Written questions by Paul.

What steps his Department is taking to develop and implement national evidence-based clinical guidelines for adult gender identity services across NHS England.

Awaiting answer.

How the experiences and clinical outcomes of individuals who have de-transitioned, alongside a range of patient outcomes, are being incorporated into the development of policy and clinical guidance in the provision of adult gender identity services.

Awaiting answer.

What steps his Department will take to improve mental health provision and outcomes for young people.

For children and young people in distress or struggling with their mental health, fast access to early, high-quality support is critical. Mental health support teams play a key role in this, providing early intervention for mental health conditions like anxiety and depression, while also assisting schools to develop a whole-school approach to positive mental health and wellbeing. By spring 2026, up to 900,000 more children and young people will have access to mental health support teams compared to Spring 2025, with full national coverage planned by 2029.Alongside this, early support hubs provide drop-in mental health support for 11- to 25‑year‑olds without the need for a referral. The Government recently confirmed an additional £7 million funding boost for early support hubs across England, enabling 10,000 additional mental health and wellbeing interventions over the next 12 months. The Government is also establishing the first of 50 Young Futures Hubs to bring local services together within communities and offer early advice and wellbeing support for young people who may not meet thresholds for specialist National Health Service care.We’re also tackling the longest waits for specialist mental health services for children and young people by reducing regional variation and improving access. Our goal is to make services more productive, so children and young people spend less time waiting for the treatment they need. Together, these initiatives, backed by recruitment of almost 8,000 additional mental health workers for adults and children since July 2024, are expanding timely, local support, reducing the need for escalation to specialist services and helping young people receive the right help at the right time, in the right place.

What assessment his Department has made of the (a) prevalence of respiratory disease and (b) number of emergency hospital admissions for respiratory conditions in Reigate constituency compared with national averages; and what steps he is taking to ensure respiratory health is prioritised nationally, including through the introduction of a Modern Service Framework for respiratory care.

Data is available for emergency finished admission episodes (FAEs) where there was a primary diagnosis of 'respiratory conditions’. The following table shows the number of FAEs where there was a primary diagnosis of 'respiratory conditions’ for Reigate and England, for activity in English National Health Service hospitals and English NHS-commissioned activity in the independent sector, for 2024/25 and provisionally for 2025/26:Westminster Parliamentary Constituency of Residence2024/25 (August 2024 to March 2025)2025/26 (April 2025 to November 2025)Reigate920765England612,855511,558Source: Hospital Episode Statistics, NHS England. Available data on trends in respiratory conditions can be found on the Department’s Fingertips dataset. Data is not available by parliamentary constituency. Data is available at regional, county, unitary authority and integrated care board level. Information for Reigate can be found at the following link: https://fingertips.phe.org.uk/search/Respiratory#page/1/gid/1/pat/6/ati/501/are/E07000211/iid/40701/age/163/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1 The Government will consider long-term conditions for future waves of modern service frameworks (MSFs), including respiratory conditions. The criteria for determining other conditions for future MSFs will be based on where there is potential for rapid and significant improvements in quality of care and productivity. After the initial wave of MSFs is complete, the National Quality Board will determine the conditions to prioritise for new MSFs as part of its work programme.

What assessment he has made of the effectiveness of the current regulatory framework for Research Ethics Committees (RECs), including the Governance Arrangements for Research Ethics Committees, in providing adequate guidance for RECs considering research proposals pertaining to gender and sex.

No specific assessment has been made by the Department. The Health Research Authority (HRA) and the devolved administrations provide a Research Ethics Service so that research proposals relating to their areas of responsibility can be reviewed by a Research Ethics Committee (REC) for all kinds of health and social care research proposals within the scope of the UK Policy Framework for Health and Social Care research, including those pertaining to gender and sex.A REC is a group of people appointed to review research proposals to assess formally if the research is ethical. This means the research must conform to recognised ethical standards. RECs protect the rights, safety, dignity and wellbeing of research participants and the Governance Arrangements for Research Ethics Committees, a United Kingdom wide policy, describes what is expected from RECs when reviewing research proposals.Each REC is required to adopt the UK Standard Operating Procedures approved by, or on behalf of, its appointing authority, and each REC is audited against these standards on a rolling basis. RECs reviewing Clinical Trials of Investigational Medicinal Products must be accredited by the UK Ethics Committee Authority before they can review applications to ensure committees comply with legislation and uphold standards.The HRA has a duty to provide an efficient and robust research ethics review service to protect participants.

When he intends to publish the document entitled Pathways Trial for GnRHa - Guidance for CYPGS Clinicians.

A document entitled PATHWAYS TRIAL for Gonadotropin Releasing Hormone Analogues (GnRHa) – Guidance for CYPGS clinicians is referenced in the published research protocol for the PATHWAYS study of puberty suppression. The Department does not hold a copy this document and would not expect to hold it, and therefore has no plans to publish it.

How many detransitioners from the Early Intervention Study run by the Tavistock Gender Identity Development Service (GIDS) in 2011-14 have presented to the NHS for either medical injury or regret; and how many detransitioners, in total, have presented to the NHS for either medical injury or regret since the Cass review was commissioned.

Data and research on detransition has been limited and the number of individuals who may wish to seek help from the National Health Service is not held.In line with recommendation 25 of the Cass Review, NHS England is developing a clinical pathway for individuals who wish to detransition. Between October and December 2025, NHS England held a 'call for evidence' aimed at healthcare professionals and medical bodies, and the responses will help to shape the development of a care pathway and service specification which NHS England plans to consult on in the summer of 2026.

What steps he is taking to ensure that NHS staff are not able to falsely certify documents later used in applications for a Mental Health Breathing Space.

Access to Mental Health Crisis Breathing Space can only be started if an Approved Mental Health Professional confirms that the individual is receiving mental health crisis treatment. The debt adviser must also seek confirmation from a nominated point of contact every 30 days that the individual is still receiving eligible mental health crisis treatment in order for the individual to continue to receive the moratorium’s protections.With regard to National Health Service staff, regulators set standards of conduct that regulated health professionals must uphold. These already emphasise the importance of good record keeping. Falsifying patient records could be considered serious misconduct and may lead to a professional's registration being restricted or revoked.We continue to keep the Breathing Space Scheme under review to ensure it is operating as intended.

What the average waiting time is for routine mental health appointments across the prison estate in England.

The information requested is not held centrally. As part of the formal prisoner induction process, all prisoners undergo health screening that incorporates a mental health assessment. The secondary care mental health assessment is carried out by a mental health professional. Routine assessments are carried out within five working days. Where an individual is in a state of mental health crisis, presents with rapidly escalating needs, or is at risk of immediate harm to themselves or others, an urgent assessment should be undertaken within 48 hours.

What recent steps his Department has taken to ensure (a) equality of access to and (b) quality of healthcare provision across the (i) women’s and (ii) Children and Young People's estate.

To improve health and social care outcomes for all women in prison and upon their release, NHS England and His Majesty’s Prison and Probation Service commissioned the National Women’s Prisons Health and Social Care Review. The review’s report identified a number of recommendations to improve equity and quality of care to meet the specific needs of women in prison.A wide range of actions to implement these recommendations are taking place at establishment, regional, and national levels, backed by £21 million across three years, and overseen by the Joint Women's Prison Health and Social Care Review Implementation Programme Board.The health issues facing those detained in the children and young people secure estate are systematically kept under review through regular health and wellbeing needs assessments and the Healthcare Standards for Children and Young People in Secure Settings.The Framework for Integrated Care operates in the children and young people secure estate as a coherent structure for a comprehensive, trauma-informed system of care that focuses on individualised care rather than on separate labels, diagnoses, or interventions.NHS England has also commissioned the three-year Benchmarking Project, aimed at assessing and supporting the implementation of the Healthcare Standards for Children and Young People in Secure Settings.Further work is underway to identify where the existing pathway in the children and young people secure estate requires enhancement to better support the placement, management, and care of all girls in secure settings. This work will be informed by evidence and best practice and will be developed with experts to test the most appropriate model of care.

Whether his Department has identified service gaps in the provision of primary care, mental health, dentistry and substance misuse services at HMP/YOI Downview.

Primary care, mental health, dentistry, and substance misuse services at HMP/YOI Downview are delivered under the national specification for integrated healthcare. As part of the commissioning monitoring processes outlined in the NHS Strategic Commissioning Framework, which covers all National Health Service commissioned services, including health and justice, providers are measured against the mandatory performance indicators within the national specification and any potential inconsistencies in service delivery are identified. Independent processes are also embedded within service delivery monitoring. These include annual healthcare needs assessments, equality impact assessments, Independent Monitoring Board reports, Care Quality Commission reports and inspections, and user experience consultations. An annual user experience has also been carried out across all prisons in the South East.

What assessment his Department has made of the potential impact of the requirement to obtain a medical exemption certificate before being eligible to claim free prescriptions on people with chronic illnesses.

The Department has made no assessment.The exemption certificate provides the patient with evidence to demonstrate to dispensers that they are entitled to have the National Health Service cover the cost of their prescriptions. The exemption certificate requirement also allows for the verification of claims for exemption, and for fraud to be identified and pursued.It is straightforward to apply for a medical exemption certificate; the patient should ask their doctor for form FP92A. The form includes guidance on how to complete it and who can authorise it. A healthcare professional (HCP), e.g. a hospital doctor or general practitioner (GP), or at the GP’s discretion a member of the GP’s practice who can access medical records, must authorise the application to confirm the patient has the qualifying condition. If a patient is unable to complete the form themselves then a relative or HCP can complete it on their behalf and insert their name in the signature box.

What assessment his Department has made of the effectiveness of issuing penalty charge notices as a deterrent against improper claims of free NHS prescriptions.

From November 2024 to October 2025, the NHS Business Service Authority issued 47,058 penalty charge notices (PCNs) to people who claimed a medical exemption but were found to have no exemption in place when checked. Of these, 21,328 were eased, for various reasons including the patient subsequently applying for an exemption successfully. The number of easements in this category cannot be confirmed. Of the 47,058 PCNs issued 3,583 people received multiple PCNs.Although the Department has made no formal assessment of the effectiveness of issuing PCNs as a deterrent against improper claims, the fact that the vast majority who receive one PCN do not go on to receive another would, in my opinion, suggest a potential deterrent effect.

How many NHS penalty charges for incorrectly claimed free prescriptions have been issued to individuals who qualified for but did not hold NHS medical exemption certificates in the last 12 months.

From November 2024 to October 2025, the NHS Business Service Authority issued 47,058 penalty charge notices (PCNs) to people who claimed a medical exemption but were found to have no exemption in place when checked. Of these, 21,328 were eased, for various reasons including the patient subsequently applying for an exemption successfully. The number of easements in this category cannot be confirmed. Of the 47,058 PCNs issued 3,583 people received multiple PCNs.Although the Department has made no formal assessment of the effectiveness of issuing PCNs as a deterrent against improper claims, the fact that the vast majority who receive one PCN do not go on to receive another would, in my opinion, suggest a potential deterrent effect.

With reference to the Independent Monitoring Board's report entitled Annual report of the Independent Monitoring Board at HMP/YOI Downview, published on 3 September 2025, what steps he is taking to ensure acutely mentally unwell prisoners are swiftly (a) identified and (b) given care in an appropriate facility at (a) HMP/YOI Downview, (b) other prisons and (c) other young offenders institutions.

NHS England commissions prison health care services for HMP/YOI Downview and every other prison and young offenders institution in England. Every prison has onsite health care services including primary care, mental health, dentistry, and substance misuse teams. The National Service Specification for integrated mental health sets out how patients within secure settings, who require support for their mental wellbeing, should receive the same level of healthcare as people in the community, both in terms of the range of interventions available to them, in order to meet their needs, and the quality and standards of those interventions. This includes access to crisis intervention and crisis prevention for those at high risk of self-harm and suicide, where such behaviours relate to poor emotional wellbeing and/or minor psychiatric morbidity. Access to mental health provision is available to every person in prison at any stage of their sentence, beginning at the point of entry. NHS England commissions first night reception screening to have a registered nurse/practitioner review patients’ medical history to address any immediate health needs and risks and to ensure medication is made available as soon as possible and that onward referrals to onsite healthcare teams, including mental health services, for both urgent face to face appointments, within 24 hours, and routine face to face appointments, within five working days, are made. Outside of reception screening, people in prison can be referred or can self-refer to mental health services, within those timeframes. When someone is acutely unwell, they can be transferred from prisons and other places of detention to hospital for treatment, under the Mental Health Act, within the target transfer period of 28 days. The Mental Health Bill, currently going through Parliament, introduces a statutory 28-day time limit within which agencies must seek to ensure individuals who meet the criteria for detention under the act are transferred to hospital for treatment. NHS England’s South East Health and Justice team is funding a transfer and remissions co-ordinator from January 2025, to improve, where possible, safe, effective, and efficient transfers to hospital level treatment and interventions. NHS England is reviewing the National Integrated Prison Service Specification to ensure it continues to meet the needs of the prison population.

Whether his Department plans to provide additional support for women who face additional prescription costs due to (a) menorrhagia and (b) other menstrual issues caused by (i) miscarriage and (ii) other significant traumas.

There are no plans to review the support available to women facing these issues.A maternity exemption certificate can be applied for as soon as a healthcare professional has confirmed that the patient is pregnant or has given birth, including still-birth, in the previous twelve months, and this provides exemption from prescription costs until 12 months after the due date. The certificate remains valid if the patient has a miscarriage. The certificate is automatically backdated one month from the date the application is received by the NHS Business Services Authority.If a patient is not entitled to the maternity exemption, they can purchase a prescription prepayment certificate (PPC), which allows them to claim as many prescriptions as they need for a set cost. A three-monthly PPC, costing £32.05, or an annual PPC, costing £114.50, will save people money if they need four or more items in three months or 12 or more items in 12 months. To help spread the cost, people can pay for an annual PPC by ten monthly direct debits. A holder of a 12-month certificate can get all the prescriptions they need for just over £2 per week.Approximately 40% of the population are currently liable to pay the prescription charge though approximately 89% of the items dispensed in the community are dispensed free of charge.

What information his Department holds on the status of the proposed PATHWAYS clinical trial.

Better quality evidence is critical if the NHS is to support young people suffering from gender incongruence, so we are supporting a programme of research, recommended by the Cass Review, including the PATHWAYS study. The health and wellbeing of the children and young people involved is our primary concern.Ethical and regulatory approvals have been received for the observational element of the study. Approval processes and site set-up are well underway for the clinical trial and we will provide an update when the study moves to the next stage.

What assessment he has made of the potential implications for his policies of the recommendations on surrogacy in the report by the UN Special Rapporteur for Violence Against Women and Girls entitled Report of the Special Rapporteur on violence against women and girls, its causes and consequences: The different manifestations of violence against women and girls in the context of surrogacy, published on 14 July 2025.

The UN Special Rapporteur’s report is framed within the context of Violence Against Women and Girls and recommends banning surrogacy in all forms.The United Kingdom Government supports surrogacy as an option for family formation, for people unable to carry their own children. For this option, we recommend the use of UK not-for-profit surrogacy organisations.For those considering surrogacy overseas, we recommend taking specialist legal advice and consulting the advice published by the Foreign, Commonwealth and Development Office, which is available at the following link:https://www.gov.uk/government/publications/surrogacy-overseas/surrogacy-overseas

What assessment his Department has made of the potential impact of £985 per cycle payments to egg donors on the level of incentive to women from the poorest backgrounds to donate eggs because of financial need.

The compensation rate for egg donation is set by the Human Fertilisation and Embryology Authority (HFEA), as provided for in the Human Fertilisation and Embryology Act 1990. The HFEA has advised that the donor compensation levels originally set in 2011 followed a thorough ethical review, which identified a set of principles that ensured altruism remained at the heart of donation and that there were not any unjustifiable barriers to donation. The HFEA has advised that the increase in donor compensation from 1 October 2024 to £985 per cycle reflects the rise in inflation since the compensation rates were first introduced in 2011.Academic research in the United Kingdom has consistently found that donating eggs and sperm is driven by altruism, and HFEA published data shows that egg and sperm donors in England from 2011 to 2020 lived in similar or more affluent socio-economic areas than the general population.

If he will make an assessment of the potential merits of running long term studies in to the impact on women's bodies of egg retrieval.

The Human Fertilisation and Embryology Authority (HFEA)’s Scientific and Clinical Advances Advisory Committee (SCAAC) recently reviewed the published evidence of health outcomes for those having fertility treatment, including egg donors. The last 10 years of evidence were reviewed and the HFEA will update relevant information on its website as needed.The HFEA also set out strict requirements in its Licence Conditions and Code of Practice relating to the information that must be given before egg retrieval takes place in United Kingdom licensed fertility clinics, whether for the patient’s own use or to donate to others. This includes information about the potential immediate or longer-term health risks and the psychological consequences of being a donor, as well as offering counselling to everyone involved.