NHS England advises that there is not a strong evidence base for the benefits of hydrotherapy for people with learning disabilities. As part of their duties under the Care Act 2014, local authorities are expected to ensure high quality services that put the wellbeing of people who draw on care at the centre of decisions and ensure positive outcomes. It is the role of local authorities to facilitate the personalisation of care and support services and encourage a variety of services for their population, such as community support options.

As set out in NHS England’s Planning Guidance, integrated care boards (ICBs) are expected to work with local system colleagues to ensure that there is high quality and accessible community infrastructure in place for people with a learning disability and autistic people. The guidance is available at the following link:

https://www.england.nhs.uk/publication/2025-26-priorities-and-operational-planning-guidance/

ICBs are expected to assign an executive lead role for learning disability and autism to support planning to meet the needs of people with a learning disability and autistic people.

I have no plans to direct the National Institute for Health and Care Excellence (NICE) to assess hydrotherapy treatments, and it would not be appropriate for ministers to circumvent the NICE’s established process for prioritising topics for guidance development.

When developing its guidelines, the NICE considers all the available evidence within the scope of the topic under consideration. Where good quality evidence supports the use of a therapy as clinically and cost effective, the NICE’s independent committee may recommend it for use in the National Health Service.

Hydrotherapy is already recommended as a form of rehabilitation therapy following nerve injury in the NICE’s Rehabilitation after traumatic injury 2022 guideline. It is also recommended in the 2017 guideline Spondyloarthritis in over 16s: diagnosis and management, as an adjunctive therapy to manage pain and maintain or improve function for people with axial spondyloarthritis.

Health services are commissioned locally by integrated care boards, which are best placed to make decisions regarding the provision of health services, including hydrotherapy, to their local population, subject to local prioritisation and funding.

Health services are commissioned locally by integrated care boards, which are best placed to make decisions regarding the provision of health services, including hydrotherapy for people living with long-term neurological conditions, to their local population, subject to local prioritisation and funding. These commissioning arrangements apply in England only given that health is a devolved issue.

The department does not collect data on the availability of hydrotherapy. Local authorities are statutorily required to keep the provision for children and young people with special educational needs and disabilities under review, including its sufficiency. Local authorities work with parents, young people, and providers to achieve this. Keeping this provision under review would include the availability of specialist facilities such as hydrotherapy provision.

Berkshire West Clinical Commissioning Group (CCG) ran a 12-week public consultation in 2020 to seek views on the future provision of hydrotherapy services in Berkshire West. At present, the CCG no longer routinely commissions the service. However, specialist hydrotherapy services will remain available via an Individual Funding Request (IFR) in certain clinical circumstances.

The IFR process will ensure that when patients, who may have a long-term condition, musculoskeletal condition, recovering from COVID-19 or in post-injury rehabilitation, would benefit from a particular treatment that is not usually funded by the National Health Service, their consultant is able to apply for funding for this treatment. In this case, a consultant or physiotherapist at the Royal Berkshire Hospital will determine if the patient would clinically benefit from hydrotherapy and make an application on their behalf.

Berkshire West Clinical Commissioning Group (CCG) ran a 12-week public consultation to seek views on the future provision of hydrotherapy services in Berkshire West. At present, the CCG no longer routinely commission the service. However, specialist hydrotherapy services will remain available via an Individual Funding Request for certain clinical circumstances.

A search of the Department’s Ministerial correspondence database has not identified any such correspondence.

NHS England continues to work with Muscular Dystrophy UK through the Bridging the Gap Project, which aims to ensure people with neuromuscular conditions, along with their families, play a leading role in the development and commissioning of the services they use.

NHS England commissions some services for patients with neuromuscular conditions nationally as part of its remit to deliver specialised neurological services. However, the majority of services are provided outside of specialised centres and are the responsibility of clinical commissioning groups to provide, should they deem it clinically appropriate. This includes services such as hydrotherapy.

In 2012 Muscular Dystrophy UK, working with the Department’s National Institute for Health Research (NIHR) issued a call for research proposals into the clinical effectiveness of hydrotherapy in maintaining physical function in people with Duchenne muscular dystrophy (DMD). The call was made because there is little evidence to support the use of hydrotherapy in relation to DMD and other neuromuscular disorders. The NIHR Health Technology Appraisal programme is now funding a pilot study to look at hydrotherapy for the treatment of DMD, with an evaluation report expected in January 2017.

The provision of National Health Service hydrotherapy services is a local matter. NHS England’s neurosciences services specification sets out what providers must have in place to offer evidence-based, safe and effective services, including for patients with muscular dystrophy. Specialised neuromuscular care may include referral to local physiotherapy, hydrotherapy or rehabilitation if appropriate, however the commissioning of hydrotherapy services is a matter for clinical commissioning groups.

The specification can be found at the following link:

www.england.nhs.uk/wp-content/uploads/2013/06/d04-neurosci-spec-neuro.pdf.

NHS England is responsible for commissioning specialised neurological services, which includes services for patients with neuromuscular disorders. NHS England has published a service specification for neurological care, which sets out what providers must have in place to offer evidence-based, safe and effective services. The specification can be found at the following link:

www.england.nhs.uk/wp-content/uploads/2013/06/d04-neurosci-spec-neuro.pdf

Specialised neuromuscular care may include referral to local physiotherapy, hydrotherapy or rehabilitation if appropriate, however the commissioning of hydrotherapy services is a matter for local clinical commissioning groups. There are no plans to conduct a national review of hydrotherapy provision.

NHS England is responsible for commissioning specialised neurological services, which includes services for patients with neuromuscular disorders. NHS England has published a service specification for neurological care, which sets out what providers must have in place to offer evidence-based, safe and effective services. The specification can be found at the following link:

www.england.nhs.uk/wp-content/uploads/2013/06/d04-neurosci-spec-neuro.pdf

Specialised neuromuscular care may include referral to local physiotherapy, hydrotherapy or rehabilitation if appropriate, however the commissioning of hydrotherapy services is a matter for local clinical commissioning groups. There are no plans to conduct a national review of hydrotherapy provision.

Since 1 April 2013, NHS England has been responsible for commissioning specialised neurological services, which includes services for patients with neuromuscular disorders. NHS England has published a service specification for neurological care, which sets out what providers must have in place to offer evidence-based, safe and effective services. The specification can be found at the following link:

www.england.nhs.uk/wp-content/uploads/2013/06/d04-neurosci-spec-neuro.pdf

Specialised neuromuscular care may include referral to local or specialised physiotherapy, hydrotherapy or rehabilitation if appropriate. Provision of hydrotherapy services is a matter for the local National Health Service and may be accessed by patients with neuromuscular and other long-term debilitating conditions, subject to assessment and referral.

Neuromuscular patients may also be referred for enabling equipment such as wheelchairs adaptations and environmental controls in line with their clinical commissioning group or specialist rehabilitation referral criteria, subject to the complexity of need.

NHS England is currently undertaking a review of wheelchair services, led by Rosamond Roughton, National Director of Commissioning Development, which will consider provision across both specialised and non-specialised wheelchairs.

NHS England has set up strategic clinical networks (SCNs) for neurological conditions to provide clinical expertise and guidance. Alongside SCNs, Operational Delivery Networks (ODNs) are working with commissioners, providers and patients to ensure the delivery of safe and effective services across the patient pathway and help secure the best outcomes for all people with neurological conditions. Providers are at liberty to set up an ODN for neuromuscular services if they consider it would benefit service provision locally.