Written questions by Lowe.

For the total spend on (i) LinkedIn membership fees (ii) other subscriptions by his Department in the last financial year.

There were no transactions (subscription costs or otherwise) identified with LinkedIn as a supplier in the 2024/25 financial year.The total subscription fees identified for the 2024/25 financial year was £832,046.14. This figure excludes membership of the World Health Organisation which is considered a subscription for accountancy purposes.The response relates to the core department only and does not include information relating to the department’s arm’s-length bodies.

Whether NHS England or NHSBSA have identified any gaps or inconsistencies in national prescribing or outcomes data relating to puberty blockers in under-18s.

In March 2024, NHS England published a suite of documentation relating to its decision to remove gonadotrophin releasing hormone analogues as a routine treatment option in the National Health Service for children under 18 years old with gender dysphoria. This documentation included a review of the published evidence, which concluded that there is very limited evidence about safety, risks, benefits, and outcomes for the use of this medication in children with gender dysphoria. Restrictions on the sale and supply of these medicines via private and NHS prescriptions were introduced in May 2024. In line with the findings and recommendations of the Cass Review, NHS England and the National Institute for Health and Care Research have commissioned a carefully designed clinical trial to assess the relative benefits and harms of puberty suppressing hormones on young people’s physical, social, and emotional well-being.With regard to national prescribing data, the Government holds information relating to NHS prescriptions of gonadotropin hormone-releasing hormone agonists for all purposes for children aged 17 years old and under that were prescribed and dispensed in community pharmacies or general practices in England in each year from 2015/16 to September 2025. The NHS Business Services Authority does not hold patient data prior to April 2015. The Government does not hold data for prescriptions dispensed within secondary care, prisons, or other detention centres, or private prescriptions other than controlled drugs.

What instructions his Department issued to NHS regional gender hubs on prescribing restrictions.

In March 2024, NHS England published its clinical policy on puberty suppressing hormones for children and young people who have gender incongruence and/or gender dysphoria.This set out that puberty supressing hormones are not available as a routine commissioning treatment option for the treatment of children and young people who have gender incongruence and/or gender dysphoria.

Whether any NHS regional gender hubs have prescribed puberty blockers to patients under 18 since the publication of the Cass Review.

From 1 April 2024, NHS England adopted a new clinical commissioning policy that prevents the newly established Children and Young People's Gender Services from initiating prescriptions for gonadotrophin releasing hormone analogues for the purpose of puberty suppression.

Whether the Department holds complete archived referral, assessment, prescribing, and safeguarding data from the former Tavistock Gender Identity Development Service; and whether the Department will publish an aggregated historical summary.

NHS England, as the responsible commissioner of the service at the time, will hold some relevant data, of the type and nature that would routinely be reported through the commissioning process. This would not include patient identifiable information.

What evidence NICE has identified as the basis for its clinical assessment of puberty blockers for gender dysphoria; and whether NICE has undertaken (a) scoping and (b) evaluation exercises since 2015.

The National Institute for Health and Care Excellence (NICE) has not developed guidance on, or made a clinical assessment of, puberty blockers for gender dysphoria. In 2020, NICE developed two evidence summaries:Gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria; andGender-affirming hormones for children and adolescents with gender dysphoria.These summaries were commissioned by NHS England and developed by NICE to an NHS England process. They helped inform the Cass review.

What aggregated safety data, including adverse-event summaries, the MHRA has recorded relating to the use of puberty blockers in under-18s since 2010; and whether the Department has been informed of any safety signals during that period.

The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for ensuring medicines, medical devices, and blood components for transfusion meet applicable standards of safety, quality, and efficacy. The MHRA rigorously assesses available data, including from the Yellow Card scheme, and seeks advice from their independent advisory committee, the Commission on Human Medicines, where appropriate to inform regulatory decisions.Puberty blockers are also known as gonadotrophin-releasing hormone (GnRH) analogues. These medicines are licenced for conditions such as young children who enter puberty too early, also known as precocious puberty, prostate cancer, and endometriosis. The use of GnRH analogues to suppress puberty in children and young people with gender dysphoria is off-label prescribing. This means that the use of these medicines for this purpose is outside of the licensed uses, and as such the benefits and risks of the medicine for use in this specific population have not been assessed. The MHRA does not regulate off-label use.The MHRA has received three United Kingdom suspected adverse drug reaction reports in which a GnRH analogue has been reported as being used in a child or young person for the purpose of puberty suppression in gender dysphoria. The GnRH analogues included in this search were buserelin, leuprorelin, goserelin, gonadorelin, nafarelin, and triptorelin. Please note it is not mandatory to provide information on indication when submitting an adverse drug reaction report.It is important to note that a reaction reported to the Yellow Card scheme does not necessarily mean it has been caused by the medicine, only that the reporter had a suspicion it may have. Underlying or concurrent illnesses may be responsible, or the events could be coincidental.The MHRA has not identified any safety signals which concern the off-label use of the GnRH analogues for the purpose of puberty suppression in gender dysphoria. However, we acknowledge that there is a clear lack of clinical evidence for the safety and efficacy of using these medicines for gender incongruence and/or dysphoria in those aged 18 years old and under. That is why NHS England and the National Institute for Health and Care Research have commissioned a carefully designed clinical trial to assess the relative benefits and harms of puberty suppressing hormones on young people’s physical, social, and emotional well-being.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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