Written questions by Lewis.

With reference to his Oral Statement of 11 December 2024 on Puberty-suppressing Hormones, Official Report, Column 923, what guidance his Department issues to parents considering taking their children to other countries for (a) top surgery and (b) other gender reassignment surgery.

There is no published guidance regarding young people under 18 years old travelling abroad for gender reassignment surgery. NHS Children and Young People’s Gender Services, which are commissioned in line with NHS England's interim service specification and the Cass Review, do not make referrals for surgical interventions. The Government strongly discourages parents from taking their child abroad for gender reassignment surgery. Parents should seek advice from appropriate medical professionals if they believe their child has gender incongruence.

What data her Department holds on the number of children travelling to (a) Poland, (b) Turkey, (c) Florida and (d) other countries for gender reassignment surgery in each of the last three years.

The requested data is not centrally held. However, Border Force has a duty under Section 55 of the Borders, Citizenship and Immigration Act 2009 to safeguard and promote the welfare of children.We take this duty very seriously and are committed to protecting vulnerable children who cross the border.All new Border Force entrants receive safeguarding training as part of their induction course. Once established, all Border Force Officers and managers have continuing training and knowledge refresh obligations.Where concerns are raised, officers will take action to safeguard individuals who could be at risk.

Commonwealth and Development Affairs, what discussions he has had with his counterparts in Mozambique on (a) violence perpetrated against Christians by Islamic extremists in Cabo Delgado and (b) the effectiveness of the steps Mozambique is taking to tackle the humanitarian and security situation in that region, in the context of its freedom of religion and belief obligations.

The UK is committed to working multilaterally and bilaterally to defend Freedom of Religion or Belief around the world. In Mozambique, the UK regularly engages with authorities and religious leaders both in the capital (Maputo) and northern Mozambique (Cabo Delgado and Nampula) to address the problems of violence and to tackle the ongoing humanitarian crisis, including several times this year. The UK is supporting efforts to counter the ongoing IS-Mozambique insurgency in Cabo Delgado, through programmes aimed at building local resilience to violent extremism and security and human rights training of Mozambican Armed Forces, as well providing humanitarian assistance to those displaced. Ongoing challenges for religious communities remain, as Christian and Muslim places of worship continue to be affected.

What recent assessment she has made of the potential impact of increasing National Insurance contributions at the Autumn Budget 2024 on the ability of (a) Citizens Advice services and (b) other community-centred charities to maintain their (i) staffing levels and (ii) contribution to society.

In order to repair the public finances and help raise the revenue required to increase funding for public services, the Government has taken the difficult decision to increase employer National Insurance. HMRC recently published on 13 November a Tax Information and Impact Note that covers the impact of employer NICs changes. The Government has protected the smallest businesses and charities from the impact of the increase to Employer National Insurance by increasing the Employment Allowance from £5,000 to £10,500, which means that 865,000 employers will pay no NICs at all next year, more than half of employers will see no change or will gain overall from this package, and all eligible employers will be able to employ up to four full-time workers on the National Living Wage and pay no employer NICs More broadly, within the tax system, we provide support to charities through a range of reliefs and exemptions, including reliefs for charitable giving, with more than £6 billion in charitable reliefs provided to charities, CASCs and their donors in 2023 to 2024.

What his policy is on (a) doctors and (b) other qualified medical personnel administering pain-relieving drugs which may shorten lives; and whether regulations on that issue changed after the conviction of Harold Shipman.

A wide variety of medicines are used for the purpose of pain-relief, and they have differing levels of regulation. Some items can be bought off-the-shelf without a prescription, whilst others require authorisation from a medical professional. The Human Medicines Regulations 2012 set out the responsibilities which certain medical professionals may undertake regarding the supply and administration of regulated medicines. The Misuse of Drugs Act 1971 sets out the legal framework for the prevention of misuse of controlled drugs.Decisions about what medicines to prescribe and administer are made by the doctor or other qualified medical personnel responsible for that part of the patient’s care. They must always satisfy themselves that the medicines they consider appropriate for their patients can be safely prescribed and administered, and they must take account of appropriate national guidance on clinical effectiveness. Clinicians are responsible for the decisions they make regarding the administration of medicines, and they are regulated by the relevant regulatory body for their profession.Professional regulators are responsible for setting and enforcing their own standards for the healthcare professionals that they regulate. The General Medical Council (GMC) is the regulator of all medical doctors practising in the United Kingdom, and the Nursing and Midwifery Council (NMC) is the regulator of nurses and midwives in the UK. Both the GMC and the NMC are independent of the Government, are directly accountable to Parliament, and are responsible for operational matters concerning the discharge of their statutory duties.Following the Shipman Inquiry's Fourth Report, published on 14 July 2004, the Government introduced tighter controls on the procurement, storage, supply and prescribing of controlled drugs, and established national and regional monitoring by the Care Quality Commission (CQC) and a network of regional NHS Controlled Drug Accountable Officers. The CQC is responsible for making sure that health and care service providers, and other regulators, maintain a safe environment for the management and use of controlled drugs in England. The CQC does this under the Controlled Drugs (Supervision of Management and Use) Regulations 2013. These regulations strengthened system governance to monitor the safe use and prescribing of controlled drugs, and require greater co-ordination between the health system and police, to investigate and take action, to protect patients and the public against the misuse and diversion of controlled drugs. Further information on these regulations is available at the following link:https://www.legislation.gov.uk/uksi/2013/373/contents/made

For what reason the Fire and Rescue Service is not receiving the exemption from the rise in National Insurance contributions as the other Emergency Services.

To repair the public finances and help raise the revenue required to fund public services, the Government has taken the difficult decision to increase employer National Insurance. The Government will provide support for public sector employers, including fire and rescue authorities, for the additional costs of Employer National Insurance Contributions. This is in line with the approach taken under the previous government’s Health and Social Care Levy. Further details will be set out in due course.

What steps he plans to take to ensure the availability of learning disability nursing studies programmes in the South East.

Individual universities are responsible for the courses that they offer. We have launched a 10-Year Health Plan to reform the National Health Service. A central and core part of this plan will be our workforce, and how we ensure we train and provide the staff the NHS needs, including doctors and nurses, to care for patients across our communities.

If he will make it his policy to extend the remit of the Care Quality Commission to include vision rehabilitation services for blind and partially sighted people.

Under the Care Act 2014, local authorities in England have a legal duty to support people with sight loss to develop practical skills and strategies to maintain independence. The Care Quality Commission (CQC) is now assessing how local authorities are meeting the full range of their duties under Part 1 of the Care Act 2014. These assessments identify local authorities’ strengths and areas for development, facilitating the sharing of good practice and helping us to target support where it is most needed. Therefore, although the CQC is not currently required to assess vision rehabilitation services as a regulated activity, under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, this does mean that sensory services, including vision rehabilitation, form part of the CQC’s overall assessment of local authorities’ delivery of adult social care. In that context, 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. The CQC’s reports and ratings of local authorities are made public on their website.

Commonwealth and Development Affairs, with reference to paragraph 4.44 of the Autumn Budget 2024, HC 295, published on 30 October 2024, whether any of the additional funding allocated to the BBC World Service will go towards BBC Monitoring; and whether his Department plans to take steps to scruitnise the distribution of this funding.

The Autumn Budget 2024 announced a government grant funding uplift for the BBC World Service in 2025-26. The uplift is for the BBC World Service only, ensuring it can continue to operate in 42 languages and helping to maintain its crisis response capability. The BBC is operationally and editorially independent and sets its own budgets.

Communities and Local Government, if she will remove the presumption in favour of granting planning permission for developments which build extra stories on top of occupied apartment blocks.

As set out in our consultation on proposed reforms to the National Planning Policy Framework, the government supports upward extensions as a route to urban intensification. Planning policy makes clear that local authorities should support upward extensions where the development would be consistent with the prevailing height and form, well designed (including complying with any local design policies and standards), and can maintain safe access and egress for occupiers.The government will keep recent changes to permitted development rights under review and as per my response to the right hon. Gentleman’s oral question on Monday 28 October 2024 (Official Report HC, Volume 755, Column 524), I will reflect further on the specific concern he has raised.

Commonwealth and Development Affairs, what steps his Department is taking to help end violations of freedom of religion or belief in Afghanistan.

The Government continues to call for the human rights of all Afghans to be protected, including the freedom of religion or belief, and we regularly press the Taliban on this through our Doha based UK Mission to Afghanistan. Ministers and officials also engage regularly with a range of Afghans, including religious and ethnic minorities, to ensure our policy and programming reflect the needs of the entire population. In October, we co-sponsored a Human Rights Council resolution extending the mandate of UN Special Rapporteur, Richard Bennett, to monitor and report on the human rights situation in Afghanistan for another year, including that of minority groups.

What recent estimate he has made of the number of NHS patients harmed by cobalt poisoning from modular neck hip replacements in each of the last three years.

The Medicines and Healthcare products Regulatory Agency (MHRA) is aware of concerns regarding modular neck hips and the risk of cobalt poisoning. We are investigating the issue with our stakeholders including the British Orthopaedic Association, British Hip Society, and the National Joint Registry to support.The term modular neck covers a broad range of designs, and adverse incident reports of this sort typically include descriptions of symptoms rather than a definitive diagnosis of cobalt poisoning. In addition, it is not possible to uniquely identify cobalt poisoning from hip replacements in the ICD-10 coding scheme currently used in Hospital Episode Statistics.The UK Medical Devices Regulations provide clear requirements for manufacturers to undertake post-market surveillance activities to ensure safety action is taken, when appropriate. The MHRA is working towards implementing a future regime for medical devices regulation. This will put in place strengthened legal requirements for how manufacturers monitor and report on their devices once they are being used in the real world.

What recent assessment he has made of the potential impact of ceding sovereignty of the Chagos Islands to Mauritius on the security of the Diego Garcia strategic base; whether he consulted Lord Robertson of Port Ellen in his capacity as Head of the Strategic Defence Review before this decision was taken; and whether the Government negotiated enforceable guarantees to prevent the use of other Chagos Islands to (a) spy upon and (b) otherwise compromise the military utility of the Diego Garcia strategic base.

This historic agreement protects the long-term secure operation of the UK-US base on Diego Garcia with Mauritius, which plays such a crucial role in regional and international security. We have full Mauritian backing for robust security arrangements, including preventing foreign armed forces from establishing themselves on the outer islands, or otherwise undermining the effective operation of the base, meaning the base is more protected than ever from foreign malign influence in a more insecure world.  This deal has been welcomed by a range of key international partners, including the US and India. It is our intention to pursue ratification in 2025 by submitting the treaty and a Bill to Parliament for scrutiny.