Pathways Study: Puberty Suppression

Debate between Caroline Johnson and James Murray

Monday 22nd June 2026 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I declare an interest as an NHS consultant paediatrician and a member of the Royal College of Paediatrics and Child Health. What does this trial do? Put simply, it takes physically healthy children with normal pubertal development and subjects them to powerful drugs that may weaken their bones, affect their ability to think, damage sexual function and make them unable to have children of their own. Serious stuff—and for what? To treat a diagnosis of gender incongruence that will probably resolve without treatment.

Let us look at this carefully. Gender incongruence is a subjective condition; it is how someone says they feel. There are no lab markers and no scans. That, of course, is not necessarily unusual. In fact, it is common in mental health conditions. Gender incongruence is often self-resolving; it gets better on its own. Again, this is not unusual in paediatrics. It is really common for children to be admitted to hospital for supported care for things like gastroenteritis and respiratory viruses. Puberty blockers are powerful drugs. This is a powerful treatment with significant long-term consequences. Again, this is not new to paediatrics. Some chemotherapy, for example, has substantial short and long-term consequences. But what is unusual and, I think, toxic is the combination of all three. Medicine is about balancing risk. Where else would we give powerful drugs with potentially serious long-term consequences for a subjective condition that is likely to get better on its own?

I understand that this trial has been approved, but time and again we have seen and heard how fear and hostility can distort priorities. We have seen tragedy occur when fears of accusations of racism limited mental health treatment. We have seen profound suffering when fear of accusations of Islamophobia limited inquiries into the grooming gangs. The healthcare of children distressed about their gender is another topic where there have been attempts to shut down debate with threats and accusations of transphobia.

Such attempts were reported in relation to the Tavistock.

When considering treatments for life, with lifelong implications, we have a duty to be careful and sensible, so I ask the Secretary of State: why are this Government funding a trial that will cause harm to physically healthy children? These children may be 11 years old, at Tanner stage 2. Some of them are primary school children with only minimal signs of puberty. This is far too young. The MHRA warned in February that the youngest patients are at greatest risk; they may end up on puberty blockers for a much longer period, and face a higher risk to fertility, because sperm and eggs have not yet fully developed at Tanner stage 2.

I am reminded of this point in the judgment in Bell v. Tavistock:

“There is no age appropriate way to explain to many of these children what losing their fertility or full sexual function may mean to them in later years.”

Yet as the Secretary of State confirmed, the children must consent or assent to being in the trial. Why did the Government not heed the MHRA’s recommendation of a minimum age of 14 years? This Labour Government think that 14 is too young to watch social media. Why do they think 11 is old enough for this trial?

What is the goal of the treatment? In the trial, the outcome is a short to medium-term effect on quality of life and body satisfaction. Does the Secretary of State believe this is proportionate to the risks of these medications? Is there any evidence suggesting that puberty blockers are safer than they were thought to be in 2024, when the Government banned them, following the expert advice from the Commission on Human Medicines? Some have suggested that the drugs help adults to pass as the opposite sex. Is the long-term damage really worth it for the cosmetic benefit of a few? And it is just a few, because we know that the vast majority will be better without any treatment.

The Secretary of State said that “when it comes to eligibility, we are talking about a very small subset of a very small group.” Even if we were to accept the premise that a very small number might benefit from treatment, how could the clinicians identify which those children might be? A study of clinical outcomes from kids treated at the Tavistock is due to be completed next year. That could help, so why is the Secretary of State not waiting until that report is completed before conducting an experiment on an unnecessarily broad group of children? Has evidence come to light since the Cass review that helps clinicians confidently work out which 11-year-olds will become adults with gender dysphoria and which will not?

The Secretary of State has said that the criteria will stop short-term harm, and that should mean that long-term harm will not occur or go unnoticed, but history is littered with examples of things that do not cause short-term harm but do cause long-term damage. He also suggested that the trial will resolve the dispute, but sadly, I do not think that will be the case, because, first, a single trial rarely resolves a dispute; and, secondly, the comparison group, who are not getting the puberty blockers, are not randomised and are an intrinsically different population. This is bound to be highlighted once the result is published. In medicine, we have a founding principle: primum non nocere—first, do no harm. I ask the Health Secretary to please cancel this trial before vulnerable children suffer unnecessary, irreversible harm on his watch.

[James Murray]

I agree with the shadow Minister that most children and young people who are questioning their identity and gender are likely to resolve those questions on their own, and I think Dr Cass would agree with that. As I said in my opening remarks, for the majority of children who question their gender, we should let them be; they will resolve the matter through their friends and family and their own development. We are talking here about a small subset within a small group of children who need further support. I also agree with the shadow Minister that the situation before Dr Cass did her review—the situation that had developed in the last few years before the turn of the decade—was totally unacceptable, and we should be clear that that was wrong.

The shadow Minister asked about protecting the young people involved in the trial from harm. As I set out, there is intense scrutiny, and there are robust mechanisms to prevent the children involved from being harmed. She mentioned the MHRA recommendation for the lower age limit. Initially, there was no lower age limit, but a scientific dialogue between the MHRA and the trial sponsor led to publication last week of the updated protocol, which recommended the minimum ages of 11 and 12.

The gateways to younger people and children becoming involved in the trial are significant. There must be not just consent or assent from the children, and consent from their parents or guardians, but approval from the NHS care team, the national multidisciplinary team and others before anyone can be involved. As I set out, I feel uncomfortable and uneasy when considering this matter, but I think that the right way for us to move forward is to have the clinical evidence on which to base decisions. I have received reassurances about there being the highest possible level of scrutiny and protection from harm for young people involved in the trial, and that is the basis on which, on balance, I think it is right for it to proceed.

Oral Answers to Questions

Debate between Caroline Johnson and James Murray

Tuesday 9th June 2026 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Does the Secretary of State agree that state-funded healthcare should be provided to all children based on clinical need, not economic or educational status?

[James Murray]

It is an essential part of our NHS and its founding principles that the NHS is available to all on the basis of need, not their ability to pay. That is a fundamental principle that we in the Labour party support. I know that some Opposition parties have been moving away from that recently and seeking to privatise the provision of our health service and move to an insurance-based model, but Labour Members believe that all people, including children, must get healthcare based on their need rather than their ability to pay.

[Dr Caroline Johnson]

I thank the Secretary of State for his answer. Does he therefore share my concern at reports that some children are being turned away from state-funded healthcare because they are not attending a state school? Will he look into those reports and ensure that he makes provision for children who are not attending state schools to receive the healthcare they need?

[James Murray]

I am surprised by the hon. Lady’s remarks, because where a child goes to school should have no bearing on their ability to access NHS services. If she would like to write to me with further details, I would be happy to look into that matter.

Budget: Press Briefings

Debate between Caroline Johnson and James Murray

Monday 17th November 2025 Commons Chamber

[James Murray]

As I have said, I am not going to comment on the ongoing Budget process. However, the right hon. Lady mentioned stability, and stability is at the heart of our approach, which is why building more resilient public finances with the headroom to withstand global turbulence is so important in giving businesses the confidence to invest.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

There appears to have been a lot of speculation about this Budget, and it seems to have been the same measures that have been speculated on by a number of different news sources, which leads to suspicions of a leak. The Minister must surely recognise that there was a possibility of a leak, in which case either he knows who the leak was and that is why he does not want to investigate, or he does not know who the leak was, in which case he should want to investigate. I am not asking him to speculate on the contents of the Budget, so he should please not give me that answer again. Why will he not institute a leak inquiry?

Family Businesses

Debate between Caroline Johnson and James Murray

Wednesday 26th February 2025 Commons Chamber

[James Murray]

My hon. Friend is absolutely right to point out that, under the previous Government, there was a series of cliff edges and one-year extensions that provided no stability whatsoever to businesses trying to plan investment, hiring or expansion decisions. That is why we have decided to extend the relief that the previous Government were due to end in April 2025 for one further year, before introducing permanently lower rates from April 2026.

[Dr Johnson]

The Minister is talking about planning—I should declare an interest as a farmer’s wife—and says that 500 farmers will be affected. Of course, none of us can know who is going to die next year. While 500 farmers will be affected, there may be many, many more who might die and might be affected. There is a discrepancy between how many he thinks will definitely be affected—how many he predicts will die—and the actual number of people who may be affected and cannot plan their businesses accordingly, because they simply do not know. He argues that they can put their assets down a generation, but no one knows if there will be a car accident and the younger generation will be killed. He is simply taxing tragedy.

[James Murray]

I think I was following the hon. Lady point that in many cases no one knows when inheritance tax will be due, because people cannot predict the sad events that may happen in their lives. But it is clear that, in trying to work out the impact of changes to tax policy, the best source of data is the actual claims data for those reliefs in the past. That is exactly what we have used. We have looked at the HMRC data on actual claims under agriculture property and business property relief. That is what determines the data that I mentioned of up to 520 estates being affected in 2026-27.

[Dr Johnson]

My point was that the Minister may be correct that 520 estates will be affected, but others who may be affected will need to plan their businesses and lives accordingly. That is why so many more people are affected by his announcement than simply those who will die next year or the year after.

[James Murray]

I return to my point that three quarters of estates claiming agricultural property relief, or agricultural property relief and business property relief, will not pay any more inheritance tax in 2026-27 as a result of these changes. In terms of the extra inheritance tax liability, which is what the data about claims points towards, the data is clear that the majority of estates will not be affected. As I mentioned to several of the hon. Member’s colleagues on Conservative Benches, the data is set out in quite some detail in the letter that the Chancellor wrote to the Treasury Committee. If she has a look at the data in that letter, that might answer some of her questions.

I will briefly finish my comments in relation to business rates. I was thanking my hon. Friend the Member for Welwyn Hatfield (Andrew Lewin) for intervening to point out what we inherited from the previous Government: a situation where relief for retail, hospitality and leisure was chopping and changing year to year. Indeed, from April this year there was to be a cliff edge, so it would have gone away entirely—according to the plans we inherited from the previous Government, there was to be no relief at all after April. We therefore decided to extend the relief at a fiscally responsible level for a further year, ahead of our permanent reforms coming in.

While we are on the subject of hospitality, let me address the absurd notion in the Opposition’s motion—I do not believe the shadow Chancellor mentioned this in his comments—that the pint is under threat. The pint is part of our nation, and we do not need a new law to protect the pint any more than we need a new law to say that the sun must rise in the morning—I wonder whether the Opposition Members who drafted that part of the motion may have been close to a number of points when they did so. In any case, I am proud to reject the insinuation in their motion and to put on record—if it needs to be said—that pints are at the heart of our nation and, under Labour, they will stay that way.

Winter Fuel Payment

Debate between Caroline Johnson and James Murray

Tuesday 10th September 2024 Commons Chamber

[James Murray]

I thank the right hon. Gentleman for his intervention. The Chancellor will take all decisions in the Budget on 30 October—[Interruption.] Let me make one important point to him as we approach the Budget on 30 October: we know there are going to be difficult decisions that we have to take in the Budget and, frankly, that is a direct consequence of the decisions taken by him and his colleagues when they were in government.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

As he is a Treasury Minister, I wonder whether he could help me with this question. How many of the pensioners who will lose the winter fuel allowance today receive less than the average train driver the Government have just given a pay rise to?

[James Murray]

I understand the political point that the hon. Lady is trying to make. But let me be clear. If she is talking about pensioners, the foundation of state support for pensioners is the state pension, which is why the Government have committed to maintaining the triple lock for the duration of this Parliament.