Department of Health and Social Care

The Department recognises that a particular treatment may not be available at local hospitals, which would mean that travel to a specialist centre would be required, in order to receive the best possible care. The Department also knows that the cost of travel is an important issue for patients, including their unpaid carers.

NHS England and the integrated care boards are responsible for commissioning and ensuring the healthcare needs of local communities in England are met.

The Department has not made a formal assessment of the potential impact of the time taken to access specialist cancer treatments on patient outcomes and long-term National Health Service costs, the potential impact of prolonged or distant cancer treatment on the personal finances of patients and unpaid carers, and the potential impact of travel distance and associated costs on access to specialist cancer treatment. In addition, the Department has not made a formal estimate of the long-term cost to the NHS of delayed and disrupted access to specialist cancer treatment.

The NHS in England runs schemes to provide financial assistance for travel to a hospital, or other NHS premises, for specialist NHS treatment or diagnostics tests, when referred by a doctor or other primary healthcare professional. This includes the NHS Healthcare Travel Costs Scheme (HTCS), which provides financial assistance to patients who do not have a medical need for transport, but who require assistance with the costs of travelling to receive certain NHS services. Patients who do not qualify for the HTCS and who are on a low income may be able to claim the costs from the Department for Work and Pensions through Universal Credit or Personal Independence Payment.

The Department oversees healthcare in England but does not routinely track how many residents have received proton beam therapy, either domestically or abroad, in the past five years.

We also do not routinely collect data on patients eligible for this treatment, associated out-of-pocket costs, and the number of individuals who have self-funded their therapy.

The Department oversees healthcare in England but does not routinely track how many residents have received proton beam therapy, either domestically or abroad, in the past five years.

We also do not routinely collect data on patients eligible for this treatment, associated out-of-pocket costs, and the number of individuals who have self-funded their therapy.

The Department does not have data on proton beam therapy commissioning costs, including overseas referrals, and has not compared the cost to NHS England of providing this treatment in England or the United Kingdom versus abroad. No assessment has been made of the potential impact of increasing the availability of proton beam therapy. Treatment for cancer is highly individualised and decisions about cancer treatment are typically made by clinicians and multidisciplinary teams of healthcare professionals.

The Department does not have data on proton beam therapy commissioning costs, including overseas referrals, and has not compared the cost to NHS England of providing this treatment in England or the United Kingdom versus abroad. No assessment has been made of the potential impact of increasing the availability of proton beam therapy. Treatment for cancer is highly individualised and decisions about cancer treatment are typically made by clinicians and multidisciplinary teams of healthcare professionals.

The Department does not have data on proton beam therapy commissioning costs, including overseas referrals, and has not compared the cost to NHS England of providing this treatment in England or the United Kingdom versus abroad. No assessment has been made of the potential impact of increasing the availability of proton beam therapy. Treatment for cancer is highly individualised and decisions about cancer treatment are typically made by clinicians and multidisciplinary teams of healthcare professionals.

The monitoring of National Health Service patient correspondence, including appointment letters, is the responsibility of individual NHS providers. Data is not held centrally on the whether appointment letters are received prior to an appointment taking place. No assessment has been made of the adequacy of mail deliveries of NHS correspondence to patients.

The Government’s focus on shifting from analogue to digital will streamline information and communication processes, including by improving the NHS App. This will make it easier and quicker for patients to access information about their appointments, to cancel and reschedule appointments, and to receive correspondence on NHS test results. 96% of acute trusts in England now allow patients to view appointment information via the NHS App if they wish, reducing reliance on physical letters. Usage has increased significantly, with the App now supporting approximately eight million patient–trust interactions per month, an increase of 82% compared to a year ago. It also saves staff time to focus on providing high quality, non-digital communication for those who want and need it.

The monitoring of National Health Service patient correspondence, including appointment letters, is the responsibility of individual NHS providers. Data is not held centrally on the whether appointment letters are received prior to an appointment taking place. No assessment has been made of the adequacy of mail deliveries of NHS correspondence to patients.

The Government’s focus on shifting from analogue to digital will streamline information and communication processes, including by improving the NHS App. This will make it easier and quicker for patients to access information about their appointments, to cancel and reschedule appointments, and to receive correspondence on NHS test results. 96% of acute trusts in England now allow patients to view appointment information via the NHS App if they wish, reducing reliance on physical letters. Usage has increased significantly, with the App now supporting approximately eight million patient–trust interactions per month, an increase of 82% compared to a year ago. It also saves staff time to focus on providing high quality, non-digital communication for those who want and need it.

The factors that determine whether a service is a prescribed specialised service are: the number of individuals who require the service; the cost of providing the service or facility; and the number of people able to provide the service or facility.

Vacuum bell therapy for pectus excavatum is not designated as a prescribed specialised service. Non surgical management of pectus excavatum is considered a pathway based intervention better managed through local medical pathways. Responsibility for commissioning therefore sits with integrated care boards (ICBs) rather than NHS England or the Department. There are no current plans to change this approach.

NHS England will continue to encourage ICBs to prioritise commissioning non surgical medical treatments for patients with pectus excavatum as part of an integrated pathway. In addition, through the National Institute for Health and Care Research, the Department is funding the RESTORE trial, which will inform future commissioning decisions in relation to surgery. More information on the RESTORE trial is available at the following link:

https://www.fundingawards.nihr.ac.uk/award/NIHR158749

The factors that determine whether a service is a prescribed specialised service are: the number of individuals who require the service; the cost of providing the service or facility; and the number of people able to provide the service or facility.

Vacuum bell therapy for pectus excavatum is not designated as a prescribed specialised service. Non surgical management of pectus excavatum is considered a pathway based intervention better managed through local medical pathways. Responsibility for commissioning therefore sits with integrated care boards (ICBs) rather than NHS England or the Department. There are no current plans to change this approach.

NHS England will continue to encourage ICBs to prioritise commissioning non surgical medical treatments for patients with pectus excavatum as part of an integrated pathway. In addition, through the National Institute for Health and Care Research, the Department is funding the RESTORE trial, which will inform future commissioning decisions in relation to surgery. More information on the RESTORE trial is available at the following link:

https://www.fundingawards.nihr.ac.uk/award/NIHR158749

Data is available for emergency Finished Admission Episodes (FAEs) where there was a primary diagnosis of ‘respiratory conditions’. The following table shows the number of FAEs where there was a primary diagnosis of ‘respiratory conditions’ for North Herefordshire and England, for activity in English National Health Service hospitals and English NHS commissioned activity in the independent sector, for 2024/25 and provisionally for 2025/26:

Source: Hospital Episode Statistics, NHS England.

Available data on trends in respiratory conditions can be found on the Department’s Fingertips dataset. Data is not available by parliamentary constituency. Data is available at regional, county, unitary authority, and integrated care board level. Information for Herefordshire can be found at the following link:

https://fingertips.phe.org.uk/search/Respiratory#page/1/gid/1/pat/15/par/E92000001/ati/502/are/E06000019/iid/90933/age/314/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1

Department officials hold regular discussions with NHS England on how integrated care boards are commissioning and delivering community health services, which includes physical therapy.

Access to sufficient, high-quality physical therapy is important in supporting patients’ physical function and overall wellbeing. Appropriate, individualised therapy can help to improve mobility, manage pain, and support participation in day-to-day activities. These outcomes may also contribute to maintaining independence and promoting engagement in activity, which can be beneficial for cognitive health and wider quality of life.

The 10 Year Workforce Plan will ensure the National Health Service has the right people in the right places, with the right skills to care for patients, when they need it. The plan will articulate the changes for different professional groups.

The Government takes patient safety seriously, including when accident and emergency departments are under severe pressure.

Patients are clinically triaged on arrival and monitored at appropriate intervals, with decisions led locally through clinical judgement and governance. Where corridor care is taking place and cannot be avoided, the National Health Service has published updated guidance to ensure this care is delivered safely, with senior clinical oversight, appropriate monitoring, and that dignity and privacy are maintained.

More broadly, the NHS Medium Term Planning Framework sets out clear action to improve urgent and emergency care performance year‑on‑year, including reducing long waits, improving patient flow, and ensuring that patients are treated in the right setting, the first time.

At Birmingham Heartlands Hospital, pressures are being addressed through system‑wide actions, including investment in hospital‑based urgent treatment centres, improvements to reduce delayed discharges, and shifting care from hospital into communities.

The Medical Training (Prioritisation) Act 2026 implements the Government’s commitment in the 10-Year Health Plan to prioritise United Kingdom medical graduates for foundation training places, and to prioritise UK medical graduates and other doctors with significant National Health Service experience for specialty training places. Under the act, a UK medical graduate is defined as someone with a UK primary medical qualification who did not spend the majority of their time training for that qualification outside the British Islands.

For specialty training places starting in 2026, we are using immigration statuses as a practical proxy to capture applicants who are most likely to have significant experience working in the health service in the UK. The effect of this is that British citizens will be prioritised. From 2027, immigration status will no longer automatically determine priority for specialty training. Instead, we will be able to make regulations to specify any additional groups who will be prioritised by reference to criteria indicating significant experience as a doctor in the health service, or by reference to immigration status.

Overseas‑qualified doctors must meet General Medical Council (GMC) registration and licensing requirements before practising in the National Health Service. A range of information and guidance is available through the GMC website to support doctors through the registration process. The Government is currently consulting on reforms to the legislative framework governing the GMC, which will provide the GMC with greater flexibility to adapt its registration pathways to meet future workforce needs. The consultation closes on 23 June 2026.

Ambulance crews work within the national clinical scope of practice and operational guidance, supported by locally risk‑assessed procedures. This enables them to attend patients safely in a wide range of environments, including homes and locations that may be difficult to access. This includes the use of appropriate equipment, alternative access arrangements, and, where necessary, coordination with other emergency services.

This is set out in the NHS England Ambulance Service Specification, which defines the requirements for safe, effective, and responsive ambulance services across England. Detailed operating procedures for managing specific access constraints are implemented locally by ambulance trusts in line with the national service specification, with further information available at the following link:

https://www.england.nhs.uk/publication/ambulance-emergency-and-urgent-care-service-specification/

The Department does not hold vacancy rates that are granular enough to identify rates for neuro-phsyiotherapists, occupational therapists, and speech and language therapists in National Health Service stroke units.

NHS England publishes quarterly vacancy statistics for total staffing, registered nurses, and medical staff across the NHS. Data is not available at a more detailed staff group level or by the setting in which staff work. The latest published data can be found at the following link:

https://digital.nhs.uk/data-and-information/publications/statistical/nhs-vacancies-survey

It has not proved possible to respond to the hon. Member in the time available before Prorogation.

The Government recognises the vital role that Parkinson’s nurse specialists play in supporting people with Parkinson’s disease, providing expert clinical input, coordinating care, and helping patients and families manage a complex, progressive condition.

Responsibility for workforce planning, including the recruitment, training, and retention of specialist nurses, such as Parkinson’s nurse specialists, lies with the National Health Service. Integrated care boards are responsible for assessing local population need and ensuring that appropriate specialist services, including neurology and nursing support, are in place to meet that need.

At a national level, the NHS is supporting service improvement and workforce development for Parkinson’s and other neurological conditions through a range of programmes. This includes the Getting It Right First Time Programme for Neurology and the RightCare Progressive Neurological Conditions Toolkit. Both aim to reduce unwarranted variation, promote best practice, and support more consistent access to specialist expertise across England.

The forthcoming 10 Year Workforce Plan will support the recruitment and retention of specialist nurses by setting out a long‑term approach to growing, training, and supporting the NHS workforce, with a focus on ensuring that staff have the right skills, career development opportunities, and working conditions to deliver high‑quality care. By improving education and training pathways, promoting advanced and specialist roles, and supporting flexible and multidisciplinary ways of working, the plan will help the NHS build a sustainable workforce able to meet future patient needs.

Everyone working in the National Health Service has a fundamental right to be safe at work. Individual employers are responsible for the health and safety of their staff, and they put in place measures, including, security, training, and emotional support for staff affected by violence or abuse.

The Department and NHS England are working with NHS Employers and trade unions to strengthen support for staff in the NHS workplace by improving security, ensuring cases are reported and investigated, providing better training for staff on de-escalating and dealing with incidents, as well as enhancing post-incident support for staff.

Additionally, staff have access to a ‘trauma-informed care’ e-learning module, which forms a suite of sessions promoting trauma-sensitive practice in health and social care. The training recognises that staff can be exposed to trauma at work and helps to support NHS staff to become more trauma-sensitive in the way care is delivered.

NHS England is committed to supporting people who need these specialist gender services and commissions three adult gender dysphoria clinics in Newcastle, Sheffield, and Leeds. While they are regionally commissioned to meet the demand of the local population, these services are accessed by patients from across the country and this has an impact on waiting times.

In some areas, general practices (GPs) are also supporting stabilised patients by prescribing their treatment locally with specialist support, ensuring the care and treatment needs of these individuals are met locally when appropriate.

NHS England has now completed its review of adult gender services, which looked at how to overcome the challenges that some individuals continue to face in accessing services in a timely manner. The review includes 20 recommendations and NHS England, in full partnership with regions and the Department, will now lead the next stage of the system-wide response.

A National Portfolio Board is being established to build and develop a full implementation plan, which will address each of the recommendations in turn and be aligned with the ambitions of the Government’s 10-Year Health Plan for England, which is available at the following link:

https://www.gov.uk/government/collections/10-year-health-plan-for-england

Immediate priorities include working with professional bodies to establish a new professional role of GP with an Extended Role in Gender Medicine, to provide support to those who have completed their care within the adult gender service clinics and to provide leadership and knowledge sharing with primary care in every neighbourhood.

The NHS Staff Standards will be mandatory. Trust performance against them will be measured via the NHS National Oversight Framework.

The number of adult patients who are registered with a general practice in the North East and Yorkshire region and who are on a waiting list for an adult gender dysphoria clinic is 5,966 at the date of 31 January 2026.

The total number of adult patients on a waiting list for an adult gender dysphoria clinic is 44,579 at the date of 31 January 2026.

In 2024, the cost of industrial action by resident doctors was approximately £180 million. In 2025, there were three rounds of industrial action, in July, November, and December, each of five days. We have estimated industrial action costs at £50 million per day, so the total estimated cost for 2025 is £750 million.

It has not proved possible to respond to the hon. Member in the time available before Prorogation.

I refer the Rt Hon. Member to the answer I gave on 29 April 2026 to Question 82312.

Information on healthcare spend with non-National Health Service bodies is provided in the Department’s annual report and accounts for 2024/25, which is available at the following link:

https://assets.publishing.service.gov.uk/media/69412aa329501ea90654a4ba/dhsc-annual-report-and-accounts-2024-2025-web-accessible-corrected.pdf

The spend is broken down by independent sector, voluntary sector, local authorities, devolved administrations, and other group bodies.

The attached table provides the independent and voluntary sector totals by integrated care board and NHS England. The other categories are public bodies so out of scope of the requested information.

Contractual redundancy terms are set out in the Agenda for Change NHS terms and conditions of service handbook under section 16, more specifically paragraph 16.6, for National Health Service staff who are on Agenda for Change contracts in England or those whose terms refer dynamically to the Agenda for Change.

The Department commissions NHS Employers to provide guidance for employers on a range of topics, including NHS redundancy arrangements and retirement options for NHS staff. This guidance clearly sets out the position in relation to partial retirement and redundancy. NHS employers are expected to comply with both contractual and statutory obligations when determining entitlement.

The NHS Business Services Authority, which administers the NHS Pension Scheme on behalf of my Rt Hon. Friend, the Secretary of State for Health and Social Care, has confirmed that, as of 23 April 2026, there are 429,451 Remedial Service Statements and 20,185 Remedial Pension Savings Statements outstanding.

It has not proved possible to respond to the hon. Member in the time available before Prorogation.

It has not proved possible to respond to the hon. Member in the time available before Prorogation.

The Department recognises the importance of providing NHS Pension Scheme members certainty about when they will receive their Remediable Service Statement. An independent review team is assessing the NHS Business Service Authority’s revised plans for the delivery of the McCloud remedy for NHS Pension Scheme members. Subject to the review team's assurance, in May 2026, we intend to issue new deadlines for Remedial Service Statements and update the House on delivery of Remedial Pension Savings Statements.

The information requested is shown in the following table:

Number of cases per month, from July 2024 to September 2025, where patients were removed from the Referral to Treatment (RTT) waiting list for reasons other than treatment:

The information for the table above was extracted from the Waiting List Minimum Data Set (WLMDS) on 18 November 2025.

A breakdown of reasons for coming off the waiting list is not available in the aggregate monthly official statistics. However, the information is collected in the weekly management information from the Waiting List Minimum Data Set (WLMDS). The WLMDS is subject to less validation than the monthly official statistics and totals do not match between the two sources.

Reasons for patients being removed from the waiting list can include them starting a period of active monitoring, a clinical decision not to treat, a patient declining treatment or a patient dying before treatment starts.

It has not proved possible to respond to the hon. Member in the time available before Prorogation.

It has not proved possible to respond to the hon. Member in the time available before Prorogation.

It has not proved possible to respond to the hon. Member in the time available before Prorogation.

The Department’s approach to learning, development, and training programmes is designed to build a highly skilled, confident workforce. The Department has progressively strengthened its offer since 2020 through the introduction and iteration of the Core Skills Programme. The training programme focuses on developing profession specific and working in Government skills.

In addition to departmental learning provisions, business areas are allocated devolved learning and development budgets, enabling them to prioritise training that addresses their own identified capability needs. These individual training requirements tend to be job-specific, personal development, technical, qualifications, or accreditation based, or subject matter expertise related, such as specific policy areas.

A full list of departmental provision since 2020 is provided below, and this is in addition to courses that can be booked individually through Civil Service Learning, the cross Civil Service Learning Platform:

- Management Fundamentals 2020;

- New Manager Programme 2021;

- Experienced Manager Programme 2021;

- Foundation Management Programme 2023;

- Practitioner Management Programme 2023;

- Department of Health and Social Care Management Fundamentals 2023;

- ACAS Line Manager training 2023;

- Core Skills Programme 2023 to present, covering policy, digital, project delivery, commercial, analysis and finance, and working in Government skills;

- the Department’s Management Academy, Managing Change Programme 2023 to 2024, to strengthen capability in leading people through organisational change;

- People Policies Workshop 2025 to present, for line-management learning intervention focused on practical application of core people policies; and

- Leadership Development Programme, which is ongoing.

The Department also delivers a number of talent schemes which incorporate formal training and development programmes alongside on‑the‑job experience. These schemes are designed to build future capability in priority professions and leadership pipelines, supporting individuals at different career stages, including both delegated grades and Senior Civil Servants (SCS), through a combination of a defined learning curriculum, practical development, and coaching and mentoring. A list of departmental talent schemes that have delivered training programmes since 2020 is set out below. For delegated grade talent schemes, they are as follows:

- Health Policy Fast Track Scheme;

- Civil Service Fast Stream;

- Future Leaders Scheme;

- Beyond Boundaries;

- Interdepartmental Talent Programme;

- Summer Internship Programme;

- Autism Exchange Internship Programme;

- Care Leavers Internship Scheme; and

- Civil Service Apprenticeship Programmes.

And for SCS talent schemes, the programmes are as follows:

- Senior Leaders Scheme;

- Directors Leadership Programme;

- Forward Institute Exchange Programme ;

- Forward Institute Fellowship;

- Individual Development Programme;

- OpDel Exchange Programme;

- Policy Fellowship for the Centre for Science and Policy;

- Whitehall and Industry Group Senior Leaders Programme;

- Whitehall and Industry Group Exchange Programme; and

- High Potential Development Scheme.

We have estimated cost of strikes at £50 million per day for resident doctors currently. This would mean that the six-day strike beginning 7 April 2026 is estimated to cost approximately £300 million. We continue to update estimates as new data becomes available, in line with receiving business as usual financial data from National Health Service providers.

The NHS has tried and tested plans in place to minimise disruption and will work with partners to ensure safe care for patients continues to be available and emergency services continue to operate.

As set out in the 10-Year Health Plan, this Government is clear that the National Health Service will be a service equipped to narrow health inequalities. We recognise the importance of safe, sustainable and accessible infrastructure in achieving this goal, which is why capital budgets will rise to £15.2 billion by the end of the Spending Review period in 2029/30.

This includes our aim to establish a Neighbourhood Health Centre (NHC) in every community over the course of the plan, transforming healthcare access by bringing historically hospital-based services into communities and addressing wider determinants of health. Nationwide coverage will take time, but we will start in the areas of greatest need, targeting places where healthy life expectancy is lowest and delivering healthcare closer to home for those that need it the most.

Beyond NHCs, we are empowering local systems to manage their capital budgets and deliver the right infrastructure in line with local need and strategic priorities. NHS England’s allocations policy aims to support equal opportunity of access for equal need as well as NHS England’s duties to reduce health inequalities that are amenable to healthcare.

It has not proved possible to respond to the hon. Member in the time available before Prorogation.

It has not proved possible to respond to the hon. Member in the time available before Prorogation.

It has not proved possible to respond to the hon. Member in the time available before Prorogation.

There are no plans to introduce national minimum staffing level guidance. Staffing levels are determined locally, supported by national guidance and regulated by the Care Quality Commission.

Guidance from the National Quality Board entitled Safe, sustainable and productive staffing, from 2016, and Developing Workforce Safeguards, from 2018, are designed to ensure a consistent, scientific, and evidence-based approach to staffing levels and to improve governance and board accountability relating to staffing decisions. Both guidance documents are available, respectively, at the following two links:

https://www.england.nhs.uk/wp-content/uploads/2013/04/nqb-guidance.pdf

https://www.england.nhs.uk/wp-content/uploads/2021/04/Developing-workforce-safeguards.pdf

It has not proved possible to respond to the hon. Member in the time available before Prorogation.

It has not proved possible to respond to the hon. Member in the time available before Prorogation.