General Medical Council: Internal Guidance

Lord Markham Excerpts

Tuesday 17th October 2023 Lords Chamber

[Baroness Hayter of Kentish Town]

To ask His Majesty’s Government what discussion they have held with the General Medical Council on its removal of the words “mother” and “women” from its internal guidance for pregnant or menopausal staff, and whether this reflects advice to doctors as to how to treat and describe patients.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The Government have not had any discussions with the General Medical Council on its internal guidance for pregnant or menopausal staff. The GMC is independent from the Government and its internal guidance is produced for its staff. It is not for doctors registered with the GMC. The Government are clear that biological sex matters and that there are different health needs between the sexes. Removing language around biological sex has the potential for unintended and adverse health consequences.

[Baroness Hayter of Kentish Town (Lab)]

I do not think that Answer is quite satisfactory and I am sorry that the Minister used the words “pregnant staff” rather than “pregnant women”. Maybe the GMC lost out on medical lessons, where they would have learned that men produce sperm. We produce eggs and when they are fertilised in our wombs, we give birth and become mothers. When that is over, it is us who go through the menopause. The GMC has a statutory duty; it is the register of all the doctors who work in the NHS and it has a duty to maintain public confidence. I wonder how many mothers would have confidence in a doctor who thinks that men can have babies. The Minister should engage with the GMC and I ask him to do so, because although its internal guidance may have upset some of us, it regulates doctors and the language it uses matters in how it oversees, trains and interviews them. I hope the Government will take this a little more seriously.

[Lord Markham (Con)]

I can definitely confirm that we are taking it very seriously. The Secretary of State was clear in his speech at the recent party conference that it is vital that we recognise the importance of the different biological health needs. That means being clear about describing a woman as a woman. I apologise: the noble Baroness was quite right to pick me up on that point, but we are very clear that biological sex is absolutely vital in addressing people’s health needs. It is clear that we are addressing women as women and men as men.

[Baroness Gohir (CB)]

My Lords, under the Government’s watch there have been attempts to erase the word “woman” in various government departments and public bodies. One example is the NHS Race & Health Observatory, which the Government fund. I wrote to it last year and it said that it would address my concerns. What assurances can the Government give that all incidents anywhere where they have oversight have been addressed? Are there any central mechanisms where the public and staff can share concerns, because it is not feasible to report concerns to a line manager when it could result in bullying? Us women will not be erased.

[Lord Markham (Con)]

I absolutely agree. That is why, as I say, we could not be firmer in saying we want to make sure it is very clear in the NHS Constitution that we are referring to women as women—that has to be the absolute primary descriptor—and men as men. We could not be clearer on that, and I am very happy to take that up across government as well.

[Lord Cormack (Con)]

My Lords—

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[Lord Cormack (Con)]

I am most grateful. Would my noble friend on the Front Bench take the opportunity to pay tribute to the heroism—I use the word deliberately —of JK Rowling and those like her who have spoken out so passionately and so often? What the noble Baroness, Lady Hayter, said, we should all echo to the rafters.

[Lord Markham (Con)]

I completely agree. I believe that, more than anything in society, we have to be tolerant of people and their ability to have free speech and express their views freely. I think we have all seen circumstances where people feel intimidated in expressing what they feel is right, particularly in this circumstance of stating clearly when a woman is a woman and when a man is a man.

[Baroness Butler-Sloss (CB)]

My Lords, I am very proud to be a grandmother as well as a mother. Will the Minister in fact talk to the GMC?

[Lord Markham (Con)]

Yes, I am very happy to do that and to make clear the feelings of this House.

[Baroness Burt of Solihull (LD)]

My Lords, I welcome the Minister’s comments on the GMC and endorse its independent role. I commend its wish to treat all patients with dignity and respect. Even though there are only a relatively tiny number of trans men giving birth each year, they all matter and they all deserve to be treated with respect and dignity. If he can, will the Minister tell the House how both women born as women and trans men are to be treated with equal respect, without offending either group?

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[Lord Markham (Con)]

People should always be treated with respect. That is why we are quite clear that the primary descriptor in this circumstance should be “woman”. However, in a few cases it has also been clear that a secondary descriptor is “people with a cervix”. It is quite clear that we are talking about a woman as a woman. By the way, that is very important for people with English as second language, so they understand very clearly that a woman is a woman. For completeness, in those cases where there might be a change of sex, we are being very clear that it is for everyone with a cervix.

[Lord Winston (Lab)]

My Lords, I intend no disrespect to anybody, but in view of the fact that the GMC has a really important role in regulating language, particularly for overseas graduates who come to Britain, can the Minister tell me how many male members of the GMC have given birth to a child? If he cannot tell me, maybe he would be good enough to send me a letter.

[Lord Markham (Con)]

I am very willing to hazard a guess that it is zero, but I will happily follow that up in writing with the exact number.

[Lord Patel (CB)]

My Lords, I do not intend to be frivolous. I have looked after thousands of mothers during their pregnancies; it has been a great privilege to do so. Terms like “mother” and “women” should not be removed from any guidance, GMC or not. I have spoken to the GMC and expressed my discomfort at its removal of the words “mother” and “women”. Of course, I recognise the transgender issues. I also recognise therefore that those who may not consider themselves women could have children, but that does not remove the importance of motherhood. Being a mother is more than that; it is about motherhood and the responsibilities and what mothers contribute to children. I regret that the GMC has decided to remove these words.

[Lord Markham (Con)]

I think the noble Lord makes the point very well. I do not think I have anything to add, apart from basic agreement.

[Lord Sandhurst (Con)]

My Lords, the GMC may be independent but it is a creature of statute and should remember that. Parliament can change its statutes at any time. Are we to anticipate that, if the doctors’ regulator —this creature of statute—refers to its female staff, by which I mean women, as chest feeders or people with cervixes, the Minister will make it plain that this language from the medical regulator is unacceptable?

[Lord Markham (Con)]

I am quite happy, as mentioned previously, to talk to the GMC about its use of language, the importance of the use of correct language and the clear feelings of all of us in the House today about women who are women and mothers, and men who are male and fathers. I will leave it to the GMC as to how it deals with staff matters, but I will be very clear on medical issues and the belief of all of us here in this House.

[Baroness Symons of Vernham Dean (Lab)]

My Lords, can the Minister tell the House how many men there are on the GMC and how many women?

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[Lord Markham (Con)]

I will need to reply in writing on that.

[Baroness Hussein-Ece (LD)]

My Lords, clear, unambiguous language in healthcare messaging saves lives. I was disturbed to read that one-third of women who are eligible for cervical screening are not coming forward. Can the Minister explain why NHS UK has not used the word “women” when it comes to cervical screening, yet for men’s conditions, the word “men” is used?

[Lord Markham (Con)]

The noble Baroness is absolutely correct, which is why we have made sure that that language is made clear. The most important thing about the whole debate is people’s health needs. Absolutely as the noble Baroness said, the vital thing is that every woman understands that it is important that she has cervical screening from time to time. In all of the communications, it is clear that we mean “her” in that instance. Obviously, in circumstances for men, we are clear where we mean “men”. So I completely agree with the noble Baroness: the health needs are paramount, and that requires clear language.