It has not proved possible to respond to this question in the time available before Dissolution. Ministers will correspond directly with the Member.

NHS England has implemented non symptom specific pathways (NSS) for patients who present with non-specific symptoms or combinations thereof that can indicate several different cancers. This includes leukaemia, which can present non-specific symptoms, such as unexpected weight loss and night sweats. As of December 2023, there are 113 NSS pathways already live, an increase from 12 live Rapid Diagnostic Centre pathways in March 2020, with over 5,500 patients seen per month and a total of over 100,000 referrals since May 2020.

Raising awareness, delivering more research, and improving early diagnosis of cancers, which includes blood related cancers such as leukaemia, are crucial for improving survival rates and are key priorities for the Government.

NHS England is taking steps to raise awareness of all cancers, including leukaemia, to improve early diagnosis. In January 2024, NHS England relaunched their ‘Help Us Help You’ cancer awareness campaign, designed to increase earlier diagnosis of cancer by encouraging people to come forward with suspected signs of cancers. The campaign aims to reduce barriers to seeking earlier help, as well as to increase body awareness and knowledge of key red flag symptoms. This relaunch follows NHS England’s launch of their original ‘Help Us Help You’ campaigns in April 2020, a major public information campaign to persuade the public to seek urgent care and treatment when they needed it.

Delivering more research is key to understanding the causes of cancers and increasing survival rates of all cancers, including leukaemia, further. That is why investment in research and innovation is a priority for the Government. Our world-leading scientists and clinicians are driving the discovery, development, and testing of new treatments. The Department invested almost £122 million into cancer research in 2022/23 via the National Institute for Health and Care Research. In addition, alongside Cancer Research UK, health departments across the United Kingdom are jointly funding a network of Experimental Cancer Medicine Centres (ECMCs), collectively investing more than £35 million between 2017 and 2022. The network of 17 adult and 12 paediatric ECMCs enhances the existing bench-to-bedside pathway by supporting the most promising innovations from the academic and industry sectors into the cancer medicines of tomorrow.

More broadly, the National Health Service is working towards its Long Term Plan ambition of diagnosing 75% of stageable cancers at stage 1 and 2 by 2028. Achieving this will mean that an additional 55,000 people each year will survive their cancer for at least five years after diagnosis. To support early diagnosis, the Government has invested £2.3 billion into community diagnostic centres across England which are speeding up diagnosis for cancer, with checks and scans being delivered at 160 sites across England. Cancer is also one of six major conditions included in our upcoming Major Conditions Strategy.

With progress made on reducing waiting times, cancer is being diagnosed at an earlier stage more often, with survival rates improving across almost all types of cancer.

NHS England has implemented non symptom specific pathways (NSS) for patients who present with non-specific symptoms or combinations thereof that can indicate several different cancers. This includes leukaemia, which can present non-specific symptoms, such as unexpected weight loss and night sweats. As of December 2023, there are 113 NSS pathways already live, an increase from 12 live Rapid Diagnostic Centre pathways in March 2020, with over 5,500 patients seen per month and a total of over 100,000 referrals since May 2020.

Raising awareness, delivering more research, and improving early diagnosis of cancers, which includes blood related cancers such as leukaemia, are crucial for improving survival rates and are key priorities for the Government.

NHS England is taking steps to raise awareness of all cancers, including leukaemia, to improve early diagnosis. In January 2024, NHS England relaunched their ‘Help Us Help You’ cancer awareness campaign, designed to increase earlier diagnosis of cancer by encouraging people to come forward with suspected signs of cancers. The campaign aims to reduce barriers to seeking earlier help, as well as to increase body awareness and knowledge of key red flag symptoms. This relaunch follows NHS England’s launch of their original ‘Help Us Help You’ campaigns in April 2020, a major public information campaign to persuade the public to seek urgent care and treatment when they needed it.

Delivering more research is key to understanding the causes of cancers and increasing survival rates of all cancers, including leukaemia, further. That is why investment in research and innovation is a priority for the Government. Our world-leading scientists and clinicians are driving the discovery, development, and testing of new treatments. The Department invested almost £122 million into cancer research in 2022/23 via the National Institute for Health and Care Research. In addition, alongside Cancer Research UK, health departments across the United Kingdom are jointly funding a network of Experimental Cancer Medicine Centres (ECMCs), collectively investing more than £35 million between 2017 and 2022. The network of 17 adult and 12 paediatric ECMCs enhances the existing bench-to-bedside pathway by supporting the most promising innovations from the academic and industry sectors into the cancer medicines of tomorrow.

More broadly, the National Health Service is working towards its Long Term Plan ambition of diagnosing 75% of stageable cancers at stage 1 and 2 by 2028. Achieving this will mean that an additional 55,000 people each year will survive their cancer for at least five years after diagnosis. To support early diagnosis, the Government has invested £2.3 billion into community diagnostic centres across England which are speeding up diagnosis for cancer, with checks and scans being delivered at 160 sites across England. Cancer is also one of six major conditions included in our upcoming Major Conditions Strategy.

With progress made on reducing waiting times, cancer is being diagnosed at an earlier stage more often, with survival rates improving across almost all types of cancer.

For the Faster Diagnostic Standard (FDS), data regarding leukaemia and its sub-types is collected using the following two categories: suspected acute leukaemia; and suspected haematological malignancies, excluding acute leukaemia. The latter category includes non-acute leukaemia when there is a suspicion. These statistics are published monthly and are available on the NHS Cancer Waiting Times website, in an online only format. Performance against the FDS for suspected acute leukaemia in March 2024 was at 74.1%. Performance against the FDS for suspected haematological malignancies, excluding acute leukaemia, in March 2024 was at 56.8%.

For the 31- and 62-day referral to treatment combined standards, data is collected at an International Classification of Diseases 10 (ICD-10) level, and NHS England publishes data as an aggregation of these reports, to manage the risk of disclosure. Data regarding leukaemia and its sub-types is reported under cancer type ‘Haematological – Other (a)’. These are ICD-10 codes that are haematological, excluding lymphoma, and this aggregation includes ICD-10 codes C91.0 to C96.9, which includes all leukaemia codes. Further information on the ICD-10 classification is available on the NHS England website, in an online only format.

According to NHS England, the 31-day referral to treatment performance for acute leukaemia, testicular, and children’s cancer is no longer published as a separate category, due to the low numbers of patients seen with these cancers. These patients continue to be included within the numerator and denominator of the 31-day and 62-day all cancer National Statistics, published by NHS England.

For the Faster Diagnostic Standard (FDS), data regarding leukaemia and its sub-types is collected using the following two categories: suspected acute leukaemia; and suspected haematological malignancies, excluding acute leukaemia. The latter category includes non-acute leukaemia when there is a suspicion. These statistics are published monthly and are available on the NHS Cancer Waiting Times website, in an online only format. Performance against the FDS for suspected acute leukaemia in March 2024 was at 74.1%. Performance against the FDS for suspected haematological malignancies, excluding acute leukaemia, in March 2024 was at 56.8%.

For the 31- and 62-day referral to treatment combined standards, data is collected at an International Classification of Diseases 10 (ICD-10) level, and NHS England publishes data as an aggregation of these reports, to manage the risk of disclosure. Data regarding leukaemia and its sub-types is reported under cancer type ‘Haematological – Other (a)’. These are ICD-10 codes that are haematological, excluding lymphoma, and this aggregation includes ICD-10 codes C91.0 to C96.9, which includes all leukaemia codes. Further information on the ICD-10 classification is available on the NHS England website, in an online only format.

According to NHS England, the 31-day referral to treatment performance for acute leukaemia, testicular, and children’s cancer is no longer published as a separate category, due to the low numbers of patients seen with these cancers. These patients continue to be included within the numerator and denominator of the 31-day and 62-day all cancer National Statistics, published by NHS England.

NHS England has implemented non symptom specific pathways (NSS) for patients who present with non-specific symptoms or combinations thereof that can indicate several different cancers. This includes leukaemia, which can present non-specific symptoms, such as unexpected weight loss and night sweats. As of December 2023, there are 113 NSS pathways already live, an increase from 12 live Rapid Diagnostic Centre pathways in March 2020, with over 5,500 patients seen per month and a total of over 100,000 referrals since May 2020.

Raising awareness, delivering more research, and improving early diagnosis of cancers, which includes blood related cancers such as leukaemia, are crucial for improving survival rates and are key priorities for the Government.

NHS England is taking steps to raise awareness of all cancers, including leukaemia, to improve early diagnosis. In January 2024, NHS England relaunched their ‘Help Us Help You’ cancer awareness campaign, designed to increase earlier diagnosis of cancer by encouraging people to come forward with suspected signs of cancers. The campaign aims to reduce barriers to seeking earlier help, as well as to increase body awareness and knowledge of key red flag symptoms. This relaunch follows NHS England’s launch of their original ‘Help Us Help You’ campaigns in April 2020, a major public information campaign to persuade the public to seek urgent care and treatment when they needed it.

Delivering more research is key to understanding the causes of cancers and increasing survival rates of all cancers, including leukaemia, further. That is why investment in research and innovation is a priority for the Government. Our world-leading scientists and clinicians are driving the discovery, development, and testing of new treatments. The Department invested almost £122 million into cancer research in 2022/23 via the National Institute for Health and Care Research. In addition, alongside Cancer Research UK, health departments across the United Kingdom are jointly funding a network of Experimental Cancer Medicine Centres (ECMCs), collectively investing more than £35 million between 2017 and 2022. The network of 17 adult and 12 paediatric ECMCs enhances the existing bench-to-bedside pathway by supporting the most promising innovations from the academic and industry sectors into the cancer medicines of tomorrow.

More broadly, the National Health Service is working towards its Long Term Plan ambition of diagnosing 75% of stageable cancers at stage 1 and 2 by 2028. Achieving this will mean that an additional 55,000 people each year will survive their cancer for at least five years after diagnosis. To support early diagnosis, the Government has invested £2.3 billion into community diagnostic centres across England which are speeding up diagnosis for cancer, with checks and scans being delivered at 160 sites across England. Cancer is also one of six major conditions included in our upcoming Major Conditions Strategy.

With progress made on reducing waiting times, cancer is being diagnosed at an earlier stage more often, with survival rates improving across almost all types of cancer.

I thank the noble Baroness for that question. The Government have made a policy decision on the eligibility of a potential respiratory syncytial virus programme, which is in line with the JCVI’s comments made in September 2023. We are working through the full business case, with costings and operational delivery, for final agreement in line with an autumn start. It is agreed by the Government that any potential RSV programme and its sidelines will be announced in the summer.

Reducing inequalities and improving breast cancer outcomes for ethnic minority women is a priority for the Government. To support this work, NHS England has commissioned six new cancer clinical audits, which will provide timely evidence for cancer service providers of where patterns of care in England may vary, increase the consistency of access to treatments, and help stimulate improvements in cancer treatments and outcomes for patients, including for breast cancer. The Royal College of Surgeons began work on this audit in October 2022, and the first outcomes are expected in September 2024.

NHS England is also leading a programme of work to tackle healthcare inequalities centred around five clear priorities, which are set out in the operational planning guidance for the health system. The Core20PLUS5 approach proactively targets groups that are less likely to engage with services in the most deprived quintile of the population, along with ethnic minority communities and inclusion health groups, across five clinical areas which includes early cancer diagnosis, specifically screening and early referral.

The issue of improving equality monitoring, by reference to ethnicity and the other eight protected characteristics, is being considered at a national level under the programme called the Unified Information Standard for Protected Characteristics (UISPC). Evaluating the use of the 2021 ethnicity census categories is part of this programme. The UISPC Publication Steering Group is reporting to NHS England and the Department this year, which will inform a view on the next steps, including any plans for publication and consultation, and an implementation timetable. Preparatory work has been undertaken by NHS England that would facilitate the introduction of the 2021 ethnicity codes, should a decision be made to adopt the 2021 ethnicity census codes, or to implement an alternative approach to ethnicity, if recommended.

NHS England’s operational planning guidance recognises the importance of improving the quality of data for patient characteristics. This is one of the five strategic priorities in their drive to reduce healthcare inequalities, as improved data quality will help to reveal health inequalities and inform action to address them. NHS England has therefore asked systems to continue to improve the collection and recording of ethnicity data across primary care, outpatients, accident and emergency, mental health, community services, and specialised commissioning.

NHS England’s National Disease Registration Service (NDRS) collects ethnicity data for all cancer patients through a variety of routine, national data feeds, including the Cancer Outcomes and Services Dataset, Hospital Episode Statistics data, and Patient Administration System data. The NDRS publishes key performance indicator data on the national registration statistics for England. The latest published indicator data, for invasive cancer cases excluding non-melanoma skin cancers, diagnosed in 2020, shows that ethnicity data is complete for 94.9% of cases.

Reducing inequalities and improving breast cancer outcomes for ethnic minority women is a priority for the Government. To support this work, NHS England has commissioned six new cancer clinical audits, which will provide timely evidence for cancer service providers of where patterns of care in England may vary, increase the consistency of access to treatments, and help stimulate improvements in cancer treatments and outcomes for patients, including for breast cancer. The Royal College of Surgeons began work on this audit in October 2022, and the first outcomes are expected in September 2024.

NHS England is also leading a programme of work to tackle healthcare inequalities centred around five clear priorities, which are set out in the operational planning guidance for the health system. The Core20PLUS5 approach proactively targets groups that are less likely to engage with services in the most deprived quintile of the population, along with ethnic minority communities and inclusion health groups, across five clinical areas which includes early cancer diagnosis, specifically screening and early referral.

The issue of improving equality monitoring, by reference to ethnicity and the other eight protected characteristics, is being considered at a national level under the programme called the Unified Information Standard for Protected Characteristics (UISPC). Evaluating the use of the 2021 ethnicity census categories is part of this programme. The UISPC Publication Steering Group is reporting to NHS England and the Department this year, which will inform a view on the next steps, including any plans for publication and consultation, and an implementation timetable. Preparatory work has been undertaken by NHS England that would facilitate the introduction of the 2021 ethnicity codes, should a decision be made to adopt the 2021 ethnicity census codes, or to implement an alternative approach to ethnicity, if recommended.

NHS England’s operational planning guidance recognises the importance of improving the quality of data for patient characteristics. This is one of the five strategic priorities in their drive to reduce healthcare inequalities, as improved data quality will help to reveal health inequalities and inform action to address them. NHS England has therefore asked systems to continue to improve the collection and recording of ethnicity data across primary care, outpatients, accident and emergency, mental health, community services, and specialised commissioning.

NHS England’s National Disease Registration Service (NDRS) collects ethnicity data for all cancer patients through a variety of routine, national data feeds, including the Cancer Outcomes and Services Dataset, Hospital Episode Statistics data, and Patient Administration System data. The NDRS publishes key performance indicator data on the national registration statistics for England. The latest published indicator data, for invasive cancer cases excluding non-melanoma skin cancers, diagnosed in 2020, shows that ethnicity data is complete for 94.9% of cases.

My Lords, the low uptake of vaccines is typically driven by barriers pertaining to confidence, convenience and complacency. The NHS continues to collaborate with local and regional leaders to deliver tailored communication and flexible vaccination sites and to raise awareness of the benefits of vaccination. The Covid-19 vaccination programme showed that using facilities and services that have familiar and trusted staff, established transport links and convenient access can be highly effective and can inspire trust and confidence in the communities of which they are part. We are also learning lessons from the Covid vaccine programme about the power of real-time specific data to improve uptake, as well as looking at system changes for delivery to make getting vaccinated easier for all, particularly those 10% of the population to which the noble Baroness referred.

My Lords, data published by the UK Health Security Agency shows provisionally that whooping cough cases are continuing to rise, with 2,793 cases in England between January and March 2024. Tragically, there have also been five infant deaths in England in this period, and our deepest sympathies are with those families. We are urging pregnant women to protect their baby by getting vaccinated and encouraging parents to ensure that young infants receive their vaccinations at the correct time.

The estimated figures show a reduction of 20% in neural tube defects with the introduction of folic acid into flour, but clearly that needs to be monitored—and from day one it will

be monitored. That data will be collected and updated; it is very important that, for this to be successful, we need to know that there is a 20% reduction. That amounts to about 200 babies per year. Systems are in place to monitor the success—I hope—of this process.

The whole point of the government strategy with introducing this data is to improve the connectivity, similar to what the noble Lord was referring to, between GPs and primary care, and indeed into those ICBs and the trusts throughout the country. I totally agree with the noble Baroness on doing it sooner rather than later, but the Government are moving at pace, and this strategy will transform patient outcomes throughout the United Kingdom.

Private medical insurers do not provide care or treatment. However, they do purchase services from independent sector providers who are responsible for delivering healthcare. All providers of healthcare undertaking regulated activities, as defined in Schedule 1 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, are regulated by the Care Quality Commission, and follow a set of fundamental standards of safety and quality, while the health and care regulators are responsible for regulating health and care professionals.

Regulations 9 and 12 of the 2014 regulations set out the importance of person-centred care, and safe care and treatment. These regulations have the intention of ensuring that people using a service have care or treatment that is personalised specifically for them, preventing people from receiving unsafe care and treatment, and thereby precluding avoidable harm or risk of harm.

It has to make sense to take more measures that are easy for people, including maybe less skilled people, to operate. Funnily enough, I was talking just today to the head of Moderna about how it is packing syringes, or has planned to for vaccinations going forward, rather than vials, to take that step out of the process. The easier we can make it, the better.

I thank the noble Baroness. All Members of the House, when we had a good Question on the take-up of Covid vaccines, agreed that information supporting the take-up is a vital health message to get across. To any detractors, I say very firmly that it is not the view of the Government, and I know that it is not the view of nearly all noble Lords.

We are aware of the issues faced by some people with physical or mental health conditions that can make attending a screening appointment, or carrying out a home test, more difficult. Currently, national screening IT systems do not have the facilities to flag conditions for individuals which could make it more difficult to carry out the bowel cancer screening, fecal immunochemical test (FIT) at home. It is therefore recommended that individuals contact their general practice (GP) in these situations, so that GPs can work with the screening provider to arrange further support. For example, carrying out a FIT test at the GP or at home, with the support of a family member or community nurse.

NHS England has started work to improve its national screening IT systems through the Digital Transformation of Screening programme. This will enable screening providers to flag heath issues that may make carrying out a FIT test at home more difficult, and to offer any appropriate support.

The national IT system for the NHS Bowel Cancer Screening Programme does not routinely collect data that could identify groups that have a lower-than-average uptake rate of the fecal immunochemical bowel cancer screening test.

Research has found that groups which are less likely to take part in bowel screening include men, people from ethnic minority backgrounds, and people in more deprived areas. Physical or mental health conditions can also make carrying out a home test more difficult.

NHS England has started work to improve its national screening IT systems through the Digital Transformation of Screening programme. This will enable screening providers to record protected characteristics, to more accurately identify groups with the lowest uptake, and target initiatives to improve uptake.

The Government is determined that all insurers, including private medical insurers, treat consumers fairly and firms are required to do so under the Financial Conduct Authority’s rules.

The FCA requires insurers to ensure their products offer fair value, meaning the price a consumer pays for a product or service must be reasonable compared to the overall benefits they can expect to receive. The FCA has been clear that it will be monitoring firms to make sure they comply with this rule and will take action where necessary.

All providers of healthcare are regulated by the Care Quality Commission and follow a set of fundamental standards of safety and quality below which care should never fall, while the General Medical Council is responsible for regulating doctors in the United Kingdom.

We recognise that the NHS Practitioner Health service is valued by many doctors. NHS England is reviewing the service as part of a wider review of its mental health and wellbeing offer to National Health Service staff. It was confirmed on 15 April 2024 that the service will continue to accept new patients from primary and secondary care whilst this review is undertaken over the next 12 months. NHS England will assess the impact and confirm future arrangements once the review has been completed.