Question to the Department of Health and Social Care:

To ask His Majesty's Government, in regard to page 219 of the Paterson Inquiry report, published on 4 February 2020, what steps they are taking to ensure that all patients are given a structured period to reflect on their diagnosis and treatment options before consenting to surgical procedures; and what monitoring the General Medical Council is undertaking of compliance with that recommendation.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

All doctors are expected to meet the standards set out in the General Medical Council’s (GMC’s) Good Medical Practice, which states that doctors must ensure patients are given the time and support they need to make informed decisions. Doctors must also follow the GMC’s guidance Decision making and consent, which came into effect in November 2020. The guidance sets out seven principles of decision making and consent, including giving patients the information they need to make a decision and the time and support they need to understand it.

The Care Quality Commission (CQC) considers GMC guidance and standards when conducting assessments. The CQC can act if a provider is failing to ensure that consent is being obtained lawfully.

NHS England has integrated decision support tools into elective pathways of care. These tools support two stage shared decision making, which introduces a period of reflection for patients when deciding on treatment options and giving consent. This allows patients to take the time to fully understand the benefits and risks of treatment, talk with friends and family, and decide whether it is the most suitable option for them.

Question to the Department of Health and Social Care:

To ask His Majesty's Government, further to the Written Answer by Baroness Merron on 10 March (HL14737), when they plan to implement each of the immediate priorities for improving adult gender services in that answer.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

Further to the written answer given on 10 March 2026 to Question HL14737, NHS England’s immediate priorities for improving adult gender services and their planned timeframes are as follows:

• the creation of a new single, national waiting list for adult gender services, with plans for a phased transfer of patients from May 2026;
• raising the referral threshold to 18 years old to align with the age of discharge from the NHS Children and Young People’s Service, which was enacted in December 2025;
• bringing an end to self-referrals into the service and, in parallel, providing advice and guidance for those finding it difficult to secure a referral, which will be enacted through the new service specification for adult gender services, which is planned to be operational for the 2027/28 financial year; and
• establishing productivity goals for every service which can then guide and inform the commissioning of additional services, underpinned by a clear understanding of the regional demand through the national waiting list, with plans for this to be in place by the autumn of 2026.

Question to the Department of Health and Social Care:

To ask His Majesty's Government, with regard to the service specification for NHS children and young people's gender services, published on 1 April, whether the NHS and relevant service providers plan to use the ICF-11 definition of gender incongruence instead of the DSM-5 diagnosis of gender dysphoria.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

NHS England's consultation report on the proposed changes to the service specification for specialist gender services for children and young people, published on 1 April 2026, describes that the open caseload within the children and young people’s gender service is defined by the International Classification of Diseases 11th Revision (ICD-11) as all children referred into the service will have a marked incongruence between their experienced/expressed gender and their natal sex.

For the purpose of diagnostic assessment, the holistic assessment framework that is described in the service specification refers to ‘gender dysphoria’ as defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) and references the Cass Review’s observation that “there is no clear consensus across international guidelines as to whether DSM-5 diagnosis of gender dysphoria or ICD 11 diagnosis of gender incongruence is preferred. However, in clinical practice the DSM-5 diagnosis of gender dysphoria is more widely used, this also applies to research publications”.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of the findings of Psychiatric Morbidity Among Adolescents and Young Adults Who Contacted Specialised Gender Identity Services in Finland in 1996–2019: A Register Study, published in Acta Paediatrica on 4 April; and whether they plan to commission a similar study in the UK.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

In response to the findings from the Cass Review, NHS England has established a National Gender Research Oversight Board (NROB), which is overseeing a joint programme of research in partnership with the National Institute of Health and Care Research.

The NROB works collaboratively with academics, clinicians, and other stakeholders to improve data and inform the ongoing development of evidence-based care. Its scope includes maintaining an up-to-date evidence synthesis of the latest international research, which will consider papers such as the one cited, through a living systematic review process, to inform national policy and front-line clinical practice. It also includes a priority setting partnership, through the James Lind Alliance, which will help identify future gender research funding priorities.

Question to the Department of Health and Social Care:

To ask His Majesty's Government, in regard to page 219 of the Paterson Inquiry report, published on 4 February 2020, what assessment the Care Quality Commission has made of compliance by hospital providers in the NHS and independent sector with national guidance on multidisciplinary team meetings, including in breast cancer care.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

Under the Care Quality Commission’s (CQC) assessment framework, the CQC assesses providers for multidisciplinary teams (MDT) working under the quality statement, How staff, teams and services work together. Where this quality statement is assessed for individual services, an assessment report with the CQC’s findings is published on the CQC website.

The CQC is currently consulting on sector-specific assessment frameworks following reviews into their operational effectiveness by Dr Penny Dash, Sir Professor Mike Richards, and the Care Provider Alliance. MDT working would be assessed in future under the hospitals framework, both secondary and specialist care, via the Safe systems, pathways and transitions key line of enquiry and via the Delivering evidence-based care and treatment key line of enquiry.

Question to the Department of Health and Social Care:

To ask His Majesty's Government whether they plan to issue guidance to ensure that assessments of gender clinic mental health outcomes focus on whether the individual (1) is employed or in school, (2) has a romantic partner, or (3) routinely ventures outside the home.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

There is no plan to issue such guidance. In response to the report, Operational and delivery review of NHS adult gender dysphoria clinics in England, published in December 2025, NHS England is developing a standard biopsychosocial assessment framework for adult gender services, which will be incorporated into a proposed new service specification for the purpose of public consultation in 2026/27.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what estimate they have made of the average number of adult gender clinic appointments a patient of those clinics has over the course of their care.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

NHS England holds detailed activity data from adult gender services that reports on the number and type of clinical appointments offered, and their outcome. It is not, however, possible to calculate an average number of appointments that an individual has from this data set.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what follow up provisions are conducted by each of the gender clinics in England to monitor the risks and prevalence of (1) comorbidities, and (2) psychiatric comorbidities.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

In line with the Cass Review, and NHS England’s service specification for National Health Service children and young people’s gender services, all children and young people will receive a holistic assessment. This process should determine whether there are any cooccurring and/or contributory elements of the individual’s presentation that are affecting their psychosocial wellbeing or functioning and require support as the basis of an individual care plan.

NHS England’s Service Specification for Gender Identity Service for Adults (Non-Surgical) describes the assessment and diagnosis process that adult gender services should undertake from initial assessment, diagnostic, and treatment planning consultation. Patients with complex or additional needs should have additional assessment consultations where appropriate.

The findings and recommendations of the Operational and delivery review of NHS adult gender dysphoria clinics in England, chaired by Dr David Levy, was published in December 2025. NHS England, in full partnership with the Department, will now lead a system-wide response. This includes the development of a standardised biopsychosocial assessment framework for use across all of the adult gender services, for new patients or when their individual needs or circumstances change, and the development of a standard clinical complexity tool.

Question to the Department for Education:

To ask His Majesty's Government, further to the Written Answer by Baroness Smith of Malvern on 30 March (HL14338), what is the expected timescale for (1) the consultation of the proposals for special educational needs and disabilities reform, and (2) the implementation of those reforms.

Answered by Baroness Smith of Malvern - Minister of State (Department for Work and Pensions)

On Monday 23 February, the department launched a full 12‑week consultation on our special educational needs and disabilities (SEND) reforms because we want to hear directly from people across the country who have an interest in these reforms.

We are also hosting a series of online and in‑person events throughout the 12-week consultation period, with some sessions delivered in partnership with the Council for Disabled Children. This consultation concludes on 18 May 2026.

The consultation, including accessible versions, can be accessed here: https://www.gov.uk/government/consultations/send-reform-putting-children-and-young-people-first.

The department will manage the implementation of the reformed SEND system carefully, hence why our investments start now, before forthcoming legislation.

The first cohort to transition will be those at the end of primary, secondary and post-16 in 2029/30. They will move to the new system in September 2030. We expect the final cohort to transition to the new system in 2035.

Question to the Department for Education:

To ask His Majesty's Government, further to the Written Answer by Baroness Smith of Malvern on 30 March (HL15056), why specialist places for pupils with special educational needs are not provided on the basis of specific distinct needs; and whether they will clarify the criteria used to decide whether specialist places are offered to pupils.

Answered by Baroness Smith of Malvern - Minister of State (Department for Work and Pensions)

The specialist sector has a vital role to play in the special educational needs and disabilities (SEND) system, and the department values the contribution specialist places make for children and young people with complex needs. A fundamental principle of the SEND Code of Practice is that assessments are individual to the child or young person, and that special educational provision should be made based on presenting need. This does not rely on any specific diagnosis or categorisation of that need. Local authorities are under a statutory duty to ensure a sufficient supply of educational provision for children and young people with SEND, and placement decisions are reached as part of the assessment process in each individual case. Parents and young people have legal rights to express a preference for the setting they wish to be named in an education, health and care plan. Allocation of specialist placements is therefore based on the needs of the child or young person under assessment and is case-specific.

Question to the Department of Health and Social Care:

To ask His Majesty's Government, in regard to page 218 of the Paterson Inquiry report, published on 4 February 2020, whether they have published information explaining to patients how care in the independent sector differs from NHS care, including in relation to practicing privileges, indemnity arrangements and emergency provision; and if so, where that information is publicly available.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

The Government is committed to fulfilling the recommendation arising from the Paterson Inquiry. Information will be published in due course.

Question to the Department of Health and Social Care:

To ask His Majesty's Government, further to the Written Answer by Baroness Merron on 10 March (HL14735), when they expect the national minimum dataset for adult gender dysphoria clinics to be completed and in use.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

NHS England plans for the national minimum dataset for adult gender dysphoria services to be operational in the next financial year, 2027/28.

Question to the Department of Health and Social Care:

To ask His Majesty's Government, with regard to the consultation report on the NHS Children and Young People’s Gender Services service specification, published on 1 April, what potential partner organisations they are considering to provide the follow through service for 17 to 25 year olds.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

NHS England is in planning discussions with the providers that form the National Provider Network for Children and Young People’s Gender Services. As of 1 April 2026, the membership comprises services managed by the Alder Hey Children's NHS Foundation Trust, the University Hospitals Bristol and Weston NHS Foundation Trust, and the Great Ormond Street Hospital for Children NHS Foundation Trust.

Question to the Department of Health and Social Care:

To ask His Majesty's Government, further to the Written Answer by Baroness Merron on 10 March (HL14740), how the Cass Review recommendations will be implemented and monitored across NHS children and young people gender services.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

On 1 April 2026, NHS England published a final service specification for National Health Service children and young people's gender services, which incorporates the findings and recommendations of the final report of the Cass Review, including adoption of the new Holistic Assessment Framework.

NHS England continues to have oversight of implementation of the various Cass Review recommendations in 2026/27, in line with the implementation plan published in August 2024. NHS England chairs a National Portfolio Board for NHS Children and Young People’s Gender Services, which is the vehicle for monitoring progress for implementing recommendations from the Cass Review. Membership of the board includes officials from the Department of Health and Social Care, Baroness Cass, the independent Chair of the National Provider Network, representatives of the royal colleges of medicine, senior clinicians, the NHS National Medical Director for Specialised Services, and the NHS National Director for Specialised Services.

Question to the Department of Health and Social Care:

To ask His Majesty's Government, in regard to page 218 of the Paterson Inquiry report, published on 4 February 2020, what assessment they have made of the compliance of the NHS and the independent healthcare sector with the recommendation that consultants write to patients in plain language to outline their condition and treatment and copy that letter to the patient's GP.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

It has not proved possible to respond to this question in the time available before Prorogation. Ministers will correspond directly with the Member.

Question to the Department of Health and Social Care:

To ask His Majesty's Government, in regard to the Paterson Inquiry report, published on 4 February 2020, whether they have established a single publicly accessible repository for consultant data across England that includes information on consultant practising privileges and performance data; if not, what steps they are taking to establish that repository; and when they expect it to be operational.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

The National Consultant Information Programme (NCIP) is a platform that is available to 10,000 National Health Service clinicians in England, providing a single source of robust, nationally benchmarked data at an individual consultant level. Updated quarterly, it contains over 6,000 clinical metrics, including volumes, readmissions, revisions, length of stay, mortality, and is already being used for clinical improvement, appraisal, and revalidation of consultant surgeons in the NHS.

The platform seeks to support clinical oversight by giving medical directors, responsible officers, and specialty clinical leads access to the data for the consultants they are responsible for, supporting their statutory responsibilities for ensuring clinical quality and safety.

Once it is fully developed and embedded in clinical practice with the full support of clinical bodies, NCIP will consult with interested parties, including patient representatives, as to what is appropriate and informative for publication.

Question to the Department of Health and Social Care:

To ask His Majesty's Government, further to the answer by Baroness Merron on 15 April (HL Deb cols 332–4), whether they will provide further details on the public consultation referred to and its findings.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

In 2017, NHS England held a public consultation on proposals for new service specifications that described how specialised gender identity services for adults would be commissioned and delivered by the NHS. Two service specifications were published: a service specification that described the proposals for how non-surgical interventions would be provided by Adult Gender Services; and a separate service specification that described proposals for the service and interventions that would be delivered by designated surgical units.

NHS England published the report of an independent analysis of consultation responses, together with its own consultation report that described how the consultation submissions influenced the final version of the service specifications, which were also published. Copies of both the analysis and the report are attached.

Question to the Department of Health and Social Care:

To ask His Majesty's Government, further to the answer by Baroness Merron on 15 April (HL Deb cols 332–4), how many assessments are required to access (1) hormones, and (2) surgical care, in these clinics.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

The number of assessment appointments will be determined according to individual clinical need and complexity. The National Health Service specification for adult gender services describes a minimum of two core assessment appointments, and it describes additional assessment appointments for people with co-existing complex physical or mental health problems, communication difficulties or learning difficulties.

Should a clinical diagnosis of gender dysphoria be determined as an outcome of the assessment process, endocrine interventions may be recommended by a registered medical practitioner.

The national service specification for Adult Gender Services requires clinicians to make all efforts to ensure that individuals are aware of the longer-term consequences of the interventions offered to them. The service specification describes that the process of obtaining informed consent is an important aspect of ethical assessment and intervention, including the emotional, social and factual issues, so as to enable the individual to make informed decisions about the treatment options, benefits, material risks, and the alternatives to the treatments proposed, including the option of having no treatment. Individuals must be given sufficient time to reflect on the clinical advice and the potential treatment options before deciding what is best for them.

Further, in response to the findings of the Operational and delivery review of NHS adult gender dysphoria clinics in England, chaired by David Levy, a national comprehensive biopsychosocial assessment framework is being developed to ensure each patient’s needs are identified, formulated and interventions are agreed.

Additional assessment appointments will be required for surgical care, determined according to individual clinical need, including for the purpose of a second medical opinion arranged by the Adult Gender Service for referrals for genital surgery and, separately, appointments with the surgeon for both chest and genital surgery. If the surgeon identifies any possible contraindications for surgery, the surgeon will consult with the referrer, and additional consultations with the Adult Gender Service may be necessary.

Given the potential range of complexities that may be experienced by individuals on the NHS pathway of care and the potential treatments, referrals to the specialist surgical team will not be accepted from providers other than NHS-commissioned Adult Gender Services.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what steps they have taken to ensure that information about how to escalate a complaint to an independent body is communicated effectively to patients in the NHS and the independent sector; and what assessment they have made of the effectiveness of those steps.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

The handling of complaints about services within the National Health Service is governed by the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009, which require NHS bodies, when issuing their response to a complaint, to inform the complainant of their right to take the matter further if they remain dissatisfied. This includes the right to refer the complaint to the independent Parliamentary and Health Service Ombudsman (PHSO), whose role is to investigate and make final decisions on unresolved NHS complaints. Information about how to do this is also available on NHS England’s and the PHSO’s website in an online-only format.

Patients accessing self-funded or private medical insurance funded care in the independent sector are not covered by the PHSO. Instead, most independent healthcare providers subscribe to the Independent Sector Complaints Adjudication Service (ISCAS), a voluntary complaints management framework. ISCAS has a Complaints Code of Practice which includes an independent adjudication service, but it does not operate as a regulatory body.

Whilst we have not made a formal assessment of the effectiveness of these steps, we recognised in our 10-Year Health Plan that NHS patients can sometimes find the NHS complaints process difficult to navigate, and have committed to reforming the NHS complaints system, including improving the timeliness and quality of responses.

Question to the Department for Work and Pensions:

To ask His Majesty's Government, further to the Written Answer by Baroness Sherlock on 20th February (HL14368), what percentage of those claiming Universal Credit had an immigration status recorded as "other" or have no immigration status recorded in (1) January 2025, and (2) January 2026.

Answered by Baroness Sherlock - Minister of State (Department for Work and Pensions)

The percentage of people on Universal Credit by immigration status for January 2025 and January 2026 is shown in the table below. The proportion of Universal Credit claimants with an immigration status recorded as ‘other’ or where there is no immigration status recorded on the digital system either stayed broadly the same or decreased in January 2026 compared with January 2025.

Table 1. Percentage of people on Universal Credit by Immigration status, Great Britain, January 2025 and 2026

Source: DWP Universal Credit - Immigration Status and Nationality statistics

Note:

1. Figures are rounded to 1 decimal place.
2. “Other” includes those no longer receiving Universal Credit payments, ineligible partners of an eligible Universal Credit claimant and claimants who have their decision overturned at Mandatory Reconsideration or Appeal stage.
3. “No immigration status recorded on digital systems” includes cases where a recorded immigration status is not held on DWP administrative data. While every effort is made to collect data to the highest quality, as with all administrative data it is dependent on the accuracy of information entered into the system. Checks are made throughout the process from collection of the data to producing the statistics, but some data entry or processing errors may filter through to the data used to produce the statistics.

Question to the Department of Health and Social Care:

To ask His Majesty's Government, further to the answer by Baroness Merron on 15 April (HL Deb cols 332-334), what definition of ‘safeguarding’ they applied to that answer.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

With reference to my answer in HL Deb cols 332-334 (NHS Adult Gender Identity Clinics), I summarised the care and safeguards provided within adult gender services, as described by the Gender Identity Services for Adults (Non-Surgical Interventions) service specification.