Asked by: Rupert Lowe (Independent - Great Yarmouth)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what amount of charges were issued by NHS trusts for treatment to non-UK residents not entitled to free secondary healthcare in each of the last three financial years; how much of that amount was successfully recovered in each of the last three financial years; and what the outstanding amount is.
Answered by Karin Smyth - Minister of State (Department of Health and Social Care)
We have taken ‘non-UK residents’ to mean chargeable overseas visitors. The Department publishes data on the income identified from chargeable overseas visitors in England as part of the Department of Health and Social Care Annual Report and Accounts. The cash payments received by the National Health Service from overseas visitors are also published annually in the consolidated NHS provider accounts. The information for the last three years is available at the following links:
https://www.england.nhs.uk/wp-content/uploads/2023/01/consolidated-provider-accounts-21-22-final.pdf (page 66)
NHS charges can be recovered up to six years from the date of invoice, and therefore the amount recovered in a year does not necessarily mean it was identified in the same financial year.
Asked by: Rupert Lowe (Independent - Great Yarmouth)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, if he will make an assessment of the potential merits of establishing a dedicated whistleblowing line for NHS staff and patients to report issues with language barriers in the National Health Service.
Answered by Zubir Ahmed - Parliamentary Under-Secretary (Department of Health and Social Care)
Speak Up Direct, funded by the Department, is a dedicated, independent helpline offering confidential advice, signposting, and guidance to National Health Service and social care staff on raising work-related concerns. Additional support includes Freedom to Speak Up Guardians, with over 1,300 now available across healthcare settings in England, and a Freedom to Speak Up policy that sets minimum standards for NHS organisations in England.
The NHS complaints process enables patients to give feedback or raise concerns about any aspect of their care.
Translation and interpretation services are available for patients who need language support. Additional support is available for individuals who may have difficulty understanding their care or communicating their needs. Patient advocates can speak on their behalf, facilitate decision-making, clarify care procedures, and help safeguard patient rights.
Asked by: Rupert Lowe (Independent - Great Yarmouth)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, how many staff in their Department have been on mental health leave for six months or more; and for what reason.
Answered by Karin Smyth - Minister of State (Department of Health and Social Care)
Based on our reporting data up to the end of September 2025, we are withholding this data due to the small number of employees involved which could make individuals and the cause of their absence identifiable.
Asked by: Rupert Lowe (Independent - Great Yarmouth)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, how many and what proportion of (i) nurses (ii) doctors (iii) midwives entering the NHS were (a) non-UK citizens (b) non-UK graduates in each of the last five years.
Answered by Karin Smyth - Minister of State (Department of Health and Social Care)
The Department does not hold data on the number and proportion non-United Kingdom citizens entering the National Health Service. NHS England publishes monthly Hospital and Community Health Services (HCHS) workforce statistics for England which includes data on the self-reported nationality of NHS staff, which may not be the same as citizenship. Not all non-UK nationals will have been recruited from abroad, as some will already be resident in the UK before they join the NHS. This information is available at the following link, within the folder “Preliminary - NHS HCHS Workforce Statistics, Turnover – CSV data files”:
https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics
The Department does not hold data on the number and proportion non-UK graduate doctors, nurses and midwives entering the NHS. The Nursing and Midwifery Council (NMC) publishes data on non-UK graduate first-time joiners to their professional register across the UK. The General Medical Council (GMC) similarly publishes data on non-UK graduates taking up, or returning to, a license to practice medicine in the UK. It is possible to apply to join the UK Registers without moving to the UK.
The most recent published NMC data is available at the following link:
https://www.nmc.org.uk/about-us/reports-and-accounts/registration-statistics/
The most recent published GMC data can be found under the “Reference tables and data annex” section of the “The state of medical education and practice in the UK: workforce report 2025”, within the file titled “The register of medical practitioners”, available at the following link:
Asked by: Rupert Lowe (Independent - Great Yarmouth)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, whether his Department consulted (a) Stonewall, (b) Mermaids and (c) other advocacy organisations at any stage during the (i) design, (ii) approval, and (iii) communication of the PATHWAYS trial.
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 package of research to find out how the National Health Service can best support children and young people with gender incongruence.
This includes the PATHWAYS trial, 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 has received independent scientific, ethical, and regulatory approvals as well as a comprehensive review. The study design, including inclusion criteria and safety protocols, has been thoroughly scrutinised to protect young people's wellbeing. The process has included consideration of robust procedures relating to consent and eligibility.
The trial was designed and will be delivered by an independent research team. This was in conjunction with patient and public involvement as well as clinical and legal experts, including those who specialise on medical ethics. The Department has not conducted its own parallel engagement with advocacy organisations on trial development but is represented, alongside patient and parent representatives, on the National Research Oversight Board to which the research team regularly reports.
Asked by: Rupert Lowe (Independent - Great Yarmouth)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, if he will hold discussions with Kings College London on the potential merits of pausing recruitment to the new Pathway puberty-blocker trial until an independent panel considers the findings of the Cass Review.
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 package of research to find out how the National Health Service can best support children and young people with gender incongruence.
This includes the PATHWAYS trial, 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 has received independent scientific, ethical, and regulatory approvals as well as a comprehensive review. The study design, including inclusion criteria and safety protocols, has been thoroughly scrutinised to protect young people's wellbeing. The process has included consideration of robust procedures relating to consent and eligibility.
The trial was designed and will be delivered by an independent research team. This was in conjunction with patient and public involvement as well as clinical and legal experts, including those who specialise on medical ethics. The Department has not conducted its own parallel engagement with advocacy organisations on trial development but is represented, alongside patient and parent representatives, on the National Research Oversight Board to which the research team regularly reports.
Asked by: Rupert Lowe (Independent - Great Yarmouth)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, whether his Department has made an assessment of the potential impact of the Pathway puberty-blocker trial on future legal claims by 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 package of research to find out how the National Health Service can best support children and young people with gender incongruence.
This includes the PATHWAYS trial, 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 has received independent scientific, ethical, and regulatory approvals as well as a comprehensive review. The study design, including inclusion criteria and safety protocols, has been thoroughly scrutinised to protect young people's wellbeing. The process has included consideration of robust procedures relating to consent and eligibility.
The trial was designed and will be delivered by an independent research team. This was in conjunction with patient and public involvement as well as clinical and legal experts, including those who specialise on medical ethics. The Department has not conducted its own parallel engagement with advocacy organisations on trial development but is represented, alongside patient and parent representatives, on the National Research Oversight Board to which the research team regularly reports.
Asked by: Rupert Lowe (Independent - Great Yarmouth)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what guidance his Department has issued on the capacity of children aged between 11 and 15 to consent to medical trials related to puberty blockers.
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 package of research to find out how the National Health Service can best support children and young people with gender incongruence.
This includes the PATHWAYS trial, 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 has received independent scientific, ethical, and regulatory approvals as well as a comprehensive review. The study design, including inclusion criteria and safety protocols, has been thoroughly scrutinised to protect young people's wellbeing. The process has included consideration of robust procedures relating to consent and eligibility.
The trial was designed and will be delivered by an independent research team. This was in conjunction with patient and public involvement as well as clinical and legal experts, including those who specialise on medical ethics. The Department has not conducted its own parallel engagement with advocacy organisations on trial development but is represented, alongside patient and parent representatives, on the National Research Oversight Board to which the research team regularly reports.
Asked by: Rupert Lowe (Independent - Great Yarmouth)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, whether he has obtained legal advice on whether putting minors on puberty blockers constitutes a breach of child-safeguarding duties.
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 package of research to find out how the National Health Service can best support children and young people with gender incongruence.
This includes the PATHWAYS trial, 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 has received independent scientific, ethical, and regulatory approvals as well as a comprehensive review. The study design, including inclusion criteria and safety protocols, has been thoroughly scrutinised to protect young people's wellbeing. The process has included consideration of robust procedures relating to consent and eligibility.
The trial was designed and will be delivered by an independent research team. This was in conjunction with patient and public involvement as well as clinical and legal experts, including those who specialise on medical ethics. The Department has not conducted its own parallel engagement with advocacy organisations on trial development but is represented, alongside patient and parent representatives, on the National Research Oversight Board to which the research team regularly reports.
Asked by: Rupert Lowe (Independent - Great Yarmouth)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, how many children under the age of 16 were administered puberty blockers, including through (a) clinical trials and (b) private routes in each of the last five years; and what adverse effects were reported.
Answered by Zubir Ahmed - Parliamentary Under-Secretary (Department of Health and Social Care)
Gonadotropin-releasing hormone agonists or ‘puberty blockers’ are used to treat several medical conditions in children and young people. These can include precocious puberty, some forms of cancer, and endometriosis. They have been used outside of their licenced indication to treat gender dysphoria.
The following table shows the National Health Service prescriptions of puberty blockers for children aged 15 years old and under that were prescribed in England and dispensed in a community pharmacy or general practice in each year from 2020/21 to September 2025:
Financial year | The unique number of identifiable children aged 15 years old and under who received an NHS prescription of gonadotropin-releasing hormone agonists for all purposes |
2020/21 | 670 |
2021/22 | 656 |
2022/23 | 644 |
2023/24 | 554 |
2024/25 | 470 |
2025/26 | 342 |
Source: ePACT2, which is sourced from the NHS Business Services Authority’s Information Services Data Warehouse
Note: figures are unrounded.
The NHS does not centrally collect data on secondary care prescribing. Information on the clinical indication for which these medications have been prescribed is not held. The Government does not hold data that shows how many children under 16 years old were administered puberty blockers through clinical trials or private routes.
The National Institute for Health and Care Research (NIHR) has not previously funded trials specifically giving puberty suppressing hormones to children and information on non-NIHR funded trials is not held.
The Medicines and Healthcare products Regulatory Agency has received three United Kingdom based suspected adverse drug reaction reports in which a gonadotropin-releasing hormone agonists analogue has been reported as being used in a child or young person for the purpose of puberty suppression in gender dysphoria.