Transgender Equality

Angela Crawley Excerpts

Thursday 1st December 2016 Commons Chamber

[Angela Crawley (Lanark and Hamilton East) (SNP)]

I thank the Backbench Business Committee for accepting this debate, which gives us an opportunity to discuss the Government’s response to the “Transgender Equality” report. I should also like to thank LGBT Youth Scotland, Stonewall, the UK LGBT Consortium on Trans Organisations, the Equality Network and the Scottish Transgender Alliance. I also want specifically to thank Tim Hopkins from the Equality Network and James Morton from the Scottish Transgender Alliance for their invaluable briefings and their work with the Scottish Government to continue the progress of LGBTI equality.

As an advocate for LGBTI equality, I am very proud that the first report from the Women and Equalities Committee focuses on the problems faced by the trans community. In the spirit of true equality, every sector of society should feel truly equal and it is our responsibility as members of the Committee and in life to ensure that that is the case. I believe that the Government’s response to our report is woefully inadequate. We need to ensure that the individuals who contributed to the inquiry and those who experience daily discrimination feel that the Government are heeding their calls for more equality. Trans equality must be the priority of every Government across the UK. I know that the Minister shares my passion for equality and I hope that today’s debate will give her an opportunity to respond, to hear the cross-party calls and to take action. I should also like to thank my friends and fellow Committee members, the right hon. Member for Basingstoke (Mrs Miller) and the hon. Member for Brentford and Isleworth (Ruth Cadbury), for securing this important debate and for their continued commitment to the cause of transgender equality.

We have only to look at the statistics from any mental health charity to understand why this debate is necessary. When one in four of the children in Scotland who identify as trans face bullying, discrimination and hate crime on a daily basis, we must do more. Statistics from Mind indicate that more than 40% of trans individuals have contemplated suicide and that, tragically, some of them have ended their own lives as a result of their experiences. This group of people is among the most marginalised in society. Trans individuals face disproportionately high levels of mental health problems and very high suicide rates. Discrimination against members of the trans community is an everyday aspect of their lives. Transphobia is endemic in the workplace, when accessing healthcare, in public services, in schools, in the media, in the criminal justice system and online. A sizeable percentage of individuals face this discrimination and prejudice on a daily basis.

The existing legislation provides some protections, and they are to be respected and admired. There was a time when the UK was a world leader in its approach to transgender equality. The Gender Recognition Act 2004 allows a trans person the right to a gender recognition certificate, should they wish their affirmed gender to be recorded as such on their birth certificate. This was applicable whether or not someone had undergone surgery or hormone therapy. However, this does not allow for people in the trans community who do not identify as either male or female to be recognised and protected within the law. During our inquiry, we heard from non-gendered and non-binary people who felt that they had been forgotten in the legislation. Additionally, we heard that the Act was rooted in clinical methods, requiring consent through a psychological diagnosis of gender dysphoria. The criticisms levelled at the legislation reinforce how outdated it has become. The Government must make changes to the Act to allow an approach of gender self-declaration.

Similarly, the once world-leading legislation for the trans community in the Equality Act 2010 is fast becoming outdated. It gave members of the trans community protection from discrimination, but we have heard that its provisions are routinely breached in relation to the trans community. The Act uses outdated terminology such as “gender reassignment” and “transsexual”; these are now considered inaccurate descriptors. Such terms have given rise to the misapprehension that the Act provides only for trans people who have undergone medical gender-reassignment treatment. To clarify, the protected characteristic should be amended to “gender identity”.

[George Kerevan (East Lothian) (SNP)]

Does my hon. Friend agree that the essence of today’s debate is that gender is a social construct, and that that should be recognised in law? It is not primarily a biological construct, but because the law is based on that outdated concept, it is failing us.

[Angela Crawley]

I thank my hon. Friend for that intervention. I reiterate that the law must be updated to recognise an individual’s gender identity, which has nothing to do with their birth gender and everything to do with the gender that they believe they are.

[Joanna Cherry (Edinburgh South West) (SNP)]

I congratulate my hon. Friend and other hon. Members on securing this important debate. Since 2007, the Scottish Government have been using the Yogyakarta principle, a fully inclusive definition of gender identity, in all their trans equality policy work. Does she agree that the use of that principle is desirable because it was devised by an international commission of jurists in recognition of the fact that gender identity is a human right?

[Angela Crawley]

Yes, and I will clarify again that the protected characteristic in the Equality Act 2010 should be amended to “gender identity”, which explicitly covers the whole spectrum of trans identities. This point was rejected in the Government’s response to the Committee’s report. Ministers believe that the current terminology is adequate, contrary to the testimony of the very people it affects.

I am prone to mentioning the word “Scotland” often in debates, and I shall do so again now. In 2017, we will mark the year of trans equality and the progress that has been made on this issue. In Scotland, we have committed to reforming the Gender Recognition Act 2004 in line with international best practice in countries such as Malta and Ireland. In Scotland, we have committed to ensuring that all trans, non-binary and intersex individuals feel protected, because it is their human right to have their gender identity recognised in law and in life. I urge this Government to follow the example not only of Scotland but of the many other countries that are leading this best practice.

[Deidre Brock (Edinburgh North and Leith) (SNP)]

The United Nations International Civil Aviation Organisation recognises M, F and X as gender markers on passports. A number of countries, including Denmark, Malta, New Zealand, India and even Australia—which is sadly not known these days for a liberal and open approach to border control—issue and accept gender X passports. Does my hon. Friend agree that it is high time the UK followed suit?

[Angela Crawley]

I wholeheartedly agree. One area that is not currently devolved to Scotland is the ability to change passports. I urge the UK Government to consider this important aspect of recognising a third gender—gender X—on passports. That could be done, and the Committee heard that it would be beneficial and would make a sizeable difference to individuals who travel for work, life and general leisure purposes. This is an opportunity to amend and correct that error.

I call on the UK Government to match the Scottish Government’s commitment: 2017 marks the year of progress on transgender equality in Scotland, and the UK can continue that progress. This debate highlights the need to address transgender equality and the remaining challenges that trans and non-binary people face. Although Scotland has made huge progress towards achieving LGBTI equality in recent years and is now rated the best country in Europe for LGBTI rights, the SNP is not complacent. We are determined to tackle the unacceptable levels of prejudice and discrimination that trans and non-binary people continue to face. I hope that, as we move into 2017, we can make it a year of progress for transgender equality not just in Scotland but across the UK. In Scotland, the SNP has pledged an important step forward for transgender equality by reforming the gender recognition law to meet international best practice, so that all trans and non-binary people are fully recognised and can access their human right to a legal recognition of their gender identity.

Scotland is the best country for LGBTI equality, and the UK can continue to lead on this agenda, too. One of the distinctive parts of our equal marriage law is its more progressive approach to transgender recognition, and the UK could follow that example as well. I am not simply preaching to the choir; a multitude of countries across the world are leading on this agenda.

I wish to finish with the words of Reina, one of many trans women who wrote to me before this debate. She wanted to give testimony about what it is like to be trans in a rural community in Scotland. She said:

“Being trans is not a choice. It isn’t something where the person wakes up and just decides to be a particular way. Being this way is something that a person is born with, and which they have to try and struggle with throughout their lives, in a society that hates diversity and constantly attacks them”—

and their friends and family, and

“even kills them, for not conforming to the restrictive ideals of control freaks. Life is hard and usually short for someone who’s trans. There is a lack of respectful education and health care. There is a lack of support and understanding.”

Her words exemplify just why we need to take action: life is incredibly difficult for trans people, and the changes we can make in this place will make a huge difference to their lives. The Government must today commit to the recommendations of the “Transgender Equality” report, and offer the support and understanding that this community definitely needs. I urge the Minister to join me in making sure that 2017 is the year of transgender equality not just for Scotland, but for every transgender individual across the UK.

--- Later in debate ---

[Lyn Brown (West Ham) (Lab)]

I have listened with real interest to the arguments made by Members about how the Gender Recognition Act 2004 and the Equality Act 2010—the first legislation I ever whipped—ought to be amended to better protect transgender equality rights. I hope the Government take these arguments seriously and respond appropriately, even if it takes them a further couple of months to do so.

I want to focus on the health aspect of the excellent report by the Women and Equalities Committee: the services provided for transgender people by the NHS. Trans people experience worse health, both physical and mental, than the general population. The Equality and Human Rights Commission has found that a higher proportion of transgender people say that their physical health is “poor or very poor” compared with other LGBT communities and non-LGBT communities. Levels of poor mental health are also higher in the transgender population, with about half of young trans people and a third of trans adults reporting that they have attempted suicide. It is therefore imperative that transgender people have full access to general medical services—appropriate ones.

Transgender people also have specific health needs; untreated gender dysphoria, which, as Members will know, is medically defined as when a person experiences discomfort or distress because of a mismatch between their biological sex and gender identity, can and does take a real toll on someone’s mental health. Dr John Dean, the chair of the NHS national clinical reference group for gender identity services, has said that

“not treating people is not a neutral act—it will do harm.”

I could not agree more with Dr Dean. Some trans people’s health and wellbeing would be greatly improved by gender confirmation treatment through our specialist gender identity clinics. Trans people have to be able to access those treatments on our NHS if they need them.

[Angela Crawley]

The Committee heard from individuals who had gone through harrowing experiences. They had gone to quite extreme lengths to receive the treatment that they wanted in order to have their gender identity recognised in countries where the practices were not as safe as they would be here in the UK. Does the hon. Lady therefore support the aim that the UK must ensure that we can cater for everyone who needs to access these health services?

[Lyn Brown]

I do indeed. The Committee’s report demonstrated that our NHS is not providing even a basic service, let alone a good service for trans people. The Committee report found:

“The NHS is letting down trans people”.

One of the first problems identified by the report was discrimination faced by trans people when they tried to access general medical services. Dr James Barrett, president of the British Association of Gender Identity Specialists, told the Committee:

“The casual, sometimes unthinking trans-phobia of primary care, accident and emergency services and inpatient surgical admissions continues to be striking.”

CliniQ, a specialist sexual health and wellbeing service provider for trans people, told the Committee that

“there is at best considerable ignorance and at worst some enduring and mistaken and highly offensive stereotypes about trans people among the public at large, amongst whom we must unfortunately number some health professionals.”

Sadly, this discrimination has real consequences. Terry Reed, of the excellent Gender Identity Research and Education Society, told the Committee that trans people were often nervous about accessing services because they were “not treated sympathetically” or even “politely” by doctors and staff. Brook, an organisation that provides sexual health and wellbeing services and advice for young people under 25, told the Committee that

“prejudice against trans people among medical staff”

was one of the reasons for poor health outcomes in trans people.

In addition, trans people report real difficulties in accessing specialist treatments and gender identity services. GPs have a legitimate role in acting as gatekeepers to NHS specialists, but I am afraid there is evidence that prejudice and ignorance among our GPs is preventing those who experience gender dysphoria from receiving the services they need. Dr James Barrett has said that there is a “persistent refusal” on behalf of some GPs to make referrals to gender identity clinics. The Beaumont Society has heard of one trans person being told by their GP at their first assessment—and let us think about how much courage someone needs to go to their first assessment:

“You’ll be taking money away from more deserving cancer patients.”

How wicked is that? It is a complete disgrace.

Where someone experiencing gender dysphoria is referred to a gender identity clinic it can take a very long time for them to receive specialist services such as hormone therapy or genital surgery. The process requires an independent assessment from two separate consultants, and a large amount of information needs to be gathered by the consultants about the individual before they can begin to proceed. That process typically takes months and spans several consultations. An additional precondition for genital surgery is that the patient must undergo at least a year of “real-life experience” of living “in the role” of their affirmed gender—it is an enforced pause. I have read the guidelines that explain the rationale behind this enforced pause, and I understand that the social aspect of changing one’s gender role is challenging and that clinicians do not want people to take on surgery until they are fully aware of those challenges, but that does not explain why the pause is often much longer than 12 months. The Government should assess the arguments made by some in the trans community that decisions over whether to go ahead with surgery should be based on the informed consent model. Under that model, doctors could immediately approve medical interventions if they are satisfied that a patient is fully aware of the implications of their decision. It is my understanding that the model is already used in parts of the United States of America. Given that it has already been tried and tested, the Government should be in a position carefully to assess its strengths and weaknesses, and bring that back to us.

It is important that the Government understand that delays in receiving treatment can, and do, cause real suffering. In the 2012 trans mental health study, one trans person said:

“Not having had my gender confirming yet has a constant effect on undermining my self-esteem and self-confidence as well as social transition—I hate every day that I have to live with ‘boy parts’ and I can’t wait to get rid of all recognisable ‘boy bits’.”

Another person told the same study:

“Permission for my chest surgery was delayed and I waited double the usual waiting time...This caused me to go into a deep depression. I had panic attacks when I left the house. I lost my job and then found I couldn’t leave the house.”

Such suffering could be prevented if we improved the speed at which our NHS works for trans people. Delays should not be any longer than is strictly necessary from a clinical point of view.

As a result of the problems that I have outlined, the Select Committee recommended that the Government conduct a root-and-branch review of how NHS services can be improved to better serve trans people and completely stamp out transphobia in our NHS. I am disappointed—I am sure that I speak for many Members here today—that the Government did not accept this clear recommendation. Instead they responded by stating that they will look into broadening the terms of reference of NHS England’s existing task and finish group for gender identity services. When such systematic failure has been identified, the Government should question the governance arrangements that are in place, rather than relying on them even more. I say that gently to the Minister and hope that she has had those conversations with her opposite numbers in the Health team. I invite the Government to give fresh consideration to a root-and-branch inquiry as part of their commitment to the cause of gender and transgender equality.

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[Hannah Bardell]

I could not agree with my hon. Friend more, and she is a doughty champion for equalities. The issue of intersections in our society—how they meet, how they interact with each other and how we support them—is hugely important.

As a relative newcomer to the LGBTI community, I have to say that one reason I am particularly glad we are having this debate is that it is of the utmost importance that we better familiarise ourselves with the language surrounding this topic. I will be honest: I was not wholly familiar with all the language and terminology. As someone who came out relatively recently, I felt there was almost an assumption that people would be totally familiar with all aspects of the LGBTI community and LGBTI life. However, like many, I am on a journey of discovery and learning, and I have to say that, after the research I did today, and having listened to the contributions from both sides of the Chamber, I feel more enlightened, and I hope others do, too.

When I was growing up, there were not enough LGBTI role models for me, and others have spoken about powerful role models, particularly in the trans community. We are now seeing actors and others coming forward—people such as Jack Monroe—and speaking so openly and passionately about their lives. There are also people taking on roles in various soap operas and normalising members of the LGBTI community and representations of them.

I read one of Jack Monroe’s interviews when I was preparing for the debate, and the passion about confusion and experimentation with identity came across. Fox Fisher has also been a fantastic role model, and has made some incredibly pioneering and powerful films about transgender issues and people’s journeys. We should take a moment to congratulate and commend all those in the transgender community who fight on a daily basis, as well as all the charities and other organisations, many of which my hon. Friend the Member for Lanark and Hamilton East mentioned, because they are at the forefront every day of the battle for equality.

Language is very important, because the truth is that correct language is not being normalised in our society and particularly, as has been said, in our media. We should be working towards a day when all our names can be preceded by Mx, because people should not have to choose their identity. For example, whether I, as a woman, am a Ms, a Miss or a Mrs defines my marriage status, which seems ridiculous. Why is it that, on the most mundane forms, we are still required to identify our gender and our marital status? I find it maddeningly unnecessary.

Beyond language, there is a huge amount of work to do, as many have said, on the Gender Recognition Act 2004. It is time to simplify the procedure for the self-declaration of gender and to put an end to the requirement for medical or psychiatric evidence. It is time that we allowed 16 and 17-year-olds access to the same process granted to 18-year-olds and up. It is time to fully and properly recognise trans, including non-binary, people in the Gender Recognition Act.

The LGBT Consortium provided some excellent briefing ahead of today’s debate and crystallised some of the really worrying challenges facing the trans community. It explained:

“When someone applies for a gender recognition certificate they are assessed by a panel…they never meet”.

Imagine someone who has perhaps spent years struggling to work out who they are, facing that panel process to be assigned. They do not meet the panel and, worst of all, there is no appeal. This is not like applying for a job; this is about people’s lives and identities. We must make sure that any process anyone has to go through is properly sensitive to their situation and to the challenges and battles they have had to go through.

The Scottish Government are publicly committed to all those changes to the Gender Recognition Act, and I hope the UK Government will now follow suit, because countries such as Australia, India, Denmark and Nepal are actually ahead of us on this front. They have the option on their passports to place an “X” next to the holder’s gender. Of course, no one’s gender makes them any less or more of a citizen of a country. As my hon. Friend the Member for Lanark and Hamilton East said, the UN’s International Civil Aviation Organisation has an internationally acceptable gender marker for passports.

[Angela Crawley]

Ireland, Denmark, Malta, Norway, Argentina and Colombia—and soon Scotland, I should add—already recognise the process of self-declaration. Will the UK follow their example?

--- Later in debate ---

[Caroline Dinenage]

Yes. Some of the legislation is very new, including that of our friends in the Republic of Ireland. We will keep it under review and we are determined to learn all the lessons of best practice from around the world, as indeed we always have.

[Angela Crawley]

On that specific point, will the Minister meet Angela Constance, the Cabinet Secretary for Communities, Social Security and Equalities in the Scottish Government, to have that discussion, given that Scotland is now embarking on that process? Perhaps there could be a shared learning experience to ensure that we take matters forward for trans equality.

[Caroline Dinenage]

Yes, I am more than happy to do that and I am keen to collaborate in any way with those from whose experience we can learn.

My right hon. Friend the Member for Basingstoke presented her Bill today. We have not yet heard a convincing case for introducing gender identity as a protected characteristic. The Equality Act, and criminal, hate crime and employment legislation all offer protection for trans people. However, we will continue to keep an open mind, listen to testimony and monitor evidence to find ways to improve the lives of trans people.

My opposite number, the hon. Member for Rotherham (Sarah Champion), asked about hate crime. We have improved the recording of hate crimes against LGBT people to support more effective prevention and action. Police forces are now required to collect those data, and the first set of data was published as official statistics in 2013. We have committed to review legislation on hate crimes and we are currently considering the options. The Crown Prosecution Service also recently launched a consultation on draft guidance on prosecuting cases of offences involving transphobic hostility.

The hon. Member for Lanark and Hamilton East spoke about gender markings and gender X on passports. As she pointed out, UK passports currently recognise only male and female genders. Legal recognition is more broad than just changing passports and would need to be considered across Government. Introducing a third category, such as that denoted by an X in a passport, would require a change in UK primary legislation. However, on gender markings, as set out in the response to the Select Committee report, the UK has agreed with the International Civil Aviation Organisation to lead on a survey of member states on gender and passport markings. The gender questionnaire was circulated in October and member states had until the end of November to provide their views. We will review the responses, compile a report and submit it to the working group early in 2017.