Advice and Guidance (A&G) is not, and has not been, mandated for use prior to a formal referral. Practices are expected to use A&G to support clinical decision making in relation to a planned care referral where clinically appropriate, alongside sending traditional referrals and following locally agreed referral pathways, and this reflects longstanding practice.

A&G supports clinical decision making, does not override it, and does not remove the clinician’s decision to refer when referral is in the patient’s best interests.

We continue to support clinicians through guidance, pathway design, and local governance arrangements to ensure specialist triage models such as A&G are used safely, proportionately, and in a way that preserves clear clinical accountability, including for those with complex, chronic, or rare conditions.

Escalation routes for concerns about A&G request outcomes will continue to operate through locally agreed referral pathways and communication processes for general practitioners and patients, supported by improvements to the NHS electronic Referral System. Where patients have concerns regarding outcomes, local patient advice and liaison service teams can provide advice and support.

Each National Health Service provider is responsible for the procurement and operation of appointment booking systems, as well as communication with patients about their appointments. National guidance expects trusts to use the Digital Technology Assessment Criteria (DTAC) when buying and implementing digital health tech. DTAC covers standards, policies, and best practice for clinical safety, data protection, technical security, interoperability, usability and accessibility.

Data is not held in the format requested.

The monitoring of National Health Service patient correspondence, including appointment letters, is the responsibility of individual NHS providers. Data is not held centrally on the whether appointment letters are received prior to an appointment taking place. No assessment has been made of the adequacy of mail deliveries of NHS correspondence to patients.

The Government’s focus on shifting from analogue to digital will streamline information and communication processes, including by improving the NHS App. This will make it easier and quicker for patients to access information about their appointments, to cancel and reschedule appointments, and to receive correspondence on NHS test results. 96% of acute trusts in England now allow patients to view appointment information via the NHS App if they wish, reducing reliance on physical letters. Usage has increased significantly, with the App now supporting approximately eight million patient–trust interactions per month, an increase of 82% compared to a year ago. It also saves staff time to focus on providing high quality, non-digital communication for those who want and need it.

It has not proved possible to respond to the hon. Member in the time available before Prorogation.

It is not Government policy for referrals to secondary care to be rejected. General practitioners (GPs) are encouraged to seek specialist advice ahead of making a referral where it is clinically appropriate to do so. Patients benefit from earlier specialist input and are more likely to receive the right care in the right place, first time.

A GP’s right to refer is unchanged. If a patient needs a hospital referral, they will get one.

The Department does not hold data in the format requested.

The Department has made no formal estimate of the cost of missed appointments in Warwickshire or nationally.

However, we’re clear that reducing missed appointments is an important part of improving elective care and making best use of National Health Service capacity to cut waiting times. The Government has committed, in the Elective Reform Plan, to focussed action to reduce missed appointments, including enhancing two-way communication between hospitals and patients, and to use artificial intelligence to predict who will miss appointments, to save up to one million missed appointments. NHS England continues to support the validation of waiting lists, as part of the Government's plans for a more productive and improved approach to elective care which is better for patients. Effective validation helps trusts to understand the true size of their waiting list for better planning and can help avoid missed appointments to reduce overall waiting times.

Locally, trusts are also using data‑led approaches to prioritise proactive appointment reminders, making greater use of the NHS App and patient portals, and targeting specialties with higher non‑attendance rates through outpatient improvement work.

The monitoring of National Health Service patient correspondence, including appointment letters, is the responsibility of individual NHS providers. Data is not held centrally on the reasons why an appointment is registered as a ‘did not attend’. This includes whether appointments have been missed specifically because a letter has not been received by the patient. Data is also not held on the number of patient samples sent via Royal Mail that have been rendered unusable due to late arrival at laboratories in each of the last five years. Therefore, no estimate has been made of the number of NHS appointments missed as a result of delays in the delivery of appointment letters by Royal Mail in the last 12 months, nor of the cost of repeat appointments, sample kits, and additional clinical activity caused by postal delays. No assessment has been made of the potential impact of routine cases becoming urgent as a result of appointment letters being delayed in the post. No assessment has been made of the potential impact of postal delays on the timely delivery of referral letters between primary and secondary care. No guidance has been issued to NHS trusts and general practices on the use of alternative communication methods in areas affected by Royal Mail delays.

The Government’s focus on shifting from ‘analogue to digital’ will streamline information and communication processes, including by improving the NHS App. This will make it easier and quicker for patients to access information about their appointments, to cancel and reschedule appointments and to receive correspondence on NHS test results. 96% of acute trusts in England now allow patients to view appointment information via the NHS App if they wish, reducing reliance on physical letters. Usage has increased significantly, with the App now supporting approximately eight million patient–trust interactions per month, an increase of 82% compared to a year ago. It also saves staff time to focus on providing high quality, non-digital communication for those who want and need it.

No assessment has been made of the potential impact of postal delays on patients who rely on written communication from the National Health Service, including older people, disabled people, and patients without access to digital services.

The NHS is shifting patient communications to a digital‑first model, with the NHS App becoming the primary channel for patient messaging. This modernised approach aims to reach patients quickly and conveniently, putting messages in a single place, and helping to reduce reliance on traditional posted letters.

However, the digital‑first model does not mean digital‑only, as accessible formats like braille, easy read, and traditional letters will continue where appropriate to meet individual patient needs. Where patients are to continue receiving written communication, it remains important that these are received in a timely manner.

The monitoring of National Health Service patient correspondence, including appointment letters, is the responsibility of individual NHS providers. Data is not held centrally on the reasons why an appointment is registered as a ‘did not attend’. This includes whether appointments have been missed specifically because a letter has not been received by the patient. Data is also not held on the number of patient samples sent via Royal Mail that have been rendered unusable due to late arrival at laboratories in each of the last five years. Therefore, no estimate has been made of the number of NHS appointments missed as a result of delays in the delivery of appointment letters by Royal Mail in the last 12 months, nor of the cost of repeat appointments, sample kits, and additional clinical activity caused by postal delays. No assessment has been made of the potential impact of routine cases becoming urgent as a result of appointment letters being delayed in the post. No assessment has been made of the potential impact of postal delays on the timely delivery of referral letters between primary and secondary care. No guidance has been issued to NHS trusts and general practices on the use of alternative communication methods in areas affected by Royal Mail delays.

The Government’s focus on shifting from ‘analogue to digital’ will streamline information and communication processes, including by improving the NHS App. This will make it easier and quicker for patients to access information about their appointments, to cancel and reschedule appointments and to receive correspondence on NHS test results. 96% of acute trusts in England now allow patients to view appointment information via the NHS App if they wish, reducing reliance on physical letters. Usage has increased significantly, with the App now supporting approximately eight million patient–trust interactions per month, an increase of 82% compared to a year ago. It also saves staff time to focus on providing high quality, non-digital communication for those who want and need it.

The monitoring of National Health Service patient correspondence, including appointment letters, is the responsibility of individual NHS providers. Data is not held centrally on the reasons why an appointment is registered as a ‘did not attend’. This includes whether appointments have been missed specifically because a letter has not been received by the patient. Data is also not held on the number of patient samples sent via Royal Mail that have been rendered unusable due to late arrival at laboratories in each of the last five years. Therefore, no estimate has been made of the number of NHS appointments missed as a result of delays in the delivery of appointment letters by Royal Mail in the last 12 months, nor of the cost of repeat appointments, sample kits, and additional clinical activity caused by postal delays. No assessment has been made of the potential impact of routine cases becoming urgent as a result of appointment letters being delayed in the post. No assessment has been made of the potential impact of postal delays on the timely delivery of referral letters between primary and secondary care. No guidance has been issued to NHS trusts and general practices on the use of alternative communication methods in areas affected by Royal Mail delays.

The Government’s focus on shifting from ‘analogue to digital’ will streamline information and communication processes, including by improving the NHS App. This will make it easier and quicker for patients to access information about their appointments, to cancel and reschedule appointments and to receive correspondence on NHS test results. 96% of acute trusts in England now allow patients to view appointment information via the NHS App if they wish, reducing reliance on physical letters. Usage has increased significantly, with the App now supporting approximately eight million patient–trust interactions per month, an increase of 82% compared to a year ago. It also saves staff time to focus on providing high quality, non-digital communication for those who want and need it.

The monitoring of National Health Service patient correspondence, including appointment letters, is the responsibility of individual NHS providers. Data is not held centrally on the reasons why an appointment is registered as a ‘did not attend’. This includes whether appointments have been missed specifically because a letter has not been received by the patient. Data is also not held on the number of patient samples sent via Royal Mail that have been rendered unusable due to late arrival at laboratories in each of the last five years. Therefore, no estimate has been made of the number of NHS appointments missed as a result of delays in the delivery of appointment letters by Royal Mail in the last 12 months, nor of the cost of repeat appointments, sample kits, and additional clinical activity caused by postal delays. No assessment has been made of the potential impact of routine cases becoming urgent as a result of appointment letters being delayed in the post. No assessment has been made of the potential impact of postal delays on the timely delivery of referral letters between primary and secondary care. No guidance has been issued to NHS trusts and general practices on the use of alternative communication methods in areas affected by Royal Mail delays.

The Government’s focus on shifting from ‘analogue to digital’ will streamline information and communication processes, including by improving the NHS App. This will make it easier and quicker for patients to access information about their appointments, to cancel and reschedule appointments and to receive correspondence on NHS test results. 96% of acute trusts in England now allow patients to view appointment information via the NHS App if they wish, reducing reliance on physical letters. Usage has increased significantly, with the App now supporting approximately eight million patient–trust interactions per month, an increase of 82% compared to a year ago. It also saves staff time to focus on providing high quality, non-digital communication for those who want and need it.

The monitoring of National Health Service patient correspondence, including appointment letters, is the responsibility of individual NHS providers. Data is not held centrally on the reasons why an appointment is registered as a ‘did not attend’. This includes whether appointments have been missed specifically because a letter has not been received by the patient. Data is also not held on the number of patient samples sent via Royal Mail that have been rendered unusable due to late arrival at laboratories in each of the last five years. Therefore, no estimate has been made of the number of NHS appointments missed as a result of delays in the delivery of appointment letters by Royal Mail in the last 12 months, nor of the cost of repeat appointments, sample kits, and additional clinical activity caused by postal delays. No assessment has been made of the potential impact of routine cases becoming urgent as a result of appointment letters being delayed in the post. No assessment has been made of the potential impact of postal delays on the timely delivery of referral letters between primary and secondary care. No guidance has been issued to NHS trusts and general practices on the use of alternative communication methods in areas affected by Royal Mail delays.

The Government’s focus on shifting from ‘analogue to digital’ will streamline information and communication processes, including by improving the NHS App. This will make it easier and quicker for patients to access information about their appointments, to cancel and reschedule appointments and to receive correspondence on NHS test results. 96% of acute trusts in England now allow patients to view appointment information via the NHS App if they wish, reducing reliance on physical letters. Usage has increased significantly, with the App now supporting approximately eight million patient–trust interactions per month, an increase of 82% compared to a year ago. It also saves staff time to focus on providing high quality, non-digital communication for those who want and need it.

The Department does not mandate a single national attendance policy for the National Health Service. Responsibility for workforce attendance management sits with individual NHS organisations who are responsible for setting and applying local attendance policies in line with employment law and good human resources practice.

Instead, NHS England has been engaging with representatives from NHS organisations and staff side partners to develop guidance on Supporting Health and Improving Attendance which will be published later this year. This guidance is intended to strengthen and align local approaches while allowing flexibility to reflect local operational circumstances and the diverse needs of our workforce. Once finalised, guidance will support NHS organisations to improve clarity, fairness, and consistency in attendance management across the service without removing local employer accountability.

Modernisation of outpatient care is a top priority for the Government so that waits for outpatient appointments are shorter and elective pathways are more productive. The majority of people on the waiting list, including for neurology, are waiting for outpatient care. Through our Elective Reform Plan (ERP), we have expanded the Advice and Guidance (A&G) scheme, which helps ensure patients get care in the right place and only see a specialist if it’s really necessary, freeing up capacity in secondary care for those who need it, including certain patients with neurology conditions or symptoms. The ERP also commits to reducing missed appointments and unnecessary follow ups to further free up capacity. This will benefit patients across England, including in North East Hampshire.

The 10-Year Health Plan builds on the ERP with a more sustainable vision for elective care where, by 2035, most outpatient care will happen outside of hospitals. Patients' access to specialists, including neurologists, will be improved by providing this specialist care in the community where possible and increasing digital access to specialists through the NHS App, where it’s more convenient for patients.

The Medium-Term Planning Framework outlines targets for the National Health Service from 2026/27 to 2028/29 to deliver the 10-Year Health Plan’s ambitions. This includes an ask of systems to transform pathways to give patients more control over their follow up care to reduce unnecessary appointments and expand the use of Advice and Guidance from April so that, by October, all requests/referrals across the 10 specialties providers deemed to have the most potential for this model to be effective go via an elective Single Point of Access. This will mean a more efficient approach to triaging patients, where all appropriate requests and referrals, excluding urgent suspect cancer, will flow through a single ‘front door’ to support clinical triage to the most appropriate service or outcome, meaning timelier, more joined up care for patients.

The Department does not centrally hold data on outpatient activity delivered outside hospital settings in Essex.

Approximately 80% of the waiting list is made up of people waiting for outpatient appointments. Modernisation of this important stage of planned care is a top priority for the Government. We have committed, in our Elective Reform Plan and 10-Year Health Plan, to modernise elective pathways to ensure that they are better for patients and more productive. This radical plan will end outpatient care as we know it by 2035.

Face-to-face hospital appointments will become the exception, as two thirds of outpatient appointments will be replaced by digital advice, direct input from specialists, and patient-initiated follow ups as we introduce a new digital front door to the National Health Service via the NHS App by 2035, which is more responsive to patients’ needs. Patients will still have a choice in where they get their care.

We will deliver this vision with a new model for planned care that is digital by default and local where possible, providing rapid access to patient-centred services.

Appointments cancelled by hospitals or other National Health Service authorities do not appear in statistics as completed appointments. For admitted patients, the Department does not hold data on the cause of cancellations or where patients did not attend their operation.

Data on the number of last-minute cancelled operations is published by NHS England. Last minute means on the day the patient was due to arrive, after the patient has arrived in hospital or on the day of the operation or surgery. It does not include cancelled operations before the day of the operation. Data is available by year and quarter and includes the number of cancellations and the percentage these represent of total elective admissions. This is available at the following link, within the ‘Time Series’ report:

https://www.england.nhs.uk/statistics/statistical-work-areas/cancelled-elective-operations/cancelled-ops-data/

For outpatient appointments, data on cancellations and patients that did not attend their appointment is published by NHS England. Data is available by year and includes the number of cancellations, whether these were hospital or patient cancellations, and the percentage these represent of total elective admissions. This is available on the following link, within "Hospital Outpatient Activity, 2024-25: Report Tables":

https://digital.nhs.uk/data-and-information/publications/statistical/hospital-outpatient-activity/2024-25

It is unacceptable that some women have such poor experiences of hysteroscopies.

The National Health Service website page on hysteroscopy was updated in January 2024. This provides information on preparing for and recovering from a hysteroscopy, including pain relief options. The importance of pain relief is reiterated in guidance from both the Royal College of Obstetricians and Gynaecologists, and the College of Sexual and Reproductive Healthcare.

In Shropshire, Telford, and Wrekin all patients receive comprehensive information about the procedure before their appointment, including advice on pain management. Patients can access both local anaesthetic and general anaesthetic for the procedure.

Patients can additionally access local and general anaesthetic and there is a patient advocate always present during the procedure to provide continuous support and aid in pain management.

The Government is committed to prioritising women’s health as we build an NHS fit for the future. Through our 10-Year Health Plan and the renewal of the Women’s Health Strategy we are delivering our commitment that never again will women’s health be neglected.