Written questions by Toale.

What recent assessment she has made of the effectiveness of police forces in the taking of custody photographs of people charged following voluntary police interviews.

Voluntary interviews are used to question a person who is not under arrest about their suspected involvement in a criminal offence, particularly in cases where the legal threshold for arrest is not met. The decision to voluntarily interview a suspect rests with the police and there are a number of factors which must be considered when making this decision including the needs of the investigation, the necessity to arrest, potential vulnerability of the suspect, and any relevant risk factors. Where the statutory conditions for arrest are met, police should always consider whether voluntary interview or arrest would be the most appropriate approach.The Home Office is aware of concerns raised about the use of voluntary attendance and the impact of this on the taking and retention of custody photographs and biometrics. Work is underway to ensure voluntary attendance is used appropriately by the police, especially in relation to sexual offences and options are being considered to increase capture of custody images and biometrics in future.It is important to note that nothing in law or in the relevant statutory codes of practice prevents police from photographing suspects who attend for a voluntary interview, although force may not be used to achieve this while the suspect is not under arrest. The National Police Chiefs’ Council (NPCC) provides guidance to forces on voluntary interviews which makes clear that it is good practice to photograph suspects attending voluntarily, not least because the photograph may be required for further confirmation of identity if the suspect is subsequently required to return to the police station for biometric samples (fingerprints and DNA), to be recorded after charge or conviction.The Home Office collects and publishes data on police custody and voluntary interviews as part of the ‘Police Powers and Procedures’ statistical series, available here: Police powers and procedures England and Wales statistics - GOV.UK However this data set does not include statistics on the number of suspects whose photographs are taken in custody.

How many people have been (a) charged and (b) convicted without a custody photograph being taken in each of the last five years.

Voluntary interviews are used to question a person who is not under arrest about their suspected involvement in a criminal offence, particularly in cases where the legal threshold for arrest is not met. The decision to voluntarily interview a suspect rests with the police and there are a number of factors which must be considered when making this decision including the needs of the investigation, the necessity to arrest, potential vulnerability of the suspect, and any relevant risk factors. Where the statutory conditions for arrest are met, police should always consider whether voluntary interview or arrest would be the most appropriate approach.The Home Office is aware of concerns raised about the use of voluntary attendance and the impact of this on the taking and retention of custody photographs and biometrics. Work is underway to ensure voluntary attendance is used appropriately by the police, especially in relation to sexual offences and options are being considered to increase capture of custody images and biometrics in future.It is important to note that nothing in law or in the relevant statutory codes of practice prevents police from photographing suspects who attend for a voluntary interview, although force may not be used to achieve this while the suspect is not under arrest. The National Police Chiefs’ Council (NPCC) provides guidance to forces on voluntary interviews which makes clear that it is good practice to photograph suspects attending voluntarily, not least because the photograph may be required for further confirmation of identity if the suspect is subsequently required to return to the police station for biometric samples (fingerprints and DNA), to be recorded after charge or conviction.The Home Office collects and publishes data on police custody and voluntary interviews as part of the ‘Police Powers and Procedures’ statistical series, available here: Police powers and procedures England and Wales statistics - GOV.UK However this data set does not include statistics on the number of suspects whose photographs are taken in custody.

How many offenders convicted of sexual offences did not have a custody photograph on police record in each of the last five years.

Voluntary interviews are used to question a person who is not under arrest about their suspected involvement in a criminal offence, particularly in cases where the legal threshold for arrest is not met. The decision to voluntarily interview a suspect rests with the police and there are a number of factors which must be considered when making this decision including the needs of the investigation, the necessity to arrest, potential vulnerability of the suspect, and any relevant risk factors. Where the statutory conditions for arrest are met, police should always consider whether voluntary interview or arrest would be the most appropriate approach.The Home Office is aware of concerns raised about the use of voluntary attendance and the impact of this on the taking and retention of custody photographs and biometrics. Work is underway to ensure voluntary attendance is used appropriately by the police, especially in relation to sexual offences and options are being considered to increase capture of custody images and biometrics in future.It is important to note that nothing in law or in the relevant statutory codes of practice prevents police from photographing suspects who attend for a voluntary interview, although force may not be used to achieve this while the suspect is not under arrest. The National Police Chiefs’ Council (NPCC) provides guidance to forces on voluntary interviews which makes clear that it is good practice to photograph suspects attending voluntarily, not least because the photograph may be required for further confirmation of identity if the suspect is subsequently required to return to the police station for biometric samples (fingerprints and DNA), to be recorded after charge or conviction.The Home Office collects and publishes data on police custody and voluntary interviews as part of the ‘Police Powers and Procedures’ statistical series, available here: Police powers and procedures England and Wales statistics - GOV.UK However this data set does not include statistics on the number of suspects whose photographs are taken in custody.

Whether she has had discussions with the National Police Chiefs’ Council on the practice of taking custody photographs of suspects who attend voluntary police interviews.

Voluntary interviews are used to question a person who is not under arrest about their suspected involvement in a criminal offence, particularly in cases where the legal threshold for arrest is not met. The decision to voluntarily interview a suspect rests with the police and there are a number of factors which must be considered when making this decision including the needs of the investigation, the necessity to arrest, potential vulnerability of the suspect, and any relevant risk factors. Where the statutory conditions for arrest are met, police should always consider whether voluntary interview or arrest would be the most appropriate approach.The Home Office is aware of concerns raised about the use of voluntary attendance and the impact of this on the taking and retention of custody photographs and biometrics. Work is underway to ensure voluntary attendance is used appropriately by the police, especially in relation to sexual offences and options are being considered to increase capture of custody images and biometrics in future.It is important to note that nothing in law or in the relevant statutory codes of practice prevents police from photographing suspects who attend for a voluntary interview, although force may not be used to achieve this while the suspect is not under arrest. The National Police Chiefs’ Council (NPCC) provides guidance to forces on voluntary interviews which makes clear that it is good practice to photograph suspects attending voluntarily, not least because the photograph may be required for further confirmation of identity if the suspect is subsequently required to return to the police station for biometric samples (fingerprints and DNA), to be recorded after charge or conviction.The Home Office collects and publishes data on police custody and voluntary interviews as part of the ‘Police Powers and Procedures’ statistical series, available here: Police powers and procedures England and Wales statistics - GOV.UK However this data set does not include statistics on the number of suspects whose photographs are taken in custody.

What discussions she has had with victims’ groups on the potential impact of convicted offenders remaining unidentified in the public domain due to the absence of custody photographs.

Voluntary interviews are used to question a person who is not under arrest about their suspected involvement in a criminal offence, particularly in cases where the legal threshold for arrest is not met. The decision to voluntarily interview a suspect rests with the police and there are a number of factors which must be considered when making this decision including the needs of the investigation, the necessity to arrest, potential vulnerability of the suspect, and any relevant risk factors. Where the statutory conditions for arrest are met, police should always consider whether voluntary interview or arrest would be the most appropriate approach.The Home Office is aware of concerns raised about the use of voluntary attendance and the impact of this on the taking and retention of custody photographs and biometrics. Work is underway to ensure voluntary attendance is used appropriately by the police, especially in relation to sexual offences and options are being considered to increase capture of custody images and biometrics in future.It is important to note that nothing in law or in the relevant statutory codes of practice prevents police from photographing suspects who attend for a voluntary interview, although force may not be used to achieve this while the suspect is not under arrest. The National Police Chiefs’ Council (NPCC) provides guidance to forces on voluntary interviews which makes clear that it is good practice to photograph suspects attending voluntarily, not least because the photograph may be required for further confirmation of identity if the suspect is subsequently required to return to the police station for biometric samples (fingerprints and DNA), to be recorded after charge or conviction.The Home Office collects and publishes data on police custody and voluntary interviews as part of the ‘Police Powers and Procedures’ statistical series, available here: Police powers and procedures England and Wales statistics - GOV.UK However this data set does not include statistics on the number of suspects whose photographs are taken in custody.

Whether his Department has commissioned research since 2000 into the health outcomes of people exposed to diethylstilbestrol in utero.

The Department invests over £1.6 billion each year on research through its research delivery arm, the National Institute for Health and Care Research (NIHR).While no research has been commissioned into the health outcomes of people exposed to diethylstilbestrol in utero via the NIHR since 2000, the NIHR would welcome high quality funding applications in this area. Further information on the scope of our research funding calls is available on the NIHR website.

What discussions he has had with the (a) UK Health Security Agency and (b) National Institute for Health and Care Research on studies into diethylstilbestrol-related health risks.

Diethylstilbestrol is a synthetic non-steroidal estrogen medication, which does not fall within the UK Health Security Agency’s remit.Decisions on topics for new or updated guidance from the National Institute for Health and Care Excellence (NICE) are considered through an established NICE prioritisation process with decisions overseen by a prioritisation board, chaired by NICE’s Chief Medical Officer.

Whether his Department has considered the potential merits of a screening protocol for people exposed to diethylstilbestrol.

The UK National Screening Committee (UK NSC), which advises the Government on all aspects of screening, has never been asked to consider the evidence for a screening programme for people exposed to diethylstilbestrol in utero.Any individual or organisation can submit a topic to the UK NSC to consider a new screening programme via the UK NSC’s open call. As part of the open call process the committee will discuss whether this falls within its remit or whether it's more aligned with clinical care.Further information about the open call is available at the following link:https://www.gov.uk/government/publications/uk-nsc-annual-call-submitting-a-screening-proposal

Whether his Department plans to fund epidemiological research into the potential impact of diethylstilbestrol exposure on third generation people.

The Department invests over £1.6 billion each year on research through its research delivery arm, the National Institute for Health and Care Research (NIHR).While no research has been commissioned into the health outcomes of people exposed to diethylstilbestrol in utero via the NIHR since 2000, the NIHR would welcome high quality funding applications in this area. Further information on the scope of our research funding calls is available on the NIHR website.

What assessment he has made of the adequacy of NHS screening programmes for the detection of gynaecological cancers linked to diethylstilbestrol exposure.

The NHS Cervical Screening Programme is the only gynaecological screening programme offered by the National Health Service. On its own, it cannot provide comprehensive care to women exposed to diethylstilbestrol (DES) in utero. This is why the NHS Cervical Screening Programme’s guidance advises that local arrangements should be made for the follow up of individuals who have been exposed to DES and who have the stigmata of DES exposure. This is usually via annual colposcopy. The management of abnormal cytology falls outside of the NHS Cervical Screening Programme.

Whether diethylstilbestrol (DES) exposure is referenced in NHS training curricula for (a) obstetrics, (b) gynaecology and (c) general practice.

The standard of training for doctors is the responsibility of the General Medical Council (GMC), who set the outcome standards expected at undergraduate level and approve courses and medical schools to write and teach the curricula content that enables their students to meet the GMC’s outcome standards.The curricula for postgraduate training are set by the Academy of Medical Royal Colleges for foundation training, and by the relevant individual royal colleges and faculties for specialty training. The GMC approves curricula and assessment systems for each training programme.Whilst not all curricula may necessarily highlight a specific condition, they all nevertheless emphasise the skills and approaches a doctor must develop in order to ensure accurate and timely diagnoses and treatment plans for their patients, including for diethylstilbestrol exposure.

Whether women (a) known and (b) suspected to have exposure to diethylstilbestrol in utero are eligible for enhanced cancer screening.

Yes, women who believe they have been exposed to diethylstilbestrol (DES) in utero are eligible for enhanced cancer screening. The NHS Cervical Screening Programme guidance reminds providers that these women are eligible for routine cervical screening and states that local arrangements should be made for the follow up of women who have been exposed to DES and who have the stigmata of DES exposure. This is usually via annual colposcopy.

What guidance is available to clinicians for patients with a family history of diethylstilbestrol exposure.

The Government encourages all women, including those exposed to diethylstilbestrol (DES) in utero, to attend regular cervical screenings which test for human papillomavirus, the cause of most cervical cancers. Women who believe or know that they were exposed to DES in utero may also need regular colposcopy which falls outside the routine screening programme. We recommend that they should speak to their general practitioner about this as local arrangements should be made for the follow up of women who display evidence of DES exposure. Further information regarding individuals exposed to DES is contained within the cervical screening guidance for the National Health Service, at the following link:https://www.gov.uk/government/publications/cervical-screening-programme-and-colposcopy-management/5-screening-and-management-of-immunosuppressed-individualsMy Rt Hon. Friend, the Secretary of State for Health and Social Care, has asked NHS England to work with local cancer alliances to ensure that providers are aware of this existing screening and follow up guidance for individuals exposed to DES, and that those who could benefit from additional screening have access to this.The National Institute for Health and Care Excellence (NICE) is the national body that develops authoritative, evidence-based guidance for the NHS on best practice in the care and treatment of patients with defined conditions. NICE has not issued any guidance on the diagnosis and management of patients potentially exposed to DES and it currently has no plans to do so. Decisions on the development of new topics for NICE guidance are taken by the NICE prioritisation board, chaired by its Chief Medical Officer, in line with its published prioritisation framework.

Whether his Department plans to update NHS clinical reference materials or NICE guidelines to include information on the diagnosis, management, and screening of patients potentially exposed to Diethylstilbestrol.

The National Institute for Health and Care Excellence (NICE) is the national body that develops authoritative, evidence-based guidance for the NHS on best practice in the care and treatment of patients with defined conditions. NICE has not issued any guidance on the diagnosis and management of patients potentially exposed to diethylstilbestrol (DES) and it currently has no plans to do so. Decisions on the development of new topics for NICE guidance are taken by the NICE prioritisation board, chaired by its Chief Medical Officer, in line with its published prioritisation framework. The current advice from the UK Health Security Agency, formerly Public Health England, is that routine cervical screening is appropriate for those who believed they were exposed to DES in utero. Further information on the UK Health Security Agency’s advice is available at the following link: https://www.gov.uk/government/publications/cervical-screening-programme-and-colposcopy-management/5-screening-and-management-of-immunosuppressed-individuals# Participation in the National Breast Screening Programme is also recommended. Pregnant women who know that they were exposed in utero to DES should inform their obstetrician and be aware of the increased risks of ectopic pregnancy and preterm labour.

What assessment his Department has made of the potential impact of diethylstilbestrol exposure on the (a) long-term and (b) intergenerational health of people in the UK.

The Government encourages all women, including those exposed to diethylstilbestrol (DES) in utero, to attend regular cervical screenings which test for human papillomavirus, the cause of most cervical cancers. Women who believe or know that they were exposed to DES in utero may also need regular colposcopy which falls outside the routine screening programme. We recommend that they should speak to their general practitioner about this as local arrangements should be made for the follow up of women who have the stigmata of DES exposure. Further information regarding individuals exposed to DES is contained within the cervical screening guidance for the National Health Service, at the following link:https://www.gov.uk/government/publications/cervical-screening-programme-and-colposcopy-management/5-screening-and-management-of-immunosuppressed-individualsMy Rt Hon. Friend, the Secretary of State for Health and Social Care has asked NHS England to work with local cancer alliances to ensure that providers are aware of this existing screening and follow up guidance for individuals exposed to DES.Furthermore, where appropriate, my Rt Hon. Friend, the Secretary of State for Health and Social Care is considering how the Department may be able to share awareness of this issue with colleagues from across the Government who are responsible for related areas of chemical and environmental health policy, with a view to minimising future public health risks.There are no plans by the Department to undertake an assessment of the potential impact of DES exposure on the long-term or intergenerational health of people in the United Kingdom.The Department invests over £1.6 billion each year on research through its research delivery arm, the National Institute for Health and Care Research (NIHR). While no research has been commissioned into the health outcomes of people exposed to DES in utero, the NIHR would welcome high quality funding applications in this area. Further information on the scope of research funding calls is available on the NIHR website.

What discussions his Department has had with patient advocacy groups representing people affected by diethylstilbestrol exposure.

We recognise the consequences for those who were exposed to diethylstilbestrol (DES) and offer our sincere sympathies to those who continue to be affected.There have been no discussions between the Department and patient advocacy groups representing people affected by exposure to DES. However, we will consider what more can be done to improve the situation for these individuals.The Department has not assessed the feasibility of using historic medical records to identify and contact people who may have been exposed to DES. In the 1970’s, medicines vigilance was only in its infancy and there were no electronic records or systematic monitoring of prescriptions. There has been a step change in reporting and record-keeping since this time, and today’s regulatory frameworks are significantly different with much stricter post-authorisation monitoring, allowing for earlier identification and action on emerging safety issues. The Medicines and Healthcare products Regulatory Agency regulates medicines supplied in the United Kingdom and its activity spans the whole of a medicine’s lifecycle.

What assessment his Department has made of the potential third-generation health impacts of Diethylstilbestrol exposure; and whether specific research has been commissioned to examine those impacts on fertility, pregnancy outcomes, and cancer risk.

The Government encourages all women, including those exposed to diethylstilbestrol (DES) in utero, to attend regular cervical screenings which test for human papillomavirus, the cause of most cervical cancers. Women who believe or know that they were exposed to DES in utero may also need regular colposcopy which falls outside the routine screening programme. We recommend that they should speak to their general practitioner about this as local arrangements should be made for the follow up of women who have the stigmata of DES exposure. Further information regarding individuals exposed to DES is contained within the cervical screening guidance for the National Health Service, at the following link:https://www.gov.uk/government/publications/cervical-screening-programme-and-colposcopy-management/5-screening-and-management-of-immunosuppressed-individualsMy Rt Hon. Friend, the Secretary of State for Health and Social Care has asked NHS England to work with local cancer alliances to ensure that providers are aware of this existing screening and follow up guidance for individuals exposed to DES.Furthermore, where appropriate, my Rt Hon. Friend, the Secretary of State for Health and Social Care is considering how the Department may be able to share awareness of this issue with colleagues from across the Government who are responsible for related areas of chemical and environmental health policy, with a view to minimising future public health risks.There are no plans by the Department to undertake an assessment of the potential impact of DES exposure on the long-term or intergenerational health of people in the United Kingdom.The Department invests over £1.6 billion each year on research through its research delivery arm, the National Institute for Health and Care Research (NIHR). While no research has been commissioned into the health outcomes of people exposed to DES in utero, the NIHR would welcome high quality funding applications in this area. Further information on the scope of research funding calls is available on the NIHR website.

If his Department will make an assessment of the potential merits of launching a public information campaign to inform individuals born between 1940 and 1980 of the potential risks associated with in utero exposure to Diethylstilbestrol.

We recognise the consequences for those who were exposed to diethylstilbestrol (DES) and are sorry that women and their families have suffered for far too long.The Department has not made an assessment of the merits of launching a public information campaign relating to DES and has no plans to do so at this time.The Government will keep listening to all those who are affected through exposure to DES and consider what more we can do to improve the situation for them.The Government is committed to advancing patient safety and a learning culture within the National Health Service so that we can avoid harmful events happening to patients in the first place. This includes continued implementation of key measures under the NHS Patient Safety Strategy. The changes we are making as part of the 10-Year Health Plan and Dr Penny Dash’s report on the patient safety landscape will improve quality and safety by making it clear where responsibility and accountability sit at all levels of the system.

Whether his Department holds data on the number of women prescribed diethylstilbestrol in (a) England, (b) Scotland, (c) Wales and (d) Northern Ireland between 1939 and 1978.

This historical information is not held by the Department.

Whether his Department plans to issue updated clinical guidance on diethylstilbestrol (DES) exposure to (a) general practitioners, (b) gynaecologists and (c) oncologists.

The Government encourages all women, including those exposed to diethylstilbestrol (DES) in utero, to attend regular cervical screenings which test for human papillomavirus, the cause of most cervical cancers. Women who believe or know that they were exposed to DES in utero may also need regular colposcopy which falls outside the routine screening programme. We recommend that they should speak to their general practitioner about this as local arrangements should be made for the follow up of women who display evidence of DES exposure. Further information regarding individuals exposed to DES is contained within the cervical screening guidance for the National Health Service, at the following link:https://www.gov.uk/government/publications/cervical-screening-programme-and-colposcopy-management/5-screening-and-management-of-immunosuppressed-individualsMy Rt Hon. Friend, the Secretary of State for Health and Social Care, has asked NHS England to work with local cancer alliances to ensure that providers are aware of this existing screening and follow up guidance for individuals exposed to DES, and that those who could benefit from additional screening have access to this.The National Institute for Health and Care Excellence (NICE) is the national body that develops authoritative, evidence-based guidance for the NHS on best practice in the care and treatment of patients with defined conditions. NICE has not issued any guidance on the diagnosis and management of patients potentially exposed to DES and it currently has no plans to do so. Decisions on the development of new topics for NICE guidance are taken by the NICE prioritisation board, chaired by its Chief Medical Officer, in line with its published prioritisation framework.