Written questions by Pochin.

What assessment has been made of the compatibility of the PATHWAYS trial with the Cass Review recommendations on clinical caution and evidence thresholds.

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 steps he plans to take to ensure that Parliament is provided with adequate opportunities for scrutinising progress and outcomes of the PATHWAYS trial while it is ongoing.

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 Ministers approved the commencement of the PATHWAYS puberty blocker 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 the Department has received formal representations from professional medical bodies regarding the PATHWAYS trial since ethical approval was granted.

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 indemnity arrangements are in place for clinicians involved in prescribing puberty blockers under 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.

If he will take steps to ensure that the PATHWAYS trial does not adversely affect a participant’s future access to NHS care.

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 guidance his Department provides to NHS bodies regarding engagement with external academic publications that discuss practices which are illegal under UK law.

In the United Kingdom, regulated healthcare professionals are required by law to maintain standards in competence, ethics, patient safety, and accountability. Failure to meet these standards can result in investigation, restrictions, suspension, or permanent removal from the register. Responsible employment practices are an important element in ensuring all those working in the research and innovation system can thrive and deliver high quality research.Researchers funded through UK Research and Innovation (UKRI), National Institute for Health and Care Research (NIHR), and other publicly funded sources are expected to comply with the highest standards of research ethics and integrity, including responsible publication practices. Both UKRI and NIHR are signatories to the Concordat to Support Research Integrity.The NIHR's support for the San Francisco Declaration on Research Assessment aligns with its dedication to research integrity, transparency, and fostering a culture where research excellence is measured in a more holistic and meaningful way.

What assessment his Department has made of the potential impact of peer reviewed medical journals publishing articles that propose alternative terminology for practices that are criminal offences in the United Kingdom on patient safeguarding and public confidence.

In the United Kingdom, regulated healthcare professionals are required by law to maintain standards in competence, ethics, patient safety, and accountability. Independent professional regulators, such as the General Medical Council and the Nursing and Midwifery Council, safeguard public health by establishing and enforcing standards. They maintain registers and ensure accountability. Although they operate independently from the Government, they function within statutory frameworks and are accountable to Parliament.Funders of research, including UK Research and Innovation (UKRI) and the National Institute for Health and Care Research (NIHR), builds assessment of skills into the research funding process. During the grant application process, proposals undergo expert peer review where all relevant skills, including statistical skills are assessed. In addition, UKRI and NIHR are signatories to the Concordat to Support Research Integrity.The Department has not made an assessment of the potential impact of peer reviewed medical journals publishing articles that propose alternative terminology for practices that are criminal offences in the United Kingdom on patient safeguarding and public confidence.

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.

If he will commission an independent audit of pre-listing referral management processes and reporting of delays across NHS trusts.

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 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

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 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.

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