Written questions by Pochin.

Whether his Department plans to assess the potential impact of changes to accreditation and registration requirements for counsellors introduced in December 2025 on (a) counsellors’ businesses, including their level of income and (b) waiting times for accreditation from professional bodies.

The Department does not set the qualification requirements for psychotherapy and counselling and was not involved in the changes to accreditation requirements introduced in December 2025. The Department does not receive any revenue or financial benefits arising from those changes.

Whether his Department has undertaken an impact assessment of the potential impact of the changes introduced in December 2025 to accreditation requirements for counsellors on the level of waiting times for patients seeking access to counselling services.

The Department does not set the qualification requirements for psychotherapy and counselling and was not involved in the changes to accreditation requirements introduced in December 2025. The Department does not receive any revenue or financial benefits arising from those changes.

What steps are being taken to guarantee access to specialist therapeutic support services for child victims of sexual abuse, in the context of the recommendation of the Independent Inquiry into Child Sexual Abuse.

Last April, we committed to ambitious proposals in response to recommendation 16 from the Independent Inquiry into Child Sexual Abuse. As part of our response to delivering on that promise, we are investing up to £50 million to roll out the internationally recognised Child House model across all National Health Service regions in England.The model brings health, justice, and social care professionals together under one roof to reduce trauma and deliver the care children deserve in a safe, child-centred environment. Too often, children are asked to retell their experiences to multiple professionals, reliving their trauma with each repetition. The Child House model changes this.This investment sits alongside our wider work to transform children’s mental health services. We are committed to reducing waiting times for specialist Child and Adolescent Mental Health Service support, as set out in our Medium-Term Planning Framework. We are accelerating the rollout of mental health support teams in schools and colleges, working towards full national coverage by 2029. And we are investing an additional £13 million to pilot enhanced training so school-based mental health teams can better support young people with complex needs, including trauma.Together, these actions represent a fundamental shift by treating child sexual abuse as the healthcare priority it is and ensuring that victims and survivors receive the very best support to rebuild their lives.

Whether NHS England monitors local trust decisions on the withdrawal of designated parking arrangements for dialysis patients; and what mechanisms are in place to ensure such decisions take account of patient mobility and clinical vulnerability.

Decisions on the provision of car parking are made locally by National Health Service organisations and should be consistent with the national guidance. This includes the provision of parking adjustments for patient groups receiving frequent treatments, including those undergoing dialysis. Further information on the guidance is available at the following link:https://www.gov.uk/government/publications/nhs-patient-visitor-and-staff-car-parking-principles/nhs-patient-visitor-and-staff-car-parking-principlesThis guidance requires the provision of free hospital parking to groups classified as most ‘in-need’. This includes disabled people, frequent outpatient attenders, parents of sick children staying overnight, and NHS staff working overnight. These groups will include dialysis patients where applicable.

What assessment NHS England has made of the potential impact of withdrawing dedicated parking provision for dialysis patients on patient safety and treatment adherence.

Decisions on the provision of car parking are made locally by National Health Service organisations and should be consistent with the national guidance. This includes the provision of parking adjustments for patient groups receiving frequent treatments, including those undergoing dialysis. Further information on the guidance is available at the following link:https://www.gov.uk/government/publications/nhs-patient-visitor-and-staff-car-parking-principles/nhs-patient-visitor-and-staff-car-parking-principlesThis guidance requires the provision of free hospital parking to groups classified as most ‘in-need’. This includes disabled people, frequent outpatient attenders, parents of sick children staying overnight, and NHS staff working overnight. These groups will include dialysis patients where applicable.

Whether NHS England plans to issue guidance to hospital trusts on providing reasonable parking adjustments for patient groups receiving frequent or intensive treatments, including those undergoing dialysis.

Decisions on the provision of car parking are made locally by National Health Service organisations and should be consistent with the national guidance. This includes the provision of parking adjustments for patient groups receiving frequent treatments, including those undergoing dialysis. Further information on the guidance is available at the following link:https://www.gov.uk/government/publications/nhs-patient-visitor-and-staff-car-parking-principles/nhs-patient-visitor-and-staff-car-parking-principlesThis guidance requires the provision of free hospital parking to groups classified as most ‘in-need’. This includes disabled people, frequent outpatient attenders, parents of sick children staying overnight, and NHS staff working overnight. These groups will include dialysis patients where applicable.

What assessment his Department has made of the potential merits of establishing a national referral pathway or specialist hub for people who cannot receive mRNA vaccines to ensure equitable access to appropriate COVID-19 vaccinations.

The Government is committed to protecting those most vulnerable to COVID-19 through vaccination, as guided by the independent Joint Committee on Vaccination and Immunisation (JCVI). The primary aim of the national COVID-19 vaccination programme remains the prevention of serious illness, resulting in hospitalisations and deaths, arising from COVID-19.The Government has accepted the JCVI’s advice for autumn 2025 and in line with the advice, a COVID-19 vaccination is being offered to the following groups:adults aged 75 years old and over;residents in care homes for older adults; andindividuals aged six months old and over who are immunosuppressed.As for all vaccines, the JCVI keeps all vaccination programmes under review.COVID-19 vaccines are procured by the UK Health Security Agency (UKHSA) in line with JCVI advice.UKHSA advise that as with all vaccines there will be an extremely small proportion of people who cannot receive a particular COVID-19 vaccine due to an anaphylactic reaction, this includes mRNA vaccines. Advice published in the UKHSA Green Book recommends that anyone with a prior allergic reaction to COVID-19 vaccines should be seen by an expert allergist and, after a review of the individual’s risks and benefits of vaccination, where it is indicated, they could then be vaccinated in hospital under clinical supervision. Information is not held centrally on how many people seen under this pathway are unable to receive an mRNA COVID-19 vaccine even in a hospital setting. Where an allergist has advised that a vaccine is not suitable, and this is the only type of vaccine available in a particular campaign, the individual should be advised of other mitigations to reduce their risk of becoming infected and be provided with information on access to treatments should they test positive for infection.

What assessment her Department has made of the potential merits of providing limited amounts of non-mRNA COVID-19 vaccines available for patients with clinical contraindications to mRNA vaccines, including through the importation of products already authorised by trusted international regulators.

The Government is committed to protecting those most vulnerable to COVID-19 through vaccination, as guided by the independent Joint Committee on Vaccination and Immunisation (JCVI). The primary aim of the national COVID-19 vaccination programme remains the prevention of serious illness, resulting in hospitalisations and deaths, arising from COVID-19.The Government has accepted the JCVI’s advice for autumn 2025 and in line with the advice, a COVID-19 vaccination is being offered to the following groups:adults aged 75 years old and over;residents in care homes for older adults; andindividuals aged six months old and over who are immunosuppressed.As for all vaccines, the JCVI keeps all vaccination programmes under review.COVID-19 vaccines are procured by the UK Health Security Agency (UKHSA) in line with JCVI advice.UKHSA advise that as with all vaccines there will be an extremely small proportion of people who cannot receive a particular COVID-19 vaccine due to an anaphylactic reaction, this includes mRNA vaccines. Advice published in the UKHSA Green Book recommends that anyone with a prior allergic reaction to COVID-19 vaccines should be seen by an expert allergist and, after a review of the individual’s risks and benefits of vaccination, where it is indicated, they could then be vaccinated in hospital under clinical supervision. Information is not held centrally on how many people seen under this pathway are unable to receive an mRNA COVID-19 vaccine even in a hospital setting. Where an allergist has advised that a vaccine is not suitable, and this is the only type of vaccine available in a particular campaign, the individual should be advised of other mitigations to reduce their risk of becoming infected and be provided with information on access to treatments should they test positive for infection.

How many people are clinically unable to receive mRNA-based COVID-19 vaccines; and how this figure has been derived.

The Government is committed to protecting those most vulnerable to COVID-19 through vaccination, as guided by the independent Joint Committee on Vaccination and Immunisation (JCVI). The primary aim of the national COVID-19 vaccination programme remains the prevention of serious illness, resulting in hospitalisations and deaths, arising from COVID-19.The Government has accepted the JCVI’s advice for autumn 2025 and in line with the advice, a COVID-19 vaccination is being offered to the following groups:adults aged 75 years old and over;residents in care homes for older adults; andindividuals aged six months old and over who are immunosuppressed.As for all vaccines, the JCVI keeps all vaccination programmes under review.COVID-19 vaccines are procured by the UK Health Security Agency (UKHSA) in line with JCVI advice.UKHSA advise that as with all vaccines there will be an extremely small proportion of people who cannot receive a particular COVID-19 vaccine due to an anaphylactic reaction, this includes mRNA vaccines. Advice published in the UKHSA Green Book recommends that anyone with a prior allergic reaction to COVID-19 vaccines should be seen by an expert allergist and, after a review of the individual’s risks and benefits of vaccination, where it is indicated, they could then be vaccinated in hospital under clinical supervision. Information is not held centrally on how many people seen under this pathway are unable to receive an mRNA COVID-19 vaccine even in a hospital setting. Where an allergist has advised that a vaccine is not suitable, and this is the only type of vaccine available in a particular campaign, the individual should be advised of other mitigations to reduce their risk of becoming infected and be provided with information on access to treatments should they test positive for infection.

Whether he plans to review national protocols that require the automatic cessation of Clozapine following a single red blood result, in the context of cases where such results have subsequently been found to be spurious.

Clozapine is used to treat people with schizophrenia in whom other medicines have not worked and it is also used to treat severe disturbances in the thoughts, emotions, and behaviour of people with Parkinson’s disease in whom other medicines have not worked.Clozapine is associated with potentially life threatening side effects including the risk of agranulocytosis. Patients must have regular blood tests to ensure their white blood cell count doesn’t drop too low which is classified as a red result. Clozapine may only be taken if the patient has a normal blood count.As with all medicines, the safety of clozapine is kept under continual review by the Medicines and Healthcare products Regulatory Agency (MHRA) using a number of data sources including reports of suspected side effects through the Yellow Card Scheme, data from marketing authorisation holders, and research published in the scientific literature.The MHRA is currently reviewing the blood monitoring requirements associated with clozapine, to ensure these continue to minimise the risk of agranulocytosis whilst allowing patients to access clozapine when needed. Currently, the product information for clozapine, including the summary of product characteristics states that patients must stop clozapine if a red result is obtained and that they should not be re-exposed to clozapine.

What steps he is taking to prevent serum Clozapine blood samples from being lost in transit within the NHS.

No specific assessment has been made of the reliability of current systems for transporting and processing serum Clozapine blood samples across National Health Service providers. Operational responsibility for the collection, transport, and processing of clozapine blood samples lies with individual NHS providers and their commissioned pathology and courier services. Further information on sample type and transport stability is available via individual NHS trust laboratory webpages.Testing for clozapine levels is carried out within the same accredited pathology framework used for other biochemical assays, with defined requirements for sample collection, labelling, storage and transport to maintain sample integrity. Laboratories providing clozapine assays hold UKAS ISO 15189 accreditation and are required to undertake internal quality control and participate in national External Quality Assessment schemes to ensure accuracy and reproducibility of results.Samples are transported through contracted courier services operating temperature controlled logistics, chain of custody processes and turnaround time requirements. These arrangements form part of routine clinical governance, incident reporting and performance management across NHS pathology services to prevent sample loss and provide assurance on the reliability of testing. Detailed operational arrangements are managed locally by individual pathology providers.

What assessment he has made of the reliability of current systems for transporting and processing serum Clozapine blood samples across NHS providers.

No specific assessment has been made of the reliability of current systems for transporting and processing serum Clozapine blood samples across National Health Service providers. Operational responsibility for the collection, transport, and processing of clozapine blood samples lies with individual NHS providers and their commissioned pathology and courier services. Further information on sample type and transport stability is available via individual NHS trust laboratory webpages.Testing for clozapine levels is carried out within the same accredited pathology framework used for other biochemical assays, with defined requirements for sample collection, labelling, storage and transport to maintain sample integrity. Laboratories providing clozapine assays hold UKAS ISO 15189 accreditation and are required to undertake internal quality control and participate in national External Quality Assessment schemes to ensure accuracy and reproducibility of results.Samples are transported through contracted courier services operating temperature controlled logistics, chain of custody processes and turnaround time requirements. These arrangements form part of routine clinical governance, incident reporting and performance management across NHS pathology services to prevent sample loss and provide assurance on the reliability of testing. Detailed operational arrangements are managed locally by individual pathology providers.

What assessment he has made of the adequacy of laboratory and record-keeping systems supporting Clozapine treatment, and whether they meet the standards expected for equivalent safety-critical medicines in physical healthcare.

NHS England’s National Patient Safety Team collect records of all patient safety incidents recorded by National Health Service trusts via the Learn From Patient Safety Events service. These records are used to identify new and under-recognised risks to patient safety and to understand themes and trends. The insight generated informs work to improve patient safety across the NHS. Further information is available at the following link:https://www.england.nhs.uk/patient-safety/patient-safety-insight/learning-from-patient-safety-events/using-patient-safety-events-data-to-keep-patients-safe/#The safety of clozapine is kept under continual review by the Medicines and Healthcare products Regulatory Agency (MHRA) using a number of data sources, including reports of suspected side effects through the Yellow Card Scheme, data from marketing authorisation holders, and research published in the scientific literature.Each clozapine marketing authorisation holder operates a Patient Monitoring Scheme which focuses on the blood monitoring requirements for clozapine. However, regular contact with healthcare professionals caring for patients receiving clozapine has resulted in a high proportion of suspected side effects being reported through the Yellow Card scheme. These reports are published by the MHRA in the interactive drug analysis profile for clozapine, with further information available at the following link:https://yellowcard.mhra.gov.uk/idaps/CLOZAPINE The Summary of Product Characteristics for clozapine outlines the monitoring requirements needed to minimise the risks of possible side effects for healthcare professionals. However, the MHRA does not regulate clinical practice or audit NHS record-keeping systems.

How learning from serious incidents involving accidental Clozapine withdrawal is being recorded and shared nationally across NHS mental health services.

Clozapine is used to treat people with schizophrenia in whom other medicines have not worked. It is also used to treat severe disturbances in the thoughts, emotions, and behaviour of people with Parkinson’s disease in whom other medicines have not worked.The known side effects of clozapine are outlined in the product information, the Summary of Product Characteristics (SPC) for healthcare professionals, and the Patient Information Leaflet which is provided in each pack of the medicine. The SPC states that clozapine should be stopped in a number of clinical situations including after developing a low white blood cell count, fever above 38oC, high blood glucose, also known as hyperglycaemia, as well as jaundice or clinically relevant increases in liver enzymes. If clozapine is restarted it must be carefully titrated and monitoring requirements followed.Inadvertent withdrawal of clozapine is an issue that is included in the National Health Service’s Time Critical Medicines Safety Improvement Programme, with further information available at the following link:https://www.sps.nhs.uk/articles/safer-use-of-time-critical-medicines-programme/The programme is supporting over 50 NHS hospitals to improve the reliability of administration of Time Critical Medicines such as clozapine.In July 2024 a thematic review of clozapine safety conducted in the North West of England was shared with the NHS England National Medication Safety Officer Network. This included a range of clozapine safety resources published online, such as:- Managing the risks associated with patients prescribed clozapine, which is available at the following link: https://www.sps.nhs.uk/articles/managing-the-risks-associated-with-patients-prescribed-clozapine/;- Clinical considerations for patients prescribed clozapine, which is available at the following link: https://www.sps.nhs.uk/articles/clinical-considerations-for-patients-prescribed-clozapine/;- Managing constipation in people taking clozapine, which is available at the following link: https://www.sps.nhs.uk/articles/managing-constipation-in-people-taking-clozapine/;- Clozapine use in adults with swallowing difficulties, which is available at the following link: https://www.sps.nhs.uk/articles/clozapine-use-in-adults-with-swallowing-difficulties/;- Managing specific interactions with smoking, which is available at the following link: https://www.sps.nhs.uk/articles/managing-specific-interactions-with-smoking/; and- Managing complexities of medication use across care boundaries, which includes a podcast on clozapine safety and which is available at the following link: https://www.sps.nhs.uk/articles/managing-complexities-of-medication-use-across-care-boundaries/. As with all medicines, the safety of clozapine is kept under continual review by the Medicines and Healthcare products Regulatory Agency (MHRA) using a number of data sources. The MHRA is currently reviewing the blood monitoring requirements associated with clozapine.

Whether his Department was consulted prior to the publication of the British Medical Journal article concerning terminology used in relation to female genital mutilation.

The Department was not consulted prior to the publication of the British Medical Journal Article concerning terminology used in relation to female genital mutilation.The Government does not tolerate female genital mutilation which can cause extreme and lifelong physical and psychological suffering to women and girls. The focus remains on preventing these crimes from happening, supporting and protecting survivors and those at risk, and bringing perpetrators to justice.This includes a mandatory reporting duty for regulated health professionals to report cases of female genital mutilation in girls under 18 years of age to the police.

Whether NHS England has issued guidance to clinicians on appropriate language to use when recording, reporting and discussing cases of female genital mutilation.

The Home Office, the Department for Education, and the Department of Health and Social Care issued multi-agency statutory guidance on female genital mutilation (FGM), which as updated in July 2020. The guidance ensures that health and other staff understand their role in responding to FGM, and that there are policies and procedures in place to protect women and girls who have undergone or are at risk of FGM.NHS England is currently updating the e-learning training for the Healthcare FGM Module for publication in 2026. This training has a section on communication and includes the importance of sensitive language, including asking healthcare staff to check which terminology the woman or girl prefers. The training will provide healthcare staff with the skills to consider, recognise, and discuss FGM with the women and girls they support, and provide sensitive and trauma-informed response.

What role NHS England played in determining the eligibility criteria for children recruited into the PATHWAYS trial.

The Government is committed to supporting research that delivers a robust, evidence-based understanding of the needs, and support and treatment options for children and young people living with gender dysphoria. A partnership between NHS England and the National Institute for Health and Care Research (NIHR) is working to fund and deliver independent research that fulfils that aim.One element of this is 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 protocol is publicly available on the NIHR website, at the following link:https://fundingawards.nihr.ac.uk/award/NIHR167530.This positively responds to the Cass Review’s recommendation that a clinical trial, alongside a broader programme of research, was necessary to gather the evidence required into the most effective way to care for this group of children and young people.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 independent clinical and legal experts, including those who specialise on medical ethics. This team is responsible for the protocol design, including eligibility criteria, consent, and outcomes.The proposal has been through all the usual review and approval stages ahead of set up and opening to recruitment. These include independent academic peer review, NIHR funding committee consideration, and a full regulatory review, including a focus on ethics. It has obtained approval from the regulatory authorities, including the Health Research Authority Ethics Committee and the Medicines and Healthcare products Regulatory Agency.

Whether children previously discharged from NHS gender services will be eligible for the PATHWAYS trial.

The Government is committed to supporting research that delivers a robust, evidence-based understanding of the needs, and support and treatment options for children and young people living with gender dysphoria. A partnership between NHS England and the National Institute for Health and Care Research (NIHR) is working to fund and deliver independent research that fulfils that aim.One element of this is 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 protocol is publicly available on the NIHR website, at the following link:https://fundingawards.nihr.ac.uk/award/NIHR167530.This positively responds to the Cass Review’s recommendation that a clinical trial, alongside a broader programme of research, was necessary to gather the evidence required into the most effective way to care for this group of children and young people.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 independent clinical and legal experts, including those who specialise on medical ethics. This team is responsible for the protocol design, including eligibility criteria, consent, and outcomes.The proposal has been through all the usual review and approval stages ahead of set up and opening to recruitment. These include independent academic peer review, NIHR funding committee consideration, and a full regulatory review, including a focus on ethics. It has obtained approval from the regulatory authorities, including the Health Research Authority Ethics Committee and the Medicines and Healthcare products Regulatory Agency.

What data sharing agreements are in place governing access to PATHWAYS trial participant data by external researchers or academic institutions.

The Government is committed to supporting research that delivers a robust, evidence-based understanding of the needs, and support and treatment options for children and young people living with gender dysphoria. A partnership between NHS England and the National Institute for Health and Care Research (NIHR) is working to fund and deliver independent research that fulfils that aim.One element of this is 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 protocol is publicly available on the NIHR website, at the following link:https://fundingawards.nihr.ac.uk/award/NIHR167530.This positively responds to the Cass Review’s recommendation that a clinical trial, alongside a broader programme of research, was necessary to gather the evidence required into the most effective way to care for this group of children and young people.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 independent clinical and legal experts, including those who specialise on medical ethics. This team is responsible for the protocol design, including eligibility criteria, consent, and outcomes.The proposal has been through all the usual review and approval stages ahead of set up and opening to recruitment. These include independent academic peer review, NIHR funding committee consideration, and a full regulatory review, including a focus on ethics. It has obtained approval from the regulatory authorities, including the Health Research Authority Ethics Committee and the Medicines and Healthcare products Regulatory Agency.

Which international clinical guidelines were used in the design of the PATHWAYS trial.

The Government is committed to supporting research that delivers a robust, evidence-based understanding of the needs, and support and treatment options for children and young people living with gender dysphoria. A partnership between NHS England and the National Institute for Health and Care Research (NIHR) is working to fund and deliver independent research that fulfils that aim.One element of this is 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 protocol is publicly available on the NIHR website, at the following link:https://fundingawards.nihr.ac.uk/award/NIHR167530.This positively responds to the Cass Review’s recommendation that a clinical trial, alongside a broader programme of research, was necessary to gather the evidence required into the most effective way to care for this group of children and young people.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 independent clinical and legal experts, including those who specialise on medical ethics. This team is responsible for the protocol design, including eligibility criteria, consent, and outcomes.The proposal has been through all the usual review and approval stages ahead of set up and opening to recruitment. These include independent academic peer review, NIHR funding committee consideration, and a full regulatory review, including a focus on ethics. It has obtained approval from the regulatory authorities, including the Health Research Authority Ethics Committee and the Medicines and Healthcare products Regulatory Agency.