Lord Cashman

In addition to the ongoing efforts to control Mpox clade IIb in the United Kingdom, there is widespread planning underway across the Government, including work by the Department, the UK Health Security Agency, and the National Health Service, to prepare for any potential cases of the high consequence infectious disease clades Ia or Ib of Mpox in the UK, and to help prevent onward transmission should any cases be imported.

An established clinical countermeasures programme is a core component of our pandemic preparedness and response capability. These clinical countermeasures include personal protective equipment and hygiene consumables, vaccines, and therapeutics, such as antivirals. The programme, including the balance of antivirals stockpiled, is informed by scientific and clinical assessment of the evidence base and is kept under review, building on lessons learned from previous outbreaks and emerging evidence on efficacy from ongoing clinical trials in epidemic hotspots.

The Department has noted the recent PALM007 study. The NHS in England has a duty to make available to patients in England any treatment or product recommended as clinically and cost effective by the National Institute for Health and Care Excellence.

Of the three vaccines, Imvanex is the only one licensed in the United Kingdom by the Medicines and Healthcare products Regulatory Agency, and in the European Union by the European Medicines Agency, for active immunisation against smallpox, Mpox, and other diseases caused by the vaccinia virus in adults.

Imvanex is the only currently available vaccine with real world evidence of protection against Mpox. The Joint Committee on Vaccination and Immunisation has agreed that the evidence it has reviewed is consistent with protection from Imvanex being maintained for approximately 10 years.

A study into the potential benefits and harms of puberty suppressing hormones being used as one of the treatment options for children and young people with gender incongruence is being developed through a joint programme between NHS England and the National Institute for Health and Care (NIHR), the research arm of the Department. The research will be co-sponsored by King’s College London and the South London and Maudsley NHS Foundation Trust. It is planned that recruitment into the study will be through specialist National Health Service gender services, ensuring that individuals accessing hormone suppression through the study do so following a holistic multidisciplinary assessment within the services above. The study team has submitted their research application, which is currently undergoing scientific review.

Subject to the study achieving the necessary approvals, including ethics approval, the NIHR will publish details of the award, including the planned trial duration and study completion date, on its website. The study forms part of a wider joint programme of research and evaluation underpinning the delivery of new services for children and young people with gender incongruence. Further research will be needed to continue to build the evidence base, and our understanding of best practice in this important clinical area, including for psychosocial interventions. Work will continue with a broad range of stakeholders, to inform further study priorities.

In August, NHS England published a service specification for the National Referral Support Service for Specialist Services for Children and Young People with Gender Incongruence. Now referrals can only be made by a National Health Service-commissioned, secondary care-level paediatric service, or a Children and Young Person mental health service. This will ensure that healthcare professionals with the relevant expertise conduct the assessment and help determine any co-existing mental health or other health needs of these children and their onward care, ultimately ensuring a holistic approach to care for these children and young people.

The impacts of the new arrangements for referral into the NHS Children and Young People's Gender Services were considered in detail by NHS England through a process of public consultation, which included publication of an impact assessment. The impact assessment concluded that the new access arrangements are unlikely to increase the waiting time into the NHS Children and Young People's Gender Services for the majority of individuals, as the referral date from primary care to the secondary care service will be honoured for determining an individual’s place on the waiting list for the NHS Children and Young People's Gender Service, and waiting times for local mental health services and paediatric services are likely to be lower for the majority of individuals than the current waiting time for the first appointment with the NHS Children and Young People's Gender Service. NHS England expects waiting times into the NHS Children and Young People's Service to fall as clinical capacity is increased through the establishment of new regional providers, in line with the recommendations of the Cass Review. The consultation materials and the impact assessment are available at the following link:

https://www.england.nhs.uk/publication/referral-pathway-for-specialist-service-for-children-and-young-people-with-gender-incongruence/