Complications from Abortions (Annual Report) Bill [HL]

Lord Sandhurst Excerpts

2nd reading
Friday 13th December 2024 Lords Chamber

[Lord Sandhurst (Con)]

My Lords, this Bill performs an important service. It highlights the absence of accurate, comprehensive statistics in respect of abortions. My noble friend Lord Moylan is to be congratulated on his clear exposition of the complex issues involved. I am also grateful to the Library and the Royal College of Obstetricians and Gynaecologists for their briefings.

The Department of Health has highlighted that the statistics on complications from abortion should be treated with caution, particularly following changes to the way that medical abortions are permitted to be carried out. It has explained that it is not possible fully to verify complications recorded on the relevant HSA4 forms. Complications that occur after discharge may not always be recorded.

My noble friends Lord Frost and Lady Lawlor have highlighted the importance of good data. In April 2021, the Government acknowledged limitations with the data provided on the HSA4 forms. The Office for Health Improvement and Disparities then undertook a project to review the system of recording abortion data to address the limitations of the data on complications recorded on the HSA4 forms.

OHID acknowledged limitations with data collected through the HSA4 form on the abortion notification system, otherwise known as ANS. Abortion complications are recorded differently in hospital episode statistics—HES—compared to the ANS. Each data source has different strengths and limitations, according to the experts. Neither data set would, however, include complications diagnosed by a GP, the 111 service or an A&E department. The OHID publication did not make any recommendation as to whether HES data should be used to supplement ANS data in the future, and they are the experts.

The royal college argues that lack of effective data collection has held women’s reproductive healthcare back in its ability to innovate and improve, and that that is to the detriment of patient care and experience. The royal college submits that data collection must be improved within women’s healthcare and that abortion should be treated and regulated like any other medical procedure. None the less, as it points out—and as I understand—in no other area of healthcare, outside of abortion, does primary legislation impose a duty on the Secretary of State to produce an annual report of complications data.

We on this side of the House fully recognise the power and benefits of transparency of data to the public and within the Government, and my noble friend has highlighted these powerfully. However, we are not fully convinced that primary legislation is the best practical, or most appropriate and proportionate way forward, to achieve the transparency he seeks. My noble friend Lady Sugg also made the same point and pointed to the sensitivity of patient confidentiality in this field. I have highlighted the challenges of collecting data consistently and robustly in this field. Some of those appear to have emerged from the 2017-21 data that was published. While we appreciate what my noble friend seeks to achieve, I hope the Minister will be able to set out how the Government propose to deliver the greater transparency of data that my noble friend seeks through the Bill.

In summary, our view is that improved data collection and reporting does not need to be delivered through legislation, but we urge the Government to do more to rationalise data recording and collection so that proper evidence-based medicine can be implemented. The Government must take steps to ensure data are gathered on a more reliable and consistent basis; the same should apply in this field as across all health aspects in this country. Those responsible for the health of women must do much better; the department must get a grip and give a lead.

Social Cohesion and Community during Periods of Change

Lord Sandhurst Excerpts

Friday 6th December 2024 Lords Chamber

[Lord Sandhurst (Con)]

My Lords, I am grateful to the most reverend Primate for initiating this debate. I pay tribute to my noble friend Lord Sharma. He has delivered an important maiden speech. I look forward to hearing much more from him. Indeed, we have heard many fine speeches today.

My theme is the misuse of the term “community”. It can be the enemy of social cohesion. Let me explain. Smaller and close-knit communities can be exclusive of others. Overstrong religious and cultural beliefs too often lead to bigotry and dangerous intolerance. If we are to be serious about wider cohesion and the people of this country living in harmony, we must face up to the misuse of the word “community” as code by some who seek special treatment to the exclusion of others.

It is not surprising that immigrants of whatever race, colour or belief find initial integration not easy. The Jews who came here in the second half of the 19th century faced discrimination and hostility, so this is not a new problem, and nor is it unique to these islands. But if we look at the last 175 years, we see what those Jews have contributed. Here I echo my noble friend Lord Leigh of Hurley.

Of course immigrants look for support on arrival, and they find it, naturally, among others of similar background who are already established here. In this way, communities of such immigrants grow in size. Since the last war, Britain has had immigration on a large scale: incomers with very different religious and cultural beliefs from around the world. They have tended, for understandable reasons, to stick together at first, but those with education, confidence and encouragement have blossomed and engaged with wider society and moved outwards. They have become British, in the true sense. People come here to live because they believe that the British way of life has something of value for them.

Strong belief in a particular religion or culture is, by definition, exclusive. If we are not careful, this can be an aggravating factor. It is the enemy of toleration. Informed observers have made the point that religious beliefs and customs have heightened differences in our big cities. People of one kind group together for support, and then one community feels threatened by another which has grown or is perceived to have intruded. Each community looks inward and becomes defensive, intolerant and possibly aggressive. This is not the social cohesion, or the strong community of people, that we want in this country.

Moreover, to stick to one’s own group or community is, economically, a form of social protectionism. Ultimately, it limits not just personal growth but economic growth for those who adopt this approach.

Where do we go from here? We have to broaden outlooks. We have to stop favouring so-called communities, in the wrong sense, when we mean, at worst, informal ghettos. We have to encourage the people of this country to think of themselves as British first. Our political leaders must not pander to interest groups based on such criteria as race and religion. We are all subject to the same laws; we are all equal before the law. Let us hear no more pleas for the interests of particular communities where this is simply shorthand for “me first” or “our group first”. We are the citizens of one nation, with the same rights and obligations.

In this respect, like my noble friend Lord Jackson of Peterborough, I commend a recent paper by Policy Exchange, A Portrait of Modern Britain: Ethnicity and Religion. Given the short time available, I plucked just two of many good points. The first is that:

“The children of Britain should be taught to be proud of their national heritage in an inclusive manner that reflects Britain’s history and traditions”.


The second point is that government and public bodies should address equality and social mobility primarily

“through a class and poverty lens, not a racial one”.

Political leaders must not look for votes on the basis of ethnic or religious interests.

I will give two examples of the dangers that we face if we do not do something. First, in the summer of 2022, Leicester saw a period of religious and ethnic tension, predominantly between British Hindus and British Muslims of South Asian origin. The causes were multifactorial. Religious beliefs and customs are said by informed observers to have heightened differences. Each community felt threatened by the other. Secondly, as we have heard from others, at the end of July and in early August of this year, far-right, anti-immigration protests and riots occurred in England, within the United Kingdom. This followed the mass stabbing in Southport on 29 July, and those riots were fuelled by false claims circulated by far-right groups that the perpetrator of the attack was a Muslim and an asylum seeker. That added to broader Islamophobic, racist and anti-immigrant sentiments that had grown up leading to the protests. We have to put a stop to those beliefs of false anti-immigrant sentiments.

At the heart of this lies the wrong sort of separateness: people sticking together for understandable reasons but leading to long-term disharmony and danger for us all. Let all of us who are in positions of influence, especially the media, stop this talk of the “such and such” community. The term “community” has become dangerous code for “my group” to the exclusion of others—it can encourage sectarian divide. To cohere, we must all be British and nothing else. We must learn to love our neighbours; to be exemplars of tolerance and to welcome outsiders and strangers—as I always read “xenia”—or foreigners. In turn, those outsiders who come to live in this country must learn what it means to be British and embrace what is best: tolerance and respect for the rule of law. Then we shall all be proper members of our communities in their true and best sense.

Product Regulation and Metrology Bill [HL]

Lord Sandhurst Excerpts

2nd reading
Tuesday 8th October 2024 Lords Chamber

[Lord Sandhurst (Con)]

My Lords, this Bill gives the Secretary of State wide powers to make product regulations. The detailed content of these regulations—the what and the how—will affect us all, whether we are manufacturers, importers, retailers or consumers. This Bill provides for yet more criminal offences and gives the power to impose civil sanctions for non-compliance. Yet it contains no detail of how all this will be achieved. What will be the limits on ministerial powers? What oversight will Parliament have in respect to the regulators? These are important questions that are as yet unanswered.

These gaps become more serious when it is appreciated that the previous Government instituted a consultation of all interested parties. That consultation closed a year ago, in October 2023. This Government have yet to publish their response. Why? What is the point of consultation if the Government do not publish a response?

As one who has, on many occasions in the past, answered government consultation papers as an interested party, I know the time and effort that go into responding to such things, often on tight timetables. A year has now passed; the previous Government did not publish a response, but they had not introduced legislation. This Government have now had three months; Ministers have had plenty of time to respond and set out their views before bringing forward this Bill. Sceptic that I am, I none the less believe that the Government would not introduce the Bill if they did not have at least some idea of their direction of travel. Yet we are kept wholly in the dark on important matters: what did the respondents have to say?

The Government have seen fit to introduce this Bill, which lacks particularity on all the issues that really matter to those who will have to live and work with it; that is, business, legislators, consumer groups and environmental groups. We all have different interests in the delivery of this legislation and in its practical impact. We will all have different points of view and things to say, yet we are being asked to legislate completely in the dark as to what the respondents to the consultation said in their submissions, and what it is this Government believe are the right answers to their points—answers have come there none.

This is poor way to begin a new Government’s legislative programme. In discussing this Bill, we should proceed today on the basis that the Government have not yet collated firm conclusions they feel could be put in a published response to that consultation—because, if they had, they would surely have published them. The Government would not be keeping us in the dark on purpose, would they?

So I am afraid that we must proceed, in considering this Bill, on the generous basis that the Government do not yet have their own answers to the responses in the consultation—unless, even worse, which I hope is not the case, they are afraid to let us know what their answers are. Are they proceeding, covertly, to ignore very good points made by respondents in the hope that legislators in Parliament will simply miss the point? Whichever it is, this is a shabby and poor way to proceed on a Bill of great practical importance to industry, consumers and the people of this country. What is the rush? We on these Benches accept the need for reform, but this is ill-informed haste and it is discourteous to us in Parliament.

So my first question is: when will we see the Government’s response to this consultation, which closed 12 months ago? Secondly, does such a response exist, at least in draft? Whatever the basis, why are we being asked to legislate without that information? We need to know what respondents have said and what the Government’s views are. Why is that being kept from us? Is it because they are afraid of the answers? Is it because they have yet to decide their direction of travel: that is, what regulations they propose to introduce and what they will address? Is it because they are afraid that, if they do reveal their plans, everyone will be up in arms? Or is it simply the Government’s view that the man in Whitehall knows best and, we—the consumers, manufacturers and legislators—should not trouble our pretty little heads and just do as we are told?

Have the Government formed a view of the landscape? They say that the regulatory regime needs modernisation: surely they must know where we are headed. This is a Henry VIII Bill par excellence, so now we must be told, in much more detail, what direction the Government think we should be taking on the matters of substance and importance that the Bill addresses.

The lack of a response to the consultation is of particular concern because the Bill grants the Secretary of State such wide-ranging powers without full parliamentary scrutiny. The Opposition would like to seek clarity on a number of areas of the Bill. Where necessary, we will probe these in Committee. I will give some examples. On enforcement, Clauses 3 and 4 grant Ministers the power to designate new relevant authorities to ensure compliance with a new body of regulations and to create new criminal offences by regulation. However, the text of the Bill gives us scant detail on what these new offences will be. Who would bring the prosecutions and gather the evidence? How will these enforcement actions be funded? All these questions are not answered in the Bill.

So, too, Clause 5(3), in the context of metrology—this new word for all of us—includes new requirements for business about units of measure. In practical terms, units of measure and how they are defined will be very important, but there is no clarity on how these rules will be tested and assessed to ensure that they are appropriate, in particular for smaller businesses. It is crucial, as the Government seek to deliver on their stated objective to grow the economy, that regulation does not hinder the growth of small and emerging businesses. Nor, indeed, should we allow a level of regulation that would discourage risk-takers and entrepreneurs from setting businesses up in the first place.

I come back to the issue of consultation. Business and all interested parties, consumers and environmental interest groups must be able to make sensible submissions about regulations before they are laid. Consultation will be critical. So I ask, on this framework Bill, as it has been described—I have described it as a Henry VIII Bill—whether the Government will undertake to publish substantive regulations in draft and consult on them before they are laid. That is really important.

These Benches are also concerned that the lack of clarity in these measures will allow Ministers to align with European Union standards without proper parliamentary scrutiny. It is true that much of our trade is with the EU, but there is a strong case to be made for standards that allow British businesses to trade also around the world. Boosting global trade is vital if we, as the Government intend, are to grow the UK economy. So can the Government confirm that no regulations made under the Bill will prevent or impede United Kingdom businesses from trading globally?

In conclusion, this is a poor way to approach legislation: rushing the Bill without responding to the consultation, without us knowing the Government’s view, is inappropriate and discourteous to the many respondents who have put a great deal of thought into their submissions. This is more worrying in the light of the wide-ranging powers to be granted to Ministers without sufficient clarity on what the Government intend. We need clarity from the Government on their real intentions and I hope that the noble Lord the Minister will engage constructively with these concerns and reassure the House of the Government’s aims as the Bill makes progress.

--- Later in debate ---

[Lord Leong (Lab)]

My Lords, I would first like to thank all noble Lords for their very kind remarks; they are much appreciated. I also thank noble Lords for taking part in today’s debate, and for the contributions from all sides of the House. Today’s debate has been not only informative and wide-ranging but also illustrated the depth of expertise and experience present in your Lordships’ House.

I was particularly pleased to hear the maiden speech of my noble friend Lady Winterton. She brings much experience and wisdom, having served with distinction as Deputy Speaker in the other place and as a Minister in multiple government departments between 2001 and 2010. Freed as she now is from the necessary neutrality of a formal role, we welcome her warmly to the government Benches, where I suspect that, like her former boss, Lord Prescott, she will pull no punches. I look forward to hearing from her many more times in the future.

As we have heard, product safety failures can have devastating consequences. We are determined that our regulatory framework is agile and flexible in its response both to new threats and to complex supply chains. For innovation to flourish and potential for growth to be realised, it is essential that consumers can have confidence in the safety of the products they buy and in the businesses that they buy from.

I will try my very best to address as many of the issues and questions raised today as possible within my timeframe of 20 minutes. If I do not have the time, I will get my office to go through Hansard and provide written answers to noble Lords and have a copy placed in the Library. Finally, let me assure all noble Lords that I want to work constructively and proactively in the passage of this Bill, and I will have many more conversations and share information with noble Lords through Peers drop-in sessions—my office is always open, so feel free to contact me and my private office.

The noble Lords, Lord Frost, Lord Browne and Lord Jackson, and the noble Baroness, Lady Lawlor, raised concerns that this Bill is tantamount to the UK rejoining the EU through the backdoor. Let me be extremely clear: this Bill is not rejoining the EU by the backdoor. This Bill gives us the flexibility to ensure that product regulation, now and in the future, is tailored to the needs of the UK. There will be some instances where we will want to take a similar approach to the EU, and there will be others where it makes sense for the UK to diverge. Those decisions will be based on the best interests of the UK’s businesses and consumers, and any secondary legislation will be subject to the usual parliamentary scrutiny. As I said in my opening speech, we are taking back control, seeking closer, more mature trading partnerships with the EU and forging new trading relationships with the global world out there.

The noble Lords, Lord Foster, Lord Browne of Ladyton, Lord Bourne, Lord Fox and Lord Johnson, and the noble Baroness, Lady Bennett, raised questions about devolution. The vast majority of product safety and metrology legislation is reserved, with some specific exceptions. We expect the overwhelming majority of secondary legislation brought forward under the main powers in Clauses 1 and 5 to be reserved. Given the technical nature of product regulation and metrology, it is possible—as many noble Lords have mentioned—that some elements of secondary legislation may touch on devolved aspects, such as regulating the environmental impact of certain products, as we consider safety impacts alongside.

Following meetings with my counterparts, I welcome their broad support for the policy intentions behind the Bill. However, we recognise that the devolved Governments have raised some concerns about the drafting and breadth of delegated power in the Bill. As outlined in our manifesto, this Government are committed to reset the UK Government’s relationship with the devolved Governments in Scotland, Wales and Northern Ireland. I have had positive meetings with my counterparts in the Welsh Government and Northern Ireland Executive and will be meeting with the Scottish Government this week. My department is engaging with all devolved Governments in an open and collaborative spirit, and we hope that we will gain legislative consent Motions from the devolved legislatures. I will keep the House informed of those discussions.

On the specific case of Northern Ireland, which has been raised by several noble Lords, in order to ensure dual access to both the UK internal market and the EU single market, Northern Ireland applies certain EU product regulations and metrology rules under the Windsor Framework. The Bill provides the Minister with the ability to make a sovereign choice and effectively manage upcoming regulatory divergence between the UK and EU, and therefore to ensure continuity across the UK internal market, where it is in our domestic interest to do so. As such, we expect that the Bill will have a positive impact on trade between Northern Ireland and the rest of the UK.

The noble Lords, Lord Foster, Lord Fox and Lord Johnson, raised the importance of ensuring that the enforcement authorities have adequate resources to fulfil their function. With this Bill we intend to improve enforcement capability, leading to more efficient and effective use of time through a better suite of notices and better data-sharing opportunities. The Office for Product Safety and Standards will continue to provide a range of support to enforcement authorities. This will include support on technical queries, access to product testing and an ongoing programme of training and continuous professional development. The Office for Product Safety and Standards will also produce guidelines for the application of any new powers so that enforcement authorities are equipped to use them efficiently.

The noble Lord, Lord Lansley, and several other noble Lords raised an important issue relating to international standards. The Bill will enable us to continue to amend product regulations as well as allow the designation of international standards for products in scope. In line with WTO obligations, the UK recognises the benefits and supports the use of international standards, as well as regional standards, to break down trade barriers with our trading partners. The British Standards Institution regularly reviews UK standards, replacing domestic standards with appropriate international ones. This is also something that the UK pursues in its international agreements.

The noble Lords, Lord Sandhurst, Lord Foster, Lord Lucas, Lord Jackson and Lord Fox, and the noble Viscount, Lord Trenchard, asked whether any draft regulations under the Bill would be produced. The Government are working through policy positions on a range of issues following the election, including addressing the sale of unsafe products via online marketplaces. Additionally, we are reviewing changes the EU is proposing to its registration regulations and considering the applications. Throughout, our response will depend on the outcome of our call for evidence and policy discussions with stakeholders.

The noble Lord, Lord Sandhurst, asked about the poor way we are approaching legislation. The review he referred to was issued by the previous Government. It was clear then that to make fundamental changes to product regulation requires primary legislation because the powers were not available to us, hence bidding for this Bill to ensure that we secure the powers to act in good time to address emerging risks.

The noble Lords, Lord Foster and Lord Sandhurst, asked about online marketplaces. It was right for us to bring forward this Bill to give us the powers we need to address sales of unsafe products by online marketplaces —an area on which the product safety review consulted. Consumer groups such as Which? have also been calling for us to take action. This Bill will allow us to take action now.

The noble Lords, Lord Sandhurst, Lord Foster and Lord Johnson, asked why we have not published a response to the product review consultation. We have bid for the necessary powers to make changes to our regulations and have introduced this Bill, which will deliver enabling powers to allow us to implement a lot of the policy proposals emanating from the product safety review to which the noble Lord, Lord Sandhurst, referred. That review received 126 responses covering regulatory changes. Action on online marketplace enforcement was supported by all respondents. The powers in the Bill are available powers and we have continued conversations with a wide range of stakeholders on the detail.

[Lord Sandhurst (Con)]

I appreciate that, but we have not actually got any detail at all, or even a summary, of what the responses are. We really do require that; it is normal.

[Lord Leong (Lab)]

I thank the noble Lord, Lord Sandhurst. I will ask my officials and come back to the noble Lord on that request.

The noble Lord, Lord Foster, asked about lithium-ion batteries. I am pleased to advise that, while we have been in this debate, Minister Madders, my colleague in the other place, is in Paris at the OECD global awareness campaign, which this year focuses on lithium-ion batteries. The UK and the Office for Product Safety and Standards have been leading on this campaign. The noble Lords, Lord Redesdale and Lord Fox, raised additional points about disposal. Ministers are referring proposals to consult on reforms to UK battery regulations before setting out next steps.

The noble Lord, Lord Russell of Liverpool, asked why the UK wished to be able to continue recognising the CE marking. This Bill will allow the Government to choose to recognise updates to EU product regulation to provide continued regulatory stability and avoid extra costs for business where this is in our interests. It will also allow us to end recognition of EU requirements where it is in the interest of business and consumers. We presently recognise current EU regulations for a range of products. Legislation passed in May 2024 to continue CE recognition for 21 product regulations is estimated to save UK businesses £640 million over a 10-year period, largely from avoiding duplicate compliance and labelling costs. Provisions in the Bill allowing us to continue or end recognition of EU requirements will enable us to provide the certainty that businesses need to plan for the future and innovate, supporting economic growth. The UK and EU share information on trade, including changes to the trade and co-operation agreement.

The noble Lord, Lord Foster, and several other noble Lords asked about the disposal of lithium-ion batteries. The Government are committed to cracking down on waste as we move towards a circular economy, where we keep the resources we use for longer and reduce waste. The existing product responsibility scheme for batteries and waste electronics makes producers responsible for the cost of end-of-life treatment. Under existing UK legislation it is already mandatory for all batteries placed on the market in the UK to be clearly marked with the crossed-out wheelie bin.

The noble Baroness, Lady Crawley, asked why there have been no changes to legislation on product safety since our exit from the EU. I can reaffirm that this is real, hence bringing forward powers in this Bill to allow us to make changes before divergence happens and we fall further behind.

The noble Lord, Lord Frost, asked why we cannot use existing powers. The new Bill powers are required to enable the Government to modernise and future-proof product regulation, ensuring that it is tailored to the needs of the UK. The powers in the retained EU law Act 2023 are limited, in that they can be used only to revoke and replace assimilated law and have other inbuilt restrictions—for example, secondary legislation that is made under REUL must be deregulatory. This means that we would not be able to use the powers to increase safety requirements to respond to new and emerging threats through further amendments and legislation which was not assimilated law before.

The noble Lord, Lord Frost, also asked whether the Bill will make the UK a rule-taker or a rule-maker. We are definitely not a rule-taker. We are a rule-maker, and the Bill will provide powers to give the UK greater flexibility in setting and updating its own product-related rules, as well as enabling the UK to choose whether to recognise relevant EU products requirements. Any further changes made using these powers will be subject to appropriate parliamentary scrutiny. The noble Lord asked whether the Bill protects internal markets. The Bill will give us flexibility to ensure product regulation and metrology now and in the future. It is tailored to the needs of the UK as a whole. It will enable us to make changes to product regulation and metrology legislation that will benefit businesses and consumers.

The noble Lord, Lord Frost, also asked about the Windsor Framework. In updating its regulation, the EU will be seeking to deal with many of the same challenges that the Bill will address: for example, online marketplaces and batteries. The Bill will enable a choice to be made as to whether it is in the interests of UK businesses and consumers for UK regulations to take the same or a similar approach, or indeed a different one.

The noble Baroness, Lady Brinton, asked whether the Government will commit to a policy of alignment with EU chemical protections. This Government are committed to protecting human health and the environment from the risks posed by chemicals. We are currently considering the best approach to chemicals regulation in the UK separately to this Bill and will set out our priorities and next steps in due course. The noble Baroness also asked how the Bill will help the Government respond to emergencies.

Conversion Therapy Prohibition (Sexual Orientation and Gender Identity) Bill [HL]

Lord Sandhurst Excerpts

Friday 9th February 2024 Lords Chamber

[Lord Sandhurst (Con)]

My Lords, my concern is safety and well-being, living in a free and fair country. As it stands, this Bill will apply to acts which cause no injury or distress and even to acts to which the recipient has consented. It applies across the range of life and in the home. The Bill will criminalise expressions of personal conviction made without expressions of hatred or intolerance, improper purpose, coercion or abuse of power. That is a wide-ranging interference with fundamental rights.

To take an example, a 15 year-old teenage girl informs her gender-critical parents that she wishes to change gender. She repeatedly asks her parents to support her request for puberty blockers. They refuse and seek to persuade her otherwise. This could demonstrate their assumption that a particular gender identity is inherently preferable. It could demonstrate that they seek to change their child’s gender identity and that they seek to suppress expression of that gender identity. It would leave them vulnerable to prosecution. The Government’s 2021 conversion therapy consultation paper explained that

“our existing criminal law framework means no act of harmful physical violence done in the name of conversion therapy is legal in this country”.

Therefore, we do not need to legislate for physical coercion.

I turn, all too briefly I fear, to the interim report of Dr Hilary Cass. It is absolutely essential reading. It shows the dangerous waters in which this Bill swims. First, as she reminds us, sex is biological, determined by anatomy, while gender is a social construction. In the short time available, gender issues are my focus today. I will give some direct quotations.

Dr Cass writes:

“there is a lack of agreement … about the extent to which gender incongruence in childhood and adolescence can be an inherent and immutable phenomenon for which transition is the best option for the individual, or a more fluid and temporal response to a range of developmental, social, and psychological factors … staff have told us that they feel under pressure to adopt an unquestioning affirmative approach and”—

I emphasise this—

“that this is at odds with the standard process of clinical assessment and diagnosis that they have been trained to undertake in all other clinical encounters”.

Dr Cass writes:

“many of the children and young people presenting have complex needs, but once they are identified as having gender-related distress, other important healthcare issues that would normally be managed by local services can sometimes be overlooked … Evidence on the appropriate management of children and young people with gender incongruence and dysphoria is inconclusive both nationally and internationally. … A lack of a conceptual agreement about the meaning of gender dysphoria hampers research, as well as NHS clinical service provision”.

Discussing sex hormones, Cass reports that

“the long-term risks and side effects are well understood. These include increased cardiovascular risk, osteoporosis, and hormone-dependent cancers … given the irreversible nature of many of the changes, the greatest difficulty centres on the decision to proceed to physical transition … Decisions need to be informed by long-term data on the range of outcomes … The NICE evidence review demonstrates the poor quality of these data, both nationally and internationally”.

Finally:

“Regardless of the nature of the assessment process, some children and young people will remain fluid in their gender identity up to early to mid-20s, so there is a limit as to how much certainty one can achieve in late teens. This is a risk that needs to be understood during the shared decision making process with the young person”.


I add that Keira Bell and others are plainly victims of this.

To conclude, for family members managing a young person with gender identity issues, the topic is complex. There will be well-meaning missteps. The Bill is in no way suitable, creating as it does a far-reaching criminal offence; thought crime comes to mind. The noble Lord, Lord Winston, is absolutely right: this is a mistaken Bill.