Puberty-suppressing Hormones

Baroness Walmsley Excerpts

Monday 16th December 2024 Lords Chamber

[Lord Kamall (Con)]

My Lords, I thank the Minister for the Statement and the right honourable Secretary of State for the careful and sensitive way in which he delivered the Statement in the other place. In line with my right honourable friend the shadow Secretary of State in the other place, from these Benches we welcome the Government’s announcement. Whatever your politics, most people believe that one of the first duties of any Government is to protect their citizens, especially our children.

As the Secretary of State said, there has been too much heat, and perhaps toxicity, around the issue of services for children experiencing gender dysphoria, so I welcome the tone with which His Majesty’s Government have approached this issue—less heat, more light—and that they continue to take an evidence-based but compassionate approach. I also take this opportunity to thank the noble Baroness, Lady Cass, for leading the review on gender services for children. The Cass review highlighted the importance of putting scientific evidence above ideology and laid out the fact that we simply do not know enough about the long-term impacts of puberty blockers on children. That is why my right honourable friend in the other place, the Member for Louth and Horncastle, when Secretary of State, banned the routine prescription of puberty blockers for gender dysphoria, and later extended that ban to private clinics.

We welcome the decision of the Government to follow the recommendations of the independent Commission on Human Medicines to extend the banning order until a safe prescribing environment can be established for these medicines. This is a common-sense approach, and allows time for more evidence to be examined to consider the holistic and long-term impacts of puberty blockers on children. The Secretary of State announced the clinical trials to gather evidence but, given understandable concerns about the risks of any clinical trial, can the Minister reassure your Lordships that these trials will have robust safeguards to ensure the well-being and safety of any children taking part, while recognising the importance of having these trials in the first place?

The Secretary of State in the other place also spoke about alternatives to puberty blockers for children suffering from gender dysphoria. As someone who takes an interest in social prescribing, I welcome the Government’s recognition that medication is not always the best solution, so will the Minister share details of some of the alternatives to puberty blockers that will be offered to children?

Finally, noble Lords will be concerned that, despite the lack of evidence, puberty blockers were prescribed to children with gender dysphoria when their safety could not be guaranteed. What steps are the Government and the NHS taking to ensure that a similar situation does not occur again and that future decisions are led by evidence? I look forward to the Minister’s responses.

[Baroness Walmsley (LD)]

My Lords, on these Benches we welcome the tone of the Secretary of State’s Statement. I have often said that there are many ways of being human. Growing up can often be a very trying time for teenagers. How much more difficult, then, for those young people with gender distress who are struggling with finding out who they are while being different from their peers, and all without adequate support? It is high time that proper services were put in place for young people struggling alone with these issues. Their families too need help to support them at this difficult time. For too long, children and young people who are struggling with their gender identity have been badly let down by a low standard of care, exceptionally long waiting lists, even by the standard of mental health waiting lists, and an increasingly toxic debate.

We always want to see policy based on the evidence. With any medical treatment, especially for children and young people, the most important thing is to follow the evidence on safety and effectiveness. It is crucial that these sorts of decisions are made by expert clinicians, based on the best possible evidence. It is also important that the results of the consultation and the advice of the Commission on Human Medicines are made public.

Some might wonder why the treatment is deemed not safe for gender dysphoria patients but safe enough for children with early-onset puberty. More transparency might clear up the confusion and give more confidence to patients and their families. However, the Secretary of State himself admits that he does not know what effect the sudden withdrawal of this treatment for young people already embarked on a course of puberty blockers will have. These are the young people with the most urgent need for other types of care in the current situation, so what clinical advice have the Government taken about the effect of withdrawing these drugs on the physical and mental state of young sufferers of gender incongruence already on the drugs, and what physical and psychological support will be offered to them?

In the current circumstances, plans for a clinical trial are welcome, but we would like to know the criteria for those eligible to participate. What assessment have the Government made of the recent Council of Europe report, which raises the ethical and rights implications of offering participation in the trial to only a small group of patients? If the only way to continue access to these drugs is through participation in the clinical trial, whose scope, length and start date have yet to be announced, this lays the Government open to accusations of coercion and breaches of human rights.

We welcome the plans for additional treatment centres in Manchester and Bristol as well as London, but can the Minister say why they will not be up and running for two years? Is it lack of funding, lack of premises or lack of sufficient therapists with the appropriate specialist training? This is a very sensitive area, so the wrong people could do more harm than good. If that is the reason, is there a plan for training up more qualified therapists in time for the opening of the regional treatment centres? I very much look forward to the Minister’s replies to these questions.

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

My Lords, I start by thanking the noble Baroness, Lady Cass, for her work in this very important area. I also refer to the actions taken by the previous Government, which set in train the action we are continuing. As both the noble Lord, Lord Kamall, and the noble Baroness, Lady Walmsley, rightly said, this is about keeping children safe. There is nothing more important than evidence-based action—which is what we have before us—and taking the necessary steps.

The Cass review made it clear that there is not enough evidence about the long-term effects of using puberty blockers to treat gender incongruence to know whether they are, first, safe and, secondly, beneficial. It is important to bear both in mind. The Commission on Human Medicines independently found that clear evidence of unsafe prescribing exists and recommended that there should be a ban until there can be a safe prescribing environment. That is where we start, and last week’s laying of legislation stops that unsafe prescribing to children and allows time to develop the necessary safeguards, as recommended by the commission. I should just clarify that the legislation is indefinite, not permanent. There will be a full review in 2027 so this continues to be a very live issue.

The clinical trials, referred to by both the noble Lord, Lord Kamall, and the noble Baroness, Lady Walmsley, will be a world first. It is important to pay tribute to that. In addition to the work currently being undertaken to respond to the recommendations of the Commission on Human Medicines, the trial is presently undergoing development and approvals. The aim is to begin recruitment early in the new year. I am sure there will be an opportunity to update the House on that detail.

In answer to the point from the noble Baroness, Lady Walmsley, the numbers will be uncapped, which is important. I am sure we all agree that better-quality evidence is critical. The development of the clinical trial between the National Institute for Health and Care Research and NHS England will provide the better-quality evidence that we are all looking for.

The noble Baroness, Lady Walmsley, spoke about new services. To make the situation clear, NHS England has already opened three new services in the north-west, London and Bristol. The fourth will be in the east of England and will open its doors in spring next year. The noble Baroness also asked about the timetable; we are on course to have a service in every region of England by 2026. I cannot always confirm developments of that nature, so I am glad to do so because it will help reduce the waiting list, which noble Lords are rightly concerned about. It will also bring services closer to home, which is crucial too.

Furthermore, this is a very specialist area, so recruitment and training are key. This is part of the reason for the—I would not call it a delay—realistic timetable. There is also the need to work with local trusts and take into account all the various operational considerations, so realism rather than delay is how I would put it to the noble Baroness.

I agree with the points made by noble Lords on the Front Bench about tone and discourse. I am very grateful to the noble Baroness, Lady Walmsley, and the noble Lord, Lord Kamall, for welcoming the way the Secretary of State made the announcement and what the announcement refers to. We have a real responsibility in this House—and outside it—to handle conversations on this topic extremely sensitively. This is about people’s lives. I absolutely agree with the point just made: the public debate has been frighteningly toxic. Irresponsible statements made recently have put young people at risk of serious harm and that has to stop. That is one of the many reasons I welcome the Statement—and the tone and discourse this evening.

On the point made by the noble Lord, Lord Kamall, about alternatives to puberty blockers, no exact alternatives are being offered. However, within the new services there will be an emphasis on, for example, psychosocial support.

In response to the point made by the noble Baroness, Lady Walmsley, about the—she did not use this word, but perhaps I might—transparency of evidence, all the commission’s recommendations have been published in full as part of the Government’s response to the consultation. The full advice, as I hope the noble Baroness will understand, was prepared solely for Ministers, but we are considering whether it should be published. I know the noble Baroness will understand that, as with all advice prepared for Ministers, there are legal and other matters that must be considered before it can happen.

I will say a word on mental health support, which is so important for children and young people. An offer of an appointment with a mental health professional has been made to everyone on the national waiting list for children and young people’s gender identity services. Those who joined the waiting list on or after 1 September will have an appointment with a mental health professional or paediatrician before being referred to specialist gender services. Those who are not on the waiting list and are directly affected by the restrictions can access NHS mental health services through a dedicated single point of contact, supported by clinical nursing.

I hope that is helpful, and if there are any points I have missed—

[Baroness Walmsley (LD)]

Can the Minister address the issue of the children who are part-way through a course of treatment? Will they get mental health support as a priority?

[Baroness Merron (Lab)]

For those who are already on puberty blockers, there is an immediate withdrawal. But I hope that what I have outlined on mental health support covers all the areas the noble Baroness, and indeed all of us, are concerned about. The approach is as compressive as possible, and the new gender services I described should make it even easier to provide the service. It is not a matter of waiting until 2026; we absolutely understand the need to provide that support now, and we are making that available.