Written questions by Pochin.

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.

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.

For what reason the PATHWAYS trial follow up period is limited to two years.

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.

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 potential merits of including a control group of children who receive no puberty suppression in 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.

How the PATHWAYS trial will distinguish true clinical effects from placebo or expectation effects in an open label 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 safeguarding measures are in place to ensure that families do not feel pressured into 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.

What therapeutic or psychosocial interventions must be provided before a child is considered for 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.

What long term monitoring will be in place to track adult reproductive, sexual and psychological outcomes of PATHWAYS trial 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 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 made of the potential merits of (a) a feasibility study and (b) external peer review 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.

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.

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.

If she will publish a list of businesses that have committed furlough fraud but have not yet repaid the money.

HMRC has a “Publishing Details of Deliberate Tax Defaulters” programme which publishes details of deliberate tax defaulters on Gov.uk for a period of 12 months. Since HMRC began compliance on the COVID-19 support schemes, details of 195 people have been published for deliberately overclaiming CJRS and/or Eat Out to Help Out. The latest publication was in November 2025: Details of deliberate tax defaulters - GOV.UK

Of the firms reported to HM Revenue and Customs for furlough fraud, how many (a) have been investigated and (b) remain to be investigated.

HMRC’s Fraud Reporting Gateway receives Human Intelligence reports on a variety of topics, including COVID-19 error and fraud, that are of interest to HMRC. This Fraud Reporting Gateway has resulted in 23,000 intelligence reports relating to the COVID schemes to assess, and a further 900 reports received from the Public Sector Fraud Authority. Due to firewalls in place to protect human sources of information, the recipients of the intelligence do not know its origin. Therefore, once the intelligence is circulated, we are unable to directly identify and attribute yield generated from the Fraud Reporting Gateway contacts, or why an investigation was or was not started.

If she will publish all correspondence between herself and the Chair of the Office for Budget Responsibility between 1 October and 1 December.

The Chancellor engages regularly with the OBR’s Budget Responsibility Committee (BRC), including its Chair, in preparation for fiscal events. The OBR publishes a log of its contact, including with the Chancellor, in the Foreword of the Economic and Fiscal Outlook (EFO).On Wednesday 26 November, Richard Hughes wrote to the Chancellor to apologise for the early release of the OBR’s Economic and Fiscal Outlook and to announce an investigation into the incident.Richard Hughes resigned as Chair of the OBR on 1 December and the Chancellor wrote to thank him for his dedicated public service and leadership of the OBR over the last 5 years.These letters are published on the OBR website and on gov.uk, respectively.

What steps she is taking to strengthen enforcement action against money service businesses that breach anti money laundering regulations.

The latest National Risk Assessment of Money Laundering and Terrorist Financing, published in July 2025, confirms that Money Service Businesses (MSBs) remain high risk for both money laundering and terrorist financing, unchanged from the 2020 rating. The report can be found here: National risk assessment of money laundering and terrorist financing 2025 - GOV.UK The Government recognises the importance of targeting anti-money laundering (AML) activity at the highest-risk sectors as part of a risk-based approach. That is why the latest amendments to the Money Laundering Regulations (MLRs), due to be laid in 2026, will make the MLRs more proportionate and effective by ensuring that so-called ‘Know Your Customer’ requirements on regulated businesses such as MSBs are clearer and more targeted at high-risk activity. HMRC is the AML supervisor for MSBs. While we cannot comment on individual cases, HMRC provides HM Treasury with data on the number and risk profile of MSBs operating in the UK, as well as information on how it assesses and responds to MSB-related risks. This information is published in HM Treasury’s annual anti-money laundering and counter-terrorist financing supervision report, the latest version of which is available here: Anti-money laundering and countering the financing of terrorism: Supervision Report 2023-24 - GOV.UK HMRC also publishes details of penalties it has issued to businesses for non-compliance with the MLRs. The information for the 2024-25 financial year can be found here: Businesses that have not complied with the money laundering regulations (2024 to 2025) - GOV.UK According to this data, in 2024-25 16 MSBs were fined a total of £50,276 for failures in: the provision of registration information; notifying HMRC of material change; having the correct policies, controls and procedures; conducting due diligence; record keeping; and providing requested information or documents. HMRC also applies a range of non-financial penalties, including preventing businesses from trading through suspension or cancellation of their supervisory registration, to address risks in its supervised sectors.

What assessment she has made of the level of financial crime linked to non compliant money service businesses.

The latest National Risk Assessment of Money Laundering and Terrorist Financing, published in July 2025, confirms that Money Service Businesses (MSBs) remain high risk for both money laundering and terrorist financing, unchanged from the 2020 rating. The report can be found here: National risk assessment of money laundering and terrorist financing 2025 - GOV.UK The Government recognises the importance of targeting anti-money laundering (AML) activity at the highest-risk sectors as part of a risk-based approach. That is why the latest amendments to the Money Laundering Regulations (MLRs), due to be laid in 2026, will make the MLRs more proportionate and effective by ensuring that so-called ‘Know Your Customer’ requirements on regulated businesses such as MSBs are clearer and more targeted at high-risk activity. HMRC is the AML supervisor for MSBs. While we cannot comment on individual cases, HMRC provides HM Treasury with data on the number and risk profile of MSBs operating in the UK, as well as information on how it assesses and responds to MSB-related risks. This information is published in HM Treasury’s annual anti-money laundering and counter-terrorist financing supervision report, the latest version of which is available here: Anti-money laundering and countering the financing of terrorism: Supervision Report 2023-24 - GOV.UK HMRC also publishes details of penalties it has issued to businesses for non-compliance with the MLRs. The information for the 2024-25 financial year can be found here: Businesses that have not complied with the money laundering regulations (2024 to 2025) - GOV.UK According to this data, in 2024-25 16 MSBs were fined a total of £50,276 for failures in: the provision of registration information; notifying HMRC of material change; having the correct policies, controls and procedures; conducting due diligence; record keeping; and providing requested information or documents. HMRC also applies a range of non-financial penalties, including preventing businesses from trading through suspension or cancellation of their supervisory registration, to address risks in its supervised sectors.

What assessment she has made of revenue lost to furlough fraud committed during the pandemic.

The Covid Counter Fraud Commissioner Tom Hayhoe’s final report to Parliament found many schemes - including Bounce Back Loans - were rolled out with huge fraud risks and no early safeguards – costing the taxpayer millions. Weak accountability, bad quality data and poor contracting were identified as the primary causes of the £10.9 billion pound losses – which were enough to fund daily free school meals for the UK’s 2.7 million eligible children for eight years.This government has already recouped almost £400m of Covid support cash. The government has already actioned many of the Commissioner’s early proposals. These include:A voluntary repayment scheme, launched in September, giving claimants until 31 December to pay up.Tougher sanctions powers through the Public Authorities (Fraud, Error and Recovery) Bill, which became law on 2 December.Specialist fraud recovery teams to track down suspected fraudsters and recover taxpayer cash, from 2026.Estimates of error and fraud for the Coronavirus Job Retention Scheme (CJRS) are published at: Error and fraud in the COVID-19 schemes: methodology and approach (an update for 2023) - GOV.UK

What assessment she has made of the effectiveness of anti money laundering controls in bureaux de change and money service businesses.

The latest National Risk Assessment of Money Laundering and Terrorist Financing, published in July 2025, confirms that Money Service Businesses (MSBs) remain high risk for both money laundering and terrorist financing, unchanged from the 2020 rating. The report can be found here: National risk assessment of money laundering and terrorist financing 2025 - GOV.UK The Government recognises the importance of targeting anti-money laundering (AML) activity at the highest-risk sectors as part of a risk-based approach. That is why the latest amendments to the Money Laundering Regulations (MLRs), due to be laid in 2026, will make the MLRs more proportionate and effective by ensuring that so-called ‘Know Your Customer’ requirements on regulated businesses such as MSBs are clearer and more targeted at high-risk activity. HMRC is the AML supervisor for MSBs. While we cannot comment on individual cases, HMRC provides HM Treasury with data on the number and risk profile of MSBs operating in the UK, as well as information on how it assesses and responds to MSB-related risks. This information is published in HM Treasury’s annual anti-money laundering and counter-terrorist financing supervision report, the latest version of which is available here: Anti-money laundering and countering the financing of terrorism: Supervision Report 2023-24 - GOV.UK HMRC also publishes details of penalties it has issued to businesses for non-compliance with the MLRs. The information for the 2024-25 financial year can be found here: Businesses that have not complied with the money laundering regulations (2024 to 2025) - GOV.UK According to this data, in 2024-25 16 MSBs were fined a total of £50,276 for failures in: the provision of registration information; notifying HMRC of material change; having the correct policies, controls and procedures; conducting due diligence; record keeping; and providing requested information or documents. HMRC also applies a range of non-financial penalties, including preventing businesses from trading through suspension or cancellation of their supervisory registration, to address risks in its supervised sectors.