The Government recognises the vital contribution made by unpaid carers, including those in Harpenden and Berkhamsted, and is committed to supporting carers to balance their caring responsibilities with employment and education.

The Department has not made a specific assessment of the adequacy of funding and support for unpaid carers in Harpenden and Berkhamsted. Under the Care Act 2014, local authorities have a duty to assess carers’ needs and, where eligible needs are identified, to provide support to help carers maintain their wellbeing, including participation in work, education and training.

The Government is reviewing the implementation of carer’s leave and looking at where any improvements may be needed to ensure that employment rights for unpaid carers are fit for the modern world of work. This includes a public consultation on employment rights for unpaid carers and parents of seriously ill children, which was launched on 9 June 2026. More information on the consultation is available at the following link:

https://www.gov.uk/government/consultations/make-work-pay-employment-rights-for-unpaid-carers-and-parents-of-seriously-ill-children

In addition, we have raised the Carer’s Allowance weekly earnings limit in April 2025, and it increased again to £204 net earnings a week for 2026/27.

The Government is also making approximately £4.6 billion of additional funding available for adult social care in 2028/29 compared to 2025/26, to support the sector in making improvements. Local areas determine how the money is best used to support carers, depending on local need and with reference to their statutory responsibilities.

Hospices, as independent organisations, are free to develop and adapt their own terms and conditions of employment, including pay scales and, therefore, it is for them to determine what is affordable within the financial model they operate and how to recoup any additional costs they face if they choose to utilise the terms and conditions of NHS staff on the Agenda for Change contract.

NHS England uprates national allocations in line with the pay rises for integrated care boards (ICBs). It is down to the local contractual arrangements whether this includes the increases for pay rises or not, which will help to determine what the hospice can afford. So, there is no single model which is consistent across England.

Additional funding for 2026/27 Pay Review Body awards will be provided to reflect the final pay award through an increase to ICB allocations and NHS Payment Scheme prices. Full guidance will be available in due course.

Hospices, as independent organisations, are free to develop and adapt their own terms and conditions of employment, including pay scales and, therefore, it is for them to determine what is affordable within the financial model they operate and how to recoup any additional costs they face if they choose to utilise the terms and conditions of NHS staff on the Agenda for Change contract.

NHS England uprates national allocations in line with the pay rises for integrated care boards (ICBs). It is down to the local contractual arrangements whether this includes the increases for pay rises or not, which will help to determine what the hospice can afford. So, there is no single model which is consistent across England.

Additional funding for 2026/27 Pay Review Body awards will be provided to reflect the final pay award through an increase to ICB allocations and NHS Payment Scheme prices. Full guidance will be available in due course.

We are pleased to have now published an interim update on Modern Service Framework (MSF) for Palliative Care and End-of-Life Care in England, detailing the progress to date. The interim update was published via a Written Ministerial Statement, alongside an annex containing further information for interested parties, and importantly, the National Director for Primary Care and Community Services at NHS England is writing to systems setting out actions that can begin ahead of the full publication of the MSF in Autumn 2026. The Written Ministerial Statement is available at the following link:

https://questions-statements.parliament.uk/written-statements/detail/2026-06-04/hcws88

Whilst the majority of palliative care and end-of-life care is provided by National Health Service staff and services, we recognise the vital part that voluntary sector organisations, including hospices, also play in providing support to people at the end of life and their loved ones.

The MSF will embed palliative care and end-of-life care within a strategic commissioning model that is centred on clear and transparent contractual arrangements for commissioned palliative care activity across all providers, including hospices, to meet population health needs, with explicit regard to reducing inequalities and improving outcomes for underserved and disadvantaged groups. NHS England is working closely with integrated care boards (ICBs) to support this process and, as detailed in the interim update, we are asking ICBs to move to sustainable contracting of adult, and children and young people’s, hospice services based on their integrated needs assessment. Initially, this will involve a move away from short-term grant funding for adult hospice services from 2027/28.

Whilst no specific assessment of the adequacy of statutory funding for hospices has been made, in February, NHS England wrote to all ICBs requesting an update on the financial stability of hospices in their footprint and the steps being taken to mitigate risks, as a matter of urgency. We are repeating this exercise, by asking ICBs and independent hospices, via Hospice UK, for an up-to-date assessment on their financial situation, risks, and mitigations.

In respect of guaranteeing equitable provision of hospice care, due to the way the hospice movement organically grew, hospice locations were largely not planned with a view to providing even access across the country or to prioritise areas of greatest need based on demographics. Therefore, there are inequalities in access to hospice services, especially for those living in rural or socio-economically deprived areas. However, the Government agrees that palliative care and end-of-life care must be provided equitably, through a range of professionals and providers, both generalist and specialist, across the NHS, social care, and voluntary sector organisations, including hospices.

We are pleased to have now published an interim update on Modern Service Framework (MSF) for Palliative Care and End-of-Life Care in England, detailing the progress to date. The interim update was published via a Written Ministerial Statement, alongside an annex containing further information for interested parties, and importantly, the National Director for Primary Care and Community Services at NHS England is writing to systems setting out actions that can begin ahead of the full publication of the MSF in Autumn 2026. The Written Ministerial Statement is available at the following link:

https://questions-statements.parliament.uk/written-statements/detail/2026-06-04/hcws88

Whilst the majority of palliative care and end-of-life care is provided by National Health Service staff and services, we recognise the vital part that voluntary sector organisations, including hospices, also play in providing support to people at the end of life and their loved ones.

The MSF will embed palliative care and end-of-life care within a strategic commissioning model that is centred on clear and transparent contractual arrangements for commissioned palliative care activity across all providers, including hospices, to meet population health needs, with explicit regard to reducing inequalities and improving outcomes for underserved and disadvantaged groups. NHS England is working closely with integrated care boards (ICBs) to support this process and, as detailed in the interim update, we are asking ICBs to move to sustainable contracting of adult, and children and young people’s, hospice services based on their integrated needs assessment. Initially, this will involve a move away from short-term grant funding for adult hospice services from 2027/28.

Whilst no specific assessment of the adequacy of statutory funding for hospices has been made, in February, NHS England wrote to all ICBs requesting an update on the financial stability of hospices in their footprint and the steps being taken to mitigate risks, as a matter of urgency. We are repeating this exercise, by asking ICBs and independent hospices, via Hospice UK, for an up-to-date assessment on their financial situation, risks, and mitigations.

In respect of guaranteeing equitable provision of hospice care, due to the way the hospice movement organically grew, hospice locations were largely not planned with a view to providing even access across the country or to prioritise areas of greatest need based on demographics. Therefore, there are inequalities in access to hospice services, especially for those living in rural or socio-economically deprived areas. However, the Government agrees that palliative care and end-of-life care must be provided equitably, through a range of professionals and providers, both generalist and specialist, across the NHS, social care, and voluntary sector organisations, including hospices.

We are pleased to have now published an interim update on Modern Service Framework (MSF) for Palliative Care and End-of-Life Care in England, detailing the progress to date. The interim update was published via a Written Ministerial Statement, alongside an annex containing further information for interested parties, and importantly, the National Director for Primary Care and Community Services at NHS England is writing to systems setting out actions that can begin ahead of the full publication of the MSF in Autumn 2026. The Written Ministerial Statement is available at the following link:

https://questions-statements.parliament.uk/written-statements/detail/2026-06-04/hcws88

Whilst the majority of palliative care and end-of-life care is provided by National Health Service staff and services, we recognise the vital part that voluntary sector organisations, including hospices, also play in providing support to people at the end of life and their loved ones.

The MSF will embed palliative care and end-of-life care within a strategic commissioning model that is centred on clear and transparent contractual arrangements for commissioned palliative care activity across all providers, including hospices, to meet population health needs, with explicit regard to reducing inequalities and improving outcomes for underserved and disadvantaged groups. NHS England is working closely with integrated care boards (ICBs) to support this process and, as detailed in the interim update, we are asking ICBs to move to sustainable contracting of adult, and children and young people’s, hospice services based on their integrated needs assessment. Initially, this will involve a move away from short-term grant funding for adult hospice services from 2027/28.

Whilst no specific assessment of the adequacy of statutory funding for hospices has been made, in February, NHS England wrote to all ICBs requesting an update on the financial stability of hospices in their footprint and the steps being taken to mitigate risks, as a matter of urgency. We are repeating this exercise, by asking ICBs and independent hospices, via Hospice UK, for an up-to-date assessment on their financial situation, risks, and mitigations.

In respect of guaranteeing equitable provision of hospice care, due to the way the hospice movement organically grew, hospice locations were largely not planned with a view to providing even access across the country or to prioritise areas of greatest need based on demographics. Therefore, there are inequalities in access to hospice services, especially for those living in rural or socio-economically deprived areas. However, the Government agrees that palliative care and end-of-life care must be provided equitably, through a range of professionals and providers, both generalist and specialist, across the NHS, social care, and voluntary sector organisations, including hospices.

The Department reviewed the price concession process as part of the 2022/23 and 2023/24 Community Pharmacy Contractual Framework Funding. This review resulted in the implementation of several improvements including:

• no discount deducted on products granted a concessionary price;

• the introduction of a ‘roll-over mechanism’ so concessionary prices granted after a certain date can be rolled over into the following month; and

• the introduction of a ‘retrospective top-up payment for concessionary prices’, which provides an additional payment to contractors when the medicine margin survey indicates that despite a concessionary price, there was a significant under payment.

The Department works closely with Community Pharmacy England (CPE), the representative body for community pharmacies in England, to ensure that we set fair and timely concessionary prices. CPE can submit requests for concessionary prices at any point during the month to the Department for consideration. The Department aims to agree and publish concessionary prices as swiftly as possible, however, the process of getting updated market data from suppliers and considering each price with CPE can take time. Concessionary price requests submitted by CPE later in the month or even re-requested once granted at the end of the month, may have final prices released towards the end of the month or early in the following month.

The Government recognises the vital role of unpaid carers supporting family members living with dementia, including in Harpenden and Berkhamsted, and is committed to ensuring they receive the support they need.

Under the Care Act 2014, unpaid carers are entitled to a carer’s assessment from their local authority to determine their support needs. Local authorities are responsible for providing a wide range of sustainable, high-quality care and support services, including respite care, peer support, and advice services for unpaid carers.

Through measures in the 10-Year Health Plan which we published in July last year, we are improving support for carers by making them more visible in the health system, strengthening their voice in care planning, joining up services, and streamlining caring responsibilities through a new ‘MyCarer’ section in the NHS App. The Government also increased the Carer’s Allowance weekly earnings limit to £204 net earnings per week for 2026/27.

On dementia specifically, we will deliver the first ever Modern Service Framework for Frailty and Dementia, to improve support for people living with dementia and their carers. Following an interim product in September, the full framework is expected by the end of the year. People with lived experience, carers, and families will be central to the development of the modern service framework.

The Department is also preparing a cross-Government action plan for unpaid carers, to improve how unpaid carers are recognised by those around them, how support is offered, and how they can be helped to reach their own personal potential and live fulfilling lives.

Government responsibility for delivering dementia research is shared between the Department for Health and Social Care, with research delivered by the National Institute for Health and Care Research (NIHR), and the Department for Science, Innovation and Technology, with research delivered via UK Research and Innovation (UKRI).

The Department for Health and Social Care is committed to ensuring that all patients, including those with dementia, have access to cutting-edge clinical trials and innovative, lifesaving treatments. Government funding is already enabling the dementia clinical trials landscape to become more efficient and accessible.

The Dame Barbara Windsor Dementia Goals programme, with up to £150 million expected to be allocated to, or aligned with it, aims to speed up the development of new treatments for dementia and neurodegenerative conditions by accelerating innovations in biomarkers, clinical trials, and implementation.

Closely aligned to the programme, the NIHR has invested up to £50 million into the UK Demetia Trials Network (UKDTN). UKDTN aims to expand the United Kingdom’s early phase clinical trial capabilities in dementia by addressing industry challenges around trial recruitment and fragmented research infrastructure. The UKDTN will establish a coordinated network of over 20 trial sites, with a real-time database to enable efficient identification of trial sites for industry collaboration. The network will also build a skilled workforce of dementia trial specialists, including early-career researchers, and embedded research nurses to support trial set-up and delivery.

In addition, the Medical Research Council’s £20 million investment into a Dementia Trials Accelerator aims to embed more innovation in how clinical trials are designed and delivered in order to increase the speed and quality, while driving down the cost of large-scale trials.

In partnership with Alzheimer’s Society, Alzheimer’s Research UK, and Alzheimer Scotland, the NIHR also delivers Join Dementia Research, an online platform which enables the involvement of people with and without a dementia diagnosis, as well as carers, to take part in a range of important research, including studies evaluating potential treatments for dementia. As of March 2026, over 110,000 participants have joined dementia research through the service, with 112 studies currently open.

Government responsibility for delivering dementia research is shared between the Department for Health and Social Care, with research delivered by the National Institute for Health and Care Research (NIHR), and the Department for Science, Innovation and Technology, with research delivered via UK Research and Innovation (UKRI).

The Department for Health and Social Care is committed to ensuring that all patients, including those with dementia, have access to cutting-edge clinical trials and innovative, lifesaving treatments. Government funding is already enabling the dementia clinical trials landscape to become more efficient and accessible.

The Dame Barbara Windsor Dementia Goals programme, with up to £150 million expected to be allocated to, or aligned with it, aims to speed up the development of new treatments for dementia and neurodegenerative conditions by accelerating innovations in biomarkers, clinical trials, and implementation.

Closely aligned to the programme, the NIHR has invested up to £50 million into the UK Demetia Trials Network (UKDTN). UKDTN aims to expand the United Kingdom’s early phase clinical trial capabilities in dementia by addressing industry challenges around trial recruitment and fragmented research infrastructure. The UKDTN will establish a coordinated network of over 20 trial sites, with a real-time database to enable efficient identification of trial sites for industry collaboration. The network will also build a skilled workforce of dementia trial specialists, including early-career researchers, and embedded research nurses to support trial set-up and delivery.

In addition, the Medical Research Council’s £20 million investment into a Dementia Trials Accelerator aims to embed more innovation in how clinical trials are designed and delivered in order to increase the speed and quality, while driving down the cost of large-scale trials.

In partnership with Alzheimer’s Society, Alzheimer’s Research UK, and Alzheimer Scotland, the NIHR also delivers Join Dementia Research, an online platform which enables the involvement of people with and without a dementia diagnosis, as well as carers, to take part in a range of important research, including studies evaluating potential treatments for dementia. As of March 2026, over 110,000 participants have joined dementia research through the service, with 112 studies currently open.

The Modern Service Framework for Frailty and Dementia will reduce unwarranted variation and narrow inequality in diagnosis and care for those living with dementia. It will set national standards and redirect National Health Service priorities to provide the best care and support.

Central to this modern service framework will be improved care and support and access to a timely and accurate diagnosis.

We are still developing plans for the Modern Service Framework for Frailty and Dementia and, in doing so, we are engaging with a wide group of partners to understand what should be included to ensure the best outcomes for people living with dementia.

As part of this exercise, we are considering all options to help reduce variation, including reviewing existing guidance and pathways. This will include the D100: Pathway Assessment Tool and the Dementia Care Pathway, covering all elements of the Well Pathway from Prevention through to Dying Well.

We are working to develop the content as soon as possible and we will keep partners updated on progress and timings as this work unfolds.

The Government is guided by the UK National Screening Committee (UK NSC), an independent scientific advisory committee which makes its recommendations based on internationally recognised criteria and a rigorous evidence review and consultation process. It is only where the UK NSC is confident that to screen would provide more good than harm that a screening programme is recommended, as all medical interventions carry an inherent risk.

A review by the UK NSC of the evidence in 2019 of supplementary ultrasound for women with dense breasts and negative mammograms showed insufficient evidence to balance the risks, benefits, and costs. In the field, there are concerns that undertaking notification of increased density without provision of any modification of screening may increase inequity and capacity issues, as well as leading to increased anxiety and confusion.

The UK NSC is considering the best approach for women with dense breast tissue. It reviewed the evidence relating to the provision of additional breast screening for women who have dense breast tissue and invited stakeholders’ feedback on the findings to inform future work. The consultation closed in August 2025. Further work is needed to understand the clinical impact and costs of adding breast density to the screening pathways in the United Kingdom.

In the meantime, the Breast Screening Risk Adaptive Imaging for Density (BRAID) trial is looking into the use of supplementary imaging techniques for women within the standard breast screening programme who are found to have radiographically dense breast tissue. The different tests include magnetic resonance imaging and ultrasound. The UK NSC is in contact with the researchers and is reviewing this evidence as it becomes available. It will make recommendations to ministers in light of this.

The NHS Breast Screening Programme advises all women, as part of its literature, that cancer may be missed and that breast symptoms should be reported even if they have recently had a negative screening mammogram.

We recognise the importance of a timely diagnosis and remain committed to increasing diagnosis rates and ensuring people can access any treatment licensed or recommended by the National Institute for Health and Care Excellence, and support they need.

We will deliver the first ever Modern Service Framework for Frailty and Dementia to deliver rapid and significant improvements in quality of care and productivity. This will be informed by phase one of the independent commission into adult social care, which is expected this year.

As part of this exercise, we are considering all options to help reduce variation, including reviewing metrics and targets.

Community pharmacy, general practice and National Health Service dental surgeries all play a vital role in delivering our Neighbourhood Health Service offer for communities across the country. They are treated differently in relation to business rates because GP practices and most NHS dental services have their premises costs reimbursed under NHS contracts, whereas community pharmacies are treated as retail businesses and do not have a comparable, automatic reimbursement mechanism for business rates.

That difference in this treatment is rooted in how each service is commissioned, contracted, and classified. Community pharmacy have been afforded support through the business rates relief for retail, hospitality or leisure which is not provided for general practice or dental surgeries. From 2026, this relief is being replaced by two lower business rates multipliers for properties with a rateable value below £500,000.

Integrated care boards (ICBs) are responsible for commissioning palliative care services to meet the reasonable needs of their population, which can include hospice services available within the ICB catchment. To support ICBs in this duty, NHS England has published statutory guidance and a service specification.

The Government is developing a Palliative Care and End-of-Life Care Modern Service Framework (MSF) for England. The MSF will drive improvements in the services that patients and their families receive at the end of life and will enable ICBs to address challenges in access, quality, and sustainability through the delivery of high-quality, personalised care.

Through our MSF, we will closely monitor the shift towards the strategic commissioning of palliative care and end-of-life care services to ensure that services reduce variation in access and quality. We will consider contracting and commissioning arrangements as part of our MSF. We recognise that there is currently a mix of contracting models in the hospice sector. By supporting ICBs to commission more strategically, we can move away from grant and block contract models. In the long term, this will aid sustainability and help hospices’ ability to plan ahead.

The recently published Strategic Commissioning Framework and Medium-Term Planning Guidance also make clear the expectations that ICBs should understand current and projected total service utilisation and costs for those at the end of life, creating an overall plan to more effectively meet these needs through neighbourhood health.

Hospices provide both core and specialist palliative care. Whilst acknowledging that not everyone will need specialist palliative care, we must ensure is that there is equitable and timely access to these services, whether they are provided by hospices or the National Health Service.

While no specific assessment has been made of the cost of changes in the levels of funding to hospices on the wider healthcare system, as part of our 10-Year Health Plan, the Government will shift the focus of healthcare out of the hospital and into the community. We recognise that it is vital to include palliative care and end-of-life care, including hospices, in this shift.

Integrated care boards (ICBs) are responsible for commissioning palliative care services to meet the reasonable needs of their population, which can include hospice services available within the ICB catchment. To support ICBs in this duty, NHS England has published statutory guidance and a service specification.

The Government is developing a Palliative Care and End-of-Life Care Modern Service Framework (MSF) for England. The MSF will drive improvements in the services that patients and their families receive at the end of life and will enable ICBs to address challenges in access, quality, and sustainability through the delivery of high-quality, personalised care.

Through our MSF, we will closely monitor the shift towards the strategic commissioning of palliative care and end-of-life care services to ensure that services reduce variation in access and quality. We will consider contracting and commissioning arrangements as part of our MSF. We recognise that there is currently a mix of contracting models in the hospice sector. By supporting ICBs to commission more strategically, we can move away from grant and block contract models. In the long term, this will aid sustainability and help hospices’ ability to plan ahead.

The recently published Strategic Commissioning Framework and Medium-Term Planning Guidance also make clear the expectations that ICBs should understand current and projected total service utilisation and costs for those at the end of life, creating an overall plan to more effectively meet these needs through neighbourhood health.

Hospices provide both core and specialist palliative care. Whilst acknowledging that not everyone will need specialist palliative care, we must ensure is that there is equitable and timely access to these services, whether they are provided by hospices or the National Health Service.

While no specific assessment has been made of the cost of changes in the levels of funding to hospices on the wider healthcare system, as part of our 10-Year Health Plan, the Government will shift the focus of healthcare out of the hospital and into the community. We recognise that it is vital to include palliative care and end-of-life care, including hospices, in this shift.

Under the Care Act 2014, local authorities have the duty to shape their care market and to commission a range of high-quality, sustainable, and person-centred care and support services to meet the diverse needs of all local people. This includes encouraging a wide range of service provision to ensure that people, including those with sight loss, have a choice of appropriate services and equipment that maximises independence.

Although the Care Quality Commission (CQC) is not currently required to assess vision rehabilitation services, as regulated activities under the Health and Social Care Act 2008, sensory services, including vision rehabilitation, do form part of CQC’s overall assessment of local authorities’ delivery of adult social care.

CQC assessments identify local authorities’ strengths and areas for development, in their delivery of their duties under part 1 of the Care Act. This facilitates the sharing of good practice and helps us to target support where it is most needed. It may be helpful to know that the CQC will report on sensory services when there is something important to highlight, for example, something being done well, innovative practice, or an area for improvement.

Integrated care boards (ICBs) are responsible for the commissioning of palliative care and end of life care services, to meet the needs of their local populations. To support ICBs, including the NHS Hertfordshire and West Essex ICB, which covers the Harpenden and Berkhamsted constituency, in this duty, NHS England has published statutory guidance and service specifications. NHS England has also developed a palliative care and end of life care dashboard, which brings together all relevant local data in one place.

Whilst the majority of palliative care and end of life care is provided by National Health Service staff and services, we recognise the vital part that voluntary sector organisations also play.

The amount of funding charitable hospices receive varies by ICB area, and will, in part, be dependent on the breadth of palliative care, including specialist palliative care, and end of life care provision within each ICB catchment area. It is important to note that hospices, like the NHS, provide both specialist and generalist palliative care and end of life care. Not all patients will require specialist palliative care. 

The Department and NHS England are currently looking at how to improve the access, quality, and sustainability of all-age palliative care and end of life care in line with the 10- Year Health Plan.

Additionally, we are supporting the hospice sector with a £100 million capital funding boost for eligible adult and children’s hospices in England to ensure they have the best physical environment for care.

We are also providing £26 million in revenue funding to support children and young people’s hospices for 2025/26. I am pleased to confirm the continuation of circa £26 million, adjusted for inflation, for the next three financial years, 2026/27 to 2028/29 inclusive, to be distributed again via ICBs. This amounts to approximately £80 million over the next three years.

Integrated care boards (ICBs) are responsible for the commissioning of palliative care and end of life care services, to meet the needs of their local populations. To support ICBs, including the NHS Hertfordshire and West Essex ICB, which covers the Harpenden and Berkhamsted constituency, in this duty, NHS England has published statutory guidance and service specifications. NHS England has also developed a palliative care and end of life care dashboard, which brings together all relevant local data in one place.

Whilst the majority of palliative care and end of life care is provided by National Health Service staff and services, we recognise the vital part that voluntary sector organisations also play.

The amount of funding charitable hospices receive varies by ICB area, and will, in part, be dependent on the breadth of palliative care, including specialist palliative care, and end of life care provision within each ICB catchment area. It is important to note that hospices, like the NHS, provide both specialist and generalist palliative care and end of life care. Not all patients will require specialist palliative care. 

The Department and NHS England are currently looking at how to improve the access, quality, and sustainability of all-age palliative care and end of life care in line with the 10- Year Health Plan.

Additionally, we are supporting the hospice sector with a £100 million capital funding boost for eligible adult and children’s hospices in England to ensure they have the best physical environment for care.

We are also providing £26 million in revenue funding to support children and young people’s hospices for 2025/26. I am pleased to confirm the continuation of circa £26 million, adjusted for inflation, for the next three financial years, 2026/27 to 2028/29 inclusive, to be distributed again via ICBs. This amounts to approximately £80 million over the next three years.