Written questions by Collins.

What assessment his Department has made of the potential impact of diagnostic overshadowing on people with Down syndrome; and if he will take steps to include expectations on condition-specific training for relevant professionals within guidance under the Down Syndrome Act 2022.

In 2023, NHS England produced a guide for frontline staff as they support people with a learning disability which asks staff to be aware of diagnostic overshadowing, and which is available at the following link:https://www.england.nhs.uk/long-read/clinical-guide-for-front-line-staff-to-support-the-management-of-patients-with-a-learning-disability-and-autistic-people-relevant-to-all-clinical-specialties/NHS England does not hold data on the extent of diagnostic overshadowing for people with Down syndrome, nor is the data held centrally.Through the implementation of the Down Syndrome Act 2022, the Government is striving to improve life outcomes for people with Down syndrome, raise awareness and understanding of their needs, and break down barriers to opportunity that they, and other disabled people, face.Under the Down Syndrome Act, my Rt Hon. Friend, the Secretary of State for Health and Social Care, is required to give guidance to relevant authorities in health, social care, education, and housing services on what they should be doing to support the needs of people with Down syndrome. The draft guidance, which was published for public consultation on 5 November 2025, acknowledges that the care of people with Down syndrome may be affected by diagnostic overshadowing and recognises its impact on the care and treatment that people receive. Once the consultation has closed on 30 March 2026, the Government will consider all consultation responses to inform the final guidance to be published.Relevant authorities, as defined in the schedule to the act, have a duty to have due regard to the final guidance once it is published. The act does not create any new functions beyond this duty. Rather, it brings together existing statutory requirements and guidance that relevant authorities must and/or should already be complying with to support people with Down syndrome and people with other conditions and/or a learning disability who have similar needs.Under existing legislation, Care Quality Comision registered providers must ensure that staff receive appropriate professional development which is necessary for them to carry out their duties and must receive specific training on learning disability and autism appropriate to their role, as per Section 20 of the Health and Social Care Act 2008, Section 181(7) of the Health and Care Act 2022 and Regulation 18 of the Health and Social Care Act 2008 Regulated Activities) Regulations 2014. We expect that providers should be considering whether specific training on Down syndrome is required for their staff, and the draft guidance under the Down Syndrome Act sets out that some staff who work frequently with people with Down syndrome may require additional training on Down syndrome.

What steps are being taken to ensure dementia diagnosis pathways align with NHS access standards for timely assessment and treatment.

We recognise the importance of a timely diagnosis and remain committed to increasing diagnosis rates and ensuring people can access any treatment licensed or recommended by the National Institute for Health and Care Excellence, and support they need.We will deliver the first ever Modern Service Framework for Frailty and Dementia to deliver rapid and significant improvements in quality of care and productivity. This will be informed by phase one of the independent commission into adult social care, which is expected this year.As part of this exercise, we are considering all options to help reduce variation, including reviewing metrics and targets.

What assessment his Department has made of the potential implications for his policies of the impact of breast density on the reliability of mammogram screening for breast cancer; and what steps his Department is taking to help ensure that women with high breast density receive appropriate (a) information and (b) access to supplementary screening methods.

The Government is guided by the UK National Screening Committee (UK NSC), an independent scientific advisory committee which makes its recommendations based on internationally recognised criteria and a rigorous evidence review and consultation process. It is only where the UK NSC is confident that to screen would provide more good than harm that a screening programme is recommended, as all medical interventions carry an inherent risk.A review by the UK NSC of the evidence in 2019 of supplementary ultrasound for women with dense breasts and negative mammograms showed insufficient evidence to balance the risks, benefits, and costs. In the field, there are concerns that undertaking notification of increased density without provision of any modification of screening may increase inequity and capacity issues, as well as leading to increased anxiety and confusion.The UK NSC is considering the best approach for women with dense breast tissue. It reviewed the evidence relating to the provision of additional breast screening for women who have dense breast tissue and invited stakeholders’ feedback on the findings to inform future work. The consultation closed in August 2025. Further work is needed to understand the clinical impact and costs of adding breast density to the screening pathways in the United Kingdom.In the meantime, the Breast Screening Risk Adaptive Imaging for Density (BRAID) trial is looking into the use of supplementary imaging techniques for women within the standard breast screening programme who are found to have radiographically dense breast tissue. The different tests include magnetic resonance imaging and ultrasound. The UK NSC is in contact with the researchers and is reviewing this evidence as it becomes available. It will make recommendations to ministers in light of this.The NHS Breast Screening Programme advises all women, as part of its literature, that cancer may be missed and that breast symptoms should be reported even if they have recently had a negative screening mammogram.

What process is available to manufacturers to seek reassignment or review of a GMDN Level 2 classification used by the MHRA where the published description no longer reflects the device’s intended purpose.

Global Medical Device Nomenclature (GMDN®) codes and categories are managed and determined by the GMDN Agency. The structure is managed independently of the Medicines and Healthcare products Regulatory Agency (MHRA) who is not involved in assigning GMDN® codes to categories. Questions regarding GMDN® code allocations to categories should therefore be directed to the GMDN Agency.

What steps the MHRA is taking to address circumstances in which a previously used GMDN Level 2 code has been obsoleted or materially amended at the point of mandatory device registration renewal.

Global Medical Device Nomenclature (GMDN) Codes and Categories are managed by the GMDN Agency. The GMDN Agency may obsolete GMDN Codes within a hierarchy of GMDN Categories. If a GMDN Code is obsoleted, the Medicine and Healthcare products Regulatory Agency (MHRA) will receive a feed notifying it of the GMDN Code obsolescence. When a GMDN Code becomes obsolete, the MHRA notifies all registrants that are impacted by the obsolescence. Applicants are notified within the MHRA Device Online Registration System (DORS). The applicant can then update the obsolete GMDN Code to an active GMDN Code within DORS.If a newly selected active GMDN Code falls within a different GMDN Level 2 Category, or Level 1 Category where no Level 2 Category exists, an annual fee may become payable from 1 April of the following year at the time of renewal. The fee will be charged if the newly selected GMDN Code is the only device within the chargeable category.

What oversight his Department exercises over the MHRA’s use of GMDN Level 2 classifications in the registration and regulation of medical devices in the UK.

The Medicines and Healthcare products Regulatory Agency (MHRA) derives most of its income from charging statutory fees for its services. Generally, wherever the MHRA provides a service for regulatory work, a statutory fee is set to recover the cost of the work involved.This means the regulated bear the cost of regulation, and Government bodies do not make a loss which must be subsidised by wider Government and ultimately the taxpayer, including patients themselves.This is in line with the HM Treasury guidance “Managing Public Money” which states that ‘the standard approach is to set charges to recover full costs’. The MHRA does not make any profit from statutory fees.In 2024, the MHRA consulted on proposals regarding ongoing cost recovery, and a Government response was published in March 2025. This is available at the following link:https://www.gov.uk/government/consultations/mhra-consultation-on-statutory-fees-proposals-on-ongoing-cost-recoveryGoing forward, the MHRA intends to update its fees every two years as regularity provides more certainty to customers and enables financial planning. This is standard practice amongst government bodies operating on a cost recovery basis.The modified Medical Device Registration Fee will be calculated by relating staff costs for post-market work to the number of Global Medical Device Nomenclature (GMDN®) codes registered to each manufacturer. The GMDN® is a comprehensive set of terms that name and group all medical device products. The Department has an agreement with the GMDN Agency for the use of the GMDN® Codes and Categories. However, these Codes and Categories are managed by the GMDN Agency.The MHRA, as an executive agency of the Department, may use the GMDN® Codes and Categories. It does so for the purposes of devices registration and vigilance reporting, which is essential for the MHRA’s work to implement the regulations for medical devices and in-vitro diagnostics.There will be an annual fee for each of the GMDN® codes under which a manufacturer registers.

What recent steps he has taken to increase access to GP appointments.

This government has invested an extra £1.6 billion into general practice since coming into office, recruited over 2000 GPs, and extended access to online services throughout core hours, delivering 6.8 million more appointments, 46,000 more benefiting your constituents in the last year. Thanks to the steps the government has taken, 75% of patients now say it is easy to contact their GP, up a sizeable 14 percentage points since July 2024, a very positive development that I’m sure the honourable lady would wish to welcome. In our manifesto we pledged to end the 8am scramble - and that is precisely what we are doing.

With reference to the National Institute for Health and Care Research's news story entitled NIHR launches £13.7 million investment into brain tumour research, published on 19 December 2025, what assessment his Department has made of the potential impact of funding the NIHR Brain Tumour Research Consortium and Brain Tumour Research Centres of Excellence on the level of patient access to tumour tissue freezing within routine NHS neuro-oncology pathways, including access for patients treated outside specialist centres to sequencing, research, and clinical trials.

The Department invests over £1.6 billion each year in research through the National Institute of Health and Care Research (NIHR).In January 2026, the NIHR announced increased investment of over £25 million in the NIHR Brain Tumour Research Consortium. The world-leading consortium aims to transform outcomes for adults and children and their families who are living with brain tumours, ultimately reducing lives lost to cancer. Its activities will include:enrolling patients to a ‘Real World’ study tracking their progress in everyday medical settings, before matching them to new clinical trials based on their cancer subtype;developing pioneering new clinical trials, including platform trials, to test medicines and radiotherapy technologies, immunotherapies, and novel gene therapies. This includes targeted precision medicine; anddeveloping new training programmes for those working in brain cancer research to build capacity and increase skills among the next generation of researchers.It is anticipated that this funding will include costs associated with freezer capacity to house frozen tissue and liquid biopsy samples specifically to support the consortium’s activities. The consortium will also engage with partners on the standardised pathways for tissue storage and whole genome sequencing for all patients for stratification into clinical trials.In addition, the NIHR’s investments for capital equipment, technology, and modular buildings support National Health Service trusts across England to deliver high-quality research to improve the health of the population. This investment includes cutting edge research equipment and fixed assets such as ultra-low and cryogenic freezers, to strengthen research capacity and improve access to samples for research.

With reference to the National Institute for Health and Care Research's news story entitled NIHR launches £13.7 million investment into brain tumour research, published on 19 December 2025, whether the funding allocated to brain tumour research through the NIHR Brain Tumour Research Consortium includes specific funding to increase tissue freezing capacity and standardise access to tumour storage across NHS trusts and health boards to allow all eligible brain cancer patients to have genomic sequencing, clinical trials, and advanced diagnostics.

The Department invests over £1.6 billion each year in research through the National Institute of Health and Care Research (NIHR).In January 2026, the NIHR announced increased investment of over £25 million in the NIHR Brain Tumour Research Consortium. The world-leading consortium aims to transform outcomes for adults and children and their families who are living with brain tumours, ultimately reducing lives lost to cancer. Its activities will include:enrolling patients to a ‘Real World’ study tracking their progress in everyday medical settings, before matching them to new clinical trials based on their cancer subtype;developing pioneering new clinical trials, including platform trials, to test medicines and radiotherapy technologies, immunotherapies, and novel gene therapies. This includes targeted precision medicine; anddeveloping new training programmes for those working in brain cancer research to build capacity and increase skills among the next generation of researchers.It is anticipated that this funding will include costs associated with freezer capacity to house frozen tissue and liquid biopsy samples specifically to support the consortium’s activities. The consortium will also engage with partners on the standardised pathways for tissue storage and whole genome sequencing for all patients for stratification into clinical trials.In addition, the NIHR’s investments for capital equipment, technology, and modular buildings support National Health Service trusts across England to deliver high-quality research to improve the health of the population. This investment includes cutting edge research equipment and fixed assets such as ultra-low and cryogenic freezers, to strengthen research capacity and improve access to samples for research.

What assessment his Department has made of the cost of changes in the levels of funding to hospices on the wider healthcare system.

Integrated care boards (ICBs) are responsible for commissioning palliative care services to meet the reasonable needs of their population, which can include hospice services available within the ICB catchment. To support ICBs in this duty, NHS England has published statutory guidance and a service specification. The Government is developing a Palliative Care and End-of-Life Care Modern Service Framework (MSF) for England. The MSF will drive improvements in the services that patients and their families receive at the end of life and will enable ICBs to address challenges in access, quality, and sustainability through the delivery of high-quality, personalised care. Through our MSF, we will closely monitor the shift towards the strategic commissioning of palliative care and end-of-life care services to ensure that services reduce variation in access and quality. We will consider contracting and commissioning arrangements as part of our MSF. We recognise that there is currently a mix of contracting models in the hospice sector. By supporting ICBs to commission more strategically, we can move away from grant and block contract models. In the long term, this will aid sustainability and help hospices’ ability to plan ahead. The recently published Strategic Commissioning Framework and Medium-Term Planning Guidance also make clear the expectations that ICBs should understand current and projected total service utilisation and costs for those at the end of life, creating an overall plan to more effectively meet these needs through neighbourhood health. Hospices provide both core and specialist palliative care. Whilst acknowledging that not everyone will need specialist palliative care, we must ensure is that there is equitable and timely access to these services, whether they are provided by hospices or the National Health Service. While no specific assessment has been made of the cost of changes in the levels of funding to hospices on the wider healthcare system, as part of our 10-Year Health Plan, the Government will shift the focus of healthcare out of the hospital and into the community. We recognise that it is vital to include palliative care and end-of-life care, including hospices, in this shift.

What assessment his Department has made of the potential merits of funding the full cost of specialist palliative care delivered by hospices.

Integrated care boards (ICBs) are responsible for commissioning palliative care services to meet the reasonable needs of their population, which can include hospice services available within the ICB catchment. To support ICBs in this duty, NHS England has published statutory guidance and a service specification. The Government is developing a Palliative Care and End-of-Life Care Modern Service Framework (MSF) for England. The MSF will drive improvements in the services that patients and their families receive at the end of life and will enable ICBs to address challenges in access, quality, and sustainability through the delivery of high-quality, personalised care. Through our MSF, we will closely monitor the shift towards the strategic commissioning of palliative care and end-of-life care services to ensure that services reduce variation in access and quality. We will consider contracting and commissioning arrangements as part of our MSF. We recognise that there is currently a mix of contracting models in the hospice sector. By supporting ICBs to commission more strategically, we can move away from grant and block contract models. In the long term, this will aid sustainability and help hospices’ ability to plan ahead. The recently published Strategic Commissioning Framework and Medium-Term Planning Guidance also make clear the expectations that ICBs should understand current and projected total service utilisation and costs for those at the end of life, creating an overall plan to more effectively meet these needs through neighbourhood health. Hospices provide both core and specialist palliative care. Whilst acknowledging that not everyone will need specialist palliative care, we must ensure is that there is equitable and timely access to these services, whether they are provided by hospices or the National Health Service. While no specific assessment has been made of the cost of changes in the levels of funding to hospices on the wider healthcare system, as part of our 10-Year Health Plan, the Government will shift the focus of healthcare out of the hospital and into the community. We recognise that it is vital to include palliative care and end-of-life care, including hospices, in this shift.

For what reason business rates treatment is different for community pharmacies and (a) GP and (b) NHS dentist surgeries; and whether his Department plans to extend business rate reimbursements to community pharmacies.

Community pharmacy, general practice and National Health Service dental surgeries all play a vital role in delivering our Neighbourhood Health Service offer for communities across the country. They are treated differently in relation to business rates because GP practices and most NHS dental services have their premises costs reimbursed under NHS contracts, whereas community pharmacies are treated as retail businesses and do not have a comparable, automatic reimbursement mechanism for business rates.That difference in this treatment is rooted in how each service is commissioned, contracted, and classified. Community pharmacy have been afforded support through the business rates relief for retail, hospitality or leisure which is not provided for general practice or dental surgeries. From 2026, this relief is being replaced by two lower business rates multipliers for properties with a rateable value below £500,000.

What assessment his Department has made of the potential impact of reductions in local authority public health nursing contracts on prevention and community-based care.

Decisions related to public health nursing contracts are taken at a local level.Public health nursing has been funded by local authorities since 2015 through the Public Health Grant. We increased the Public Health Grant by £224 million this year, 2025/26, to support local authorities to deliver public health services. We will continue to invest in local authorities' vital public health work, providing over £13.4 billion, a 5.6% cash increase, over the next three years through a consolidated ringfenced Public Health Grant. This is the first three-year public health settlement in a decade, giving local authorities far greater certainty over their future funding and supporting their ability to plan ahead. We have refreshed guidance for the Healthy Child Programme to strengthen service delivery and promote consistency in the quality of public health nursing across the country. This guidance is due for publication in early 2026.

Whether his Department plans to introduce a statutory right to access free period products.

The Government recognises the importance of women and girls being able to access the care they need for their reproductive health, including period products.We know that poverty doesn’t recognise gender, and that women and girls may suffer given the cost of period products. However, we know that period poverty reflects wider cost-of-living pressures, which is why the Government is tackling the root causes of poverty, through measures to make work pay, boosting the living wage, and investing in public services, so no one has to go without the essentials.There are a number of schemes across the Government which ensure that those who are most vulnerable can access the products they need. The Department for Education’s Period Products scheme launched in 2020 and provides free period products to girls and women in their place of study so that nobody misses out on education because of their period. Similarly, all women and girls being cared for by the National Health Service are entitled to be given, upon request, appropriate period products free of charge.We are also taking steps to ensure that products are as affordable as possible, as the tax on period products has been zero-rated since 2021, and in 2023 this was extended to include reusable period underwear.

What assessment his Department has made of the potential impact of Agenda for Change mileage reimbursement rates, including the change to the rate for travelling over 3,500 miles annually, on the (a) recruitment and (b) retention of community-based NHS staff.

This specific assessment has not been made. As set out in the NHS Terms and Conditions of Service Handbook, which is maintained by the NHS Staff Council, mileage reimbursement rates are reviewed twice a year in April and November.The outcome of the November 2025 review resulted in reimbursement rates reducing due to sustained decreases in fuel prices for the 12-month period ending in October 2025. Reimbursement rates dropped to 56 pence per mile for the first 3,500 miles claimed before dropping to 21 pence per mile thereafter. The revised rates apply to mileage incurred from 1 January 2026 onwards.These changes apply to all staff directly employed in England under Agenda for Change terms and conditions and Resident Doctors. There are no specific rates for community staff.

What the average waiting time is for paediatric referrals in (a) East and North Hertfordshire NHS Trust, (b) Hertfordshire and West Essex ICB and (c) England; and what steps his Department is taking to reduce paediatric referral backlogs.

The median average waiting time for paediatric referrals for those that are currently on the referral to treatment waiting list is:- 8.7 weeks for the East and North Hertfordshire NHS Trust;- 8.7 weeks for the Hertfordshire and West Essex Integrated Care Board (ICB); and- 9.9 weeks for England.Our Elective Reform Plan (ERP), published in January 2025, sets out how the National Health Service will reform elective care services and meet the 18-week referral to treatment standard for all patients, including children and young people, by March 2029. As a first step to achieving this, we exceeded our pledge to deliver an extra two million operations, scans, and appointments in our first year of Government, delivering 5.2 million more appointments.We have made it easier to monitor elective waiting times for children and young people by publishing new demographic data as part of monthly inequalities statistical releases. This is a big step forward in improving the transparency of waiting times and will provide accountability for children’s elective waiting lists.The ERP outlined several commitments specifically in relation to children and young people including that ICBs and providers should ensure interventions are in place to reduce disparities for groups who face additional waiting list challenges, and that primary and secondary care clinicians are encouraged to improve digital referral functionality by including data that enables better prioritisation.In addition, the clinically led Getting It Right First Time Children and Young people programme continues to work with providers to ensure they are implementing best practice to improve children’s outcomes and waiting times across all medical and surgical specialities.Lastly, dedicated paediatric surgery days are being introduced across England, using existing NHS estate in day surgery or hub settings, to boost surgical activity for children and young people. We are also making the most of surgical hubs to deliver better outcomes for children, through promoting greater paediatric ear, nose, and throat access. Surgical hubs will play a key role in delivering this increased activity and ensuring timely access to planned care.

What assessment his Department has made of the potential merits of enabling children waiting over 26 weeks for a paediatric appointment to be seen by alternative NHS-commissioned providers.

Patients in England have a right to request their local integrated care board (ICB) find an alternative provider when they have been waiting, or expect to wait, over 18 weeks to begin treatment for consultant-led care.ICBs are required to take all reasonable steps to ensure the patient is offered an appointment with a clinically appropriate alternative provider with whom an ICB or NHS England has an NHS Standard Contract for the relevant service, who can start their treatment more quickly. Further information is available on the NHS Choice Framework at the following link:https://www.gov.uk/government/publications/the-nhs-choice-framework/

What steps his Department is taking to provide support or funding to NHS Trusts with paediatric waiting times exceeding 26 weeks.

The Government’s ambition is to restore performance against the NHS Constitutional standard, which requires 92% of patients to start consultant-led treatment within 18 weeks.All waiting lists are subject to clinical prioritisation at a local level. The National Health Service triages patients waiting for elective care, including surgeries, ensuring the order in which patients are seen reflects clinical judgement on need as well as taking into account overall wait time.The Spending Review 2025 has prioritised health, with record investment in the health and social care system, including investment in elective services. Through the Spending Review, the Government announced that NHS day to day spending will increase by £29 billion in real terms by 2028/29 compared to 2023/24.The Department recognises the impact of long waits on children and young people and is committed to reducing paediatric waiting times.Through the Elective Recovery Plan, we have invested in additional capacity, including surgical hubs, community diagnostic centres, and increased use of the independent sector to support challenged trusts.Targeted support is provided via Getting It Right First Time and specialty-specific improvement programmes, including paediatric ear, nose, and throat, and ophthalmology. National planning guidance sets expectations for systems to prioritise clinically urgent cases and those at risk of deterioration.

How many children have waited more than (a) 26 and (b) 40 weeks for an initial paediatric referral triage in the most recent 12-month period for which data is available.

We do not hold data on how many children have waited more than 26 and 40 weeks for an initial paediatric referral triage in the most recent 12-month period.Published referral to treatment data covers the period on waiting time from referral to first definitive treatment.

What guidance his Department has issued to Integrated Care Boards on clinically prioritising children whose symptoms are deteriorating while awaiting paediatric referral allocation.

The Government is committed to ensuring that patient outcomes will be at the heart of building a National Health Service that is fit for the future.National planning guidance sets expectations for systems to prioritise clinically urgent cases and those at risk of deterioration. The NHS triages patients waiting for elective care at a local level, ensuring the order in which patients are seen reflects clinical judgement on need as well as taking into account overall wait time.We have committed to ensuring that integrated care boards and providers have interventions in place to reduce disparities for groups who face additional waiting list challenges, and primary and secondary care clinicians are to improve e-RS functionality, a national digital platform for referring patients into elective care, by including data to enable better prioritisation of children and young people.The clinically led Getting It Right First Time children and young people programme continue to work with providers to ensure they are implementing best practice to improve children’s outcomes and waiting times across all medical and surgical specialities.