The Government and NHS England recognise the importance of genomic testing to support more personalised treatment for cancer patients, including those with breast cancer. While decisions on specific treatment pathways, including the use of chemotherapy for breast cancer, are made by clinicians based on individual patient circumstances and the latest clinical evidence and guidance, genomic testing is increasingly being used to inform those decisions where appropriate.

As set out in the National Cancer Plan, genomic testing is being expanded across the National Health Service so that every patient who would benefit receives testing within a clinically relevant timeframe. The plan also commits to further embedding genomic testing as a routine and timely part of treatment planning. This will support more precise clinical decision-making and ensure that patients benefit from advances in personalised medicine as the evidence base continues to develop.

The NHS Genomic Medicine Service, delivered through a national network of Genomic Laboratory Hubs and guided by the National Genomic Test Directory, already provides access to a wide range of genomic tests for over 200 cancer indications. These tests are used to inform diagnosis and treatment planning across cancer pathways. The Test Directory sets out the eligibility criteria for patients to access testing as well as the genomic targets to be tested and the method that should be used. This includes a range of testing for breast cancer that can inform treatment decisions.

The UK has played a leading role on Neglected Tropical Diseases (NTDs) and remains committed to tackling today's key global health challenges within the framework of a modern development partnership approach. The UK continues to invest in NTD research, including £3 million support to the Coalition for Operational Research on NTDs (COR-NTD) for research on Female Genital Schistosomiasis. We are also proud to provide up to £15 million to support the Eliminating Lymphatic Filariasis in Africa (ELFA) programme as part of the World Health Organisation 2030 NTD Road Map to prevent, control and eliminate NTDs by 2030. Announcements on future Official Development Assistance budgets will be made in due course.

The Government recognises that patients with a cancer diagnosis can have specific dental needs. Free National Health Service dental care is available to people who meet the following criteria:

- under 18 years old, or under 19 years old and in full-time education;

- pregnant or have had a baby in the previous 12 months;

- being treated in an NHS hospital and the treatment is carried out by the hospital dentist, although patients may have to pay for any dentures or bridges; and

- receiving low-income benefits, or under 20 years old and a dependant of someone receiving low-income benefits.

Support is also available through the NHS Low Income Scheme for those patients who are not eligible for exemption or full remission of dental patient charges. In 2023/24, 49% of NHS dentistry courses of treatment were delivered to children and adults exempt from paying patient charges. While there are no current plans to extend the list of people eligible for free NHS dental care, the Government is working across the system to ensure that patients who have a diagnosis of cancer receive timely, safe and effective dental care. Further information is available at the following link:

https://www.nhs.uk/nhs-services/dentists/who-is-entitled-to-free-nhs-dental-treatment-in-england/

Research is crucial in tackling brain cancer, which is why the Department spends £1.5 billion each year on research through its research delivery arm, the National Institute for Health and Care Research (NIHR), with cancer as one of the largest areas of investment, at over £121.8 million in 2022/23, reflecting its high priority.

The NIHR welcomes funding applications for research into any aspect of human health, including clinical trials for brain cancer treatments. Applications are subject to peer review and judged in open competition, with awards being made on the basis of the importance of the topic to patients and health and care services, value for money, and scientific quality.

The Department aims to ensure that all patients, including those with brain tumours, have access to cutting-edge clinical research and innovative, lifesaving treatments. In order to maximise our potential to be a world leader and develop a more competitive, efficient, and accessible clinical research system, the Department is committed to rapidly implementing recommendations from the Lord O'Shaughnessy independent review of commercial clinical trials, and going further in our support for the forthcoming 10-Year Health Plan.

NHS England and integrated care boards (ICBs) have responsibility for the commissioning of healthcare services which respond to population health needs including in relation to the treatment of cancer. Therefore, any decisions on commissioning chemosaturation would be a decision for NHS England and the relevant ICB, not for the Department. NHS England and ICBs are guided by the recommendations made by the National Institute for Healthcare Excellence.

NHS England has set a target for systems to increase cancer treatment capacity by 13%, with the aim of further reducing cancer waiting lists. The latest statistics for February 2023 show that 98.04% of National Health Service patients have received their subsequent chemotherapy treatment within 31 days, against a target of 98%.

There is no limit on the distance that would be required for someone to receive cancer treatment. Specialised services are not available in every local hospital because they have to be delivered by specialist teams of health professionals who have the necessary skills, experience and access to equipment and medicines.

Patient-specific requirements are based on what each individual could manage and cope with and would be discussed between the patient and clinician. Patients travelling for cancer treatment via NHS Patient Transport Services (PTS) are exempt from any eligibility checks both on medical and mobility grounds and are automatically deemed PTS eligible for both the inbound and outbound journeys as frequently as these are required.

Following a review of its diagnostics guidance on tumour profiling tests to guide adjuvant chemotherapy decisions in early breast cancer [DG34], the National Institute for Health and Care Excellence (NICE) has confirmed that an update of its guidance on tumour profiling tests to guide adjuvant chemotherapy decisions in early breast cancer [DG34] is in the very early stages of development.

Further information will be made available on NICE’s website as development of the updated guidance progresses.

Following a review of its diagnostics guidance on tumour profiling tests to guide adjuvant chemotherapy decisions in early breast cancer [DG34], the National Institute for Health and Care Excellence (NICE) has confirmed that an update of its guidance on tumour profiling tests to guide adjuvant chemotherapy decisions in early breast cancer [DG34] is in the very early stages of development.

Further information will be made available on NICE’s website as development of the updated guidance progresses.

No assessment has been made.

Radiotherapy services are currently provided to patients living in the York area at Castle Hill Hospital in Cottingham, East Yorkshire or at the Leeds Cancer Centre.

Chemotherapy services are provided by York and Scarborough Teaching Hospitals NHS Foundation Trust at York and Scarborough hospitals and at a mobile chemotherapy unit, which is funded by York Against Cancer.

Specialised services are not available in every local hospital because they have to be delivered by specialist teams of health professionals who have the necessary skills, experience and access to equipment and medicines.

This information is not collected in the format requested. NHS England has allocated specific funding to support treatment and pandemic recovery, including £2.3 billion to improve diagnostic care, and £1.5 billion through the Targeted Investment Fund to support the wider elective recovery plan.

The National Institute for Health and Care Excellence (NICE) is actively considering options for its diagnostics guidance on tumour profiling tests to guide adjuvant chemotherapy decisions in early breast cancer. A number of technologies are recommended in the current guidance, provided data is collected to reduce uncertainties in the evidence base.

In line with its published process and methods, NICE routinely monitors for new information, such as changes to the evidence base, assessing its likely effect on current recommendations. NICE will only undertake a formal review to determine if an update to the guidance review if this is indicated by its monitoring activities.

The National Institute for Health and Care Excellence (NICE) is actively considering options for its diagnostics guidance on tumour profiling tests to guide adjuvant chemotherapy decisions in early breast cancer. A number of technologies are recommended in the current guidance, provided data is collected to reduce uncertainties in the evidence base.

In line with its published process and methods, NICE routinely monitors for new information, such as changes to the evidence base, assessing its likely effect on current recommendations. NICE will only undertake a formal review to determine if an update to the guidance review if this is indicated by its monitoring activities.

All National Health Service (NHS) Trusts delivering chemotherapy services have the flexibility to put in place out of hospital chemotherapy services – this assessment should be made locally, in conjunction with the wider healthcare system, and should take account of population health needs as well as workforce capacity and overall delivery of the chemotherapy service.

Decisions about out of hospital chemotherapy delivery should be taken by Trusts and their health system partners. However, as part of pandemic recovery, the NHS is seeking to retain the beneficial changes that were introduced during the pandemic, this could include virtual consultations and home delivery of oral medications.

Whilst no formal assessment of funding models has taken place, strengthening system integration and place-based commissioning is an essential component of pandemic recovery. The NHS is planning to continue the transition to system-based financial allocations and enabling local systems to make decisions about payment models that best serve their population’s health needs. Where out of hospital chemotherapy is seen as a priority, local systems will be able to incentivise this.

All National Health Service (NHS) Trusts delivering chemotherapy services have the flexibility to put in place out of hospital chemotherapy services – this assessment should be made locally, in conjunction with the wider healthcare system, and should take account of population health needs as well as workforce capacity and overall delivery of the chemotherapy service.

Decisions about out of hospital chemotherapy delivery should be taken by Trusts and their health system partners. However, as part of pandemic recovery, the NHS is seeking to retain the beneficial changes that were introduced during the pandemic, this could include virtual consultations and home delivery of oral medications.

Whilst no formal assessment of funding models has taken place, strengthening system integration and place-based commissioning is an essential component of pandemic recovery. The NHS is planning to continue the transition to system-based financial allocations and enabling local systems to make decisions about payment models that best serve their population’s health needs. Where out of hospital chemotherapy is seen as a priority, local systems will be able to incentivise this.

All National Health Service (NHS) Trusts delivering chemotherapy services have the flexibility to put in place out of hospital chemotherapy services – this assessment should be made locally, in conjunction with the wider healthcare system, and should take account of population health needs as well as workforce capacity and overall delivery of the chemotherapy service.

Decisions about out of hospital chemotherapy delivery should be taken by Trusts and their health system partners. However, as part of pandemic recovery, the NHS is seeking to retain the beneficial changes that were introduced during the pandemic, this could include virtual consultations and home delivery of oral medications.

Whilst no formal assessment of funding models has taken place, strengthening system integration and place-based commissioning is an essential component of pandemic recovery. The NHS is planning to continue the transition to system-based financial allocations and enabling local systems to make decisions about payment models that best serve their population’s health needs. Where out of hospital chemotherapy is seen as a priority, local systems will be able to incentivise this.

The differential level of spending between different services and treatments is a feature of cost and volume. Levels of spending on chemotherapy is due to greater activity, drug, staff, equipment and facility costs.

However, significant investment has been made in radiotherapy, including £32 million to replace 17 Linear Accelerators aged over 10 years by the end of March 2022. Progress ontinues to be made in the range and availability of innovative radiotherapy, where the evidence base supports it through NHS England and NHS Improvement’s clinical commissioning policy process.

Specialist clinical nursing workforce working in chemotherapy and palliative care are post-registration qualifications. It is the responsibility of individual employers to ensure that they have the staff available to provide clinical services. NHS England and NHS Improvement are developing a programme in 2022 to assess the palliative workforce, training, and support requirements of health care systems in England.

The Spending Review in 2020 provided £260 million to continue to support commitments made in the NHS Long Term Plan, of which £52 million was provided to Health Education England (HEE) to invest in the cancer and diagnostics workforce. In 2021/22 HEE has provided 105 training grants to National Health Service trusts in England for existing and aspiring chemotherapy nurses to enable them to undertake further training and education.

Over the next three years, £36 billion will be invested in the health and care system to ensure it has the appropriate long term resources. Allocations and profiles will be confirmed as part of the up-coming Spending Review, which will set out the Government’s spending plans including investment in the NHS workforce.