Question to the HM Treasury:

To ask His Majesty's Government how many (1) calls, and (2) online submissions, have been made to HMRC fraud hotline services in relation to illicit tobacco in each of the past ten years.

Answered by Lord Livermore - Financial Secretary (HM Treasury)

The table below shows the number of contacts received by HMRC’s Fraud Reporting Gateway in relation to illicit tobacco. The data is only available for the last 7 years due to HMRC’s retention policies.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of the potential cost savings to the NHS and social care system of implementing automatic stop smoking support at NHS touchpoints; and how will that inform future funding decisions.

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

Whilst no specific assessment has been made of the potential cost savings from stop smoking support in all National Health Services, we know that supporting more people to stop smoking reduces preventable illness and therefore pressure on health and social care services.

An evaluation of a pilot opt-out model in Manchester showed the gross financial return was £2.12, and the public value return was £30.49, per £1 invested. NHS England has also made a tool that estimates the potential cost savings associated with the reduced demand on front line services available for maternity services.

As of the end of 2024/25, 93% of NHS in-patient services and 97% of maternity services had a tobacco dependence treatment offer.

As set out in the 10-Year Health Plan, we remain committed to ensuring that all hospitals integrate smoking cessation interventions into routine care. As part of their allocations for 2025/26, integrated care boards have access to funding to support the provision of tobacco dependency treatment for smokers. Funding for future years is subject to final decisions following the recent Spending Review.

Question to the Department of Health and Social Care:

To ask His Majesty's Government whether the national cancer plan will include steps to integrate exercise, nutrition and well-being support into prehabilitation and rehabilitation programmes for all cancer patients, as recommended in The White Rose Cancer Report, published by Yorkshire Cancer Research on 18 June; and what plans they have to adopt the ROSE model to ensure equity in research funding and implementation across the country.

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

The Government and the National Health Service recognise the importance of physical activity for the prevention and management of long-term health conditions, including cancer.

The National Cancer Plan, due to be published later this year, will set out how experiences and outcomes can be improved for people at every stage of the cancer pathway, including prehabilitation and rehabilitation. The Department acknowledges that more can be done to support people living with and beyond cancer.

The NHS Cancer Programme, through local Cancer Alliances, is working to ensure physical activity is fully integrated across the whole cancer pathway, which includes opportunities within rehabilitation for people who have undergone treatment.

NHS England has highlighted the positive impact of efficient prehabilitation and rehabilitation on cancer outcomes and the potential to lead to cost savings. The ‘PRosPer’ Cancer Prehabilitation and Rehabilitation learning programme, launched in partnership between NHS England and Macmillan Cancer support, aims to support allied health professionals and the wider healthcare workforce in developing their skills in providing personalised care, prehabilitation, and rehabilitation in the cancer pathway.

The Department is committed to ensuring that all patients have access to cutting-edge clinical trials and innovative, lifesaving treatments, and to supporting equity of research funding and implementation cross the country.

The Department funded National Institute for Health and Care Research (NIHR) supports the principles outlined in the ROSE model, by funding research and research infrastructure, which supports patients and the public to participate in high-quality research.

The NIHR has made research inclusion a condition of its funding. Applicants to domestic research programmes are required to demonstrate how inclusion is being built into all stages of the research lifecycle and are also required to provide details of how their research contributes towards the NIHR’s mission to reduce health and care inequalities.

The NIHR’s Applied Research Collaborations are regional partnerships which generate high-quality research and evaluation, and work with the system to support the scaling and adoption of effective interventions and models of care nationally, particularly in areas of high disease burden and service demand.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what steps they are taking to reduce the number of people diagnosed with cancer in an emergency care setting in (1) Yorkshire, and (2) other regions of the country.

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

It is a priority for the Government to support the National Health Service to diagnose cancer as early and quickly as possible and to treat it faster, to improve outcomes. This will help cancer patients across England, including in Yorkshire.

We are improving public awareness of cancer signs and symptoms, streamlining referral routes, and increasing the availability of diagnostic capacity through the roll-out of more community diagnostic centres. We are also investing an additional £889 million in general practices (GPs) to reinforce the front door of the National Health Service, bringing total spend on the GP Contract to £13.2 billion in 2025/26. This is the biggest increase in over a decade.

Alongside improving cancer waiting time performance, the NHS has implemented non-specific symptom pathways for patients who present with vague and non-site-specific symptoms, which do not clearly align to a tumour type. To support the use of rapid diagnostic centres, non-specific symptom (NSS) pathways have been rolled out across England for patients who present with vague symptoms which could indicate multiple different types of cancer, for example unexplained weight-loss and fatigue.

The Government has announced that the National Cancer Plan will be published later this year, following the recent publication of the 10-Year Health Plan. The National Cancer Plan will ensure that cancer patients in England, including in Yorkshire, will have access to the best cancer care and treatments. It will have patients at its heart and will cover the entirety of the cancer pathway, from referral and diagnosis to treatment and ongoing care.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of adopting reimbursed access at the point of marking authorisation for medicines; and what assessment they have made of the impact of cost-effectiveness appraisals after real world use on the consideration of potential long-term clinical and patient benefits.

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

The Government wants National Health Service patients in England to be able to benefit from rapid access to effective new medicines. The National Institute for Health and Care Excellence (NICE) evaluates all new licensed medicines and makes recommendations for the NHS on whether they should be routinely funded based on the evidence of clinical and cost effectiveness. NICE aims, wherever possible, to issue its recommendations close to the time of marketing authorisation to ensure that there is no gap between licensing and patient access to NICE recommended medicines. The 10-Year Health Plan and Life Science Sector Plan outline our commitments to speeding up access for NHS patients to new medicines through the introduction of a parallel marketing authorisation and NICE process.

NHS patients are able to benefit from access to promising new medicines through the Cancer Drugs Fund and Innovative Medicines Fund while further real-world evidence is collected on their use to inform a final NICE decision on whether they can be recommended for routine NHS funding.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of the effectiveness of the National Institute for Health and Care Excellence's (NICE) evaluation processes at reflecting the pace of innovation in medical technologies, in particular for chronic conditions such as type 1 and 2 diabetes; and what assessment they have made of increasing NICE's cost-effectiveness threshold in line with the voluntary scheme growth rates since 2014.

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

With the pace of innovation increasing, it is crucial now more than ever that the National Institute for Health and Care Excellence (NICE) is focused on the highest impact technologies.

The Rules-Based Pathway (RBP), recently announced in the 10-Year Health Plan and Life Sciences Sector Plan, will, for the first time, create a national pathway that guarantees funding for several rigorously selected transformative technologies each year, streamlining the route to adoption in the National Health Service for selected devices, diagnostics, and digital tools. This will give NICE a powerful lever to drive healthcare transformation and help to position the United Kingdom as a first-to-market location for cutting-edge technology.

NICE assessments have been carried out on diabetes technologies, including: insulin pumps; continuous glucose monitors; and most recently, hybrid closed loop systems. Diabetes technologies listed on Part IX of the NHS Drug Tariff are also subject to more frequent review.

The 2024 voluntary scheme for branded medicines pricing, access, and growth, which is an agreement between the Department, NHS England, and the Association of the British Pharmaceutical Industry, states that the standard NICE cost-effectiveness threshold will not change for the duration of the scheme, which ends in December 2028.

Under the current arrangements, NICE is able to recommend the majority of medicines it appraises for use on the NHS, with an approval rate of 84%.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of the progress of the National Institute for Health and Care Excellence towards their priorities for 2025–26, including diabetes, and the impact of those priorities on patient access to novel technologies and treatments.

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

The National Institute for Health and Care Excellence (NICE) will shortly be publishing its business plan, which will set out its priorities for 2025/26, following approval by the NICE Board. NICE’s priorities will include delivery of commitments outlined in the 10-Year Health Plan. These include:

- the adoption of a dynamic approach to appraisals that identifies where existing innovation should be retired and where technologies should be sequenced within the clinical pathway, to improve value and health outcomes;

- expanding NICE’s technology appraisal process to cover devices, diagnostics, and digital products, supported by the introduction of a rules-based pathway for HealthTech, to reduce variation in access to high-impact medical technologies; and

- alignment of NICE and the Medicines and Healthcare products Regulatory Agency processes, supported by information sharing and joint scientific advice, to speed up decision making and reduce the administrative burden for the system and industry, allowing new and innovative technologies to get to patients faster.

Question to the Department of Health and Social Care:

To ask His Majesty's Government whether long-term clinical benefits and broader impacts, such as economic activity and emotional wellbeing, of medical innovations are routinely considered by the National Institute for Health and Care Excellence; and what assessment they have made of incorporating consideration of those impacts into evolving cost-effectiveness technologies.

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

The National Institute for Health and Care Excellence (NICE) develops its guidance independently and on the basis of an assessment of the available evidence, taking into account all health-related costs and benefits for patients and caregivers, including health outcomes, in line with its established methods and processes.

NICE does not take account of economic productivity in its assessments. It would involve valuing interventions differently based on the working status of the recipient population, which would be methodologically and ethically challenging and could systematically disadvantage certain groups including children, long-term sick and unemployed people, and could result in fewer treatments being recommended for these populations.

Question to the Department of Health and Social Care:

To ask His Majesty's Government how they are working with NHS England to ensure equitable access to diabetes innovations, particularly for patients from disadvantaged and ethnic minority backgrounds.

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

NHS England is working at a national level on behalf of the Department as part of a wider equality monitoring review programme. This review is exploring how best to update equality monitoring arrangements, including ethnicity categories, by reference to the protected characteristics outlined in the Equality Act 2010.

The National Diabetes Audit (NDA) is a major national clinical audit, which measures the effectiveness of diabetes healthcare against National Institute for Health and Care Excellence (NICE) clinical guidelines and NICE quality standards, in England and Wales. This includes NICE’s guidance on diabetes innovations like continuous glucose monitors and hybrid closed loop systems. The NDA is delivered by NHS England, in partnership with Diabetes UK.

The NDA consistently reveals inequalities in diabetes care and outcomes across different socioeconomic and demographic groups. People living in more deprived areas, younger individuals, and some ethnic minorities experience poorer access to care processes and treatment targets compared to their counterparts in less deprived areas and among older individuals.

Question to the Department of Health and Social Care:

To ask His Majesty's Government, in regard to the NHS 10 Year Health Plan for England, what assessment they have made of opportunities to identify genetic risk for diabetes, and what plans they have to implement that genetic testing as part of the shift to diabetes prevention.

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

The National Health Service, in partnership with Our Future Health, will trial the use of Integrated Risk Scores, which combine genomic data with lifestyle and other non-biological risk factors, within neighbourhood health services. This partnership will generate important evidence to inform whether, and how, integrated risk scores could be used more widely in the NHS. The partnership will initially focus on cardiovascular disease but is set to expand to include diabetes, breast cancer, glaucoma, and osteoporosis. This work represents a significant step towards embedding genetic testing into routine preventive care, enabling earlier identification of individuals at higher genetic risk and personalised healthcare based on risk. This approach directly supports the ambitions set out in the 10-Year Health Plan for England, which commits to shifting the NHS from a reactive model to one that is predictive and preventive, using genomics and data-driven tools to tackle major conditions like diabetes earlier and more effectively.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what discussions they have held with social media companies on the moderation of pro-eating disorder material and misinformation relating to diabetes and body image.

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

Under the Government’s Online Safety Act, all in-scope services are now required to protect their users from illegal content, and platforms likely to be accessed by children need to prevent their users from accessing eating disorder content.

No discussions have been held with social media companies. However, we are working closely with the Department for Science, Innovation and Technology, Ofcom and others as the Online Safety Act takes effect. This includes exploring further opportunities to address harmful pro-eating disorder material and misinformation shared on social media and websites.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of the Yorkshire Cancer Research’s ROSE model for research funding; and whether this model will be included the National Cancer Plan.

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

The National Cancer Plan will seek to ensure equitable access to the benefits of health research, as set out by Yorkshire Cancer Research’s ROSE model. The Department invests in research through its research delivery arm, the National Institute for Health and Care Research (NIHR). NIHR welcomes funding applications for research into any aspect of human health and care including cancer. These applications are subject to peer review and judged in open competition, with awards being made based on the importance of the topic to patients and health and care services, value for money and scientific quality.

Welcoming applications on cancer to all NIHR programmes enables maximum flexibility both in terms of amount of research funding a particular area can be awarded, and the type of research which can be funded. In line with prior commitments, the Department has increased funding for NIHR research infrastructure schemes delivering cancer research outside the Greater South East, including biomedical research centres, clinical research facilities, and HealthTech research centres.

Question to the Department of Health and Social Care:

To ask His Majesty's Government whether they will require integrated care boards to provide sustainable funding for successful pilot projects on type 1 diabetes and eating disorders to enable them to become regional centres of excellence.

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

NHS England has provided up to £1.5 million a year for the five current Type 1 Disordered Eating pilots for three years. This funding is transferred to integrated care boards on an annual basis and in 2025/26 has been ringfenced.

Decisions on funding for future years have yet to be taken.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what steps they are taking to raise awareness of type 1 diabetes and eating disorders (T1DE) among healthcare professionals in diabetes and eating disorder services; and whether they plan to establish a national framework for preventing T1DE, including risk screening tools for use in clinical practice.

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

NHS England is currently funding five Type 1 Disordered Eating (T1DE) Pilots, with the aim of increasing understanding of the characteristics and care needs of people with T1DE, assessing the feasibility of the service delivery model and build the evidence base for an integrated diabetes and mental health pathway.

Pilot sites are delivering a national high level service specification alongside testing local novel approaches to improving care including to awareness raising of the condition amongst both diabetes and eating disorder health care professionals.

A national evaluation is currently underway to assess the impact of the five current pilot services. NHS England will review the evaluation findings to understand further opportunities to promote awareness of Type 1 disordered eating amongst healthcare professionals.

NHS England works alongside its partners to support the delivery of key messages around diabetes education and awareness. This includes through a digital diabetes platform which is developing educational resources for T1DE.

No assessment has been made of the merits of creating a national framework.

Question to the Department of Health and Social Care:

To ask His Majesty's Government whether they will support the creation of an international symposium of experts on type 1 diabetes and eating disorders to share best practice and guidance on diagnosis and treatment.

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

No assessment has been made of the merits of creating an international symposium of experts on type 1 diabetes and eating disorders. NHS England is currently funding five Type 1 Disordered Eating (T1DE) pilots, with the aim of increasing understanding of the characteristics and care needs of people with T1DE, assessing the feasibility of the service delivery model and build the evidence base for an integrated diabetes and mental health pathway.

A national evaluation is currently underway to assess the impact of the five current pilot services. NHS England will review the evaluation findings to understand further opportunities to promote awareness of T1DE amongst healthcare professionals.

Question to the Department of Health and Social Care:

To ask His Majesty's Government whether they will work with diabetes and eating disorder charities to support national campaigns aimed at reducing stigmatisation of type 1 diabetes and eating disorders (T1DE) in the media, drawing on NHS England's Language Matters guidance.

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

The national diabetes programme works closely with charity partners including Diabetes UK who take a multi-pronged approach to reducing stigma experienced by those with all types of diabetes. This includes raising awareness of the complex and serious nature of type 1 diabetes, including type 1 disordered eating (T1DE), providing support to those that experience stigma, and supporting research into stigma and how it can be reduced or prevented.

NHS England is partnering with the National Institute for Health and Care Research to deliver a qualitative evaluation of the five current T1DE pilot sites. A core element of this approach has been engagement with service users to understand their experiences of having the condition, both before and during their involvement with the T1DE service.

The National Diabetes Experience Survey led by NHS England is a further mechanism for understanding the experiences of those living with type 1 diabetes including T1DE to inform national and local approaches to improvement.

In response to feedback on the experiences of people of all ages who live with diabetes, NHS England published the document, Language Matters: language and diabetes, a guide for health care professionals which sets out the good practice principles for interactions with people living with diabetes including around reducing stigma. The guide is available on the NHS website in an online-only format.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what steps they are taking to improve training for healthcare practitioners in recognising and managing type 1 diabetes and eating disorders, including provision for GPs.

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

The standard of training for healthcare professionals is the responsibility of the independent professional regulators, who set the outcome standards expected at undergraduate level, and who approve the courses and curricula that universities write and teach in order to enable their students to meet these outcome standards.

The curricula for postgraduate medical specialty training are set by individual royal colleges and faculties. For general practice, it is set by the Royal College of General Practitioners. The General Medical Council approves the curricula and assessment systems for each training programme.

Whilst not all curricula may necessarily highlight a specific condition, they all emphasise the skills and approaches a healthcare practitioner must develop in order to ensure accurate and timely diagnoses and treatment plans for their patients, including for type 1 diabetes with disordered eating.

Employers in the health system are responsible for ensuring that their staff are trained to the required standards to deliver appropriate treatment for patients.

Question to the Department of Health and Social Care:

To ask His Majesty's Government whether the NHS Long Term Workforce Plan will include measures to recruit, train and retain mental health professionals with specialism in type 1 diabetes and eating disorders.

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

The 10 Year Workforce Plan will ensure that the National Health Service has the right people in the right places, with the right skills to care for patients, when they need it. To support this, the Department and NHS England will be engaging with key stakeholders to ensure that the particular needs of different patient groups and relevant health professionals are reflected in this work.