Asked by: Tim Farron (Liberal Democrat - Westmorland and Lonsdale)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, which public health factors created the 10 largest direct cost impacts on the NHS in 2024; and how much the NHS spent in 2024 on tackling the health impacts of the following public health factors: (a) air pollution, (b) alcoholism, (c) obesity, (d) excessive salt consumption and (e) smoking.
Answered by Ashley Dalton - Parliamentary Under-Secretary (Department of Health and Social Care)
Global Burden of Disease data considers the top ten public health factors in the United Kingdom in 2023 in order of importance to be: tobacco, high body mass index, dietary risks, high fasting plasma glucose, high blood pressure, high alcohol use, high cholesterol, occupational risks, kidney dysfunction, and drug use. Further information on the Global Burden of Disease data is available at the following link:
https://vizhub.healthdata.org/gbd-compare/
The following table shows the various estimates of the cost to the National Health Service of the five factors specified:
Risk factor | Estimated NHS cost | Source of Estimate |
Air Pollution | £1.6 billion for fine particulate matter and nitrogen dioxide combined between 2017 and 2025. | Public Health England Agency, 2018 |
Alcohol | £4.9 billion annually | Institute of Alcohol Studies, 2021/22 |
Obesity | £9.3 billion annually | Frontier Economics & NESTA, 2025 |
Hypertension (excessive salt consumption is linked to an increased risk of hypertension) | £2.1 billion annually | Optimity Matrix (commissioned by Public Health England), 2014 |
Smoking | £1.8 billion annually | Action on Smoking and Health, 2025 |
Comparisons of costs should not be made between these estimates because of the different methodologies used in their construction.
Asked by: Tim Farron (Liberal Democrat - Westmorland and Lonsdale)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, pursuant to the Answer of 10 May 2023 to Question 183643 on Public Health, what methodologies were used to estimate the costs to the NHS for each of the five risk factors specified.
Answered by Ashley Dalton - Parliamentary Under-Secretary (Department of Health and Social Care)
The applicable methodologies for the National Health Service cost attributed to each of the risk factors outlined are explained in the following reports.
The estimated air pollution related costs to the NHS can be found in the Public Health England report ‘Estimation of costs to the NHS and social care due to the health impacts of air pollution: summary report’ , from 2018, which is available at the following link:
https://www.gov.uk/government/publications/air-pollution-a-tool-to-estimate-healthcare-costs
An estimate of the NHS and healthcare costs of alcohol from 2021/22, produced by the Institute of Alcohol Studies, can be found at the following link:
https://www.ias.org.uk/factsheet/economy/
Estimated obesity related costs to the NHS can be found in the Frontier Economics report for NESTA, published in July 2025, ‘The Economic and Productivity Costs of Obesity and Overweight in the UK’, which is available at the following link:
Estimated Hypertension related costs to the NHS can be found in the Optimity Matrix Cost-effectiveness review of blood pressure interventions, ‘A Report to the Blood Pressure System Leadership Board’, published November 2014, available at the following link:
The most recent estimated smoking related costs to the NHS can be found in the press release, ‘New figures show cost of smoking to society in England dwarfs tobacco tax revenue’. This is available at the following link:
Asked by: Tim Farron (Liberal Democrat - Westmorland and Lonsdale)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, how much did (a) Health Education England and (b) NHS England pay Hill Dickinson in (i) costs and (ii) fees for legal services between 2012 and 2023.
Answered by Karin Smyth - Minister of State (Department of Health and Social Care)
As a parent organisation, including commissioning support units but excluding integrated care boards, NHS England has spent approximately £8 million including VAT with Hill Dickinson between 2012/13 and 2022/23. Approximately 90% of these costs were spent on legal or professional fees.
Please note that this figure includes the NHS Trust Development Authority and Monitor, which merged to become NHS Improvement in 2016, as well as the two months of NHS Digital following its merger with NHS England from 1 February 2023.
Health Education England, which was merged into NHS England on 1 April 2023, spent £5.2 million with Hill Dickinson between 2012/13 and 2022/23. We do not hold a breakdown of this spend.
Asked by: Tim Farron (Liberal Democrat - Westmorland and Lonsdale)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what discussions his Department has had with ‘Heating, ventilation and air conditioning’ (HVAC) professionals and facilities managers to understand how they reduce air pollution in dwellings and non-domestic buildings while minimising energy use and heat loss.
Answered by Ashley Dalton - Parliamentary Under-Secretary (Department of Health and Social Care)
The Department and the UK Health Security Agency engage with a range of stakeholders on ways to reduce the health impacts of both indoor and outdoor air pollution.
This includes engagement by officials with relevant bodies in the United Kingdom and internationally, such as the Chartered Institution of Building Services Engineers and the Air Infiltration and Ventilation Centre, which operates under the International Energy Agency, on issues related to indoor air quality, including ventilation.
Asked by: Tim Farron (Liberal Democrat - Westmorland and Lonsdale)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, whether research is being conducted into the potential association between Gabapentin use and the development of attentional amnestic disorders or other cognitive impairments.
Answered by Zubir Ahmed - Parliamentary Under-Secretary (Department of Health and Social Care)
Gabapentin is authorised to treat epilepsy and peripheral neuropathic pain, or nerve pain. The known side effects of gabapentin are outlined in the product information, the Summary of Product Characteristics (SPC) for healthcare professionals, and the Patient Information Leaflet which is provided in each pack of the medicine.
The SPC states that in the treatment of peripheral neuropathic pain, such as painful diabetic neuropathy and post-herpetic neuralgia, efficacy and safety have not been examined in clinical studies for treatment periods longer than five months. If a patient requires the medication for longer than five months to treat peripheral neuropathic pain, the treating physician should assess the patient's clinical status and determine the need for additional therapy. Epilepsy normally requires long-term treatment and the SPC states that the dosage for gabapentin should be determined by the treating physician according to the clinical response and side effects experienced by the individual patient.
The product information for gabapentin lists amnesia as a common side effect and mental impairment as an uncommon side effect. Dementia is not a known side effect of gabapentin.
Gabapentin can cause drug dependence, and the product information includes warnings that patients treated with gabapentin should be monitored for symptoms of misuse, abuse, or dependence. After discontinuation of short- and long-term treatment with gabapentin, withdrawal symptoms have been observed, and gabapentin should be discontinued gradually over a minimum of one week.
As with all medicines, the safety of gabapentin is kept under continual review by the Medicines and Healthcare products Regulatory Agency using a number of data sources including reports of suspected side effects through the Yellow Card Scheme, data from marketing authorisation holders, and research published in the scientific literature.
Asked by: Tim Farron (Liberal Democrat - Westmorland and Lonsdale)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what assessment has been made of the potential impact of prolonged use of Gabapentin on long-term neurological risks, including dementia and brain damage.
Answered by Zubir Ahmed - Parliamentary Under-Secretary (Department of Health and Social Care)
Gabapentin is authorised to treat epilepsy and peripheral neuropathic pain, or nerve pain. The known side effects of gabapentin are outlined in the product information, the Summary of Product Characteristics (SPC) for healthcare professionals, and the Patient Information Leaflet which is provided in each pack of the medicine.
The SPC states that in the treatment of peripheral neuropathic pain, such as painful diabetic neuropathy and post-herpetic neuralgia, efficacy and safety have not been examined in clinical studies for treatment periods longer than five months. If a patient requires the medication for longer than five months to treat peripheral neuropathic pain, the treating physician should assess the patient's clinical status and determine the need for additional therapy. Epilepsy normally requires long-term treatment and the SPC states that the dosage for gabapentin should be determined by the treating physician according to the clinical response and side effects experienced by the individual patient.
The product information for gabapentin lists amnesia as a common side effect and mental impairment as an uncommon side effect. Dementia is not a known side effect of gabapentin.
Gabapentin can cause drug dependence, and the product information includes warnings that patients treated with gabapentin should be monitored for symptoms of misuse, abuse, or dependence. After discontinuation of short- and long-term treatment with gabapentin, withdrawal symptoms have been observed, and gabapentin should be discontinued gradually over a minimum of one week.
As with all medicines, the safety of gabapentin is kept under continual review by the Medicines and Healthcare products Regulatory Agency using a number of data sources including reports of suspected side effects through the Yellow Card Scheme, data from marketing authorisation holders, and research published in the scientific literature.
Asked by: Tim Farron (Liberal Democrat - Westmorland and Lonsdale)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, whether prescribing guidelines for Gabapentin include warnings about potential risks associated with extended use.
Answered by Zubir Ahmed - Parliamentary Under-Secretary (Department of Health and Social Care)
There are a number of resources available to prescribers to advise them on the potential risks associated with extended use of gabapentin.
The British National Formulary (BNF) for adults provides healthcare professionals with a range of information on the selection, prescribing, dispensing, and administration of medicines. The BNF monograph for gabapentin provides information on the cautions and side effects relating to use of the medicine. The BNF also provides important safety information, such as advice from the Medicines and Healthcare products Regulatory Agency on the risks associated with use of gabapentin.
In addition, the known side effects of gabapentin are outlined in the product information, the Summary of Product Characteristics for healthcare professionals, and the Patient Information Leaflet which is provided in each pack of the medicine. These provide prescribers with special warnings and precautions regarding the use of gabapentin to inform decision-making.
Asked by: Tim Farron (Liberal Democrat - Westmorland and Lonsdale)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps are being taken to inform patients and healthcare professionals about the potential long-term risks of Gabapentin use.
Answered by Zubir Ahmed - Parliamentary Under-Secretary (Department of Health and Social Care)
Gabapentin is authorised to treat epilepsy and peripheral neuropathic pain, or nerve pain. The known side effects of gabapentin are outlined in the product information, the Summary of Product Characteristics (SPC) for healthcare professionals, and the Patient Information Leaflet which is provided in each pack of the medicine.
The SPC states that in the treatment of peripheral neuropathic pain, such as painful diabetic neuropathy and post-herpetic neuralgia, efficacy and safety have not been examined in clinical studies for treatment periods longer than five months. If a patient requires the medication for longer than five months to treat peripheral neuropathic pain, the treating physician should assess the patient's clinical status and determine the need for additional therapy. Epilepsy normally requires long-term treatment and the SPC states that the dosage for gabapentin should be determined by the treating physician according to the clinical response and side effects experienced by the individual patient.
The product information for gabapentin lists amnesia as a common side effect and mental impairment as an uncommon side effect. Dementia is not a known side effect of gabapentin.
Gabapentin can cause drug dependence, and the product information includes warnings that patients treated with gabapentin should be monitored for symptoms of misuse, abuse, or dependence. After discontinuation of short- and long-term treatment with gabapentin, withdrawal symptoms have been observed, and gabapentin should be discontinued gradually over a minimum of one week.
As with all medicines, the safety of gabapentin is kept under continual review by the Medicines and Healthcare products Regulatory Agency using a number of data sources including reports of suspected side effects through the Yellow Card Scheme, data from marketing authorisation holders, and research published in the scientific literature.
Asked by: Tim Farron (Liberal Democrat - Westmorland and Lonsdale)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what measures are in place to monitor patients on Gabapentin for signs of neurological or cognitive decline during treatment.
Answered by Zubir Ahmed - Parliamentary Under-Secretary (Department of Health and Social Care)
Gabapentin is authorised to treat epilepsy and peripheral neuropathic pain, or nerve pain. The known side effects of gabapentin are outlined in the product information, the Summary of Product Characteristics (SPC) for healthcare professionals, and the Patient Information Leaflet which is provided in each pack of the medicine.
The SPC states that in the treatment of peripheral neuropathic pain, such as painful diabetic neuropathy and post-herpetic neuralgia, efficacy and safety have not been examined in clinical studies for treatment periods longer than five months. If a patient requires the medication for longer than five months to treat peripheral neuropathic pain, the treating physician should assess the patient's clinical status and determine the need for additional therapy. Epilepsy normally requires long-term treatment and the SPC states that the dosage for gabapentin should be determined by the treating physician according to the clinical response and side effects experienced by the individual patient.
The product information for gabapentin lists amnesia as a common side effect and mental impairment as an uncommon side effect. Dementia is not a known side effect of gabapentin.
Gabapentin can cause drug dependence, and the product information includes warnings that patients treated with gabapentin should be monitored for symptoms of misuse, abuse, or dependence. After discontinuation of short- and long-term treatment with gabapentin, withdrawal symptoms have been observed, and gabapentin should be discontinued gradually over a minimum of one week.
As with all medicines, the safety of gabapentin is kept under continual review by the Medicines and Healthcare products Regulatory Agency using a number of data sources including reports of suspected side effects through the Yellow Card Scheme, data from marketing authorisation holders, and research published in the scientific literature.
Asked by: Tim Farron (Liberal Democrat - Westmorland and Lonsdale)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, if he will make an assessment of the potential implications for his policies of the press notice by the Royal College of Physician of 13 November 2025, which called for a UK-wide public health campaign on air pollution.
Answered by Ashley Dalton - Parliamentary Under-Secretary (Department of Health and Social Care)
Clean air is a key part of our shift from ‘sickness to prevention’ as per the 10-Year Health Plan for England, which sets out action to further improve the quality of the air we breathe.
Alongside the 10-Year Health Plan, the Department for Environment, Food and Rural Affairs’ Environmental Improvement Plan, published in December 2025, outlines commitments to improve the communication of air quality information.
Government action is being informed by the recommendations from the Air Quality Information System review report published in 2025, which specifically considered ways to increase public awareness about air pollution.
We will continue to work closely with the Department for Environment, Food and Rural Affairs to reduce the health harms of air pollution and to help make air quality part of everyday conversations.