The Department responded to the Observer on 17 July.

The National Institute for Health and Care Excellence (NICE) has made a number of recommendations for research on managing chronic pain, including the use of psychological therapies, acupuncture and pharmacological interventions.

NHS England and NHS Improvement are collaborating with stakeholders such as Versus Arthritis to co-produce and coordinate a strategy. Versus Arthritis have been commissioned to produce a decision support tool based on NICE guidance which can help people living with pain and their clinical teams understand all evidence-based options available. Alongside this tool, NHS England and NHS Improvement will also be publishing a commissioning framework to help local services reduce opioid prescribing in summer 2021.

If an individual is allergic to any component of a COVID-19 vaccine, they may be directed towards a suitable alternative vaccine following a discussion with a healthcare professional.

The Joint Committee on Vaccination and Immunisation (JCVI) advised that it is preferable for adults aged under 30 years old without underlying health conditions that put them at a higher risk of severe COVID-19 disease, to be offered an alternative to the Oxford/AstraZeneca vaccine, if available. The JCVI currently advises that in addition to those aged under 30 years old, unvaccinated adults aged 30-39 years old who are not in a clinical priority cohort at higher risk of severe COVID-19 disease, should also be preferentially offered an alternative to the Oxford/AstraZeneca vaccine, where available.

If a person is under 40 years old, the National Booking Service will direct them to appointments for the Pfizer/BioNTech or Moderna vaccines.

As part of the Tessa Jowell Brain Cancer Mission, the National Institute for Healthcare Research has received 69 applications, 10 of which have been funded and a further seven are under consideration. One of the funded applications is focused solely on children and others include young people.

We remain committed to the aims of the NHS Long Term Plan to invest at least an additional £2.3 billion a year into mental health services for all ages, including for children and young people aged 0 to 25 years old, by 2023/24. We are introducing new models of care that will give 370,000 people, including young adults with serious mental illness, greater choice and control over their care and that will support them to live well in their communities. These models include access to employment support.

The information is not held in the format requested. All healthcare staff must undertake mandatory safeguarding training that enable staff to effectively safeguard, protect and promote the welfare of children and young people.

The High Court ruling of 1 December 2020 is subject to ongoing legal proceedings and as such we are unable to comment.

The Care Quality Commission (CQC) shared the report on Tavistock and Portman NHS Foundation Trust Gender Identity Services (GIDS) with the Department prior to publication. The Department welcomes the report and is aware that the CQC will follow its normal process of monitoring and further inspection activity to further review the GIDS.

The CQC continues engagement with NHS England and NHS Improvement on their independent review of gender services for children and young people, led by Dr Hillary Cass on how care can be enhanced. The review will report later in the year. This report will cover issues such as how and when young people are referred to specialist services, clinical decisions around how doctors and healthcare professionals support and care for patients with gender dysphoria.

We recognise that early language development is a significant health inequalities issue. Improving the number of children having good speech, language and communication skills by five years old is a national priority. Public Health England, with the Department for Education, is working to ensure that speech, language and communication needs are identified early on. We are monitoring the effectiveness of local joint arrangements through inspections by Ofsted and the Care Quality Commission. This will inform what further action is needed.

We are working with NHS Digital, mental health providers and partner organisations to improve the collection of data in the mental health services data set on people referred to secondary mental health services for anxiety and those who self-harm whilst an inpatient. We also fund the Multicentre for Self-Harm to provide representative and reliable data on self-harm in England.

Data on suicide registrations by coroners is collected by the Office for National Statistics and there is a time lag due to the length of time it can take to hold an inquest. Public Health England is piloting a national real-time surveillance system to monitor suspected suicide, by collecting early real time data which can be used to identify patterns of risk and causal factors, to inform national and local responses. HM Treasury has announced £1.2million funding to help support the development of the national system.

NHS Digital separately collects data though hospital episode statistics on the number of accident and emergency (A&E) attendances due to intentional self-harm and the number of finished admission episodes with a secondary diagnosis of intentional self-harm for male patients under the age of 18 years old.

Between 23 March 2020 and 30 November 2020 there were 4,011 A&E attendances due to intentional self-harm for male patients under the age of 18 years old and 2,022 finished admission episodes with a secondary diagnosis of intentional self-harm for male patients under the age of 18 years old. This information only represents activity serious enough to require hospital treatment.

Diagnosis recording within the Mental Health Services Data Set (MHSDS) is not mandatory and not all providers submit this information. The recording of diagnoses within the MHSDS is entered using clinical coding which some providers may be unable to do for various reasons. Additionally, a diagnosis may not be confirmed immediately for some patients. There are also other data quality issues around non-completion. Month on month reporting by providers can also be irregular. We are working with NHS Digital, providers and partner organisations to address these issues.

The board of the Tavistock and Portman NHS Foundation Trust will meet to formally agree a remedial plan that responds to the various concerns. In the interim, the Chief Executive of the Trust has publicly acknowledged the need for improvements in the service and has announced plans for bringing in senior clinical expertise from outside the service to help implement change.

The information requested is shown in the following table:

Source: Mental Health Services Dataset

Notes:

1. Treatment for mental health issues has been defined as people with a hospital stay in a ward setting categorised as a child and adolescent mental health ward.
2. The total provided for 23 March 2020 to 30 November 2020 represents the latest available data.
3. This data for both ranges includes patients whose hospital spell began prior to 23 March but whose hospital treatment continued after that date.

The National Institute for Health Research (NIHR) welcomes funding applications for research into any aspect of human health, including brain tumours in young people. As with other Government funders of health research, the NIHR does not allocate funding for specific disease areas. The level of research spend in a particular area, is driven by factors including scientific potential and the number and scale of successful funding applications.

The NIHR is working with the Tessa Jowell Brain Cancer Mission towards funding workshops for previously unsuccessful researchers to support them in submitting higher quality research applications. The NIHR only fund high quality research and all applications are subject to peer review and judged in open competition.

Additionally, through the Tessa Jowell Brain Cancer Mission, we are working with research funding partners who fund research into new scientific discoveries, such as Cancer Research UK, the Medical Research Council and the brain tumour charities. We stand ready to translate these much-needed discoveries as quickly as possible into new treatments and diagnostics for patients via the NIHR. In May 2018 the Government announced £40 million over five years for brain tumour research as part of the Tessa Jowell Brain Cancer Mission through the NIHR.

Following its inspection of Tavistock and Portman NHS Foundation Trust’s specialist community mental health services for children and young people in January 2016, the Care Quality Commission (CQC) rated the core service as good. All CQC reports undergo a robust internal quality assurance process, as well as factual accuracy checks by the provider. In addition to this, the CQC’s ratings review team will consider any challenges from providers in regard to published ratings.

As part of the CQC's regulatory model, the CQC monitors providers on an ongoing basis. This activity helps the CQC to understand which services are progressing well and which are not and informs decisions about which core services are inspected and how frequently. The CQC have undertaken monitoring activity with Tavistock and Portman NHS Foundation Trust since the 2016 inspection.

Between 23 March 2019 and 22 March 2020, there were 34,754 boys reported in the Mental Health Services Data Set (MHSDS) under 18 years old who were referred to secondary mental health services with a primary reason for referral of anxiety. For the period 23 March 2020 to 30 November 2020, 20,842 boys were referred.

The MHSDS shows that between 23 March 2019 and 22 March 2020 there were 122 incidents of self-harm reported by boys under the age of 18 years old, and between 23 March 2020 and 30 November 2020, there were 82 incidents of self-harm. These numbers are based on the data submitted by the secondary care mental health services to MHSDS and include only incidents of self-harm in the mental health hospitals. The numbers include November provisional data and are likely to be an undercount of the true activity. This is the latest data available to NHS Digital.

For suicide, the Office for National Statistics (ONS) reports that there were 123 suicide registrations relating to boys aged 10-19 years old in 2019 (92 registrations between January and September 2019). Provisional information for January to September 2020 shows that there were 80 suicide registrations relating to boys aged 10-19 years old. All deaths caused by suicide in England are investigated by coroners. Given the length of time it takes to hold an inquest, most deaths are registered around five to six months after they occurred. The number of suicides registered in 2020 should be interpreted with caution due to the pandemic causing further delays on the coroner’s service resulting in further delays to inquests.

NHS England is the responsible commissioner for the Gender Identity Development Service (GIDS). In response to the recent High Court ruling regarding treatment pathways at the GIDS, NHS England is considering the future data reporting requirements for the service. These considerations will also be informed by the planned publication of a report by the Care Quality Commission following its inspection of the GIDS in November 2020.

The information requested is not held. In order to measure waiting times to mental health services, or to determine if an assessment took place after the patient entered treatment, an access and waiting times standard for the service must be defined for analysis purposes. A national access and waiting times standard has not yet been defined for child and adolescent mental health services.

This information is not held in the required format. We remain committed to delivering the core proposals of the children and young people’s mental health Green Paper, including the introduction of senior leads in mental health and mental health support teams in schools and colleges, as well as the piloting of a four-week waiting time for specialist NHS services. Under the NHS Long Term Plan, an additional 345,000 children and young people will be able to access support through NHS-funded services or school and college-based mental health support teams by 2023-24.