Written questions by Lowe.

Whether his Department reviews NHS England expenditure reports relating to the prescribing of puberty blockers for children; and whether (a) financial oversight and (b) risk assessments have been conducted since 2010.

All arms-length bodies, including NHS England, are held to high standards of financial responsibility and publish annual reports and accounts which are laid before Parliament.Gonadotrophin releasing hormone analogues, or puberty blockers, have been prescribed to children under 16 years of age in England for licenced uses, for instance precocious puberty and endometriosis, and off label uses, such as gender dysphoria. The cost of prescribing drugs to a patient is met by the patient's integrated care board.Regarding risks assessments conducted since 2010, in March 2024 NHS England published a suite of documentation relating to its decision to remove gonadotrophin releasing hormone analogues as a routine treatment option in the National Health Service for children under 18 years old with gender dysphoria. This documentation included a review of the published evidence, which concluded that there is very limited evidence about safety, risks, benefits, and outcomes for the use of this medication in children with gender dysphoria.Restrictions on the sale and supply of these medicines via private and NHS prescriptions were introduced in May 2024. As part of that legislation the Government conducted a targeted consultation and sought advice on patient safety from the independent Commission on Human Medicines (CHM) and Cass Review.The Government response to the consultation, the full report of the CHM, and the Cass review are available publicly, and respectively, at the following three links:https://www.gov.uk/government/consultations/proposed-changes-to-the-availability-of-puberty-blockers-for-under-18s/outcome/governments-response-to-the-targeted-consultation-on-proposed-changes-to-the-availability-of-puberty-blockershttps://www.gov.uk/government/publications/chms-report-on-proposed-changes-to-the-availability-of-puberty-blockers/commission-on-human-medicines-report-on-proposed-permanent-order-to-restrict-the-sale-and-supply-of-gnrh-agonists-in-children-and-young-people-under-1https://webarchive.nationalarchives.gov.uk/ukgwa/20250310143633/https://cass.independent-review.uk/

What was the total annual NHS expenditure on GnRH analogue puberty blockers for under-18s in each financial year since 2010.

Gonadotropin-releasing hormone (GnRH) agonists or ‘puberty blockers’ are used to treat several medical conditions in children and young people. These can include precocious puberty, some forms of cancer, and endometriosis. They have also been used outside of their licenced indication to treat gender dysphoria. There is no central registry that provides the total number of children in England who have been prescribed GnRH agonists through the National Health Service since 2010. The following table shows the number of identifiable patients and total net ingredient cost for NHS prescriptions of GnRH agonists for all purposes for children aged 17 years old and under that were prescribed and dispensed in community pharmacies or general practices in England in each year from 2015/2016 to September 2025: Financial yearThe unique number of identified patients aged 17 years old and under who received an NHS prescription of GnRH for all purposesThe total net ingredient cost of prescriptions known to be issued to those aged 17 and under who received an NHS prescription of GnRH for all purposes2015/16885£621,033.412016/17987£692,927.422017/181,047£772,767.712018/191,072£806,393.822019/201,048£781,151.722020/21936£703,531.552021/22864£607,597.802022/23849£586,845.562023/24746£525,321.932024/25622£449,611.722025/2026432£219,338.73Source: ePACT2, which sources data from the NHS Business Services Authority’s Information Services Data Warehouse. Note: the net ingredient cost is the basic price of a product excluding VAT. It does not take account of discounts, rebates, dispensing costs, fees, and allowances paid to pharmacists and appliance contractors for the service they provide to the NHS, or prescription charge income received, where the single charge or Prescription Prepayment Certificate fee is paid, or foregone where prescriptions are dispensed free of charge. The NHS Business Services Authority does not hold patient data prior to April 2015. This data excludes dispensing in secondary care and other settings, and private prescriptions.

How many patients aged under 18 have been prescribed GnRH analogue puberty blockers through the NHS in each year since 2010.

Gonadotropin-releasing hormone (GnRH) agonists or ‘puberty blockers’ are used to treat several medical conditions in children and young people. These can include precocious puberty, some forms of cancer, and endometriosis. They have also been used outside of their licenced indication to treat gender dysphoria. There is no central registry that provides the total number of children in England who have been prescribed GnRH agonists through the National Health Service since 2010. The following table shows the number of identifiable patients and total net ingredient cost for NHS prescriptions of GnRH agonists for all purposes for children aged 17 years old and under that were prescribed and dispensed in community pharmacies or general practices in England in each year from 2015/2016 to September 2025: Financial yearThe unique number of identified patients aged 17 years old and under who received an NHS prescription of GnRH for all purposesThe total net ingredient cost of prescriptions known to be issued to those aged 17 and under who received an NHS prescription of GnRH for all purposes2015/16885£621,033.412016/17987£692,927.422017/181,047£772,767.712018/191,072£806,393.822019/201,048£781,151.722020/21936£703,531.552021/22864£607,597.802022/23849£586,845.562023/24746£525,321.932024/25622£449,611.722025/2026432£219,338.73Source: ePACT2, which sources data from the NHS Business Services Authority’s Information Services Data Warehouse. Note: the net ingredient cost is the basic price of a product excluding VAT. It does not take account of discounts, rebates, dispensing costs, fees, and allowances paid to pharmacists and appliance contractors for the service they provide to the NHS, or prescription charge income received, where the single charge or Prescription Prepayment Certificate fee is paid, or foregone where prescriptions are dispensed free of charge. The NHS Business Services Authority does not hold patient data prior to April 2015. This data excludes dispensing in secondary care and other settings, and private prescriptions.

How many staff in their Department have been on mental health leave for six months or more; and for what reason.

Based on our reporting data up to the end of September 2025, we are withholding this data due to the small number of employees involved which could make individuals and the cause of their absence identifiable.

What information his Department holds on the number of de-transitioners reporting harm from puberty blockers; and whether his Department considered this data as part of its approval of the trial.

There is currently no registry in place in the United Kingdom that routinely collects data that is specific to individuals who choose to detransition at any point following a previous medical intervention for gender reassignment.Last month, NHS England published a Call for Evidence aimed at healthcare professionals and medical bodies to gather evidence on the care needs of individuals who choose to detransition, in line with the recommendations of the Cass Review. NHS England will publish plans for the establishment of a clinical detransition pathway in 2026, informed by the outcome of the Call for Evidence and a review of the published evidence.The PATHWAYS trial has been subject to extensive scientific, clinical, ethical, and regulatory approvals. It was approved by an independent National Institute for Health and Care Research funding committee, with the final protocols all subject to rigorous approval processes from both the Medicines and Healthcare products Regulatory Agency and the Health Research Authority, including review by an independent Research Ethics Committee.

What guidance his Department has issued on the capacity of children aged between 11 and 15 to consent to medical trials related to puberty blockers.

Children’s healthcare must always be evidence-led. That’s why we are following expert, independent advice from the Cass Review to implement a package of research to find out how the National Health Service can best support children and young people with gender incongruence. This includes the PATHWAYS trial, a carefully designed clinical trial to assess the relative benefits and harms of puberty-suppressing hormones as a treatment option for children and young people with gender incongruence. The trial has received independent scientific, ethical, and regulatory approvals as well as a comprehensive review. The study design, including inclusion criteria and safety protocols, has been thoroughly scrutinised to protect young people's wellbeing. The process has included consideration of robust procedures relating to consent and eligibility. The trial was designed and will be delivered by an independent research team. This was in conjunction with patient and public involvement as well as clinical and legal experts, including those who specialise on medical ethics. The Department has not conducted its own parallel engagement with advocacy organisations on trial development but is represented, alongside patient and parent representatives, on the National Research Oversight Board to which the research team regularly reports.

If he will hold discussions with Kings College London on the potential merits of pausing recruitment to the new Pathway puberty-blocker trial until an independent panel considers the findings of the Cass Review.

Children’s healthcare must always be evidence-led. That’s why we are following expert, independent advice from the Cass Review to implement a package of research to find out how the National Health Service can best support children and young people with gender incongruence. This includes the PATHWAYS trial, a carefully designed clinical trial to assess the relative benefits and harms of puberty-suppressing hormones as a treatment option for children and young people with gender incongruence. The trial has received independent scientific, ethical, and regulatory approvals as well as a comprehensive review. The study design, including inclusion criteria and safety protocols, has been thoroughly scrutinised to protect young people's wellbeing. The process has included consideration of robust procedures relating to consent and eligibility. The trial was designed and will be delivered by an independent research team. This was in conjunction with patient and public involvement as well as clinical and legal experts, including those who specialise on medical ethics. The Department has not conducted its own parallel engagement with advocacy organisations on trial development but is represented, alongside patient and parent representatives, on the National Research Oversight Board to which the research team regularly reports.

Whether he has obtained legal advice on whether putting minors on puberty blockers constitutes a breach of child-safeguarding duties.

Children’s healthcare must always be evidence-led. That’s why we are following expert, independent advice from the Cass Review to implement a package of research to find out how the National Health Service can best support children and young people with gender incongruence. This includes the PATHWAYS trial, a carefully designed clinical trial to assess the relative benefits and harms of puberty-suppressing hormones as a treatment option for children and young people with gender incongruence. The trial has received independent scientific, ethical, and regulatory approvals as well as a comprehensive review. The study design, including inclusion criteria and safety protocols, has been thoroughly scrutinised to protect young people's wellbeing. The process has included consideration of robust procedures relating to consent and eligibility. The trial was designed and will be delivered by an independent research team. This was in conjunction with patient and public involvement as well as clinical and legal experts, including those who specialise on medical ethics. The Department has not conducted its own parallel engagement with advocacy organisations on trial development but is represented, alongside patient and parent representatives, on the National Research Oversight Board to which the research team regularly reports.

Whether his Department has made an assessment of the potential impact of the Pathway puberty-blocker trial on future legal claims by participants.

Children’s healthcare must always be evidence-led. That’s why we are following expert, independent advice from the Cass Review to implement a package of research to find out how the National Health Service can best support children and young people with gender incongruence. This includes the PATHWAYS trial, a carefully designed clinical trial to assess the relative benefits and harms of puberty-suppressing hormones as a treatment option for children and young people with gender incongruence. The trial has received independent scientific, ethical, and regulatory approvals as well as a comprehensive review. The study design, including inclusion criteria and safety protocols, has been thoroughly scrutinised to protect young people's wellbeing. The process has included consideration of robust procedures relating to consent and eligibility. The trial was designed and will be delivered by an independent research team. This was in conjunction with patient and public involvement as well as clinical and legal experts, including those who specialise on medical ethics. The Department has not conducted its own parallel engagement with advocacy organisations on trial development but is represented, alongside patient and parent representatives, on the National Research Oversight Board to which the research team regularly reports.

Whether his Department consulted (a) Stonewall, (b) Mermaids and (c) other advocacy organisations at any stage during the (i) design, (ii) approval, and (iii) communication of the PATHWAYS trial.

Children’s healthcare must always be evidence-led. That’s why we are following expert, independent advice from the Cass Review to implement a package of research to find out how the National Health Service can best support children and young people with gender incongruence. This includes the PATHWAYS trial, a carefully designed clinical trial to assess the relative benefits and harms of puberty-suppressing hormones as a treatment option for children and young people with gender incongruence. The trial has received independent scientific, ethical, and regulatory approvals as well as a comprehensive review. The study design, including inclusion criteria and safety protocols, has been thoroughly scrutinised to protect young people's wellbeing. The process has included consideration of robust procedures relating to consent and eligibility. The trial was designed and will be delivered by an independent research team. This was in conjunction with patient and public involvement as well as clinical and legal experts, including those who specialise on medical ethics. The Department has not conducted its own parallel engagement with advocacy organisations on trial development but is represented, alongside patient and parent representatives, on the National Research Oversight Board to which the research team regularly reports.

How many children under the age of 16 were administered puberty blockers, including through (a) clinical trials and (b) private routes in each of the last five years; and what adverse effects were reported.

Gonadotropin-releasing hormone agonists or ‘puberty blockers’ are used to treat several medical conditions in children and young people. These can include precocious puberty, some forms of cancer, and endometriosis. They have been used outside of their licenced indication to treat gender dysphoria. The following table shows the National Health Service prescriptions of puberty blockers for children aged 15 years old and under that were prescribed in England and dispensed in a community pharmacy or general practice in each year from 2020/21 to September 2025: Financial yearThe unique number of identifiable children aged 15 years old and under who received an NHS prescription of gonadotropin-releasing hormone agonists for all purposes2020/216702021/226562022/236442023/245542024/254702025/26342Source: ePACT2, which is sourced from the NHS Business Services Authority’s Information Services Data WarehouseNote: figures are unrounded.The NHS does not centrally collect data on secondary care prescribing. Information on the clinical indication for which these medications have been prescribed is not held. The Government does not hold data that shows how many children under 16 years old were administered puberty blockers through clinical trials or private routes. The National Institute for Health and Care Research (NIHR) has not previously funded trials specifically giving puberty suppressing hormones to children and information on non-NIHR funded trials is not held. The Medicines and Healthcare products Regulatory Agency has received three United Kingdom based suspected adverse drug reaction reports in which a gonadotropin-releasing hormone agonists analogue has been reported as being used in a child or young person for the purpose of puberty suppression in gender dysphoria.

Pursuant to the answer of 17 November 2025 to question 81592 on Medical Treatments: Gaza, what the estimated total cost of the programme will be to the public purse.

I refer the Hon. Member to the answer I gave on 17 November 2025 to Question 81587.

What proportion of internationally recruited NHS workers were required to retake the International English Language Testing System more than once to meet employment eligibility criteria between 2020 and 2025.

The Department does not collect data on repeat International English Language Testing System (IELTS) attempts or average test scores for National Health Service staff. Information on English language competence for professional registration is held by the relevant United Kingdom healthcare regulators. Any assessment data for candidates applying to join the NHS Performers List would be managed by NHS England, while local NHS trusts and employers may hold records of candidate performance where assessments form part of their recruitment process. Additionally, IELTS publishes global test statistics on its website, at the following link:https://ielts.org/researchers/our-research/test-statistics

What the average International English Language Testing System scores were for internationally recruited healthcare professionals entering the NHS via the international recruitment programme in each of the last three years.

The Department does not collect data on repeat International English Language Testing System (IELTS) attempts or average test scores for National Health Service staff. Information on English language competence for professional registration is held by the relevant United Kingdom healthcare regulators. Any assessment data for candidates applying to join the NHS Performers List would be managed by NHS England, while local NHS trusts and employers may hold records of candidate performance where assessments form part of their recruitment process. Additionally, IELTS publishes global test statistics on its website, at the following link:https://ielts.org/researchers/our-research/test-statistics

How many and what proportion of (i) nurses (ii) doctors (iii) midwives entering the NHS were (a) non-UK citizens (b) non-UK graduates in each of the last five years.

The Department does not hold data on the number and proportion non-United Kingdom citizens entering the National Health Service. NHS England publishes monthly Hospital and Community Health Services (HCHS) workforce statistics for England which includes data on the self-reported nationality of NHS staff, which may not be the same as citizenship. Not all non-UK nationals will have been recruited from abroad, as some will already be resident in the UK before they join the NHS. This information is available at the following link, within the folder “Preliminary - NHS HCHS Workforce Statistics, Turnover – CSV data files”:https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statisticsThe Department does not hold data on the number and proportion non-UK graduate doctors, nurses and midwives entering the NHS. The Nursing and Midwifery Council (NMC) publishes data on non-UK graduate first-time joiners to their professional register across the UK. The General Medical Council (GMC) similarly publishes data on non-UK graduates taking up, or returning to, a license to practice medicine in the UK. It is possible to apply to join the UK Registers without moving to the UK. The most recent published NMC data is available at the following link: https://www.nmc.org.uk/about-us/reports-and-accounts/registration-statistics/ The most recent published GMC data can be found under the “Reference tables and data annex” section of the “The state of medical education and practice in the UK: workforce report 2025”, within the file titled “The register of medical practitioners”, available at the following link:https://www.gmc-uk.org/about/what-we-do-and-why/data-and-research/the-state-of-medical-education-and-practice-in-the-uk/workforce-report

If he will make an assessment of the potential merits of establishing a dedicated whistleblowing line for NHS staff and patients to report issues with language barriers in the National Health Service.

Speak Up Direct, funded by the Department, is a dedicated, independent helpline offering confidential advice, signposting, and guidance to National Health Service and social care staff on raising work-related concerns. Additional support includes Freedom to Speak Up Guardians, with over 1,300 now available across healthcare settings in England, and a Freedom to Speak Up policy that sets minimum standards for NHS organisations in England.The NHS complaints process enables patients to give feedback or raise concerns about any aspect of their care.Translation and interpretation services are available for patients who need language support. Additional support is available for individuals who may have difficulty understanding their care or communicating their needs. Patient advocates can speak on their behalf, facilitate decision-making, clarify care procedures, and help safeguard patient rights.

Pursuant to the Answer of 11 November to Question 82825 on NHS: English Language, how many tests were taken, by nationality; and how many were failed.

The Department does not hold data about these tests or assessments. Where collected, this would be held by the relevant lead organisation for each process. For data about English language competence for registration, this would be held by the healthcare regulators. Any available assessment data on candidates applying for the NHS Performers List would be held by NHS England. The International English Language Testing System and Occupational English Test would hold data for their respective tests and local National Health Service trusts and employers would hold data on candidate performance where an assessment has been carried out as part of a recruitment process.

To provide a breakdown of (a) total pay-outs (b) total value of claims to category A patients by (i) UK citizens (ii) asylum seekers for the financial year 24/25.

NHS Resolution manages clinical negligence and other claims against the National Health Service in England. This data is not held by NHS Resolution.

What the total (a) number of claims and (b) value of clinical negligence claims paid out in financial year 24/25 were attributed to language barrier issues.

This data is not held by NHS Resolution.

What information his Department holds on the number of physicians responsible for medical malpractice which resulted in a pay-out in the 2024-25 financial year, broken down by nationality.

This data is not held by NHS Resolution.