Asked by: Sarah Pochin (Reform UK - Runcorn and Helsby)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, for what reason the PATHWAYS trial follow up period is limited to two years.
Answered by Zubir Ahmed - Parliamentary Under-Secretary (Department of Health and Social Care)
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.
Asked by: Sarah Pochin (Reform UK - Runcorn and Helsby)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, whether the PATHWAYS trial is insured against potential (a) loss of fertility, (b) impaired bone or cognitive development and (c) other long-term harms.
Answered by Zubir Ahmed - Parliamentary Under-Secretary (Department of Health and Social Care)
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.
Asked by: Sarah Pochin (Reform UK - Runcorn and Helsby)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what assessment he has made of the compatibility of the PATHWAYS trial with the requirement that clinical trials minimise foreseeable risks to child development.
Answered by Zubir Ahmed - Parliamentary Under-Secretary (Department of Health and Social Care)
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.
Asked by: Sarah Pochin (Reform UK - Runcorn and Helsby)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what long term monitoring will be in place to track adult reproductive, sexual and psychological outcomes of PATHWAYS trial participants.
Answered by Zubir Ahmed - Parliamentary Under-Secretary (Department of Health and Social Care)
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.
Asked by: Julian Smith (Conservative - Skipton and Ripon)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what mechanisms are in place for NHS mental health trusts to be held accountable when written recommendations for improving carer involvement and crisis support following formal apologies are not implemented within agreed timescales.
Answered by Zubir Ahmed - Parliamentary Under-Secretary (Department of Health and Social Care)
Anyone receiving treatment for their mental health deserves safe, high-quality care, and to be treated with dignity and respect.
Families, staff, and the public deserve answers when things go wrong in mental health settings and it is vitally important that, where care falls short, we learn from any mistakes made to improve care across the National Health Service and protect patients in the future.
All NHS providers are held to account under the NHS Oversight Framework 2025/26 when they fail to implement written recommendations, for instance on carer involvement or crisis support, in agreed timescales. This includes a capability assessment, where trusts are evaluated for leadership, governance, and ability to implement change, with failures heightening oversight. As part of the Provider Improvement Programme, low performing trusts enter a structured programme, gaining intensive, formal improvement interventions.
NHS England can formally step in using its enforcement guidance if performance or governance is below acceptable standards. NHS England regional teams convene regular meetings with trusts and integrated care boards to review progress on agreed recommendations and implementation plans.
It is the role of the Parliamentary and Health Service Ombudsman to carry out independent investigations into complaints about treatment or service provided through the NHS where organisation level complaints processes have already been followed.
Asked by: Rachael Maskell (Labour (Co-op) - York Central)
Question to the Department for Education:
To ask the Secretary of State for Education, what steps she has taken to ensure family hubs are accessible for adoptive and kinship families.
Answered by Olivia Bailey - Parliamentary Under-Secretary of State (Department for Education) (Equalities)
Best Start Family Hubs (BSFHs) will be open to all families, including adoptive and kindship families. Best Start Family Hubs (BSFHs) are focused on universal, preventative services, targeting disadvantaged families. They can also serve as a non-stigmatising gateway for more targeted, intensive, support delivered by Family Help services and other interventions.
Parents and carers including adoptive and kinship families will have access to a universal offer of parenting programmes through their local hub, alongside targeted support for those most in need.
When adoptive and kinship families walk through the door of their local BSFH, they should be able to see evidence of various services co-located in one place and be easily connected to a wider range of support delivered elsewhere in the BSFH network. BSFHs should bring together a wide range of statutory and non-statutory services for children ages 0 to 5 within BSFHs, spanning education, childcare, health and social care.
Asked by: James McMurdock (Independent - South Basildon and East Thurrock)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what the longest inpatient stays were for mental health patients in each age group discharged in 2025.
Answered by Zubir Ahmed - Parliamentary Under-Secretary (Department of Health and Social Care)
The information requested for the latest available period (1 January to 30 June 2025) is in the table below. Counts below 5 are suppressed using an asterisk.
Age Band at Discharge | Bed Type at Discharge1 | Total Number of Discharges | Longest hospital stay (days)2 |
0 to 17 | Child and Young Person Learning Disabilities | 945 | 2,968 |
0 to 17 | Unknown3 | 400 | 2,385 |
0 to 17 | Acute Mental Health Unit for Adults with a Learning Disability and/or Autism | * | 2,033 |
0 to 17 | General Child and Young Person Young Person (13 years up to and including 17 years) | 930 | 853 |
0 to 17 | Child and Young Person Low Secure Mental Illness | * | 699 |
0 to 17 | Eating Disorders Child and Young Person | 135 | 662 |
0 to 17 | General Child and Young Person Child (up to and including 12 years) | 240 | 609 |
0 to 17 | Child and Young Person Psychiatric Intensive Care Unit | 110 | 563 |
0 to 17 | Adult Low Secure | 5 | 392 |
0 to 17 | Adult Eating Disorders | * | 200 |
0 to 17 | Child Mental Health Services for the Deaf | * | 114 |
0 to 17 | Acute Adult Mental Health Care | 30 | 59 |
0 to 17 | Child and Young Person Medium Secure Mental Illness | * | 43 |
0 to 17 | Adult Psychiatric Intensive Care Unit (Acute Mental Health Care) | * | 42 |
0 to 17 | Adult Mental Health Rehabilitation (Mainstream Service) | 5 | 4 |
0 to 17 | Adult Neuro-Psychiatry / Acquired Brain Injury | 10 | 3 |
18 to 64 | Adult High Secure | 55 | 10,514 |
18 to 64 | Adult Medium Secure | 380 | 7,897 |
18 to 64 | Adult Mental Health Rehabilitation (Mainstream Service) | 1,360 | 6,785 |
18 to 64 | Unknown3 | 2,950 | 6,666 |
18 to 64 | Acute Mental Health Unit for Adults with a Learning Disability and/or Autism | 730 | 6,199 |
18 to 64 | Adult Low Secure | 420 | 5,916 |
18 to 64 | Acute Older Adult Mental Health Care (Organic and Functional) | 555 | 5,381 |
18 to 64 | Adult Neuro-Psychiatry / Acquired Brain Injury | 160 | 5,250 |
18 to 64 | Acute Adult Mental Health Care | 30,905 | 3,920 |
18 to 64 | Adult Mental Health Rehabilitation for Adults with a Learning Disability and/or Autism (Specialist Service) | 155 | 3,763 |
18 to 64 | Child and Young Person Learning Disabilities | 30 | 2,956 |
18 to 64 | Adult Personality Disorder | 10 | 2,701 |
18 to 64 | Adult Mental Health Services for the Deaf | 20 | 1,892 |
18 to 64 | Eating Disorders Child and Young Person | 35 | 1,538 |
18 to 64 | General Child and Young Person Child (up to and including 12 years) | * | 1,414 |
18 to 64 | Adult Psychiatric Intensive Care Unit (Acute Mental Health Care) | 2,580 | 1,181 |
18 to 64 | Adult Eating Disorders | 390 | 943 |
18 to 64 | Child and Young Person Low Secure Mental Illness | 5 | 876 |
18 to 64 | General Child and Young Person Young Person (13 years up to and including 17 years) | 35 | 693 |
18 to 64 | Child and Young Person Medium Secure Mental Illness | * | 600 |
18 to 64 | Mother and Baby | 465 | 285 |
18 to 64 | Severe Obsessive Compulsive Disorder and Body Dysmorphic Disorder - Young Person | 5 | 245 |
18 to 64 | Child and Young Person Psychiatric Intensive Care Unit | 10 | 188 |
65+ | Adult Mental Health Rehabilitation (Mainstream Service) | 195 | 8,768 |
65+ | Adult Low Secure | 20 | 6,361 |
65+ | Adult Neuro-Psychiatry / Acquired Brain Injury | 45 | 6,167 |
65+ | Acute Older Adult Mental Health Care (Organic and Functional) | 5,705 | 5,671 |
65+ | Adult Medium Secure | 15 | 4,960 |
65+ | Acute Mental Health Unit for Adults with a Learning Disability and/or Autism | 15 | 2,606 |
65+ | Acute Adult Mental Health Care | 1,055 | 1,832 |
65+ | Adult Psychiatric Intensive Care Unit (Acute Mental Health Care) | 30 | 1,576 |
65+ | Unknown3 | 125 | 1,195 |
65+ | Adult Mental Health Services for the Deaf | * | 534 |
65+ | Adult Mental Health Rehabilitation for Adults with a Learning Disability and/or Autism (Specialist Service) | 5 | 514 |
65+ | Severe Obsessive Compulsive Disorder and Body Dysmorphic Disorder - Young Person | * | 310 |
65+ | Adult Eating Disorders | 10 | 260 |
65+ | General Child and Young Person Child (up to and including 12 years) | * | - |
Data source: Mental Health Services Dataset, NHS England
1 Bed type is the bed that the patient was in when they were discharged.
2 The length of stay is the patient’s total length of stay during the hospital spell.
3 Where a patient’s bed type is not recorded or cannot be matched to a valid value, the bed type is recorded as unknown.
Asked by: Suella Braverman (Reform UK - Fareham and Waterlooville)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what assessment his Department has made of the potential impact of levels of epilepsy medication availability on patient safety.
Answered by Zubir Ahmed - Parliamentary Under-Secretary (Department of Health and Social Care)
Medicine supply issues are global in their nature and, whilst not wholly preventable, the Department has a range of well-established processes and tools to manage and mitigate risks to patients. The Department has worked hard with industry to help resolve intermittent supply issues with some epilepsy medications. As a result of ongoing activity and intensive work, including asking manufacturers to expedite deliveries, most issues have been resolved.
The Department is currently aware of supply issues affecting some suppliers of clobazam 10 milligram tablets, all strengths of topiramate tablets, clonazepam 2 milligram tablets, and phenobarbital 15 milligram tablets, used in the management of epilepsy.
The supply issue with clonazepam 2mg tablets from one manufacturer is expected to resolve late January 2026. The affected suppliers of topiramate 25 milligram and 50 milligram tablets, and clobazam 10 milligram tablets, are expected to resupply these products by early December 2025. The resupply date from the other affected manufacturers for topiramate 50 milligram, 100 milligram and 200 milligram tablets and phenobarbital 15 milligram tablets is yet to be confirmed. Stock remains available from alternative manufacturers of these products to meet patient demand, and we have issued comprehensive management guidance to the National Health Service.
We have issued guidance for the discontinuation of sodium valproate (Epilim Chronosphere) 750 milligram and 1000 milligram modified release (MR) granules sachets. Alternative strengths of sodium valproate MR granules sachets remain available.
Asked by: Gregory Stafford (Conservative - Farnham and Bordon)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what assessment his Department has made of the adequacy of the availability of ADHD medication.
Answered by Zubir Ahmed - Parliamentary Under-Secretary (Department of Health and Social Care)
The Department has made substantial progress in improving the availability of medicines for attention deficit hyperactivity disorder (ADHD), working closely with industry and key stakeholders to resolve previous supply challenges. Through intensive work with industry, NHS England and the Medicines and Healthcare products Regulatory Agency have resolved most of the previous shortages. All strengths of lisdexamfetamine, atomoxetine, both the capsules and the oral solution, guanfacine prolonged-release tablets, and methylphenidate prolonged-release tablets are now available.
There is a current supply issue with methylphenidate 30 milligram prolonged-release capsules, brand name Equasym XL, which is out of stock until late December. The Department has issued guidance to healthcare professionals with advice on how to manage patients until this shortage resolves.
We continue to work closely with suppliers to resolve the few remaining challenges and to strengthen resilience in the supply chain. This includes securing additional stocks, expediting deliveries, and expanding the United Kingdom supplier base to support future demand. In collaboration with NHS England’s ADHD taskforce and national data improvement plan, we are developing growth forecasts to improve demand planning and ensure a sustainable supply of ADHD medicines.
To support prescribers and dispensers, the Department maintains and regularly updates a list of currently available and unavailable ADHD products on the Specialist Pharmacy Service website, at the following link:
www.sps.nhs.uk/articles/prescribing-available-medicines-to-treat-adhd
Asked by: Ben Obese-Jecty (Conservative - Huntingdon)
Question to the Department for Education:
To ask the Secretary of State for Education, what assessment has she made of the potential implications for her policies of the outcome of the joint Ofsted and CQC Area SEND Inspection published on 13 May 2025.
Answered by Georgia Gould - Minister of State (Education)
Cambridgeshire local area partnership was inspected by Ofsted and the Care Quality Commission (CQC) from 27 to 31 January 2025. The inspection outcome was that the local areas partnership’s arrangements lead to inconsistent experiences and outcomes for children and young people with special educational needs and disabilities (SEND). Five areas for improvement were identified and the department is working with the local partnership to monitor improvement in these five areas.
Where a council does not meet its duties, the department can take action that prioritises children’s needs and supports local areas to bring about rapid improvement. We offer a range of universal, targeted and intensive support through department-managed programmes, such as our sector led improvement Partners.
The current Ofsted/CQC area SEND inspection framework was launched in January 2023. All local areas are due to receive a full inspection under this framework by the end of 2027, driving better outcomes and standards in the system.
As part of our Plan for Change, the department is determined to fix the SEND system and restore the trust of parents. We will bring forward a full Schools White Paper early in the new year.