Department of Health and Social Care

Respiratory disease, including chronic obstructive pulmonary disease (COPD) is a clinical priority and the National Health Service is investing in the provision of more and better rehabilitation services for respiratory patients. This has the objective of improving outcomes for people with COPD through early diagnosis including via spirometry tests, and through increased access to treatments.

The NHS RightCare COPD pathway has been rolled out nationally and defines the optimal service for people with COPD. Furthermore, the National Respiratory Audit Programme aims to improve quality of care, services, and clinical outcomes for patients with asthma and COPD, by collecting and providing data on a range of indicators and pulmonary rehabilitation activity.

A national programme of work is underway to support systems with improving access to Pulmonary Rehabilitation for the eligible population; increase capacity of provision to reduce waiting lists; and improve the quality and consistency of rehabilitation programmes through accreditation. Pulmonary rehabilitation is effective for people with COPD, improving exercise capacity or increased quality of life in 90% of patients who complete a programme.

Within NHS Greater Manchester, action being taken to address COPD includes:

- improving equity of access to diagnostic spirometry and fractional exhaled nitric oxide, particularly for disadvantaged population groups;

- increasing capacity and reducing waiting times for pulmonary rehabilitation services;

- increasing vaccination uptake and focusing on secondary prevention of pneumonia;

- running smoking cessation services; and

- introducing a respiratory standard to improve quality in general practice in managing COPD.

This standard utilises a tool to identify patients with COPD who are at the highest risk and asks practices to do an enhanced review and management of these patients to help manage their COPD better.

Data on the average time to diagnosis of COPD following patient contact with their general practitioner (GP) is not available. COPD diagnosis typically involves a spirometry test, and data related to such tests may be available at the level of individual GP practices and secondary care providers but is not yet routinely collected in national datasets or in Greater Manchester Integrated Care Board. Furthermore, the test is also used in the diagnosis of other respiratory conditions, not just COPD.

Work is progressing at pace to develop the design and operating model for the new integrated organisation, and to plan for the smooth transfer of people, functions, and responsibilities

It is only right that with such significant reform, we commit to carefully assessing and understanding the potential impacts, as is due process. These ongoing assessments will inform our programme as appropriate.

The Government is committed to transparency and will consider how best to ensure that the public and parliamentarians are informed of the outcomes.

The baby loss certificate scheme was launched by the Department in February 2024, initially for losses that occurred after 1 September 2018. In October 2024, the scheme was extended to make the service available for all losses. The scheme has received very positive feedback from families, enabling those who have experienced pregnancy loss to receive a certificate recognising their loss, if they wish to do so. To date, over 100,000 certificates have been issued. The scheme currently only applies to losses that took place in England.

A formal assessment of the implementation of the baby loss certificate scheme has not been made. As part of plans for the future of the scheme, the Department and its Welsh and Northern Irish counterparts have discussed the possibility of the Baby Loss Certificate scheme becoming available in Wales and Northern Ireland. As healthcare in Wales and Northern Ireland is the responsibility of their respective governments, Welsh and Northern Irish officials are leading on this piece of work.

As set out in the Immigration White Paper, visa extensions and in-country switching for those already in the country with working rights will be permitted for a transition period until 2028. This will be kept under review.

Care workers are essential to those who draw on care and support, helping them to maintain their quality of life, independence and connection to the things that matter to them. In England, as per the Care Act 2014, it is the responsibility of local government to develop a market that delivers a wide range of sustainable high-quality care and support services, that will be available to their communities. 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.

The care worker route has seen unacceptable levels of abuse and exploitation, between July 2022 and December 2024 the Home Office revoked over 470 sponsor licences, impacting around 40,000 workers in the care sector. The Department of Health and Social Care is providing up to £12.5 million to regional partnerships in 2025/26 to respond to unethical international recruitment practices in the adult social care sector. This includes supporting international recruits impacted by sponsor licence revocations to find alternative employment.

In the technical annex published alongside the Immigration White Paper on 12 May 2025, the Home Office has estimated an annual reduction of approximately 7,000 main visa applicants as a result of ending overseas recruitment for care workers and senior care workers. This is based on their internal management information for entry visas granted covering the period March 2024 to February 2025. This estimate reflects that there was a drop in visa grants of more than 90% compared with the 12 months ending in March 2024. This analysis will be refined and included within the relevant Impact Assessments accompanying the rule changes, as appropriate.

The Department of Health and Social Care continues to monitor adult social care workforce capacity, bringing together national data sets from Skills for Care’s monthly tracking data, the Capacity Tracker tool and intelligence from key sector partners. The Department of Health and Social Care primarily uses filled posts as the most accurate measure of adult social care workforce capacity rather than number of vacancies. As vacancies are the total number of posts advertised by the adult social care sector’s independent and competing providers, they don’t necessarily reflect the number of workers required to meet adult social care needs. Vacancies are ultimately impacted by other factors such as providers’ ambitions to grow and are not necessarily a good indicator of capacity pressures as a result.

As set out in the Immigration White Paper, visa extensions and in-country switching for those already in the country with working rights will be permitted for a transition period until 2028. This will be kept under review.

Care workers are essential to those who draw on care and support, helping them to maintain their quality of life, independence and connection to the things that matter to them. In England, as per the Care Act 2014, it is the responsibility of local government to develop a market that delivers a wide range of sustainable high-quality care and support services, that will be available to their communities. 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.

The care worker route has seen unacceptable levels of abuse and exploitation, between July 2022 and December 2024 the Home Office revoked over 470 sponsor licences, impacting around 40,000 workers in the care sector. The Department of Health and Social Care is providing up to £12.5 million to regional partnerships in 2025/26 to respond to unethical international recruitment practices in the adult social care sector. This includes supporting international recruits impacted by sponsor licence revocations to find alternative employment.

In the technical annex published alongside the Immigration White Paper on 12 May 2025, the Home Office has estimated an annual reduction of approximately 7,000 main visa applicants as a result of ending overseas recruitment for care workers and senior care workers. This is based on their internal management information for entry visas granted covering the period March 2024 to February 2025. This estimate reflects that there was a drop in visa grants of more than 90% compared with the 12 months ending in March 2024. This analysis will be refined and included within the relevant Impact Assessments accompanying the rule changes, as appropriate.

The Department of Health and Social Care continues to monitor adult social care workforce capacity, bringing together national data sets from Skills for Care’s monthly tracking data, the Capacity Tracker tool and intelligence from key sector partners. The Department of Health and Social Care primarily uses filled posts as the most accurate measure of adult social care workforce capacity rather than number of vacancies. As vacancies are the total number of posts advertised by the adult social care sector’s independent and competing providers, they don’t necessarily reflect the number of workers required to meet adult social care needs. Vacancies are ultimately impacted by other factors such as providers’ ambitions to grow and are not necessarily a good indicator of capacity pressures as a result.

The report from Asthma + Lung UK highlights the relatively high mortality rate in the United Kingdom from lung conditions such as chronic obstructive pulmonary disease (COPD) and asthma. It asks for better and faster diagnosis, new treatments, new technology, and more action on prevention. These are consistent with the Government’s policies and priorities.

The Government has committed to delivering three big shifts that the National Health Service needs to be fit for the future: from hospital to community, from analogue to digital, and from sickness to prevention. All of these are relevant to improving respiratory health in all parts of the country.

This will support earlier diagnosis, better joint working between services, and greater use of apps and wearable technology will all help people manage their long-term conditions, including respiratory conditions, closer to home. Earlier diagnosis of conditions will help prevent deterioration and improve survival rates. Taking action to reduce the causes of the biggest killers, such as enabling a smoke free generation through the Tobacco and Vapes Bill, can further help prevent lung conditions.

On COPD and asthma specifically, the NHS is investing in the provision of more and better rehabilitation services for respiratory patients. This has the objective of improving outcomes through early diagnosis including via spirometry tests, and through increased access to treatments.

The NHS RightCare COPD pathway has been rolled out nationally and defines the optimal service for people with COPD. Furthermore, the National Respiratory Audit Programme aims to improve quality of care, services, and clinical outcomes for patients with asthma and COPD, by collecting and providing data on a range of indicators and pulmonary rehabilitation activity. A national programme of work is underway to support systems with improving access to Pulmonary Rehabilitation for the eligible population. Pulmonary rehabilitation is effective for people with COPD, improving exercise capacity or increased quality of life in 90% of patients who complete a programme.

Appropriate treatment and support for people with chronic urinary tract infections (UTIs) are dependent on receiving an accurate diagnosis. Diagnostic tests for chronic UTIs, such as urinalysis and urine culture, are widely available across all pathology networks in England, including Surrey. Ensuring accurate diagnostic testing not only aids more effective identification of infection but can also reduce unnecessary prescribing and overprescribing of broad-spectrum antimicrobials and directly benefit patients in Surrey Heath who will get the right treatment sooner.

General practitioners can request testing for chronic UTIs via several pathways, including at point-of-care, via community diagnostic centres, or via laboratories. Laboratories across England adhere to stringent quality standards for diagnostic tests, including the UK Accreditation Standard ISO 15189, and implement robust internal and external quality assurance schemes. Together, these measures ensure the accuracy and reliability of diagnostic testing.

Through the National Institute for Health and Care Research, the Department is supporting work to understand the research gaps on UTIs that matter most to patients, carers and clinicians. This is through a James Lind Alliance Priority Setting Partnership (PSP), led by Antibiotic Research UK, Bladder Health UK and The Urology Foundation. This partnership will publish its findings in spring 2026. The aim of the Chronic and Recurrent UTI PSP is to identify the unanswered questions about chronic and recurrent UTIs from patient, carer and clinical perspectives and then prioritise those that patients, carers and clinicians agree are the most important for research to address.

NHS England is also supporting research into newer, more accurate point-of-care tests for UTIs, such as via the Toucan study.

More information on the study is available at the following link:

https://www.phctrials.ox.ac.uk/recruiting-trials/toucan-platform-for-uti-diagnostic-evaluation

The Human Medicines Regulations include specific incentives to support orphan medicines, designed to encourage the development of medicines for rare diseases. The regulations enable the Medicines and Healthcare products Regulatory Agency (MHRA) to grant orphan designation to a medicine intended for the prevention, diagnosis, or treatment of a rare condition. This orphan designation provides the product with a period of market exclusivity for the specified condition, preventing similar competitor medicines from entering the market during this time. Pancreatic cancer can be considered as falling under the definition of the rare diseases.

The MHRA further supports developers of orphan medicines by offering a full or partial refund of the marketing authorisation fee following a positive orphan designation. There is evidence that the regulations for orphan medicines do support development, with around 150 medicines successfully developed and authorised for the diagnosis, prevention and treatment of rare diseases and given a United Kingdom orphan designation.

The MHRA will continue to review its approach to orphan medicines and, where necessary, propose updates to the criteria to further encourage research into rare diseases and improve patient outcomes.

The Elective Reform Plan, published on 6 January 2025, sets out that we will deliver additional community diagnostic centre (CDC) capacity in 2025/26 by expanding several existing CDCs and building up to five new ones, as well as increasing the number of CDCs offering services 12 hours a day, seven days a week.

NHS England is working with local National Health Service systems to identify the most appropriate locations for additional investment, including new CDCs. New CDCs should be positioned in a location that addresses local need and health inequalities. Details of future sites will be set out in due course.

£1.65 billion of capital funding has been made available in 2025/26 for secondary and emergency care, which includes £0.6 billion for investment in diagnostics. This will enable the NHS to expand existing CDCs and build new CDCs as part of our Elective Reform Plan. It will also enable the completion of 2024/25 schemes.

The 2025 Spending Review confirmed over £6 billion of additional capital investment over five years across new diagnostic, elective and urgent care capacity, including the £1.65 billion investment already announced. Further details and allocations will be set out in due course.

The Department has made no estimate of the number of National Health Service trusts with recruitment freezes for physiotherapists or physiotherapy support workers. How NHS systems and trusts plan resources within their budgets is a matter for local discretion.

The Department has not made an assessment. Integrated care boards are responsible for delivery, implementation, and funding decisions for local services, rather than the Department.

There are over 70 hormone replacement therapy products, and the vast majority are in good supply. Currently, there are limited supplies of Estradot (estradiol) 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, however, supply issues are anticipated for the remainder of the year.

We have a range of well-established processes to manage supply issues when they arise, working closely with industry, the National Health Service, and the Medicines and Healthcare products Regulatory Agency to resolve issues as soon as possible. We have issued comprehensive management guidance to the NHS, which includes advice for prescribers to review patients individually if they are unable to tolerate suggested alternative products.

We have also issued Serious Shortage Protocols 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.

NHS England is committed to ensuring equitably accessible, high-quality services, for anyone who requires hyperbaric oxygen therapy (HBOT). This will be achieved through the commissioning of six geographically dispersed services across England. Three preferred providers have been identified to date, and a further procurement exercise will take place to identify the three remaining centres. NHS England is unable to provide details of timescales for the provider selection process for outstanding lots at this stage.

The contract for HBOT services, also known as recompression, was reviewed in 2024, as existing contract terms expired. This included an update of the service specification using the published full methods process, and a public consultation on the proposal to reduce the number of commissioned providers in England from eight to six centres. Further information on the service specification, the published full methods process, and the consultation is available, respectively, at the following three links:

https://www.england.nhs.uk/wp-content/uploads/2018/11/Hyperbaric-oxygen-therapy-services-all-ages-Service-specification-January-2025.pdf

https://www.england.nhs.uk/publication/methods-national-service-specifications/

https://www.england.nhs.uk/long-read/reviewing-hyperbaric-oxygen-services-consultation-guide/#:~:text=Background-,Background,Manual%20of%20Prescribed%20Specialised%20Services

The updates to the specification seek to ensure timely access to treatment for the most acutely unwell patients with the specification requiring:

• the delivery of care that is integrated with other services, including the emergency department, critical care, and other healthcare professionals as required; and
• facilities should be capable of receiving patients in any diagnostic category who may require advanced life support either immediately or during HBOT.

The geographical scope of the six services will ensure that there are no more than four hours travelling time by road from coastal locations, from the furthest borders, or between neighbouring commissioned HBOT centres, which is in line with good practice guidelines. The published Equality and Health Inequalities Impact Assessment sets out an evaluation, including access to services and where appropriate action was taken to ensure fair access to any patient who requires this service. Further information on the Equality and Health Inequalities Impact Assessment is available at the following link:

https://www.england.nhs.uk/wp-content/uploads/2018/11/2.1-Hyperbaric-oxygen-therapy-equality-and-health-inequalities-impact-assessment.pdf

The National Institute for Health and Care Excellence (NICE) makes recommendations on whether licensed medicines should be routinely funded by the National Health Service in England based on a thorough assessment of the available evidence of clinical and cost effectiveness. The NHS in England is legally required to fund medicines recommended by NICE.

In July 2024, NICE approved three disease modifying treatments, Orkambi, Symkevi, and Kaftrio, as treatment options for eligible NHS patients with cystic fibrosis, under the terms of a commercial agreement reached between NHS England and the manufacturer, Vertex. These treatments are now routinely funded by the NHS in England for eligible patients.

NICE is also currently developing guidance for the NHS on whether vanzacaftor-tezacaftor-deutivacaftor can be recommended for routine funding for the treatment of cystic fibrosis. NICE is expecting to publish final guidance in August 2025.

The Department has made no estimate of the amount the National Health Service spends on drugs imported from the United States. Published information from the Office for National Statistics on imports into the United Kingdom from the United States for all pharmaceutical products, including human blood, bandages, and wadding type goods, is available at the following link:

https://www.ons.gov.uk/economy/nationalaccounts/balanceofpayments/articles/uktradewiththeunitedstates2023/2023#:~:text=There%20were%20%C2%A37.8%20billion,chemicals%20from%20the%20United%20States

The data included does not disaggregate NHS and non-NHS spending.

In the United Kingdom, the majority of artificial intelligence (AI) products being used in health and social care are regulated as medical devices. This means they are subject to stringent safety, performance, and efficacy requirements, primarily set out in the Medical Devices Regulations 2002, with robust monitoring by the Medicines and Healthcare products Regulation Agency. These requirements also apply to non-deterministic AI systems that are medical devices used in the National Health Service, such as large language models.

The National Institute for Health and Care Excellence (NICE), an arms-length body of the Department, makes recommendations on the safety and cost-effectiveness of products for health and social care services in England. NICE routinely evaluates medical technologies, including innovative AI-enabled technologies, which are assessed in NICE’s Early Value Assessment programme, for those technologies that are most needed and in-demand.

NHS England is also developing guidance for those adopting or considering adopting AI technologies, which is expected to support the safe uptake of these technologies and alleviate concerns that clinicians currently have when buying and using these technologies.

Although many generative AI systems need minimal intervention from users, clinicians still need to review and approve the text which has been produced. AI tools are to be used to support clinicians with their own decision making, rather than to make decisions on the clinicians’ behalf. AI augments, rather than replaces, human expertise.

To ensure that clinicians understand the tools they are working with, we have developed tailored guidance for users and regulators. Through public dialogue, we’ve involved patients and the public in deciding how and why access to health data should be granted for AI research and development. In addition, to bridge the gap between policy and practice we have launched the AI Ambassador Network, which currently has 5,000 members.

In the United Kingdom, the majority of artificial intelligence (AI) products being used in health and social care are regulated as medical devices. This means they are subject to stringent safety, performance, and efficacy requirements, primarily set out in the Medical Devices Regulations 2002, with robust monitoring by the Medicines and Healthcare products Regulation Agency. These requirements also apply to non-deterministic AI systems that are medical devices used in the National Health Service, such as large language models.

The National Institute for Health and Care Excellence (NICE), an arms-length body of the Department, makes recommendations on the safety and cost-effectiveness of products for health and social care services in England. NICE routinely evaluates medical technologies, including innovative AI-enabled technologies, which are assessed in NICE’s Early Value Assessment programme, for those technologies that are most needed and in-demand.

NHS England is also developing guidance for those adopting or considering adopting AI technologies, which is expected to support the safe uptake of these technologies and alleviate concerns that clinicians currently have when buying and using these technologies.

Although many generative AI systems need minimal intervention from users, clinicians still need to review and approve the text which has been produced. AI tools are to be used to support clinicians with their own decision making, rather than to make decisions on the clinicians’ behalf. AI augments, rather than replaces, human expertise.

To ensure that clinicians understand the tools they are working with, we have developed tailored guidance for users and regulators. Through public dialogue, we’ve involved patients and the public in deciding how and why access to health data should be granted for AI research and development. In addition, to bridge the gap between policy and practice we have launched the AI Ambassador Network, which currently has 5,000 members.

NHS England is committed to ensuring equitably accessible, high-quality services, for anyone who requires hyperbaric oxygen therapy (HBOT). This will be achieved through the commissioning of six geographically dispersed services across England. Three preferred providers have been identified to date, and a further procurement exercise will take place to identify the three remaining centres.

The contract for HBOT services, also known as recompression, was reviewed in 2024, as existing contract terms expired. This included an update of the service specification using the published full methods process, and a public consultation on the proposal to reduce the number of commissioned providers in England from eight to six centres. Further information on the service specification, the published full methods process, and the consultation is available, respectively, at the following three links:

https://www.england.nhs.uk/wp-content/uploads/2018/11/Hyperbaric-oxygen-therapy-services-all-ages-Service-specification-January-2025.pdf

https://www.england.nhs.uk/publication/methods-national-service-specifications/

https://www.england.nhs.uk/long-read/reviewing-hyperbaric-oxygen-services-consultation-guide/#:~:text=Background-,Background,Manual%20of%20Prescribed%20Specialised%20Services

The updates to the specification seek to ensure timely access to treatment for the most acutely unwell patients with the specification requiring:

• the delivery of care that is integrated with other services, including the emergency department, critical care, and other healthcare professionals as required; and
• facilities should be capable of receiving patients in any diagnostic category who may require advanced life support either immediately or during HBOT.

The geographical scope of the six services will ensure that there are no more than four hours travelling time by road from coastal locations, from the furthest borders, or between neighbouring commissioned HBOT centres, which is in line with good practice guidelines.

We are committed to ensuring equitably accessible, high-quality services, for any patient who requires hyperbaric oxygen therapy. NHS England set out their assessment of service requirements in their commissioning intentions during the public consultation which took place in September 2024. Further information on the public consultation is available at the following link:

https://www.england.nhs.uk/long-read/reviewing-hyperbaric-oxygen-services-consultation-guide/#:~:text=Background-,Background,Manual%20of%20Prescribed%20Specialised%20Services

The reconfiguration of services ensures service provision which meets optimal time to treatment guidelines, in which providers must be located no more than four hours, based on 200 miles radial distance, from the coast and four hours from the next nearest commissioned provider.

We actively encourage individuals and organisations to register as stakeholders to ensure a full range of views are included in any service developments. Stakeholders can register their interest in services commissioned by NHS England on their website, at the following link:

https://www.engage.england.nhs.uk/application/crg-stakeholder-reg-april-2019/

The published Equality and Health Inequalities Impact Assessment sets out an evaluation, including access to services, and where appropriate action was taken to ensure fair access to any patient who requires this service. Further information on the Equality and Health Inequalities Impact Assessment is available at the following link:

https://www.england.nhs.uk/wp-content/uploads/2018/11/2.1-Hyperbaric-oxygen-therapy-equality-and-health-inequalities-impact-assessment.pdf

The following table sets out the full-time equivalent (FTE) staff in NHS England’s regional teams as of 30 March 2025:

Source: NHS England

Notes:

1. Workforce data is collected at a single point as a ‘snapshot’, so we are unable to provide it for a whole financial year.
2. We are unable to provide data at the equivalent time point within 2023/24 as data has not been validated, and the equivalent time point within 2025/26 has not happened yet.

Site visits were not conducted as part of the formal procurement and subsequent evaluation or scoring processes. All bids were evaluated solely on the written responses provided within the bid submissions, in accordance with the published criteria.

Informal site visits, or an informal virtual meeting in the case of one provider, were held with the eight existing providers during 2024. These were solely to support the Commissioner’s understanding of service delivery models. Any information gathered during these visits was external to the provider selection process and was not considered in the scoring of the submissions from bidders.

The allowed rate of growth for branded medicines is established by the 2024 Voluntary Scheme for Branded Medicines Pricing, Access and Growth (VPAG).

The VPAG plays an important role in delivering improved health gains from medicines in the National Health Service across the United Kingdom, by securing rapid access to new medicines, supporting economic growth, and contributing to a financially sustainable health service.

We are taking decisive action to review the scheme to unlock innovation and drive investment in the UK's world-class pharmaceutical sector.

This review is ongoing, demonstrating our commitment to creating an environment where this innovative sector can thrive.

Last year, NHS England undertook stakeholder testing and a public consultation on the revised service specification for hyperbaric oxygen services. The main impact of the proposals was the reconfiguration of the number of commissioned hyperbaric oxygen therapy centres in England, from eight centres to six.

The review was led by the chair of the Hyperbaric Oxygen Therapy Clinical Reference Group and the lead commissioner for the service, and was supported by a Specification Working Group (SWG). Membership of the SWG included a patient representative, clinical leads from current commissioned providers, consultants in public health, and members of the British Hyperbaric Association. Specialist advice was sought on relevant inter-dependent services including adult critical care, HM Coastguard, adult critical care transfer services, and children’s services.

Stakeholder testing on the revised service specification took place from 8 June 2024 to 25 June 2024. 14 responses were received, six of which were on behalf of organisations and eight from individuals. Public consultation was carried out from 13 September to 12 October 2024. A total of 923 individuals responded to the public consultation, from across all regions and devolved nations of the United Kingdom.

NHS England is committed to ensuring equitably accessible, high-quality services, for anyone who requires hyperbaric oxygen therapy (HBOT). This will be achieved through the commissioning of six geographically dispersed services across England. Three preferred providers have been identified to date, and a further procurement exercise will take place to identify the three remaining centres.

The contract for HBOT services, also known as recompression, was reviewed in 2024, as existing contract terms expired. This included an update of the service specification using the published full methods process, and a public consultation on the proposal to reduce the number of commissioned providers in England from eight to six centres. Further information on the service specification, the published full methods process, and the consultation is available, respectively, at the following three links:

https://www.england.nhs.uk/wp-content/uploads/2018/11/Hyperbaric-oxygen-therapy-services-all-ages-Service-specification-January-2025.pdf

https://www.england.nhs.uk/publication/methods-national-service-specifications/

https://www.england.nhs.uk/long-read/reviewing-hyperbaric-oxygen-services-consultation-guide/#:~:text=Background-,Background,Manual%20of%20Prescribed%20Specialised%20Services

The updates to the specification seek to ensure timely access to treatment for the most acutely unwell patients with the specification requiring:

• the delivery of care that is integrated with other services, including the emergency department, critical care, and other healthcare professionals as required; and
• facilities should be capable of receiving patients in any diagnostic category who may require advanced life support either immediately or during HBOT.

The geographical scope of the six services will ensure that there are no more than four hours travelling time by road from coastal locations, from the furthest borders, or between neighbouring commissioned HBOT centres, which is in line with good practice guidelines. The published Equality and Health Inequalities Impact Assessment sets out an evaluation, including access to services and where appropriate action was taken to ensure fair access to any patient who requires this service. Further information on the Equality and Health Inequalities Impact Assessment is available at the following link:

https://www.england.nhs.uk/wp-content/uploads/2018/11/2.1-Hyperbaric-oxygen-therapy-equality-and-health-inequalities-impact-assessment.pdf

The contract for hyperbaric oxygen therapy (HBOT) services, also known as recompression, was reviewed in 2024, as existing contract terms expired. This included an update of the service specification using the published full methods process, and a public consultation on the proposal to reduce the number of commissioned providers in England from eight to six centres. Further information on the service specification, the published full methods process, and the consultation is available, respectively, at the following three links:

https://www.england.nhs.uk/wp-content/uploads/2018/11/Hyperbaric-oxygen-therapy-services-all-ages-Service-specification-January-2025.pdf

https://www.england.nhs.uk/publication/methods-national-service-specifications/

https://www.england.nhs.uk/long-read/reviewing-hyperbaric-oxygen-services-consultation-guide/#:~:text=Background-,Background,Manual%20of%20Prescribed%20Specialised%20Services

The updates to the specification seek to ensure timely access to treatment for the most acutely unwell patients with the specification requiring:

- the delivery of care that is integrated with other services, including the emergency department, critical care, and other healthcare professionals as required; and

- facilities should be capable of receiving patients in any diagnostic category who may require advanced life support either immediately or during HBOT.

The geographical scope of the six services will ensure that there are no more than four hours travelling time by road from coastal locations, from the furthest borders, or between neighbouring commissioned HBOT centres, which is in line with good practice guidelines.

The Government is committed to delivering a National Health Service that is fit for the future, and this means we require world class infrastructure across the NHS estate. We recognise the challenges that areas of significant housing and population growth can place on primary care infrastructure.

Integrated care boards are responsible for commissioning, planning, securing, and monitoring health services within their system boundaries through delegated responsibility from NHS England. The NHS has a statutory duty to ensure there are sufficient medical services, including general practices, in each local area. It should take account of population growth and demographic changes associated with new retirement developments, alongside other housing growth.

Integrated care systems’ estates infrastructure strategies have been developed to create a long-term plan for future estate requirements and investment for each local area and its needs. These strategies help manage existing estates and take any future requirements into account when considering how best to deliver local services.

We are committed to transforming diagnostic services and will support the National Health Service to increase capacity to meet the demand for diagnostic services through investment in new capacity, including artificial intelligence (AI) where it is beneficial to do so.

AI can be used to accelerate the diagnosis and treatment of a number of diseases, including prostate cancer. This technology enables patients to be seen more quickly, which increases their likelihood of a successful outcome whilst simultaneously being more cost effective.

Through the AI in Health and Care Award, the Department has provided £113 million to test and evaluate AI technologies in crucial areas. Two of the tools funded by the AI award are Ibex Medical Analytics’ AI System and Paige Prostate Cancer Detection Tool. Both of these tools help with the early detection and grading of prostate cancer. Funding from the AI award helps to generate the evidence needed to deploy effective AI tools across the NHS and improve the lives and health outcomes of our population.

The National Institute for Health and Care Excellence (NICE) recommends that general practitioners (GPs) should offer an annual health check to all adults, children and young people with a learning disability. The Government expects integrated care boards (ICBs) and health professionals to have due regard to NICE guidelines when making commissioning decisions. NHS Operational Planning Guidance for 2025/26 requires ICBs to report on the number of people on the quality outcome framework learning disability register aged 14 years old and over who receive an annual health check during the quarter.

A consultation on the NHS Constitution, as part of a 10-year review, was launched by the previous administration in May 2024, and was superseded by the General Election in July 2024. The Government will launch a new consultation on the NHS Constitution, with the exact timings for this to be set out in due course.

The proposals that will be included within the upcoming consultation have been developed from a range of evidence, including feedback from the previous consultation, intelligence gathered as part of the 10-Year Health Plan engagement exercise, and the Government’s ambitions for the National Health Service.

The Department has worked with NHS England to produce various guidance for integrated care systems (ICSs) to plan and deliver eating disorder services, and to provide treatment for patients with longstanding eating disorders.

NHS England published guidance in 2019 for adult eating disorder services, to support delivery of community eating disorder services, reduce admissions, length-of-stay and improve outcomes for users, families and carers. A revised service specification for Adult Eating Disorder inpatient provision has just been through public consultation, and following a review of the comments received will progress to publication in 2025.

NHS England is currently producing new national guidance for eating disorders in children and young people, to update and replace the previous commissioning guidance for the Access and Waiting Time Standard for Children and Young People with an Eating Disorder.

NHS England also worked with the Royal College of Psychiatrists to produce guidance on managing medical emergencies in eating disorders amongst young people and adults.

ICSs also have access to National Institute for Health and Care Excellence (NICE) guidelines which sets out best practice for commissioners and providers for identifying and treating eating disorders.

In addition to this guidance, all ICSs have received support via fair shares funding since April 2021 to transform their adult community mental health services. This includes the transformation and expansion of eating disorder services. For children and young people, additional long term plan funding was made available for systems, rising to £54 million from 2023/24 and with further funding in 2024/25 to support increasing capacity in community eating disorder services.

The Department has worked with NHS England to produce various guidance for integrated care systems (ICSs) to plan and deliver eating disorder services, and to provide treatment for patients with longstanding eating disorders.

NHS England published guidance in 2019 for adult eating disorder services, to support delivery of community eating disorder services, reduce admissions, length-of-stay and improve outcomes for users, families and carers. A revised service specification for Adult Eating Disorder inpatient provision has just been through public consultation, and following a review of the comments received will progress to publication in 2025.

NHS England is currently producing new national guidance for eating disorders in children and young people, to update and replace the previous commissioning guidance for the Access and Waiting Time Standard for Children and Young People with an Eating Disorder.

NHS England also worked with the Royal College of Psychiatrists to produce guidance on managing medical emergencies in eating disorders amongst young people and adults.

ICSs also have access to National Institute for Health and Care Excellence (NICE) guidelines which sets out best practice for commissioners and providers for identifying and treating eating disorders.

In addition to this guidance, all ICSs have received support via fair shares funding since April 2021 to transform their adult community mental health services. This includes the transformation and expansion of eating disorder services. For children and young people, additional long term plan funding was made available for systems, rising to £54 million from 2023/24 and with further funding in 2024/25 to support increasing capacity in community eating disorder services.

The Government is committed to putting patients first. This means making sure that patients are seen on time and ensuring that people have the best possible experience during their care.

We also recognise that care, including phlebotomy, should be more easily accessible, and located in the community where possible, which is more convenient for patients than going to hospital.

The Elective Reform Plan, published in January 2025, sets out the productivity and reform efforts needed to return to the 18-week constitutional standard by the end of this parliament. The plan commits to transform and expand diagnostic services and speed up waiting times for tests, a crucial part of reducing overall waiting times and returning to the RTT 18-week standard.

Community diagnostic centres (CDCs) are supporting one of the Government’s top priorities for health, to shift care from the hospital to the community. CDCs offer local populations a wide range of diagnostic tests, including phlebotomy, closer to home and greater choice on where and how they are undertaken whilst also reducing pressure on hospitals. Latest management information data shows that CDCs have delivered over 3.7 million phlebotomy tests since July 2021.

Healthcare services provided by general practice, including phlebotomy are commissioned locally by integrated care boards based on population need.

The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for ensuring medicines, medical devices, and blood components for transfusion meet applicable standards of safety, quality, and efficacy. The MHRA rigorously assesses available data, including from the Yellow Card scheme, and seeks advice from their independent advisory committee, the Commission on Human Medicines, where appropriate, to inform regulatory decisions.

It is important to note that a reaction reported to the Yellow Card scheme does not necessarily mean it has been caused by the medicine, only that the reporter had a suspicion it may have. Underlying or concurrent illnesses may be responsible, or the events could be coincidental.

The following table shows the number of Yellow Card reports classified as serious, excluding fatal outcomes, and those with a fatal outcome, received for mifepristone from the initial licensing of the medicine, up to 13 May 2025:

Reports received via the Yellow Card scheme can contain more than one suspect medicine. It should be noted that mifepristone is used in combination with misoprostol, and as such 60 of the serious reports and five reports with a fatal outcome include both products as the suspect drug.

Misoprostol is licenced for a variety of indications, including gastroprotection in duodenal and gastric ulcers, termination of pregnancy, and induction of labour. Mifepristone is licenced for termination of pregnancy and induction of labour.

A list of the possible side effects of mifepristone and misoprostol are provided in the product information document for healthcare professionals, the Summary of Product Characteristics, and in the UK Patient Information Leaflet.

A Yellow Card report is considered serious according to two criteria. Firstly, a reported reaction can be considered serious according to our medical dictionary. Secondly, if the original reporter considers the report to be serious, they can select from the six serious criteria available, which are: patient died due to reaction; life threatening; resulted in hospitalisation or prolonged inpatient hospitalisation; congenital abnormality; involved persistent or significant disability or incapacity; or if the reaction was deemed medically significant.

The Government is committed to making the National Health Service the best place to work, to ensure the retention of our hardworking and dedicated staff, including physiotherapists.

NHS England is leading work nationally through its retention programme to drive a consistent, system-wide approach to staff retention across NHS trusts. This ensures trusts have access to proven retention strategies, data-driven monitoring, and can foster a more stable, engaged, productive, and supported workforce.

The Department does not hold information on the number of full time equivalent multiple Sclerosis (MS) nurses employed in the National Health Service in England.

The Nursing and Midwifery Council (NMC) sets the standards for nurse education. There is no NMC requirement for specific post-graduate education for nurses working with those with MS; however, the education and practice learning that prepares nurses to join the register covers learning outcomes to support good care.

Local employers will plan the specialist nurse workforce they require to meet population needs. The NHS funds several post registration education programmes that supports the development of the knowledge and skills required in practice. Each nurse working in the NHS also has access to a continuing professional development budget of £1,000 over three years to enable them to develop their knowledge and skills.

The Medicines and Healthcare products Regulatory Agency (MHRA) is taking proactive steps to inform the public on the very latest safety issues relating to sodium valproate in pregnancy. The MHRA has, most recently in May 2025, approved updated safety and educational materials to support the implementation of the pregnancy prevention programme and the regulatory measures announced in the November 2023 National Patient Safety Alert, as well as the September 2024 Drug Safety Update. We would welcome the Hon. Member to write to the Department, where we can provide due consideration to any points raised.

The Medicines and Healthcare products Regulatory Agency (MHRA) is a member of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH), which uses internationally standardised guidelines and principles in its assessment and approval of medicinal products.

Teratogenicity is a complex issue which requires an overlapping approach, encompassing preclinical risk evaluation and assessment, close monitoring during clinical trials, and post-authorisation surveillance measures.

The preclinical assessment of teratogenicity is conducted in accordance with ICH S5(R3) Guidelines on the detection of reproductive and developmental toxicity for human pharmaceuticals. The guideline recommends the evaluation of potential teratogenicity in two animal species, typically rodent and non-rodent. The drugs are administered to pregnant females, and teratogenic effects are examined in the offspring. While there is some flexibility, these studies are mandatory. Whole embryo culture systems and other in vitro methods may be used for rapid screening.

Regarding potential reproductive toxicity, which covers teratogenicity, for participants in clinical trials, it is required that a preclinical evaluation of the male and female reproductive organs is conducted, assessed, and confirmed as acceptably safe prior to the inclusion of fertile human participants into early phase clinical trials. Furthermore, appropriate precautions and safety monitoring during the exposure of such participants minimises the risk of unintentional exposure to an embryo or foetus.

Any detected signals or predicted risks of teratogenicity are outlined in the labelling requirements, which may emphasize contraception mandates during the clinical trials and following marketing authorisation approval.

A system of safety reporting and reviews by sponsors and the MHRA is in place to ensure that any safety information relating to concerns that emerge from a clinical trial or following marketing authorisation is addressed in the interests of patient safety.

The information is not held in the format requested. HC2 certificates are generic and do not have categories such as student or asylum seeker attributed to them. The NHS Business Services Authority does not collect information on what category a patient using the HC2 belongs to for any of the National Health Service charges covered by the scheme. Therefore, it is not possible to calculate the cost to the public purse in terms of lost NHS charge revenue.

In making its recommendations on new medicines, the National Institute for Health and Care Excellence (NICE) takes into account all health-related costs and benefits, including health benefits to carers. It does not, however, take into account wider societal or economic considerations. Taking a wider perspective could have unintended consequences such as reducing access to treatments for patients who are disproportionately older, economically inactive, or have greater care needs. NICE’s methods are set out in its published health technology evaluations manual, which is available at the following link:

https://www.nice.org.uk/process/pmg36

When presenting health effects for carers, evidence should show when the condition is associated with a substantial effect on a carer’s health-related quality of life, and how the technology affects carers. This applies for all therapies, including therapies for rare diseases. NICE appraisals specifically consider health-related quality of life, for both patients and carers, rather than quality of life as a whole.

In making its recommendations on new medicines, the National Institute for Health and Care Excellence (NICE) takes into account all health-related costs and benefits, including health benefits to carers. It does not, however, take into account wider societal or economic considerations. Taking a wider perspective could have unintended consequences such as reducing access to treatments for patients who are disproportionately older, economically inactive, or have greater care needs. NICE’s methods are set out in its published health technology evaluations manual, which is available at the following link:

https://www.nice.org.uk/process/pmg36

When presenting health effects for carers, evidence should show when the condition is associated with a substantial effect on a carer’s health-related quality of life, and how the technology affects carers. This applies for all therapies, including therapies for rare diseases. NICE appraisals specifically consider health-related quality of life, for both patients and carers, rather than quality of life as a whole.

The Government has set a bold ambition to raise the healthiest generation of children ever, and will take action to address the childhood obesity crisis. As part of this, we are committed to implementing the advertising restrictions for less healthy food and drink on television and online.

The Government appointed Ofcom as the statutory regulator for the advertising restrictions and this was set out in primary legislation via the Health and Care Act 2022. Ofcom appointed the Advertising Standards Authority as the frontline regulator of the advertising restrictions, using powers in the Communications Act 2003. It consulted on this appointment and published the statement, Regulation of advertising for less healthy food and drink: Implementation of new statutory restrictions, following the consultation in July 2023.

The Department of Health and Social Care has indicated that it will not be possible to answer this question within the usual time period. An answer is being prepared and will be provided as soon as it is available.

The Department of Health and Social Care has indicated that it will not be possible to answer this question within the usual time period. An answer is being prepared and will be provided as soon as it is available.

The Department of Health and Social Care has indicated that it will not be possible to answer this question within the usual time period. An answer is being prepared and will be provided as soon as it is available.