs. Following a review in 2019, the position in England remains that GF bread and mixes can be provided to all eligible coeliac patients on a National Health Service prescription, and a wide range of these items continue to be listed in Part XV of the Drug Tariff. NHS England currently has no plans to update the guidance.

What steps he is taking to improve the retention of social care workers in areas with a high rate of vacancies.

English local authorities have responsibility under the Care Act 2014 to meet social care needs, and statutory guidance directs them to ensure there is sufficient workforce in adult social care. Skills for Care data suggests the adult social care workforce is growing. Skills for Care data shows in 2024/25 there were 1.6 million filled posts, an increase of 52,000, or 3.4%, from 2023/24. Skills for Care data also shows that the turnover rate decreased from 25.8% in 2023/24 to 24.7% in 2024/25 in the independent sector. The Government is committed to a well-supported adult social care workforce who are recognised as the professionals they are. Those with the opportunity to develop and progress in their role are far more likely to remain within the adult social care workforce. That is why we are delivering an ambitious programme of reforms with the aim of attracting people to join and remain in the sector, help professionalise the workforce, and improve the quality and experience of those receiving care. These include delivering the first universal career structure for the whole adult social care sector, a Learning and Development Support Scheme backed by up to £12 million funding in 2025/26, and introducing a Fair Pay Agreement.

How much funding his Department has allocated to community mental health transformation programmes in the North East since 2022.

The following table shows the funding allocated to community mental health transformation programmes in the North East and North Cumbria Integrated Care Board area:YearAllocated Funding2022/23£17.4 million2023/24£21.7 million2024/25£22.1 millionSource: NHS EnglandNote: These figures represent service development funding directed at transformation and do not represent the total amount allocated to community mental health services in the area.

What funding has been allocated to support mental health crisis response services in the Tees Valley since 2021.

The following table shows the nationally allocated funding to support mental health crisis response services in the Tees Valley area:YearAllocated Funding (,000)2023/24£8442024/25£8542025/26 (planned spend)£1,079Source: NHS England Notes:Information for 2021/22 and 2022/23 is not available.These figures represent service development funding directed at transformation and do not represent the total amount allocated to community mental health services in the area.