Asked by: Baroness Maclean of Redditch (Conservative - Life peer)
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.
Asked by: Baroness Maclean of Redditch (Conservative - Life peer)
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:
Asked by: Baroness Maclean of Redditch (Conservative - Life peer)
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”.
Asked by: Baroness Maclean of Redditch (Conservative - Life peer)
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.
Asked by: Baroness Maclean of Redditch (Conservative - Life peer)
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.
Asked by: Baroness Maclean of Redditch (Conservative - Life peer)
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.
Asked by: Baroness Maclean of Redditch (Conservative - Life peer)
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.
Asked by: Baroness Maclean of Redditch (Conservative - Life peer)
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.
Asked by: Baroness Maclean of Redditch (Conservative - Life peer)
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.
Asked by: Baroness Maclean of Redditch (Conservative - Life peer)
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.