Gender Identity Services: Children and Young People
(Limited Text - Ministerial Extracts only)
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The Secretary of State for Health and Social Care (Wes Streeting)
I am writing to update the House about the Government and NHS England’s work to improve gender identity services, as well as implement the recommendations of the independent review into gender identity services for children and young people by Dr Hilary Cass.
During summer recess the Government and NHS England made progress toward these recommendations. The aim of this work is to ensure that children and young people who are experiencing gender incongruence or dysphoria receive a high standard of care that meets their needs and is safe, holistic and effective.
Puberty blockers
The Cass review made it clear that there is not enough evidence about the long-term effects of using puberty blockers to treat gender dysphoria and incongruence to know whether they are safe or beneficial.
The review recommended that puberty suppressing hormones should only be prescribed in the context of a clinical trial or under the guidance of the national multidisciplinary team. The report also recommended defining the dispensing responsibilities of pharmacists of private prescriptions of puberty blockers and considering other statutory solutions that would prevent inappropriate overseas prescribing.
The NHS has subsequently ceased the routine use of puberty blockers to treat gender incongruence in children. The former Secretary of State also issued an emergency order to extend restrictions to the private sector.
That emergency order came into force from 3 June 2024 in Great Britain and was due to expire on 2 September 2024. On 22 August, this Government renewed the order jointly with the Minister of Health in Northern Ireland. It commenced in Northern Ireland on 27 August 2024.
The Government recognise that the introduction of this order may cause concern to individuals and families who are impacted. If a young person has already taken these medicines or has been prescribed these medicines in the 6 months prior to 3 June 2024 (in Great Britain) or 27 August 2024 (in Northern Ireland), they can continue to do so, providing their prescription is now issued by a UK registered prescriber. They are strongly advised to meet with their prescribing clinician to fully understand the safety risks. For those patients accessing prescriptions from an EEA-registered prescriber, they can seek help from a UK private provider or see their GP.
The new order extends to Northern Ireland. The First Minister and Deputy First Minister gave their approval for the Minister of Health to co-sign the order. This will remain in place until the end of 26 November 2024 while we gather responses to a targeted consultation on a permanent banning order issued last month to representative organisations of those likely to be impacted by a permanent order. The proposed permanent order would continue the same restrictions and apply to the same medicines impacted by the emergency order, on a permanent basis. This would apply to private and overseas prescribing.
We do not yet know enough about the impacts of using puberty suppressing hormones at this critical stage in young people’s lives. In partnership with the National Institute for Health and Care Research, NHS England is launching a clinical trial to assess the potential benefits and harms of puberty suppressing hormones.
Within this trial, the effects of puberty blockers can be safely monitored, and the research will give Government and the NHS the evidence we need to decide whether they can be used as a safe and effective treatment. The trial aims to begin recruiting participants early in the new year.
New children’s services
In April, NHS England opened two new children and young person gender services in the north-west and London that offer a different clinical model, embedding multidisciplinary teams in specialist children’s hospitals. This includes a nominated paediatrician or psychiatrist with overall clinical responsibility for patient safety in these services. A third new service will open in the south-west in the autumn, and a fourth in the east of England in spring of next year. NHS England is advancing towards meeting its commitment for there to be a specialist children’s gender service in every region by 2026.
Referral service specification
NHS England has published a new service specification for the national referral support service for specialist services for children and young people with gender incongruence. A referral can only be made by an NHS-commissioned, secondary care-level paediatric service or a children and young person mental health service. This will ensure that healthcare professionals with the relevant expertise conduct the assessment and help determine any co-existing mental health or other health needs of these children and their onward care.
Adult services review
Dr Cass also recommended a review of the adult service specification for gender services, given the changing demographic presenting to children and young people’s services is reflected in a change of presentations to adult services. In response, NHS England has taken the decision to conduct a review of the operation and delivery of adult gender dysphoria clinics. The review will examine the model of care and operating procedures of each service, with the aim of producing an updated service specification for adult gender services. This will be led by Dr David Levy, medical director of Lancashire and South Cumbria integrated care board, and previously NHS England’s north-west regional medical director. Dr Levy will act as the independent chair of the review, which will include an expert panel of professionals and patients.
Conclusion
The trans community is disproportionately affected by issues of mental ill health, suicide and self-harm. We have a duty to them to lower the temperature and look for common ground away from the toxicity of the current debate.
The Government will not lose sight of the fundamental point that anyone accessing a gender identity service deserves the highest quality of care and support, and to be treated with dignity and respect, just as we would expect from any other service. This Government are determined that the public discourse about these issues does not lead to harm.
That is why this Government are absolutely committed to making sure every trans person feels fully part of our society. I believe the Cass review will deliver material improvements in the wellbeing, safety, and dignity of trans people of all ages and gender identities.
There is much to do in overhauling children’s gender identity services, and I can assure the House that I will be working closely with NHS England to implement further changes as soon as possible to ensure that every child receives the best possible care.
We will proceed with caution at every step, always putting the evidence first, and putting people above politics.
[HCWS70]