Written questions by Pochin.

If he will publish the number of patients currently in (a) pre listing triage and (b) referral assessment stages for consultant led elective care pathways.

For referral to treatment (RTT) pathways that start within an interface service, which is any form of intermediary clinical triage, assessment, and/or treatment between primary and secondary care, a patient's clock start will begin at the point the general practice referral is made and not the date that the referral is received by the secondary care provider. Further information can be found in the RTT consultant-led waiting times: rules suite guidance document, which is available at the following link:https://www.gov.uk/government/publications/right-to-start-consultant-led-treatment-within-18-weeks/referral-to-treatment-consultant-led-waiting-times-rules-suite-october-2022The complete time elapsed between referral and treatment will be recorded on the published consultant led RTT waiting time data, at the following link:https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/rtt-data-2025-26/Advice and Guidance (A&G) is where a general practitioner requests advice from a specialist digitally, prior to or instead of a referral, and it has helped divert over 655,000 referrals between April and August 2025. The NHS Electronic Referral System, the platform used for most A&Gs, can allow the specialist to "convert" a request into a referral. An RTT waiting time clock would not commence unless the request is converted to a referral. Where a referral to the waiting list is not required, we expect patients to receive care sooner, in a more convenient setting, having benefitted from specialist advice to inform their care management plan.The Medium-Term Planning Framework, published in October 2025, outlines plans to move toward delivering care through a ‘Single Point of Access’. This describes a model where all appropriate referrals and requests, other than those for urgent suspected cancer, are directed through a single ‘front door’ to support triage to the most appropriate next step or outcome for the patient. This will help ensure a more consistent approach to triage which provides quicker access to patients.There are no plans for an independent audit of pre-listing referral management processes and reporting of delays across National Health Service trusts.

If he will take steps to ensure that NHS trusts do not manage referral pipelines, triage processes, or administrative allocation methods in ways that reduce the apparent size of the elective waiting list without reducing the actual waiting time experienced by patients.

For referral to treatment (RTT) pathways that start within an interface service, which is any form of intermediary clinical triage, assessment, and/or treatment between primary and secondary care, a patient's clock start will begin at the point the general practice referral is made and not the date that the referral is received by the secondary care provider. Further information can be found in the RTT consultant-led waiting times: rules suite guidance document, which is available at the following link:https://www.gov.uk/government/publications/right-to-start-consultant-led-treatment-within-18-weeks/referral-to-treatment-consultant-led-waiting-times-rules-suite-october-2022The complete time elapsed between referral and treatment will be recorded on the published consultant led RTT waiting time data, at the following link:https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/rtt-data-2025-26/Advice and Guidance (A&G) is where a general practitioner requests advice from a specialist digitally, prior to or instead of a referral, and it has helped divert over 655,000 referrals between April and August 2025. The NHS Electronic Referral System, the platform used for most A&Gs, can allow the specialist to "convert" a request into a referral. An RTT waiting time clock would not commence unless the request is converted to a referral. Where a referral to the waiting list is not required, we expect patients to receive care sooner, in a more convenient setting, having benefitted from specialist advice to inform their care management plan.The Medium-Term Planning Framework, published in October 2025, outlines plans to move toward delivering care through a ‘Single Point of Access’. This describes a model where all appropriate referrals and requests, other than those for urgent suspected cancer, are directed through a single ‘front door’ to support triage to the most appropriate next step or outcome for the patient. This will help ensure a more consistent approach to triage which provides quicker access to patients.There are no plans for an independent audit of pre-listing referral management processes and reporting of delays across National Health Service trusts.

Whether his Department records how many patients have withdrawn from treatment or deteriorated clinically while waiting to be added to an elective care waiting list.

The Department does not hold the data in this format.

What assessment he has made of the average length of time patients are currently waiting between GP referral and being added to an NHS consultant-led elective care waiting list; and whether any such waiting periods are included in official waiting list statistics.

In line with referral to treatment rules, a patient's waiting time clock starts from the moment they are referred for consultant-led elective treatment. According to these rules, there should be no time between a general practice referral and entry onto a consultant-led elective waiting list. The complete time elapsed between referral and treatment will be recorded on the published consultant led referral to treatment waiting time data, with further information available at the following link:https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/rtt-data-2025-26/Guidance is provided to NHS England and integrated care boards through the Referral to treatment consultant-led waiting times: rules suite, which is available at the following link:https://www.gov.uk/government/publications/right-to-start-consultant-led-treatment-within-18-weeks/referral-to-treatment-consultant-led-waiting-times-rules-suite-october-2022

Whether the period between GP referral and a patient being added to an elective waiting list has increased or decreased in the past five years.

In line with referral to treatment rules, a patient's waiting time clock starts from the moment they are referred for consultant-led elective treatment. According to these rules, there should be no time between a general practice referral and entry onto a consultant-led elective waiting list. The complete time elapsed between referral and treatment will be recorded on the published consultant led referral to treatment waiting time data, with further information available at the following link:https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/rtt-data-2025-26/Guidance is provided to NHS England and integrated care boards through the Referral to treatment consultant-led waiting times: rules suite, which is available at the following link:https://www.gov.uk/government/publications/right-to-start-consultant-led-treatment-within-18-weeks/referral-to-treatment-consultant-led-waiting-times-rules-suite-october-2022

Whether his Department monitors variation between NHS trusts in the time taken to convert GP referrals into entries on consultant led elective waiting lists.

In line with referral to treatment rules, a patient's waiting time clock starts from the moment they are referred for consultant-led elective treatment. According to these rules, there should be no time between a general practice referral and entry onto a consultant-led elective waiting list. The complete time elapsed between referral and treatment will be recorded on the published consultant led referral to treatment waiting time data, with further information available at the following link:https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/rtt-data-2025-26/Guidance is provided to NHS England and integrated care boards through the Referral to treatment consultant-led waiting times: rules suite, which is available at the following link:https://www.gov.uk/government/publications/right-to-start-consultant-led-treatment-within-18-weeks/referral-to-treatment-consultant-led-waiting-times-rules-suite-october-2022

How many patients have received a GP referral but who have not yet been allocated an NHS number on a consultant led waiting list.

In line with referral to treatment rules, a patient's waiting time clock starts from the moment they are referred for consultant-led elective treatment. According to these rules, there should be no time between a general practice referral and entry onto a consultant-led elective waiting list. The complete time elapsed between referral and treatment will be recorded on the published consultant led referral to treatment waiting time data, with further information available at the following link:https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/rtt-data-2025-26/Guidance is provided to NHS England and integrated care boards through the Referral to treatment consultant-led waiting times: rules suite, which is available at the following link:https://www.gov.uk/government/publications/right-to-start-consultant-led-treatment-within-18-weeks/referral-to-treatment-consultant-led-waiting-times-rules-suite-october-2022

Whether his Department monitors variation between NHS trusts in the time taken to convert GP referrals into entries on consultant led elective waiting lists.

In line with referral to treatment rules, a patient's waiting time clock starts from the moment they are referred for consultant-led elective treatment. According to these rules, there should be no time between a general practice referral and entry onto a consultant-led elective waiting list. The complete time elapsed between referral and treatment will be recorded on the published consultant led referral to treatment waiting time data, with further information available at the following link:https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/rtt-data-2025-26/Guidance is provided to NHS England and integrated care boards through the Referral to treatment consultant-led waiting times: rules suite, which is available at the following link:https://www.gov.uk/government/publications/right-to-start-consultant-led-treatment-within-18-weeks/referral-to-treatment-consultant-led-waiting-times-rules-suite-october-2022

Whether he has made an assessment of the potential impact of extended pre-listing delays on patient outcomes and clinical risk in high-volume specialities.

In line with referral to treatment rules, a patient's waiting time clock starts from the moment they are referred for consultant-led elective treatment. According to these rules, there should be no time between a general practice referral and entry onto a consultant-led elective waiting list. The complete time elapsed between referral and treatment will be recorded on the published consultant led referral to treatment waiting time data, with further information available at the following link:https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/rtt-data-2025-26/Guidance is provided to NHS England and integrated care boards through the Referral to treatment consultant-led waiting times: rules suite, which is available at the following link:https://www.gov.uk/government/publications/right-to-start-consultant-led-treatment-within-18-weeks/referral-to-treatment-consultant-led-waiting-times-rules-suite-october-2022

Whether NHS England includes the period between receipt of a GP referral and the issuing of the first appointment offer within published consultant led referral to treatment waiting time data.

In line with referral to treatment rules, a patient's waiting time clock starts from the moment they are referred for consultant-led elective treatment. According to these rules, there should be no time between a general practice referral and entry onto a consultant-led elective waiting list. The complete time elapsed between referral and treatment will be recorded on the published consultant led referral to treatment waiting time data, with further information available at the following link:https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/rtt-data-2025-26/Guidance is provided to NHS England and integrated care boards through the Referral to treatment consultant-led waiting times: rules suite, which is available at the following link:https://www.gov.uk/government/publications/right-to-start-consultant-led-treatment-within-18-weeks/referral-to-treatment-consultant-led-waiting-times-rules-suite-october-2022

What guidance his Department has issued to NHS England and integrated care boards on the recording, monitoring and reporting of delays between referral and formal waiting list entry.

In line with referral to treatment rules, a patient's waiting time clock starts from the moment they are referred for consultant-led elective treatment. According to these rules, there should be no time between a general practice referral and entry onto a consultant-led elective waiting list. The complete time elapsed between referral and treatment will be recorded on the published consultant led referral to treatment waiting time data, with further information available at the following link:https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/rtt-data-2025-26/Guidance is provided to NHS England and integrated care boards through the Referral to treatment consultant-led waiting times: rules suite, which is available at the following link:https://www.gov.uk/government/publications/right-to-start-consultant-led-treatment-within-18-weeks/referral-to-treatment-consultant-led-waiting-times-rules-suite-october-2022

Whether his Department records how many patients are experiencing delays of more than 12 months before being added to a consultant led elective care waiting list following GP referral.

In line with referral to treatment rules, a patient's waiting time clock starts from the moment they are referred for consultant-led elective treatment. According to these rules, there should be no time between a general practice referral and entry onto a consultant-led elective waiting list. The complete time elapsed between referral and treatment will be recorded on the published consultant led referral to treatment waiting time data, with further information available at the following link:https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/rtt-data-2025-26/Guidance is provided to NHS England and integrated care boards through the Referral to treatment consultant-led waiting times: rules suite, which is available at the following link:https://www.gov.uk/government/publications/right-to-start-consultant-led-treatment-within-18-weeks/referral-to-treatment-consultant-led-waiting-times-rules-suite-october-2022

What recent assessment she has made of the adequacy of waiting times for and availability of trauma-informed therapeutic support for child victims of peer-on-peer or child-on-child sexual abuse; and whether she intends to introduce access targets for such support.

We know that timely support is critical for child victims of sexual abuse, and that demand for child and adolescent mental health services (CAMHS) has risen significantly. The 10-Year Health Plan set out an ambitious reform agenda to transform the National Health Service and make it fit for the future. In line with this, we will go further to ensure that NHS mental health services deliver the care that people deserve, including child victims of sexual abuse. We are committed to reducing waiting times for specialist CAMHS support, as set out in our Medium-Term Planning Framework. We are also accelerating the rollout of Mental Health Support Teams in schools and colleges to reach full national coverage by 2029. As part of this, we are investing an additional £13 million to pilot enhanced training for staff so that they can offer more effective support to young people with complex needs, such as trauma. By bringing in vital services to schools, we can intervene early, promote wellbeing, and support recovery. Our action so far has resulted in more young people being supported to access NHS mental health services. In the first 12 months of the Government, nearly 40,000 more children and young people received support compared to the previous 12 months. There are currently no plans to introduce such an access target. The Darzi Review highlighted that there are too many NHS targets, so we have reduced the number of national priorities for 2025/26, focusing on what matters most to patients.

Whether he has received legal advice on the PATHWAYS trial.

The healthcare of children, like all patients, deserves evidence-based treatments where possible. That is why we are following expert, independent advice from the Cass Review to implement a programme of research to support the National Health Service to provide the best support to children and young people with gender incongruence. The programme 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 Government Legal Department is the Government’s principal legal advisers. Its core purpose is to help the Government to govern well, within the rule of law. They regularly provide advice to the Department of Health and Social Care.

What assessment the Department has made of the potential impact of puberty suppression on levels of likelihood of progression to cross sex hormones.

The Cass Review recommended that there is a need to build a more robust evidence base for the use of puberty suppressing hormones as a response to gender dysphoria in childhood, through a carefully considered research programme. The PATHWAYS Trial Study has been established for that purpose, in which puberty suppression will be offered solely within the context of the comprehensive assessment and psychosocial support now offered by the National Health Service.Kings College London University, which is leading the research, has advised that it is not possible to know before starting puberty suppressing hormones what the treatment plan for any single young person will be at the end of the trial. This will depend on several factors, including their experience of puberty suppressing hormones, their mental and physical health, and their preferences for future care.

Whether (a) detransitioners and (b) whistleblowers were consulted in the design 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 programme of research to support the National Health Service to provide the best support to children and young people with gender incongruence. The programme includes a data linkage study which will provide valuable information about the needs, experiences, and outcomes of former Gender Identity Development Service patients. However, the study will not provide high-quality or ‘causal’ data about the relative benefits and harms of puberty supressing hormones, when administered to current National Health Service patients alongside an improved model of care. Only a high-quality prospective clinical trial can provide that data. Therefore, the Government has commissioned the PATHWAYS study, which will provide new evidence directly relevant to the current cohort of children and young people accessing newly designed NHS gender services which reflect the Holistic Assessment Framework proposed by the Cass Review. The study includes the PATHWAYS trial, which is 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 National Institute for Health and Care Research website at the following link: https://fundingawards.nihr.ac.uk/award/NIHR167530 It includes details on eligibility criteria, control group design, and follow up. It includes details of HORIZON INTENSIVE, which will provide a non-randomised control group of young people with gender incongruence not receiving puberty-suppressing hormones. The trial has been subject to independent scientific, ethical, and regulatory scrutiny and peer review and has received the necessary research approvals. The study design, including inclusion criteria and safety protocols, has been thoroughly scrutinised to protect young people's wellbeing. Acceptance into the trial is subject to robust procedures including consent from a parent/carer and informed assent from the young person, a diagnosis of gender incongruence for at least two years, receipt of tailored psychosocial support, and the puberty suppression being deemed clinically appropriate, within the context of a study, by both their NHS care team and the national multi-disciplinary team. The research sponsor is responsible for organising insurance for the trial. After the first two years, all participants will be included in annual follow-up throughout the study period. Follow-up into adult life is important and participants will also be asked to consent to long-term follow-up through ongoing involvement with the PATHWAYS team, with a national health registry for gender care and linkage to health information routinely collected by NHS Digital.

Whether the PATHWAYS trial is insured against potential (a) loss of fertility, (b) impaired bone or cognitive development and (c) other long-term harms.

Children’s healthcare must always be evidence-led. That’s why we are following expert, independent advice from the Cass Review to implement a programme of research to support the National Health Service to provide the best support to children and young people with gender incongruence. The programme includes a data linkage study which will provide valuable information about the needs, experiences, and outcomes of former Gender Identity Development Service patients. However, the study will not provide high-quality or ‘causal’ data about the relative benefits and harms of puberty supressing hormones, when administered to current National Health Service patients alongside an improved model of care. Only a high-quality prospective clinical trial can provide that data. Therefore, the Government has commissioned the PATHWAYS study, which will provide new evidence directly relevant to the current cohort of children and young people accessing newly designed NHS gender services which reflect the Holistic Assessment Framework proposed by the Cass Review. The study includes the PATHWAYS trial, which is 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 National Institute for Health and Care Research website at the following link: https://fundingawards.nihr.ac.uk/award/NIHR167530 It includes details on eligibility criteria, control group design, and follow up. It includes details of HORIZON INTENSIVE, which will provide a non-randomised control group of young people with gender incongruence not receiving puberty-suppressing hormones. The trial has been subject to independent scientific, ethical, and regulatory scrutiny and peer review and has received the necessary research approvals. The study design, including inclusion criteria and safety protocols, has been thoroughly scrutinised to protect young people's wellbeing. Acceptance into the trial is subject to robust procedures including consent from a parent/carer and informed assent from the young person, a diagnosis of gender incongruence for at least two years, receipt of tailored psychosocial support, and the puberty suppression being deemed clinically appropriate, within the context of a study, by both their NHS care team and the national multi-disciplinary team. The research sponsor is responsible for organising insurance for the trial. After the first two years, all participants will be included in annual follow-up throughout the study period. Follow-up into adult life is important and participants will also be asked to consent to long-term follow-up through ongoing involvement with the PATHWAYS team, with a national health registry for gender care and linkage to health information routinely collected by NHS Digital.

What assessment he has made of the compatibility of the PATHWAYS trial with the requirement that clinical trials minimise foreseeable risks to child development.

Children’s healthcare must always be evidence-led. That’s why we are following expert, independent advice from the Cass Review to implement a programme of research to support the National Health Service to provide the best support to children and young people with gender incongruence. The programme includes a data linkage study which will provide valuable information about the needs, experiences, and outcomes of former Gender Identity Development Service patients. However, the study will not provide high-quality or ‘causal’ data about the relative benefits and harms of puberty supressing hormones, when administered to current National Health Service patients alongside an improved model of care. Only a high-quality prospective clinical trial can provide that data. Therefore, the Government has commissioned the PATHWAYS study, which will provide new evidence directly relevant to the current cohort of children and young people accessing newly designed NHS gender services which reflect the Holistic Assessment Framework proposed by the Cass Review. The study includes the PATHWAYS trial, which is 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 National Institute for Health and Care Research website at the following link: https://fundingawards.nihr.ac.uk/award/NIHR167530 It includes details on eligibility criteria, control group design, and follow up. It includes details of HORIZON INTENSIVE, which will provide a non-randomised control group of young people with gender incongruence not receiving puberty-suppressing hormones. The trial has been subject to independent scientific, ethical, and regulatory scrutiny and peer review and has received the necessary research approvals. The study design, including inclusion criteria and safety protocols, has been thoroughly scrutinised to protect young people's wellbeing. Acceptance into the trial is subject to robust procedures including consent from a parent/carer and informed assent from the young person, a diagnosis of gender incongruence for at least two years, receipt of tailored psychosocial support, and the puberty suppression being deemed clinically appropriate, within the context of a study, by both their NHS care team and the national multi-disciplinary team. The research sponsor is responsible for organising insurance for the trial. After the first two years, all participants will be included in annual follow-up throughout the study period. Follow-up into adult life is important and participants will also be asked to consent to long-term follow-up through ongoing involvement with the PATHWAYS team, with a national health registry for gender care and linkage to health information routinely collected by NHS Digital.

What assessment he has made of the potential merits of completing the Data Linkage Study to help inform safe PATHWAYS trial design.

Children’s healthcare must always be evidence-led. That’s why we are following expert, independent advice from the Cass Review to implement a programme of research to support the National Health Service to provide the best support to children and young people with gender incongruence. The programme includes a data linkage study which will provide valuable information about the needs, experiences, and outcomes of former Gender Identity Development Service patients. However, the study will not provide high-quality or ‘causal’ data about the relative benefits and harms of puberty supressing hormones, when administered to current National Health Service patients alongside an improved model of care. Only a high-quality prospective clinical trial can provide that data. Therefore, the Government has commissioned the PATHWAYS study, which will provide new evidence directly relevant to the current cohort of children and young people accessing newly designed NHS gender services which reflect the Holistic Assessment Framework proposed by the Cass Review. The study includes the PATHWAYS trial, which is 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 National Institute for Health and Care Research website at the following link: https://fundingawards.nihr.ac.uk/award/NIHR167530 It includes details on eligibility criteria, control group design, and follow up. It includes details of HORIZON INTENSIVE, which will provide a non-randomised control group of young people with gender incongruence not receiving puberty-suppressing hormones. The trial has been subject to independent scientific, ethical, and regulatory scrutiny and peer review and has received the necessary research approvals. The study design, including inclusion criteria and safety protocols, has been thoroughly scrutinised to protect young people's wellbeing. Acceptance into the trial is subject to robust procedures including consent from a parent/carer and informed assent from the young person, a diagnosis of gender incongruence for at least two years, receipt of tailored psychosocial support, and the puberty suppression being deemed clinically appropriate, within the context of a study, by both their NHS care team and the national multi-disciplinary team. The research sponsor is responsible for organising insurance for the trial. After the first two years, all participants will be included in annual follow-up throughout the study period. Follow-up into adult life is important and participants will also be asked to consent to long-term follow-up through ongoing involvement with the PATHWAYS team, with a national health registry for gender care and linkage to health information routinely collected by NHS Digital.

What criteria will be used to decide whether PATHWAYS trial participants are offered cross sex hormones at the end of the study.

Children’s healthcare must always be evidence-led. That’s why we are following expert, independent advice from the Cass Review to implement a programme of research to support the National Health Service to provide the best support to children and young people with gender incongruence. The programme includes a data linkage study which will provide valuable information about the needs, experiences, and outcomes of former Gender Identity Development Service patients. However, the study will not provide high-quality or ‘causal’ data about the relative benefits and harms of puberty supressing hormones, when administered to current National Health Service patients alongside an improved model of care. Only a high-quality prospective clinical trial can provide that data. Therefore, the Government has commissioned the PATHWAYS study, which will provide new evidence directly relevant to the current cohort of children and young people accessing newly designed NHS gender services which reflect the Holistic Assessment Framework proposed by the Cass Review. The study includes the PATHWAYS trial, which is 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 National Institute for Health and Care Research website at the following link: https://fundingawards.nihr.ac.uk/award/NIHR167530 It includes details on eligibility criteria, control group design, and follow up. It includes details of HORIZON INTENSIVE, which will provide a non-randomised control group of young people with gender incongruence not receiving puberty-suppressing hormones. The trial has been subject to independent scientific, ethical, and regulatory scrutiny and peer review and has received the necessary research approvals. The study design, including inclusion criteria and safety protocols, has been thoroughly scrutinised to protect young people's wellbeing. Acceptance into the trial is subject to robust procedures including consent from a parent/carer and informed assent from the young person, a diagnosis of gender incongruence for at least two years, receipt of tailored psychosocial support, and the puberty suppression being deemed clinically appropriate, within the context of a study, by both their NHS care team and the national multi-disciplinary team. The research sponsor is responsible for organising insurance for the trial. After the first two years, all participants will be included in annual follow-up throughout the study period. Follow-up into adult life is important and participants will also be asked to consent to long-term follow-up through ongoing involvement with the PATHWAYS team, with a national health registry for gender care and linkage to health information routinely collected by NHS Digital.