Question to the Department of Health and Social Care:

To ask His Majesty's Government what estimate they have made of the impact of the lack of accessibility of the Enhertu drug for HER2-low metastatic breast cancer in England upon the objective of becoming one of the top three fastest places in Europe for patient access to medicines by 2030.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

HER2‑low breast cancer is managed with treatments for HER2‑negative breast cancer. The National Institute for Health and Care Excellence (NICE) has published guidance recommending a number of medicines for the treatment of HER2-negative breast cancer which are now available for the treatment of National Health Service patients in line with NICE’s guidance.

Trastuzumab deruxtecan (Enhertu) is the first licensed treatment for HER2‑low metastatic or unresectable breast cancer. The Government recognises how disappointing it was for all those affected that NICE was unable to recommend Enhertu for use in the treatment of HER2-low metastatic or unresectable breast cancer. This was because, at the price offered by the company in 2024, the treatment was too expensive for the benefits it provided, and NICE concluded it was not cost effective. Despite NICE and NHS England offering unprecedented flexibilities, the companies were unable to offer Enhertu at a cost-effective price. It is estimated that approximately 1,000 to 1,500 people would have been eligible for treatment with Enhertu for HER2-low metastatic or unresectable breast cancer after chemotherapy, had NICE been able to recommend it.

As part of the United States and United Kingdom partnership, announced in April 2026, NICE is now using a new higher cost-effectiveness threshold. The update to the NICE cost effectiveness threshold has already made a direct difference for NHS patients with several treatments, including treatments for cancer, that may not have been recommended under the previous threshold. Given these new circumstances, discussions involving NICE, the manufacturers, and NHS England have resumed to try to seek an agreement on a commercial offer that would make Enhertu cost-effective.

The Department has made no assessment on the of the impact of the lack of accessibility of the Enhertu drug for HER2-low metastatic breast cancer in England upon the objective of becoming one of the top three fastest places in Europe for patient access to medicines by 2030.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what estimate they have made of the number of patients who would have otherwise benefited from the HER2-low metastatic breast cancer drug Enhertu since it was rejected for use on the NHS in England in 2024.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

HER2‑low breast cancer is managed with treatments for HER2‑negative breast cancer. The National Institute for Health and Care Excellence (NICE) has published guidance recommending a number of medicines for the treatment of HER2-negative breast cancer which are now available for the treatment of National Health Service patients in line with NICE’s guidance.

Trastuzumab deruxtecan (Enhertu) is the first licensed treatment for HER2‑low metastatic or unresectable breast cancer. The Government recognises how disappointing it was for all those affected that NICE was unable to recommend Enhertu for use in the treatment of HER2-low metastatic or unresectable breast cancer. This was because, at the price offered by the company in 2024, the treatment was too expensive for the benefits it provided, and NICE concluded it was not cost effective. Despite NICE and NHS England offering unprecedented flexibilities, the companies were unable to offer Enhertu at a cost-effective price. It is estimated that approximately 1,000 to 1,500 people would have been eligible for treatment with Enhertu for HER2-low metastatic or unresectable breast cancer after chemotherapy, had NICE been able to recommend it.

As part of the United States and United Kingdom partnership, announced in April 2026, NICE is now using a new higher cost-effectiveness threshold. The update to the NICE cost effectiveness threshold has already made a direct difference for NHS patients with several treatments, including treatments for cancer, that may not have been recommended under the previous threshold. Given these new circumstances, discussions involving NICE, the manufacturers, and NHS England have resumed to try to seek an agreement on a commercial offer that would make Enhertu cost-effective.

The Department has made no assessment on the of the impact of the lack of accessibility of the Enhertu drug for HER2-low metastatic breast cancer in England upon the objective of becoming one of the top three fastest places in Europe for patient access to medicines by 2030.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of the impact of the decision not to approve the use of Enhertu on the NHS for patients in England affected by HER2-low metastatic breast cancer.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

HER2‑low breast cancer is managed with treatments for HER2‑negative breast cancer. The National Institute for Health and Care Excellence (NICE) has published guidance recommending a number of medicines for the treatment of HER2-negative breast cancer which are now available for the treatment of National Health Service patients in line with NICE’s guidance.

Trastuzumab deruxtecan (Enhertu) is the first licensed treatment for HER2‑low metastatic or unresectable breast cancer. The Government recognises how disappointing it was for all those affected that NICE was unable to recommend Enhertu for use in the treatment of HER2-low metastatic or unresectable breast cancer. This was because, at the price offered by the company in 2024, the treatment was too expensive for the benefits it provided, and NICE concluded it was not cost effective. Despite NICE and NHS England offering unprecedented flexibilities, the companies were unable to offer Enhertu at a cost-effective price. It is estimated that approximately 1,000 to 1,500 people would have been eligible for treatment with Enhertu for HER2-low metastatic or unresectable breast cancer after chemotherapy, had NICE been able to recommend it.

As part of the United States and United Kingdom partnership, announced in April 2026, NICE is now using a new higher cost-effectiveness threshold. The update to the NICE cost effectiveness threshold has already made a direct difference for NHS patients with several treatments, including treatments for cancer, that may not have been recommended under the previous threshold. Given these new circumstances, discussions involving NICE, the manufacturers, and NHS England have resumed to try to seek an agreement on a commercial offer that would make Enhertu cost-effective.

The Department has made no assessment on the of the impact of the lack of accessibility of the Enhertu drug for HER2-low metastatic breast cancer in England upon the objective of becoming one of the top three fastest places in Europe for patient access to medicines by 2030.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of the timeline for Enhertu medication for the treatment of patients with HER2-low metastatic breast cancer to be made available on the NHS.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

HER2‑low breast cancer is managed with treatments for HER2‑negative breast cancer. The National Institute for Health and Care Excellence (NICE) has published guidance recommending a number of medicines for the treatment of HER2-negative breast cancer which are now available for the treatment of National Health Service patients in line with NICE’s guidance.

Trastuzumab deruxtecan (Enhertu) is the first licensed treatment for HER2‑low metastatic or unresectable breast cancer. The Government recognises how disappointing it was for all those affected that NICE was unable to recommend Enhertu for use in the treatment of HER2-low metastatic or unresectable breast cancer. This was because, at the price offered by the company in 2024, the treatment was too expensive for the benefits it provided, and NICE concluded it was not cost effective. Despite NICE and NHS England offering unprecedented flexibilities, the companies were unable to offer Enhertu at a cost-effective price. It is estimated that approximately 1,000 to 1,500 people would have been eligible for treatment with Enhertu for HER2-low metastatic or unresectable breast cancer after chemotherapy, had NICE been able to recommend it.

As part of the United States and United Kingdom partnership, announced in April 2026, NICE is now using a new higher cost-effectiveness threshold. The update to the NICE cost effectiveness threshold has already made a direct difference for NHS patients with several treatments, including treatments for cancer, that may not have been recommended under the previous threshold. Given these new circumstances, discussions involving NICE, the manufacturers, and NHS England have resumed to try to seek an agreement on a commercial offer that would make Enhertu cost-effective.

The Department has made no assessment on the of the impact of the lack of accessibility of the Enhertu drug for HER2-low metastatic breast cancer in England upon the objective of becoming one of the top three fastest places in Europe for patient access to medicines by 2030.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of the medicines available to treat patients with HER2-low metastatic breast cancer.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

HER2‑low breast cancer is managed with treatments for HER2‑negative breast cancer. The National Institute for Health and Care Excellence (NICE) has published guidance recommending a number of medicines for the treatment of HER2-negative breast cancer which are now available for the treatment of National Health Service patients in line with NICE’s guidance.

Trastuzumab deruxtecan (Enhertu) is the first licensed treatment for HER2‑low metastatic or unresectable breast cancer. The Government recognises how disappointing it was for all those affected that NICE was unable to recommend Enhertu for use in the treatment of HER2-low metastatic or unresectable breast cancer. This was because, at the price offered by the company in 2024, the treatment was too expensive for the benefits it provided, and NICE concluded it was not cost effective. Despite NICE and NHS England offering unprecedented flexibilities, the companies were unable to offer Enhertu at a cost-effective price. It is estimated that approximately 1,000 to 1,500 people would have been eligible for treatment with Enhertu for HER2-low metastatic or unresectable breast cancer after chemotherapy, had NICE been able to recommend it.

As part of the United States and United Kingdom partnership, announced in April 2026, NICE is now using a new higher cost-effectiveness threshold. The update to the NICE cost effectiveness threshold has already made a direct difference for NHS patients with several treatments, including treatments for cancer, that may not have been recommended under the previous threshold. Given these new circumstances, discussions involving NICE, the manufacturers, and NHS England have resumed to try to seek an agreement on a commercial offer that would make Enhertu cost-effective.

The Department has made no assessment on the of the impact of the lack of accessibility of the Enhertu drug for HER2-low metastatic breast cancer in England upon the objective of becoming one of the top three fastest places in Europe for patient access to medicines by 2030.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of whether current Government funding arrangements adequately support resilience, redundancy and preparedness across healthcare supply chains, including the UK blood supply chain.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

The Government keeps the funding and wider arrangements that support the resilience and preparedness of health supply chains, including blood supplies, under review.

Through implementation of Value-Based Procurement (VBP), the Department and NHS England are prioritising resilience in future purchasing decisions. VBP enables consideration of a broader range of factors than upfront cost alone, including patient outcomes, workforce benefits, efficiency, and supply chain considerations.

Alongside this, the Government has committed up to £520 million through the Life Sciences Innovative Manufacturing Fund to support investment in the manufacture of medicines, medical diagnostics, and medical technologies in the United Kingdom. The fund is intended to strengthen domestic manufacturing capability and support wider private investment in UK life sciences manufacturing.

Specifically on blood stocks, NHS Blood and Transplant (NHSBT) is responsible for the blood service in England, working closely with the Department to review the criticality and resilience of blood services. NHSBT is taking forward a Blood Supply Chain and Conflict Preparedness Programme to strengthen resilience during routine operations and incidents, including mass casualty events, cyber-attacks, power outages, and conflict scenarios. The Joint Blood Stocks Working Group, jointly chaired by the Department and NHSBT, is also considering measures to support longer-term blood supply resilience. It is due to report in autumn 2026.

More broadly, the Government actively monitors emerging threats to supply resilience and has established shortage management procedures in place to help mitigate patient impact. These include buffer stocks, sourcing alternative products, and use of the Express Freight Service, a global logistics contingency to transport goods in a critical supply disruption.

Question to the Ministry of Defence:

To ask His Majesty's Government what assessment they have made of the resilience of the UK's blood supply to support military operations during a prolonged conflict or major national emergency.

Answered by Lord Coaker - Minister of State (Ministry of Defence)

Defence Medical Command (DMedC) has completed a detailed assessment of the requirement for blood to support military operations across a range of scenarios, including warfighting at scale. This work supports the ongoing strategic partnership with NHS Blood and Transplant (NHSBT) and the Department for Health and Social Care (DHSC) to assess and strengthen the resilience of the UK's blood supply in support of national defence planning. Further, the UK is leading work within NATO to improve how blood and blood products are collected, stored, and shared among NATO allies.

DMedC and NHSBT have signed a strategic partnership which will help innovate battlefield transfusion in an era of drone warfare. The joint research will drive research, improve urgent transfusion care in complex environments, and have dual use capability, which improve both military and civilian healthcare. This partnership underpins our commitment to providing the very best medical support to our people, wherever they serve.

The Defence Investment Plan has set out £20 million investment in battlefield blood products with £10 million for dried blood products, supporting the Blood Far Forward programme which enables life-saving blood transfusion care closer to the battlefield by reducing reliance on refrigeration, and £10 million for Tranexamic Acid (TXA) autoinjectors, which allows blood-clotting medication to be administered rapidly on the battlefield improving survival from severe blood loss.

Question to the Ministry of Defence:

To ask His Majesty's Government what joint work is being undertaken between the Ministry of Defence, the Department of Health and Social Care, and NHS bodies to assess and strengthen the resilience of the UK's blood supply in support of national defence planning.

Answered by Lord Coaker - Minister of State (Ministry of Defence)

Defence Medical Command (DMedC) has completed a detailed assessment of the requirement for blood to support military operations across a range of scenarios, including warfighting at scale. This work supports the ongoing strategic partnership with NHS Blood and Transplant (NHSBT) and the Department for Health and Social Care (DHSC) to assess and strengthen the resilience of the UK's blood supply in support of national defence planning. Further, the UK is leading work within NATO to improve how blood and blood products are collected, stored, and shared among NATO allies.

DMedC and NHSBT have signed a strategic partnership which will help innovate battlefield transfusion in an era of drone warfare. The joint research will drive research, improve urgent transfusion care in complex environments, and have dual use capability, which improve both military and civilian healthcare. This partnership underpins our commitment to providing the very best medical support to our people, wherever they serve.

The Defence Investment Plan has set out £20 million investment in battlefield blood products with £10 million for dried blood products, supporting the Blood Far Forward programme which enables life-saving blood transfusion care closer to the battlefield by reducing reliance on refrigeration, and £10 million for Tranexamic Acid (TXA) autoinjectors, which allows blood-clotting medication to be administered rapidly on the battlefield improving survival from severe blood loss.

Question to the Department for Environment, Food and Rural Affairs:

To ask His Majesty's Government what discussions they had with the devolved governments about missing the 1 July deadline to submit an action plan setting out their response to the Aarhus Convention Compliance Committee's recommendations.

Answered by Baroness Hayman of Ullock - Parliamentary Under-Secretary (Department for Environment, Food and Rural Affairs)

This Government is committed to the effective implementation of all of its international obligations, including those under the Aarhus Convention. The UK continues to carefully consider decisions taken by the Parties to the Convention concerning the UK.

Defra works closely with the devolved governments on issues relating to the Aarhus Convention.

The UK is not required to provide a plan of action to the Aarhus Convention Compliance Committee. As such, no deadline has been missed. We will continue to provide updates to the Committee on relevant developments. Updates from the UK are available on the UN website here.

Question to the Department for Environment, Food and Rural Affairs:

To ask His Majesty's Government what steps they intend to take to address the UK’s non-compliance with the Aarhus Convention.

Answered by Baroness Hayman of Ullock - Parliamentary Under-Secretary (Department for Environment, Food and Rural Affairs)

This Government is committed to the effective implementation of all of its international obligations, including those under the Aarhus Convention. The UK continues to carefully consider decisions taken by the Parties to the Convention concerning the UK.

Defra works closely with the devolved governments on issues relating to the Aarhus Convention.

The UK is not required to provide a plan of action to the Aarhus Convention Compliance Committee. As such, no deadline has been missed. We will continue to provide updates to the Committee on relevant developments. Updates from the UK are available on the UN website here.

Question to the Department of Health and Social Care:

To ask His Majesty's Government, further to the Written Answer by Baroness Merron on 8 October 2025 (HL10538), whether the NHS Supply Chain procurement exercises, including the Total Cardiology and Vascular Solutions Framework, are being developed in line with the draft Value Based Procurement Standard Guidance; and what assessment they have made of whether the evaluation criteria in that guidance include sufficient thresholds for non-price value criteria in particular (1) clinical outcomes, (2) patient quality of life, (3) innovation, (4) sustainability, and (5) whole system efficiencies.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

NHS Supply Chain has worked closely with the Department to support the implementation of its value based procurement (VBP) guidance. Within the Total Cardiology and Vascular Solutions Framework, the Department’s methodology has been piloted on a national procurement and integrated into the non-financial evaluation criteria, with appropriate adaptations made to reflect the specific clinical and operational requirements of the specialty. Value-based assessment criteria and associated non-financial questions have been included where supplier claims can be objectively assessed ensuring a fair, transparent, and equitable evaluation process.

Extensive pre-market engagement was undertaken between March 2025 and September 2025, providing suppliers, customers, clinical associations, and professional bodies with the opportunity to share insights, feedback, and observations on the proposed procurement strategy and overall approach. Communication has been conducted in forms such as team meetings, face to face meetings, and email exchanges with all stakeholders, including clinicians. Draft versions of the VBP questions were circulated during this period to support supplier readiness and to enable meaningful challenge and feedback in advance of tender publication. NHS Supply Chain clinical and category teams engaged extensively with key clinical stakeholder groups, including members of the British Heart Rhythm Society, members of the British Cardiovascular Intervention Society, and NHS England Device Working Groups, to inform the development and refinement of the VBP criteria. The final questions focus on areas where value can be clearly evidenced, including clinical outcomes, innovation, sustainability, social value, and whole-system costs and efficiencies.

While the NHS Supply Chain has successfully incorporated VBP principles into the cardiology and vascular framework evaluation, a key challenge remains the limited availability of standardised Patient Reported Outcome Measures, clinical registries, and other robust outcome datasets to enable consistent and comparable assessment of supplier value claims. Consequently, VBP evaluation has been focused on evidence that can be objectively assessed at the tender stage, with a clear commitment to further validate and measure value throughout the lifetime of the framework as more comprehensive clinical, operational, and patient outcome data becomes available. This approach balances fairness and transparency in procurement with the longer-term ambition of embedding a mature, evidence-based value assessment model across the specialty.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what steps they have taken to seek input from (1) patients, (2) clinicians, (3) medical societies, and (4) suppliers, in the development of the NHS Supply Chain Total Cardiology and Vascular Solutions Framework; and how that input has informed the weighting and clinical assessment of value-based procurement criteria.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

NHS Supply Chain has worked closely with the Department to support the implementation of its value based procurement (VBP) guidance. Within the Total Cardiology and Vascular Solutions Framework, the Department’s methodology has been piloted on a national procurement and integrated into the non-financial evaluation criteria, with appropriate adaptations made to reflect the specific clinical and operational requirements of the specialty. Value-based assessment criteria and associated non-financial questions have been included where supplier claims can be objectively assessed ensuring a fair, transparent, and equitable evaluation process.

Extensive pre-market engagement was undertaken between March 2025 and September 2025, providing suppliers, customers, clinical associations, and professional bodies with the opportunity to share insights, feedback, and observations on the proposed procurement strategy and overall approach. Communication has been conducted in forms such as team meetings, face to face meetings, and email exchanges with all stakeholders, including clinicians. Draft versions of the VBP questions were circulated during this period to support supplier readiness and to enable meaningful challenge and feedback in advance of tender publication. NHS Supply Chain clinical and category teams engaged extensively with key clinical stakeholder groups, including members of the British Heart Rhythm Society, members of the British Cardiovascular Intervention Society, and NHS England Device Working Groups, to inform the development and refinement of the VBP criteria. The final questions focus on areas where value can be clearly evidenced, including clinical outcomes, innovation, sustainability, social value, and whole-system costs and efficiencies.

While the NHS Supply Chain has successfully incorporated VBP principles into the cardiology and vascular framework evaluation, a key challenge remains the limited availability of standardised Patient Reported Outcome Measures, clinical registries, and other robust outcome datasets to enable consistent and comparable assessment of supplier value claims. Consequently, VBP evaluation has been focused on evidence that can be objectively assessed at the tender stage, with a clear commitment to further validate and measure value throughout the lifetime of the framework as more comprehensive clinical, operational, and patient outcome data becomes available. This approach balances fairness and transparency in procurement with the longer-term ambition of embedding a mature, evidence-based value assessment model across the specialty.

Question to the Department for Environment, Food and Rural Affairs:

To ask His Majesty's Government what progress they have made in changing existing policies to deliver a complete ban on the use of certain neonicotinoid pesticides.

Answered by Baroness Hayman of Ullock - Parliamentary Under-Secretary (Department for Environment, Food and Rural Affairs)

This Government is committed to preventing the use of three neonicotinoid pesticides that threaten vital pollinators.

This Government has already taken decisive action. In December 2024, Defra set out plans to change policies to prevent use of neonicotinoid pesticides (thiamethoxam, clothianidin, imidacloprid) that threaten vital pollinators. In September 2025, the Health and Safety Executive published updated guidance for emergency authorisations of pesticides.

Question to the Department for Environment, Food and Rural Affairs:

To ask His Majesty's Government what discussions they have had with the devolved governments about introducing legislation to enshrine a legal right to a clean, healthy and sustainable environment.

Answered by Baroness Hayman of Ullock - Parliamentary Under-Secretary (Department for Environment, Food and Rural Affairs)

There is no international consensus on the legal basis of the human right to a clean, healthy and sustainable environment, and no agreement on either the definition of the right or its scope. The UK supported United Nations General Assembly Resolution 76/300 on the right to a clean, healthy and sustainable environment, accompanied by an explanation of vote which referred to this lack of consensus. This Government has no current plans to introduce legislation on the right but is monitoring discussions exploring a new instrument at the international level to enshrine the right, including at the Council of Europe. Officials have previously raised this with the Devolved Governments and will consult with them ahead of any formal international negotiations.

Found: Foster of Aghadrumsee Baroness Goudie Lord Hain Baroness Ludford Baroness O’Loan Baroness Ritchie of Downpatrick

Found: Baroness Foster of Aghadrumsee; Baroness Goudie; Baroness Ludford; Baroness O’Loan; Baroness Ritchie of Downpatrick

Found: Baroness Hodgson of Abinger Baroness Neuberger Baroness Nye Lord Randall of Uxbridge Baroness Ritchie of Downpatrick

Found: Foster of Aghadrumsee; Baroness Goudie; Lord Hain; Baroness Ludford; Baroness O’Loan; Baroness Ritchie of Downpatrick

Found: Baroness Hodgson of Abinger; Baroness Neuberger; Baroness Nye; Lord Randall of Uxbridge; Baroness Ritchie of Downpatrick