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.

Bread and Flour Regulations 1998

Baroness Walmsley Excerpts

Wednesday 11th December 2024 Lords Chamber

[Baroness Merron (Lab)]

I will be glad to look into that and to update the noble Lord and your Lordships’ House on the matter.

[Baroness Walmsley (LD)]

My Lords, I congratulate the noble Lord, Lord Rooker, on his persistence; these Benches have always supported him. I welcome that more NTDs will be prevented. However, given that we have to wait yet another two years and that the Government’s guidance for women who wish to become pregnant or who are pregnant is to continue taking folic acid supplements, are the Government looking at creative ways of making it easier for them to do that —for example, having them available for free in antenatal clinics or at family hubs?

[Baroness Merron (Lab)]

As I mentioned earlier, while 24 months is a realistic transition, not everything will wait that long. It is the case, as the noble Baroness says, that there is still advice to women who could become pregnant to take folic acid supplements, and it is important that we keep that message going. However, 50% of pregnancies are not planned, so it is not possible to prepare by taking supplements. We are looking at all ways of effectively getting the message across.

Bread and Flour Regulations 1998

Baroness Walmsley Excerpts

Wednesday 11th September 2024 Lords Chamber

[Baroness Merron (Lab)]

My noble friend has been a tremendous campaigner. Indeed, he reminded me that this is, I believe, his 22nd Question on this matter, so I do not wish to test his patience. I absolutely assure him that, as he said, the policy is being taken forward as a UK-wide measure and all the necessary preliminary legislative steps have been taken, including the public consultations he mentioned, which were reported on earlier this year. Subject to renewed collective agreement in England, Defra will lay legislation later in 2024.

[Baroness Walmsley (LD)]

My Lords, I am hearing that, unfortunately, the Government are not being very ambitious in the level of fortification that they will propose. They are considering a level that will reduce neural defects by only about 20%, whereas 1 milligram of folic acid in 100 grams of flour could reduce neural tube defects by 80%, which is a massive amount. Can the Minister at least reassure me that the appropriate committees will look at the level of fortification being proposed, so that it is appropriate and safe?

[Baroness Merron (Lab)]

I assure the noble Baroness that that has already happened. As I am sure your Lordships’ House is aware, the proposal is to add 250 micrograms of folic acid per 100 grams of non-wholemeal wheat flour. I emphasise that this fortification would be in addition to the foods that are already voluntarily fortified, such as a wide variety of breakfast cereals, so we are not talking about just bread. The feeling among the experts, to whom we listen, and the committees to which the noble Baroness referred is that this is the right level at which we can provide reassurance, and so this is where we are focusing our efforts.

NHS: Breast Screening Programme

Baroness Walmsley Excerpts

Tuesday 3rd September 2024 Lords Chamber

[Baroness Merron (Lab)]

If a woman in the age group to which the noble Baroness refers has concerns, she may request follow-up and investigation. But it is the case that we follow the scientific advice, which is that going beyond that age as a matter of course will not give the rewards that we would hope. I can certainly reassure any woman in that age group that she will be seen should she have concerns, and she should present herself as soon as possible.

[Baroness Walmsley (LD)]

My Lords, artificial intelligence has been very efficient in helping to interpret breast imaging, reducing false positives and false negatives, and significantly reducing the workload of the second reader. We know that early detection is key to reducing mortality, and I understand that AI can be used to identify patients with high risk so that they can be screened more frequently and proactively. What work is being done to use AI to identify high-risk individuals, so they can be screened more frequently?

[Baroness Merron (Lab)]

It is important to ensure that the service is there for those who are at greater risk. The noble Baroness is right to refer to the growing interest in and potential use of AI, which is indeed very exciting. The National Screening Committee is very aware of this point. The committee is working with the National Institute for Health and Care Research and NHS England, and has designed a research project to see whether AI can be safely used to read mammograms in the breast screening programme, and whether that is acceptable both to women and to clinicians. That work will continue.

Vaping Products: Usage by Children

Baroness Walmsley Excerpts

Monday 2nd September 2024 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, a YouGov poll this year showed that almost 1 million young people under 18 have tried vaping, almost half of whom have only tried it once or twice. That leaves half a million who regularly use a product that is illegal for people to sell to them, and which is probably harmful to their physical, mental and social health. This indicates that half of those who try vaping once or twice go on to become regular vapers. Most children who try their first vape obtain it from a friend, although some obtain it from companies that give them away free, which unfortunately is still legal. You have to ask why companies do that. The answer is obvious: to encourage a child to like the vape and buy more, and for many to become addicted to the nicotine in them and carry on vaping for years. Will the Minister confirm that this loophole will be closed?

Children are being manipulated by the manufacturers, some of which are tobacco companies trying to remain profitable for as long as possible by using attractive packaging, colours and flavours; it is a bit like some unhealthy foods. More research, as we have heard from the noble Lord, Lord Winston, needs to be done on the toxicology of these colours and flavours—perhaps the Minister could say whether the Government are funding any.

Research has shown that children are more attracted to colourful branded packaging than to vapes in a plain package, such as is now mandatory for cigarettes. For adult smokers who wish to carry on—probably for good reasons—branded or unbranded packaging does not make much difference at all, and this indicates that, at the very least, removing brand imagery from single-use vapes, which are the product of choice for children, could have an impact in reducing the appeal of e-cigarettes for young people without compromising their legitimate appeal to adult smokers who are using them to quit smoking tobacco. Colours, images and flavours attractive to children must go: will the Government legislate for this?

Far too many young people find it easy to obtain vapes from shops, street markets and online. There seems to be very little enforcement of these illegal practices, but I think this is because of a lack of resources among local authorities to do it. Will the Government consider the impact of this lack of enforcement and introduce a licensing system with substantial fines for those who sell vapes without a licence and for all outlets who sell to children, as well as any unlicensed vaping products? Research shows that a third of vapes reaching UK retailers do not comply with regulations, and there should be fines for selling these, too.

For many young people, it is hard to avoid the promotion of vaping. Nearly three-quarters of 11 to 17 year-olds reported that they were exposed to vape promotion, which is an increase from previous years. Only one in five said they did not see promotion of e-cigarettes at all. The most common source of exposure, as my noble friend Lord Storey said, is in shops and online. Why do companies spend the money on the promotion? The answer is clear: because it works. Vapes should always be behind the counter in plain displays, and that should apply to petrol station shops and convenience stores, too. I was at a petrol station the other day and there were multicoloured vapes right next to the till—far too attractive. We have to make vaping boring, because research by the NUT found that about 30% of young people vape by the time they leave school, and some of its research found that some of the vapes had been adulterated with other drugs—including heroin, which is unbelievable.

Vaping was introduced and made legal in this country to help smokers stop killing themselves with tobacco and to protect the NHS. That is what vapes were meant for—all well and good. The Government are rightly proposing to gradually phase out the legal selling of cigarettes by raising the age of a customer to whom it is legal to sell them. If vapes are harmful—and of course they are, because they contain the addictive element nicotine—why not also phase out their sale except in medical circumstances? Children’s lungs and brains are more sensitive to nicotine and all the other additives than those of adults. That is why the current age restriction was introduced in the first place. But the horse has already bolted. Although four out of five children aged 11 to 17 have never tried vaping, which is good, over a third of those who have tried it have never smoked; that is significant. Yet this is a product that is promoted as a device to help people stop smoking.

There is already evidence that young people below the legal age are addicted to vapes because of the nicotine in them. I heard a young man on television the other day saying that—and by the way, he said “unfortunately”. That was clear from the YouGov poll. In 2020, only 26% of young vapers reported strong, very strong or extremely strong urges to vape, but this year it is up to 44%. Only one in 20 young vapers say they usually use a so-called nicotine-free version. Presumably they are the clever ones who understand the dangers of nicotine addiction, but some are choosing products with levels of nicotine even higher than the legal level for adults, and that is very dangerous. Local authorities report children approaching them for help to stop vaping, but they do not have any resources to provide that service and that must change, alongside the new legislation which we are expecting soon. Can the Minister say whether the Government plan to provide those public health resources alongside that legislation?

It may be helpful to look at why children use vapes. Most say they just try it to see what it is like, not realising that it could become addictive; some say it is because their friends do it and it is cool to vape. Some say they think it is helping with their mental health; that is very worrying, and nobody seems to be telling them that becoming dependent on vaping could do entirely the opposite.

That brings me to education and information. Many teachers are concerned about the disruptive effect of vaping on children’s education. Some children crave nicotine so much that they vape in class, or in the cloakroom, and it has even been reported that they miss lessons in order to vape. Teachers are crying out for resources to help them educate children about the many harms of vaping, which half of them know is better than smoking, but half of them think is just as harmful and do it anyway. Are the Government planning to ensure that appropriate resources are provided for teachers to help children discuss the issue of vaping in a way that is respectful of the pressures on young people and therefore likely to be more effective? This is a complex issue with strong public health, economic and educational consequences, and I look forward to the Minister’s reply.

NHS Blood and Transplant Service: Blood Stocks

Baroness Walmsley Excerpts

Tuesday 30th July 2024 Lords Chamber

[Baroness Merron (Lab)]

I will need to come back to my noble friend on that last question, but I assure your Lordships’ House that action was taken to increase the number of donors and the supply of the necessary blood even before the alert was announced. An alert creates better conditions, because more people come forward and rally. I thank them very much for that. On the donor centres, it is possible, of course, to give blood every day of the year apart from Christmas Day.

[Baroness Walmsley (LD)]

My Lords, as the universities return in the autumn, many new students will be recruited to be blood donors, which is a very good thing, because they often remain blood donors for many decades. The system needs to recruit 140,000 new donors every year for various reasons. But what about other young people? Will the Government do what they can to help the blood transfusion service to devise ways and means of encouraging other young people to become blood donors and, we hope, carry on doing so for decades?

[Baroness Merron (Lab)]

The noble Baroness is absolutely right that we need to encourage young people to come forward and to stay in the system. I have been in discussion with the chief executive and the chair of the service about how we can build more resilience and extend the number of donors. I am sure noble Lords will be pleased to know that, with the assistance of the actors Hugh Jackman and Ryan Reynolds, there is an exciting partnership with the Disney action film “Deadpool & Wolverine”, which is exactly intended to reach new and younger donors, and donors of black heritage. I am sure it will.