Written questions by Morrison.

Pursuant to the Answer of 6 May 2025 to Question 47908 on Community Health Services: Finance, what options to improve homecare services are under consideration; and what his planned timetable is for the implementation of changes.

The Department remains committed to moving more healthcare out of hospitals and into the community, to ensure patients and families receive the care they need when and where they need it. The 10-Year Health Plan will see more tests and scans and services delivered in the community, better joint working between services, and greater use of apps and wearable technology. All will support people to manage their conditions closer to home.Homecare medicines services will play a key role in this and have already grown considerably in the past five years, now supporting approximately 600,000 patients in England to receive specialist, hospital prescribed medicines at home, work or another convenient place.The Department and NHS England recognise the importance of strengthening homecare medicine services and continue to prioritise improvements in this area following the House of Lords Public Services Committee’s report, Homecare medicines services: an opportunity lost. The recommendations accepted by the Department and NHS England continue to be explored and developed. Work is underway to scope the opportunities to improve how homecare services can be procured, contracted, and delivered to meet the future needs of the NHS. An update on progress will be provided to the House of Lords Public Services Committee later this year.

How much and what proportion of the Primary Care Utilisation and Modernisation Fund has been allocated to practices in Greater Manchester.

The Government is committed to delivering a National Health Service that is fit for the future and recognises the importance of strategic, value for money investments in capital projects. We recently announced schemes which will benefit from the £102 million Primary Care Utilisation and Modernisation Fund (PCUMF) to deliver upgrades this financial year to more than a thousand general practice surgeries across England.We have made sure that every single region across the country receives part of the funding, so benefits are felt nationwide. Decisions were made based on the highest priority of need and where the investment would quickly create additional clinical space, specifically to deliver more appointments.NHS England worked with all the integrated care boards (ICBs), including in Greater Manchester, to prioritise the schemes that local health leaders identified as meeting their communities’ most urgent needs.The Greater Manchester ICB has been allocated £5.6 million from the PCUMF to be spent on physical improvements resulting in additional clinical space and increased access to appointments. Digital transformation projects were not considered to be in scope for the £102 million of funding.

If he will take steps to ensure that GP practices with (a) poor building quality, (b) insufficient capacity and (c) other significant estate issues are allocated funding through future rounds of the Primary Care Utilisation and Modernisation Fund.

The Government is committed to delivering a National Health Service that is fit for the future and that recognises the importance of strategic, value for money investments in capital projects, such as new facilities, significant upgrades, or other targeted capital investments, to ensure we have world class infrastructure across the entire NHS estate.We recently announced schemes which will benefit from the £102 million Primary Care Utilisation and Modernisation Fund, supporting improved use of existing buildings and space, boosting productivity, and enabling delivery of more appointments. Further support for NHS organisations delivering local and national priorities beyond this financial year is being considered as part of the Government’s Spending Review.However, general practices are not reimbursed for service charges nor additionally funded to undertake maintenance and improvements, and are independent contractors who should fund investment in maintaining their estate by utilising their own funds, borrowing, or through partnerships with third party developers.

What steps he is taking to ensure that Integrated Care Boards are able to support the revenue consequences of primary care estate expansions enabled by capital investment.

We recently announced schemes which will benefit from the £102 million Primary Care Utilisation and Modernisation Fund (PCUMF) to deliver upgrades this financial year to more than a thousand general practice (GP) surgeries across England.These schemes will create additional clinical space within existing building footprints to enable practices to see more patients, boost productivity, and improve patient care. By working within existing footprints there will be no additional revenue costs associated to the work funded by the PCUMFThis will directly address the issue of staff who cannot work at full capacity due to space limitations and will enable practices to offer more appointments with their existing workforce through better use of space. The Government has already hired more than 1,500 extra GPs and announced an £889 million funding boost, the biggest for the sector in years.To ensure good management of public money, the schemes that have been selected will of course be subject to final business case approvals and due diligence. Integrated care boards and GP federations will not be able to unilaterally realign the schemes which have already been agreed, however if an individual surgery is not able to proceed, then local leaders will select another priority scheme to utilise the funding.

Whether (a) integrated care boards and (b) local GP federations will be able to reprioritise bids for funding under the Primary Care Utilisation and Modernisation Fund.

We recently announced schemes which will benefit from the £102 million Primary Care Utilisation and Modernisation Fund (PCUMF) to deliver upgrades this financial year to more than a thousand general practice (GP) surgeries across England.These schemes will create additional clinical space within existing building footprints to enable practices to see more patients, boost productivity, and improve patient care. By working within existing footprints there will be no additional revenue costs associated to the work funded by the PCUMFThis will directly address the issue of staff who cannot work at full capacity due to space limitations and will enable practices to offer more appointments with their existing workforce through better use of space. The Government has already hired more than 1,500 extra GPs and announced an £889 million funding boost, the biggest for the sector in years.To ensure good management of public money, the schemes that have been selected will of course be subject to final business case approvals and due diligence. Integrated care boards and GP federations will not be able to unilaterally realign the schemes which have already been agreed, however if an individual surgery is not able to proceed, then local leaders will select another priority scheme to utilise the funding.

What criteria were used to determine which GP surgeries received funding under the Primary Care Utilisation and Modernisation Fund in the 2025-26 financial year; and what role integrated care boards had in the decision-making process.

The Government is committed to delivering a National Health Service that is fit for the future and recognises the importance of strategic, value for money investments in capital projects. We recently announced schemes which will benefit from the £102 million Primary Care Utilisation and Modernisation Fund (PCUMF) to deliver upgrades this financial year to more than a thousand general practice surgeries across England.We have made sure that every single region across the country receives part of the funding, so benefits are felt nationwide. Decisions were made based on the highest priority of need and where the investment would quickly create additional clinical space, specifically to deliver more appointments.NHS England worked with all the integrated care boards (ICBs), including in Greater Manchester, to prioritise the schemes that local health leaders identified as meeting their communities’ most urgent needs.The Greater Manchester ICB has been allocated £5.6 million from the PCUMF to be spent on physical improvements resulting in additional clinical space and increased access to appointments. Digital transformation projects were not considered to be in scope for the £102 million of funding.

How much of the Primary Care Utilisation and Modernisation Fund is being used for (a) digitisation projects and (b) physical improvements to GP premises.

The Government is committed to delivering a National Health Service that is fit for the future and recognises the importance of strategic, value for money investments in capital projects. We recently announced schemes which will benefit from the £102 million Primary Care Utilisation and Modernisation Fund (PCUMF) to deliver upgrades this financial year to more than a thousand general practice surgeries across England.We have made sure that every single region across the country receives part of the funding, so benefits are felt nationwide. Decisions were made based on the highest priority of need and where the investment would quickly create additional clinical space, specifically to deliver more appointments.NHS England worked with all the integrated care boards (ICBs), including in Greater Manchester, to prioritise the schemes that local health leaders identified as meeting their communities’ most urgent needs.The Greater Manchester ICB has been allocated £5.6 million from the PCUMF to be spent on physical improvements resulting in additional clinical space and increased access to appointments. Digital transformation projects were not considered to be in scope for the £102 million of funding.

Whether NHS England held discussions with (a) NHS Greater Manchester Integrated Care Board and (b) Place Leads in Stockport before finalising the list of GP practices funded through the Primary Care Utilisation and Modernisation Fund.

The Government is committed to delivering a National Health Service that is fit for the future and recognises the importance of strategic, value for money investments in capital projects. We recently announced schemes which will benefit from the £102 million Primary Care Utilisation and Modernisation Fund (PCUMF) to deliver upgrades this financial year to more than a thousand general practice surgeries across England.We have made sure that every single region across the country receives part of the funding, so benefits are felt nationwide. Decisions were made based on the highest priority of need and where the investment would quickly create additional clinical space, specifically to deliver more appointments.NHS England worked with all the integrated care boards (ICBs), including in Greater Manchester, to prioritise the schemes that local health leaders identified as meeting their communities’ most urgent needs.The Greater Manchester ICB has been allocated £5.6 million from the PCUMF to be spent on physical improvements resulting in additional clinical space and increased access to appointments. Digital transformation projects were not considered to be in scope for the £102 million of funding.

What steps the is taking to help increase the number of midwifery staff in hospitals in Greater Manchester.

Decisions about the recruitment of midwifery staff are a matter for individual National Health Service trusts. NHS trusts manage their recruitment at a local level to ensure they have the right number of staff in place, with the right skill mix, to deliver safe and effective care.We will publish a refreshed workforce plan to deliver the transformed health service we will build over the next decade and treat patients on time again.

What steps he is taking to increase the number of midwives in Stepping Hill hospital.

Decisions about the recruitment of midwifery staff are a matter for individual National Health Service trusts. NHS trusts manage their recruitment at a local level to ensure they have the right number of staff in place, with the right skill mix, to deliver safe and effective care.We will publish a refreshed workforce plan to deliver the transformed health service we will build over the next decade and treat patients on time again.

What steps he plans to take through the NHS 10 year plan to increase the number of NHS midwives.

A central part of the 10-Year Health Plan will be our workforce and those who support our workforce, and how we ensure the National Health Service has the right people, in the right places, with the right skills to deliver the care patients need when they need it.Getting the NHS back to working for patients means ending the workforce crisis across the health service. We intend to take a fresh look at the Long Term Workforce Plan, to ensure it fully aligns with the level of ambition and reforms required following the 10-Year Health Plan. Decisions about recruitment are matters for individual NHS trusts.

What the average waiting time was for a wheelchair-bound patient to access an NHS appointment in (a) Stockport Borough and (b) Greater Manchester in the latest period for which data is available.

Cutting waiting lists is a key priority for the Government. We promised change, and we’ve delivered early, with a reduction in the list of over 219,000 pathways from July 2024 to February 2025.We do not hold data on the average waiting time for a wheelchair-bound patient to access a National Health Service appointment. This patient characteristic is not collected in the data which is used to assess waiting times.The current waiting list for all patients at the Stockport NHS Foundation Trust currently stands at 35,824 patients waiting, with a median average waiting time of 16 weeks. The current total waiting list for all patients in Greater Manchester stands at 436,509 as of February 2025, with a median average waiting time of 16 weeks.

What the average waiting time was for an able-bodied patient to access an NHS appointment in (a) Stockport Borough and (b) Greater Manchester in the latest period for which data is available.

Cutting waiting lists is a key priority for the Government. We promised change, and we have delivered early, with a reduction in the list of over 219,000 pathways from July 2024 to February 2025.We do not hold data on the average waiting time for able-bodied patients to access a National Health Service appointment. This patient characteristic is not collected in the data which is used to assess waiting times.The current waiting list for all patients at the Stockport NHS Foundation Trust currently stands at 35,824 patients, with a median average waiting time of 16 weeks. The current total waiting list for all patients in Greater Manchester stands at 436,509 as of February 2025, with a median average waiting time of 16 weeks.

What recent assessment he has made of the potential impact on waiting for an NHS dental appointment for (a) people in wheelchairs and (b) able- bodied people.

No specific assessment has been made on the impact of waiting for a National Health Service dental appointment for people in wheelchairs or able-bodied people. The Government is committed to NHS dental services being available for all who need them. We recognise that certain groups of patients may be vulnerable to oral health problems, and may find it more difficult to access dental care.We are tackling the challenges for all patients trying to access NHS dental appointments with a rescue plan providing 700,000 more urgent dental appointments and by recruiting new dentists to the areas that need them most.Many high street dental practices are wheelchair-accessible and patients can contact local practices directly to inquire about their facilities. If patients in wheelchairs have difficultly locating a high street dentist that caters to their specific accessibility requirements, community dental services provide specialised dental services to people with additional needs. Integrated care boards are responsible for assessing the needs of their population and ensuring that the relevant dental services are available.

What discussions he has had with relevant stakeholders on how to provide long term, sustainable funding for transforming palliative and end of life care services.

In February, I met with key palliative and end of life care and hospice stakeholders, in a roundtable format, with a focus on long-term sector sustainability within the context of our 10-Year Health Plan. I also recently met Rachael Maskell MP and Baroness Finlay to discuss the progress of their independent commission into palliative and end of life care. As part of the work to develop the 10-Year Health Plan, we will be carefully considering policies, including those that impact people with palliative and end of life care needs, with input from the public, patients, health staff, and our partners. We want a society where every person receives high-quality, compassionate care from diagnosis through to the end of life. The Government is determined to shift more healthcare out of hospitals and into the community, to ensure patients and their families receive personalised care in the most appropriate setting, and palliative and end of life care services will have a big role to play in that shift.

What estimate his Department has made of the increase in the number of people that will have palliative care needs over the next 10 years.

Currently, approximately 600,000 people die per year in the United Kingdom. It is estimated that up to 90% of deaths could benefit from palliative and end of life care. The Office for National Statistics has projected that, by 2040, approximately 800,000 people a year will die in the UK. Also, current trends point to a growing proportion of people dying from chronic disease, particularly cancer and dementia. Taking these considerations together, it has been estimated that the number of people needing palliative and end of life care could increase by 42% by 2040.We have committed to develop a 10-Year Plan to deliver a National Health Service fit for the future, by driving three shifts in the way health care is delivered, from hospital to community, from treatment to prevention, and from analogue to digital. We will carefully be considering policies, including those that impact people with palliative and end of life care needs, with input from the public, patients, health staff, and our stakeholders as we develop the plan.In February, I met with key palliative and end of life care and hospice stakeholders, in a roundtable format with a focus on long-term sector sustainability within the context of our 10-Year Health Plan. I have followed up with meetings with officials from the Department and NHS England. I also recently met with my Hon. Friend the Member for York Central, and Baroness Finlay of Llandaff, to discuss the progress of their independent commission into palliative and end of life care, including the commission’s first of three reports, published on 13 May, to which we will formally respond in the coming weeks.

What guidance he has provided to (a) GPs and (b) pharmacists to support patients unable to access Estradot patches.

There are over 70 hormone replacement therapy (HRT) products, and the vast majority are in good supply. Previously there have been issues with the supply of a limited number of these products, primarily driven by very sharp increases in demand. Following the Department’s intensive engagement with industry, the supply position has improved considerably. As part of this we have previously met with individual suppliers on a very regular basis. We have also hosted nine HRT supply roundtables since April 2022, with the most recent in September 2024, attended by suppliers, wholesalers, and community pharmacists, to provide updates on the supply position and the actions being taken to address them, to share data, and to discuss relevant policy developments and their potential impacts.Currently, there are limited supplies of Estradot (estradiol) 37.5, 50, 75, and 100 microgram/24 hour patches, which may be available to local pharmacies to order. We are working with the sole supplier of Estradot to expedite further resupplies, where possible. Further deliveries of all patches are expected in May 2025, except for the 37.5 microgram/24 hour patches, which will be resupplied in July 2025. Alternative brands of the same medicine remain available.We have issued comprehensive management guidance to the National Health Service, including Serious Shortage Protocols (SSPs) for Estradot 25, 50, 75, and 100 microgram/24 hour patches, allowing community pharmacists to supply the equivalent strength patch of an alternative brand without the need for a new prescription.All SSPs are developed with the input of clinical and patient safety experts and include advice for pharmacists about any potential risks. Pharmacists may decide not to supply a patient in accordance with an SSP if they have any concerns. In the case of some SSPs, pharmacists are required to notify prescribers that they have supplied a patient in accordance with an SSP rather than the prescription. Pharmacists and prescribers are informed by an email to their NHS email address whenever a new SSP is issued, or changes are made to an SSP currently in effect. All currently active and expired SSPs are available to view on the NHS Business Services Authority’s website, at the following link:https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/serious-shortage-protocols-ssps

What steps his Department is taking to resolve the shortage of Estradot hormone replacement therapy patches; and when supply is expected to return to normal levels.

There are over 70 hormone replacement therapy (HRT) products, and the vast majority are in good supply. Previously there have been issues with the supply of a limited number of these products, primarily driven by very sharp increases in demand. Following the Department’s intensive engagement with industry, the supply position has improved considerably. As part of this we have previously met with individual suppliers on a very regular basis. We have also hosted nine HRT supply roundtables since April 2022, with the most recent in September 2024, attended by suppliers, wholesalers, and community pharmacists, to provide updates on the supply position and the actions being taken to address them, to share data, and to discuss relevant policy developments and their potential impacts.Currently, there are limited supplies of Estradot (estradiol) 37.5, 50, 75, and 100 microgram/24 hour patches, which may be available to local pharmacies to order. We are working with the sole supplier of Estradot to expedite further resupplies, where possible. Further deliveries of all patches are expected in May 2025, except for the 37.5 microgram/24 hour patches, which will be resupplied in July 2025. Alternative brands of the same medicine remain available.We have issued comprehensive management guidance to the National Health Service, including Serious Shortage Protocols (SSPs) for Estradot 25, 50, 75, and 100 microgram/24 hour patches, allowing community pharmacists to supply the equivalent strength patch of an alternative brand without the need for a new prescription.All SSPs are developed with the input of clinical and patient safety experts and include advice for pharmacists about any potential risks. Pharmacists may decide not to supply a patient in accordance with an SSP if they have any concerns. In the case of some SSPs, pharmacists are required to notify prescribers that they have supplied a patient in accordance with an SSP rather than the prescription. Pharmacists and prescribers are informed by an email to their NHS email address whenever a new SSP is issued, or changes are made to an SSP currently in effect. All currently active and expired SSPs are available to view on the NHS Business Services Authority’s website, at the following link:https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/serious-shortage-protocols-ssps

What steps his Department is taking to ensure that the serious shortage protocols introduced for Estradot patches are (a) communicated clearly to (i) pharmacies and (ii) prescribers and (b) implemented to ensure (A) patient safety and (B) continuity of care.

There are over 70 hormone replacement therapy (HRT) products, and the vast majority are in good supply. Previously there have been issues with the supply of a limited number of these products, primarily driven by very sharp increases in demand. Following the Department’s intensive engagement with industry, the supply position has improved considerably. As part of this we have previously met with individual suppliers on a very regular basis. We have also hosted nine HRT supply roundtables since April 2022, with the most recent in September 2024, attended by suppliers, wholesalers, and community pharmacists, to provide updates on the supply position and the actions being taken to address them, to share data, and to discuss relevant policy developments and their potential impacts.Currently, there are limited supplies of Estradot (estradiol) 37.5, 50, 75, and 100 microgram/24 hour patches, which may be available to local pharmacies to order. We are working with the sole supplier of Estradot to expedite further resupplies, where possible. Further deliveries of all patches are expected in May 2025, except for the 37.5 microgram/24 hour patches, which will be resupplied in July 2025. Alternative brands of the same medicine remain available.We have issued comprehensive management guidance to the National Health Service, including Serious Shortage Protocols (SSPs) for Estradot 25, 50, 75, and 100 microgram/24 hour patches, allowing community pharmacists to supply the equivalent strength patch of an alternative brand without the need for a new prescription.All SSPs are developed with the input of clinical and patient safety experts and include advice for pharmacists about any potential risks. Pharmacists may decide not to supply a patient in accordance with an SSP if they have any concerns. In the case of some SSPs, pharmacists are required to notify prescribers that they have supplied a patient in accordance with an SSP rather than the prescription. Pharmacists and prescribers are informed by an email to their NHS email address whenever a new SSP is issued, or changes are made to an SSP currently in effect. All currently active and expired SSPs are available to view on the NHS Business Services Authority’s website, at the following link:https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/serious-shortage-protocols-ssps

If his Department will make an assessment of the potential merits of creating a national strategy on the efficiency and effectiveness of community equipment services.

Individual National Health Service trusts and foundation trusts are responsible and accountable for their own purchasing decisions, which will include community equipment. NHS organisations are independent commercial entities, and it is for an NHS procuring authority to satisfy itself on how best to obtain quality and value for money through its procurement activity.Local NHS organisations have access to a wide range of procurement routes, but the Government has put in place a range of initiatives to help NHS bodies make informed choices about products and the route through which they are bought. These include the NHS Supply Chain, a national body which is responsible for procuring and delivering the majority of consumables, equipment, and other supplies to the NHS. The NHS Supply Chain was set up to leverage the collective buying power of the NHS to drive savings and provide a standardised range of clinically assured quality products at the best value.