The Government recognises the importance of patients with rare diseases being able to access effective new medicines. The National Institute for Health and Care Excellence (NICE) assesses whether medicines should be funded by the National Health Service. Its process has been proven to be suitable for rare disease medicines, including advanced therapies, where companies work constructively with NICE and NHS England. Since March 2024, NICE has recommended 89% of the rare disease medicines it has appraised for some or all eligible patients.

There are approximately 14,000 licensed medicines and the overwhelming majority are in good supply. Medicine supply chains are complex, global and highly regulated and there are several reasons why supply can be disrupted, many of which are not specific to the United Kingdom and outside of Government control. These include manufacturing difficulties, access to raw materials, sudden demand spikes, or distribution and regulatory issues.

The Department uses a sophisticated, multi-layered approach to monitor, assess, and respond to medicines at risk of future supply disruption. Intelligence is drawn from a wide range of sources, including our existing communication channels with our partners in the National Health Service, suppliers, industry, and international partners. In 2020, the Department developed a global risk register which draws on information on medicines licensed in the UK to map manufacturing touchpoints within the supply chain. It is used to help understand medicines supply chains vulnerability and risk.

The development and implementation of the Single Patient Record (SPR) will be overseen through the governance arrangements for the Transforming and Connecting Care (TCC) Programme. These provide accountability for design and delivery, with oversight from the Senior Responsible Officer, Programme Director and Programme Design Director. The Programme Board will provide overall governance, strategic leadership and decision-making authority.

Delivery will be overseen by the TCC Programme Delivery Group, which will focus on how and when programme outcomes are delivered. Design will be overseen by the TCC Programme Design Authority, which will assure what the programme is delivering, including coherence across products, architecture, clinical safety, cyber security, information governance, policy and transformation. SPR project-level governance will report into these.

Independent scrutiny will be provided through advisory and assurance routes, including the Clinical Advisory Group and the Data Transformation Check and Challenge Group. The programme also engages with external organisations and expert bodies as part of its governance and assurance arrangements, including participation by the National Cyber Security Centre in relevant design authority discussions to provide specialist cyber security expertise and challenge.

These advisory, assurance and external challenge mechanisms will support robust scrutiny throughout the design and implementation of the SPR, complemented by additional independent assurance commissioned at key points in the programme.

The Government is committed to improving patient safety across the National Health Service and ensuring that the system identifies, responds to and learns from recurring safety failures. NHS trusts are subject to a range of regulatory and contractual requirements to identify patterns of harm, manage risks and take action to improve services.

The Patient Safety Incident Response Framework, which became a contractual requirement for all NHS trusts from 1 April 2024, has reformed how organisations respond to patient safety incidents. It supports a more proportionate, transparent and compassionate approach, focused on understanding how incidents happen, identifying local risks and priorities, and ensuring learning leads to improvement.

The Learn from Patient Safety Events service collects and analyses information on patient safety incidents across the NHS, with NHS England continuingly reviewing incidents to identify emerging or under-recognised risks. Where appropriate, these risks can be acted on through National Patient Safety Alerts, national guidance or work with partner organisations, such as the Care Quality Commission.

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.

For specialty training places starting in 2026, immigration statuses are being used as a proxy to capture applicants who are most likely to have significant experience working in the health service in the UK.

From 2027, under the Act, immigration status will no longer automatically determine priority for specialty training. Instead, the act provides a power to specify in regulations 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. The Department is working with NHS England, the devolved administrations, and other partners on how best to define and evidence significant NHS experience as part of the development of those regulations. We will set out next steps in due course.

The Act is not designed to, and does not, exclude any eligible applicants from applying for medical foundation or specialty training. Non-prioritised graduates can still apply, and they will be offered places if vacancies remain after prioritised applicants have received offers. For individuals who do not secure a foundation year one post this year, there are alternative routes to pursuing a medical career in the UK. These include obtaining full General Medical Council (GMC) registration through the established GMC pathways, such as completing an approved internship in the country where they trained and then entering the UK healthcare system through applying to a locally employed doctor role or another non-training post.

The Government has no plans to introduce transitional arrangements for the implementation of the Act.

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.

For specialty training places starting in 2026, immigration statuses are being used as a proxy to capture applicants who are most likely to have significant experience working in the health service in the UK.

From 2027, under the Act, immigration status will no longer automatically determine priority for specialty training. Instead, the act provides a power to specify in regulations 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. The Department is working with NHS England, the devolved administrations, and other partners on how best to define and evidence significant NHS experience as part of the development of those regulations. We will set out next steps in due course.

The Act is not designed to, and does not, exclude any eligible applicants from applying for medical foundation or specialty training. Non-prioritised graduates can still apply, and they will be offered places if vacancies remain after prioritised applicants have received offers. For individuals who do not secure a foundation year one post this year, there are alternative routes to pursuing a medical career in the UK. These include obtaining full General Medical Council (GMC) registration through the established GMC pathways, such as completing an approved internship in the country where they trained and then entering the UK healthcare system through applying to a locally employed doctor role or another non-training post.

The Government has no plans to introduce transitional arrangements for the implementation of the Act.

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.

For specialty training places starting in 2026, immigration statuses are being used as a proxy to capture applicants who are most likely to have significant experience working in the health service in the UK.

From 2027, under the Act, immigration status will no longer automatically determine priority for specialty training. Instead, the act provides a power to specify in regulations 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. The Department is working with NHS England, the devolved administrations, and other partners on how best to define and evidence significant NHS experience as part of the development of those regulations. We will set out next steps in due course.

The Act is not designed to, and does not, exclude any eligible applicants from applying for medical foundation or specialty training. Non-prioritised graduates can still apply, and they will be offered places if vacancies remain after prioritised applicants have received offers. For individuals who do not secure a foundation year one post this year, there are alternative routes to pursuing a medical career in the UK. These include obtaining full General Medical Council (GMC) registration through the established GMC pathways, such as completing an approved internship in the country where they trained and then entering the UK healthcare system through applying to a locally employed doctor role or another non-training post.

The Government has no plans to introduce transitional arrangements for the implementation of the Act.

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.

For specialty training places starting in 2026, immigration statuses are being used as a proxy to capture applicants who are most likely to have significant experience working in the health service in the UK.

From 2027, under the Act, immigration status will no longer automatically determine priority for specialty training. Instead, the act provides a power to specify in regulations 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. The Department is working with NHS England, the devolved administrations, and other partners on how best to define and evidence significant NHS experience as part of the development of those regulations. We will set out next steps in due course.

The Act is not designed to, and does not, exclude any eligible applicants from applying for medical foundation or specialty training. Non-prioritised graduates can still apply, and they will be offered places if vacancies remain after prioritised applicants have received offers. For individuals who do not secure a foundation year one post this year, there are alternative routes to pursuing a medical career in the UK. These include obtaining full General Medical Council (GMC) registration through the established GMC pathways, such as completing an approved internship in the country where they trained and then entering the UK healthcare system through applying to a locally employed doctor role or another non-training post.

The Government has no plans to introduce transitional arrangements for the implementation of the Act.

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.

For specialty training places starting in 2026, immigration statuses are being used as a proxy to capture applicants who are most likely to have significant experience working in the health service in the UK.

From 2027, under the Act, immigration status will no longer automatically determine priority for specialty training. Instead, the act provides a power to specify in regulations 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. The Department is working with NHS England, the devolved administrations, and other partners on how best to define and evidence significant NHS experience as part of the development of those regulations. We will set out next steps in due course.

The Act is not designed to, and does not, exclude any eligible applicants from applying for medical foundation or specialty training. Non-prioritised graduates can still apply, and they will be offered places if vacancies remain after prioritised applicants have received offers. For individuals who do not secure a foundation year one post this year, there are alternative routes to pursuing a medical career in the UK. These include obtaining full General Medical Council (GMC) registration through the established GMC pathways, such as completing an approved internship in the country where they trained and then entering the UK healthcare system through applying to a locally employed doctor role or another non-training post.

The Government has no plans to introduce transitional arrangements for the implementation of the Act.

The Health Bill, subject to parliamentary passage, proposes to transfer the requirement to conduct annual assessments of integrated care boards from NHS England to my Rt Hon. Friend, the Secretary of State for Health and Social Care, and to focus assessments on the statutory functions of these organisations.

The Health Bill also proposes that my Rt Hon. Friend, the Secretary of State for Health and Social Care, must publish a report each financial year containing a summary of the results of each performance assessment conducted with respect to that year.

Waiting times for 15 key diagnostic tests (DM01) are collected and published monthly, reported two months in arrears. Diagnostic performance is reported as the proportion of diagnostic waits of over six weeks. Statistics on DM01 performance variation by integrated care board are published on the NHS.UK website in an online-only format.

It is always a delight to hear from those in the party opposite on this, because of their childlike wonder and astonishment as they discover new features and issues in a system that they designed and have overseen for quite some time. I am happy to write to the noble Earl with more details on that scenario. We are considering all the ways to ensure that we have an affordable welfare bill, including making sure that we have efficiencies across the board.

Emerging evidence from local services suggests Single Point of Access (SPoA) supports patients to receive rapid specialist assessments and a clear next step for their treatment by embedding a timely specialist clinical review at the start of the pathway, including for cardiology and cardiothoracic referrals. The model helps patients access the right clinic, diagnostic service, or care setting the first time, and averts the need for them to join lengthy hospital waiting lists unnecessarily, ensuring capacity is available for patients that need specialist care. We are also supporting the development and evaluation of streamlined referral pathways, including SPoA and rapid access valve assessment models, as part of wider cardiovascular pathway improvement work.

As set out in the Medium Term Planning Framework all providers are, from April 2026, expected to prioritise Advice and Guidance (A&G) requests for at least 10 specialties, selected locally for the greatest overall benefit, ahead of ensuring all appropriate requests and referrals flow through a SPoA model from October 2026. Providers are expected to begin implementation of SPoA by prioritising the 10 specialties selected for A&G. The specialties selected by providers could include cardiology or cardiothoracic surgery, which would cover care for heart valve disease.

Technical guidance has been issued to providers outlining expectations to support SPoA implementation. There are currently no specific plans to mandate SPoA in national service specifications. However, we are developing a new Cardiovascular Disease Modern Service Framework, due to be published shortly, which will support the adoption of evidence‑based pathway improvements.

Emerging evidence from local services suggests Single Point of Access (SPoA) supports patients to receive rapid specialist assessments and a clear next step for their treatment by embedding a timely specialist clinical review at the start of the pathway, including for cardiology and cardiothoracic referrals. The model helps patients access the right clinic, diagnostic service, or care setting the first time, and averts the need for them to join lengthy hospital waiting lists unnecessarily, ensuring capacity is available for patients that need specialist care. We are also supporting the development and evaluation of streamlined referral pathways, including SPoA and rapid access valve assessment models, as part of wider cardiovascular pathway improvement work.

As set out in the Medium Term Planning Framework all providers are, from April 2026, expected to prioritise Advice and Guidance (A&G) requests for at least 10 specialties, selected locally for the greatest overall benefit, ahead of ensuring all appropriate requests and referrals flow through a SPoA model from October 2026. Providers are expected to begin implementation of SPoA by prioritising the 10 specialties selected for A&G. The specialties selected by providers could include cardiology or cardiothoracic surgery, which would cover care for heart valve disease.

Technical guidance has been issued to providers outlining expectations to support SPoA implementation. There are currently no specific plans to mandate SPoA in national service specifications. However, we are developing a new Cardiovascular Disease Modern Service Framework, due to be published shortly, which will support the adoption of evidence‑based pathway improvements.

Emerging evidence from local services suggests Single Point of Access (SPoA) supports patients to receive rapid specialist assessments and a clear next step for their treatment by embedding a timely specialist clinical review at the start of the pathway, including for cardiology and cardiothoracic referrals. The model helps patients access the right clinic, diagnostic service, or care setting the first time, and averts the need for them to join lengthy hospital waiting lists unnecessarily, ensuring capacity is available for patients that need specialist care. We are also supporting the development and evaluation of streamlined referral pathways, including SPoA and rapid access valve assessment models, as part of wider cardiovascular pathway improvement work.

As set out in the Medium Term Planning Framework all providers are, from April 2026, expected to prioritise Advice and Guidance (A&G) requests for at least 10 specialties, selected locally for the greatest overall benefit, ahead of ensuring all appropriate requests and referrals flow through a SPoA model from October 2026. Providers are expected to begin implementation of SPoA by prioritising the 10 specialties selected for A&G. The specialties selected by providers could include cardiology or cardiothoracic surgery, which would cover care for heart valve disease.

Technical guidance has been issued to providers outlining expectations to support SPoA implementation. There are currently no specific plans to mandate SPoA in national service specifications. However, we are developing a new Cardiovascular Disease Modern Service Framework, due to be published shortly, which will support the adoption of evidence‑based pathway improvements.

The Government recognises the benefits that emerging innovative technologies such as digital breast tomosynthesis (DBT) may bring to the NHS Breast Screening Programme. At present, DBT is an optional tool in the assessment of screen detected soft tissue breast abnormalities following mammography. Digital mammography, which offers high quality images, currently remains the primary screening tool for the programme as recommended by the UK National Screening Committee (UK NSC).

In 2025, the UK NSC, who advise the Government on all screening matters, set up a working group of breast cancer screening experts to help it consider new and emerging evidence and developments that could further improve the United Kingdom breast screening programmes. This includes exploring modalities such as DBT in addition to other tests and technologies, to detect breast cancer in women with dense breast tissue.

If, following this work, the UK NSC makes a recommendation regarding DBT, my Rt Hon. Friend, the Secretary of State for Health and Social Care, would be asked to make a decision on whether to accept the recommendation, alongside wider policy and operational advice.

The Government recognises the benefits that emerging innovative technologies such as digital breast tomosynthesis (DBT) may bring to the NHS Breast Screening Programme. At present, DBT is an optional tool in the assessment of screen detected soft tissue breast abnormalities following mammography. Digital mammography, which offers high quality images, currently remains the primary screening tool for the programme as recommended by the UK National Screening Committee (UK NSC).

In 2025, the UK NSC, who advise the Government on all screening matters, set up a working group of breast cancer screening experts to help it consider new and emerging evidence and developments that could further improve the United Kingdom breast screening programmes. This includes exploring modalities such as DBT in addition to other tests and technologies, to detect breast cancer in women with dense breast tissue.

If, following this work, the UK NSC makes a recommendation regarding DBT, my Rt Hon. Friend, the Secretary of State for Health and Social Care, would be asked to make a decision on whether to accept the recommendation, alongside wider policy and operational advice.