PATHWAYS Study: Puberty Suppression

Debate between Baroness Blake of Leeds and Baroness Merron

Wednesday 24th June 2026 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I am grateful to the noble Baronesses, Lady Barker and Lady Cash, for their contributions, both of which highlight why my right honourable friend the Secretary of State led on this Statement by saying that this is

“a sensitive, emotive and difficult issue”.

He also said, which goes the point raised by both noble Baronesses, albeit coming at it from very different angles, that our duty as a Government—a duty for any Government and one which the last Government accepted and acted on—is

“to protect the safety and wellbeing of children”

and

“to follow expert clinical advice and take an evidence-led approach”.

We, like the previous Government will be sticking to that.

The noble Baroness, Lady Cash, used the word “outsourcing”. I do not believe that the last Government outsourced responsibility when NHS England commissioned a review from the most respected paediatrician in this area, the noble Lady Baroness, Lady Cass, who we are fortunate to have with us now in the House. I do not believe the last Government outsourced. I think they took a responsible, evidence-led approach.

It is worth reminding ourselves that the noble Baroness, Lady Cass, said at the time of her review:

“This is an area of remarkably weak evidence”.


Again, I agree. It is also important to observe a very strong divergence of medical opinion. There is always a choice. We can continue with uncertainty in an unsafe setting, where there is that strong divergence of medical opinion, or we can seek the evidence. Nobody in your Lordships’ House can predict the evidence because it does not exist yet.

As I say, I think the previous Government had the right approach, which was why we supported it in opposition. They accepted the recommendations of the review by the noble Baroness, Lady Cass, and, again, I feel that that is the responsible way forward.

It is worth reminding ourselves that the use of puberty-suppressing hormones has been banned indefinitely for gender dysphoria outside of research settings, so the trial we are talking about today is being set up to gather the evidence that the last Government wanted and we continue to want.

The trial was first approved by regulators in November 2025 and in February the MHRA requested changes to the trial protocol to make it even safer. This is quite normal in how these matters are dealt with. Perhaps I can give the noble Baroness, Lady Cash, the clear assurance that the changes to make it safer—which is absolutely the right thing to do—were around the age of those included in the trial, and monitoring possible impacts on bone density, future fertility and cognitive abilities. These are all points and concerns rightly raised by the noble Baroness, Lady Cash, and have indeed been raised on a number of occasions in your Lordships’ House. I emphasise that it is usual for dialogue such as this to take place during a trial.

Reference was made to safeguards. There are a number listed. Again, I would ask noble Lords to look at them, but I will mention some of them. Children can participate only with the consent of a parent or guardian, and the child themselves must consent or assent. To the point raised by the noble Baroness, Lady Cash, they can participate only if they are not subject to any safeguarding concerns, and if there is sufficient understanding by the young person—but also by their parent or guardian—of the nature of the treatment and its potential advantages and disadvantages. They can participate only if they have been deemed clinically appropriate by both the NHS care team and the national multidisciplinary team, and only if they are already accessing NHS gender services, including participating in a tailored package of psychosocial care.

All these safeguards rightly build in considerable safety preservation and ensure that it is the right people. I emphasise that there is no compulsion to take part in a trial, and indeed just getting close to one is a rigorous process. Due to ongoing legal proceedings, as referred to by the noble Baroness, Lady Cash, recruitment on to the trial will not begin immediately. We are currently in a set-up period, and we will set out our future plans in due course.

The noble Baroness, Lady Barker, referred to protecting researchers from “relentless” attacks. I hope the whole of your Lordships’ House would agree with that. Those who carry out research and those who lead reviews—such as the noble Baroness, Lady Cass, and indeed many others on our own Benches—in many different areas have been subject to the most relentless attacks. These have not all been via social media: sometimes they have been physical attacks. Violence is totally unacceptable and we cannot condone it in any way.

To the noble Baroness, Lady Cash, I say that prospective participants will indeed have comprehensive information on the advantages and the potential risks, in a way that speaks to how they need that information. The minimum ages were agreed through detailed scientific discussions between the MHRA and the trial sponsor. This is all driven by what will provide the right evidence that we need for decisions, and that evidence is clinically led. I return to the point about age, which I know exercises noble Lords, and is a fair question to raise. It was recognised during discussions between the trial sponsor and the MHRA that the right balance had to be struck between the maturity level of participants and providing treatment at the most clinically appropriate point in puberty. That would, of course, be earlier for birth-registered females compared with birth-registered males.

The noble Baroness, Lady Cass, may make this point herself, but I am grateful to the noble Baroness, who will be available for a drop-in discussion with anybody who would like to go into more detail. I hope that noble Lords will avail themselves of that.

The noble Baroness, Lady Cash, asked whether the Government had carried out an assessment of future liability. All research trials are expected to have appropriate insurance, and this one will. It will take into account any potential risks in a financial setting, as the noble Baroness referred to.

I will address one final point, although I am always happy to assist if noble Lords have other questions. The noble Baroness, Lady Cash, asked about six out of seven clinics not releasing data. Data is very important. That is why NHS England is re-engaging with data-sharing organisations, on which the data study will be dependent. Of course, that is separate to this trial, but we absolutely expect all commissioned adult gender services to collaborate with the study to ensure its successful completion.

[Baroness in Waiting/Government Whip (Baroness Blake of Leeds) (Lab)]

My Lords, I remind the House that the next 20 minutes are for questions from Back-Benchers only.

NHS England Update

Debate between Baroness Blake of Leeds and Baroness Merron

Wednesday 19th March 2025 Lords Chamber

[Baroness Merron (Lab)]

I recognise what the right reverend Prelate is saying. I myself have experienced change in large organisations, and change is never easy. We are talking about job losses; we cannot shy away from that. But it is appropriate that I re-emphasise the reassurance of our respect for and thanks to all those talented and hard-working staff in both the department and NHSE. We will, as I said, work with trade unions on this change in order to be fair and transparent and to deal with it properly. Of course it is uncomfortable, and people naturally find it difficult.

It is also important to look at the benefits. Currently, we have rather too much micromanagement, which frustrates progress and staff. Reducing that is one of the liberations that this will provide, so we can innovate and get on with caring for patients.

On maintaining people’s morale, this is a big challenge for us because morale has not been good at all, so we will pay particular attention to this as we publish the workforce plan later in the summer. This work continues. Senior managers and transformation team are very alive to the points the right reverend Prelate has made, and they will continue in that regard.

[Baroness in Waiting/Government Whip (Baroness Blake of Leeds) (Lab)]

My Lords, I am very conscious that a number of noble Lords want to get in. Can all keep their questions brief? I will take the Liberal Democrat contribution first and then Labour.