Gender Recognition Act

Debate between George Howarth and Jackie Doyle-Price

Monday 21st February 2022 Westminster Hall

[Jackie Doyle-Price (Thurrock) (Con)]

It is a pleasure to serve under your chairmanship today, Sir George. It was also a pleasure to listen to the opening speech by my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn), who I think set the tone extremely well.

If there is one thing that I think about this debate, it is that it has become very toxic. It is—dare I say it—rather too binary. There is, in effect, a clash of rights here between sex and gender, and I am afraid that we, as a political class, have failed. We have failed to show leadership in this area, and it is high time that we did. We should not run shy of debating these issues.

However, by viewing the issues through the sentiments of the petition and the existence of the current Gender Recognition Act, we are rather limiting ourselves when it comes to the remedies to ensure that we properly empower people of all genders—however anyone wishes to live and express themselves. As I said in my intervention on my hon. Friend, that Act predates same-sex marriage. We really need to have a fresh look at how we approach all issues of sex and gender in our legislation, because the world has changed. The hon. Member for Wallasey (Dame Angela Eagle) was absolutely right: the Act was groundbreaking in 2004, but it now looks very out of date.

I make one comment about the toxicity of the gender recognition debate. We can all condemn the abuse and vitriol that people are exposed to when they engage in the debate, but we must recognise that the reason why that happens is that, for many people, this is very personal. It is very personal for the transgender person who thinks that their existence is being erased, and equally personal for women who feel that their sex-based rights, for which they and their forebears fought for generations, are being erased. However, it should not be beyond the wit of us all, as policy makers, to overcome that, because the truth is that they are both right. We have to get behind that and keep up with meaningful solutions.

As I said, we need a fresh look at the whole issue of how we tackle sex and gender in our legislation. I come to the point mentioned by the hon. Member for Wallasey and my hon. Friend the Member for Carshalton and Wallington: the fact that so few trans people actually apply for a GRC. That, perhaps, begs the question of whether we need a GRC. Do we need a GRA that enables people to have a certificate that confirms their gender? In this country, we do not need papers to tell us who we are and how we live.

That is really the point: what useful purpose does a GRC serve? I look forward to hearing the Minister’s views on that. I know we are looking at it from what has been described as a “minor reform”, but let us just challenge the purpose of the documentation. What is it designed to deliver? Does it really deliver any enhanced rights over and above those that anyone has under the law as it is?

For a lot of people, moving towards self-ID puts trans people on a collision course with women’s rights—a collision course that no one really wants to see—so I want a more challenging approach. For me, the way forward is not about establishing gender recognition certificates; it is about going into our laws to determine where sex matters and where gender identity can prevail.

There are a number of areas where sex needs to trump gender, one of which is health. It is fundamentally unhelpful for people’s declared gender to trump their sex on their medical records. We are seeing people not being called for routine screenings, based on sex, for example. The hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) said that transgender prisoners are risk-assessed in the criminal justice system—well, they are if they do not have a GRC, but a trans woman with a GRC is automatically put in the women’s estate. [Interruption.] It is the transgender person who self-declares who is risk assessed—

[Sir George Howarth (in the Chair)]

Order.

[Jackie Doyle-Price]

We have transgendered prisoners with or without a GRC in the women’s estate.

It should be for service providers to risk-assess their premises. That would be a safer situation all round. Do we need to rely on a piece of paper that is no longer necessary? I come back to the fact that the Act was passed to enable same-sex marriages, which are now uniformly enabled in law, so do we need a GRC?

The other area where sex really matters is in sport. It appals me, as I am sure it appals most people, that sports governing bodies are turning a blind eye to women’s sport being destroyed by transgender athletes, where there is an innate physiological advantage. This is all practical common sense. We as a political class have neglected to grip these issues for so long that we have allowed this toxic debate to happen. We have allowed the extremes to happen, and it is incumbent on all of us, as my hon. Friend the Member for Carshalton and Wallington said in his opening remarks, to bring back some common sense. We as legislators need to have cool heads and come up with a law that suits anyone and that empowers transgendered people to be who they want to be and to live their lives free of prejudice and discrimination, but that enables everyone to be comfortable with that and that protects women’s spaces.

NHS: Hysteroscopies

Debate between George Howarth and Jackie Doyle-Price

Tuesday 11th December 2018 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship, Mr Howarth. It is an even bigger pleasure to respond to the hon. Member for West Ham (Lyn Brown). I pay tribute to the work she has done to highlight this issue, which has affected many women over many years who have been left to suffer in silence.

As the hon. Lady said, there were 47,000 signatures on the campaign petition, which is an indication of just how many women have been badly affected by what is actually a common procedure. It does not matter that it is only one in four, which is probably the most generous estimate. It could be as low as one in 10; it does not matter. We are talking about individuals who have been badly affected and who have been traumatised to the point where it effects their ability to look after themselves in the future. Frankly, it is no value to the NHS to leave those women suffering in silence, and I am very grateful to the hon. Lady for sharing the experiences of the women who have been brave enough to come forward.

The hon. Lady set me a challenge. She is quite right to demand swift action, because this has been going on for many years. She had four asks. On the first two, I will work with her and the campaign to make sure we can deliver them. They are extremely reasonable, to be brutally frank. On her third ask, we need to make sure that we have sufficient resource to enable women to exercise genuine, informed choice about how they take this procedure. On the fourth ask, about the tariff, notwithstanding the guidance about what might be best practice in most cases, we need to make sure that the tariff does not encourage perverse incentives that will disadvantage women. At the heart of all this, we need to ensure that running through every piece of treatment for women with gynaecological conditions is the ability to make informed and empowered choices—genuine choices. In that respect, I see the hon. Lady as a strong ally in working towards far better treatment for all women at the hands of the NHS.

The hon. Lady has given a great voice to people who have been through such terrible experiences. She again shared some of the distressing accounts of women for whom current practice has not been good enough. She is right that in the past not enough attention has been paid to a common procedure that generates harm to far too many women. I hope that the very fact of our debate today will shine a light on the situation, because the more we can do to spread awareness, the more women are empowered to look after themselves when facing treatment in the NHS. I hope that she will take some reassurance from the fact that I will continue to work with her to improve women’s health outcomes.

I also want to put something else on the record: the hon. Lady talked about a complete lack of humanity in how those women were treated. I would not be the first to say this—I have spoken to many female colleagues across the House as well—but we often feel that, when our reproductive organs are not being used for the purpose of having children, they are just an inconvenience. The NHS needs to do better. She mentioned my women’s health taskforce, and it is very much at the heart of that. As we go through life, the virtue of having our reproductive organs brings morbidities which are not always treated well in the NHS. We need to do better.

Hysteroscopy, as the hon. Lady explained, is a useful tool in the diagnosis and treatment of a number of conditions, such as the investigation of heavy menstrual bleeding, which affects as many as one in four women between the ages of 15 and 50. That gives some indication of just how many women might consider the procedure. Hysteroscopy is also used to treat fibroids and polyps, which are conditions that can cause long-term symptoms of pain and discomfort. The procedure is without doubt useful in treating women, so hysteroscopies have a role, but as she illustrated beautifully, they can be invasive and traumatic. We need only think about what the procedure involves to understand how traumatic it can be when it becomes painful.

Women’s least expectation of going through the procedure—this is crucial—is that they should be treated with sympathy and respect. They should also have full understanding before undertaking such an experience. As the hon. Lady explained, however, often women find themselves in profound shock at what is happening, and it does not always take place in the most appropriate setting. We clearly need to do better. Information is crucial in that regard: we need to ensure that nothing comes as a surprise.

I encourage women to access the NHS webpage on hysteroscopy, which includes information on what the procedure involves, the likely recovery period and the alternative procedures available. It notes that experiences of pain during a hysteroscopy can vary considerably from one woman to another but—the hon. Lady highlighted this point—I do not think that it properly reflects that, for women who have never had children, the pain can be particularly acute. We should consider the question whether it is ever appropriate for women who have not had children to have the procedure. Clearly, from the evidence she has presented to me, that is where the highest risk is.

I also feel strongly that merely giving information is not enough. Not only is this about providing clarity about what will happen and whether there are decision points for patients—some women will experience little or no pain, but for others it can be severe. We should also remember that for some women the hysteroscopy might be a first encounter with gynaecological services and that some might need to confront past pain or trauma. The hon. Lady has illustrated that well today. It is concerning when medical professionals do not prepare patients for the treatment in a sensitive way.

I fully agree with the hon. Lady that when a woman is clearly suffering during the procedure, it should be stopped. In any case, consent means that at any point people should be able to request that a procedure is stopped. It horrified me to read some of the accounts that she shared, such as women being held down and told, in essence, “You’ve got to continue this treatment or it will be worse for you.” That sort of conversation does not belong in 21st-century Britain in our fantastic NHS. I think we would all agree, women need to be treated better in that regard.

I also agree that we need better training on pain relief and managing women who are to have what can be a traumatic procedure. For practitioners, gynaecological procedures might be an everyday thing, but us women who present ourselves for such a procedure might have to have an out-of-body experience to go through it, because it is not comfortable—[Interruption]—excuse me—to have people engaged in that. We need more sensitivity—[Interruption.] Excuse me, Chair, I have a terrible cold.

The Royal College of Obstetricians and Gynaecologists has produced a guideline to provide clinicians with evidence-based information regarding outpatient hysteroscopy—[Interruption.] Excuse me—[Interruption.]

[Mr George Howarth (in the Chair)]

Order. The Minister is clearly in some distress. She must feel that she has more to say, but it would be perfectly in order if she wished to conclude the debate at this point. How can I put this? In these troubled times, it is really nice to see the amount of co-operation taking place across the Chamber. We have established that there is a consensus, so if she feels that she is still in some distress, it is perfectly acceptable if she wishes me to put the question, or we can continue—it is her choice.

[Jackie Doyle-Price]

I give way to the hon. Member for West Ham.

Woodlands Hospice, Aintree

Debate between George Howarth and Jackie Doyle-Price

Wednesday 7th February 2018 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

I thank the hon. Member for Liverpool, Walton (Dan Carden) for the way in which he has approached this debate. I commend him on making an excellent speech, as he could not have been better at articulating the positive contribution that hospices make. I do not think there was anything in his speech with which I disagreed, which is quite unusual.

I was struck by the hon. Gentleman’s description of hospices as places where people go to live. When I visit hospices, I am struck by the very real efforts that their staff go to to make them comforting places. It can be a more difficult time for the loved ones than it is for the person who is ending their life, but they really are comforting places, and the hon. Gentleman is right to pay tribute to all the staff who work in them.

The hon. Gentleman powerfully praised the efforts of his own hospice, Woodlands, which is clearly providing an excellent service. I am grateful that he has given me the opportunity to address some of the concerns and make it clear how much we value the contribution that hospices make to the NHS.

It is testament to the excellence of our hospice sector that last October’s “State of Care” report by the Care Quality Commission showed that 70% of hospices are rated as good and 25% as outstanding. Those figures are higher than for any other secondary care service, which illustrates the significance of hospices’ contribution. Woodlands Hospice received a good rating in the CQC report. Like the hon. Gentleman, I congratulate its hard-working staff and volunteers on ensuring that patients get the personalised care and support that they need.

NHS England has advised that Liverpool clinical commissioning group, which is the main commissioner for the hospice—I hear what the hon. Gentleman says about there being more than one CCG, which probably adds to the strain on the hospice with regard to long-term funding—provides £900,000 of funding a year. Sefton also provides £240,000 per year, which brings the total amount provided to the hospice to over £1 million a year. As the hon. Gentleman outlined, the CCGs of Liverpool, South Sefton and Knowsley are in the process of reviewing their end-of-life care provision. They are taking into account population need, service demand, and all providers of that care, including Woodlands Hospice.

I am sure that the hon. Gentleman welcomes, as I do, the attention that local healthcare planners are giving to this important area of care. I suggest that the commissioners should pay close attention to what the hon. Gentleman and his colleagues have said tonight, speaking on behalf of their communities, about the value they place on this service. I hope that the commissioners will also take note of my comments when I say that the hospice sector, and this particular hospice, are making a very real contribution to people at the end of their life.

I know that many Members have hospices in their constituencies that they support and champion, so I thought that it might be helpful if I set out the broader position on hospice funding. As the hon. Gentleman outlined, the sector is characterised by strong voluntary contributions and philanthropic activity, which is to be celebrated.

We have 223 registered independent hospices and small number of public hospices that are run internally by NHS trusts. Around three quarters of hospices provide adult services, with the remainder caring for children and young people. The hospice movement was established from charitable and philanthropic donations, so the vast majority of hospices rely heavily on charitable income for the lion’s share of their budgets, but they do receive some statutory funding from CCGs and the Government for providing local services. As the hon. Gentleman suggested, the statutory funding varies from place to place for a wide number of reasons—he highlighted deprivation as one of them—but adult hospices receive an average of 30% of their overall funding from the NHS.

Funding remains a local decision, which I think is right, and the hon. Gentleman will be aware that we take deprivation into account when making our allocations to CCGs. He referred to long-term funding stability and the importance of knowing how much the Government will provide, and I will reflect on that important point. It would be good practice to give as much certainty as possible, which is a principle of our health funding more generally, so that will bear examination.

[Mr George Howarth (Knowsley) (Lab)]

I am grateful that the Minister has committed to reflect on the thoughts of my hon. Friend the Member for Liverpool, Walton (Dan Carden) about a national framework, but the difficulty in having locally determined support from CCGs is that that will inevitably vary from place to place. Some CCGs are under much more financial pressure than others, which is why it is important that we have some kind of national framework.

[Jackie Doyle-Price]

I would not want to depart from the principle that this is for local decision makers, but that is not to say we do not make clear our expectations about what CCGs should be delivering as we develop our national policies on end of life, and support for hospices forms part of that. Given the number of people who pass away in hospices and the care that they receive, we would encourage CCGs to carefully consider the extent to which they support hospices.

In addition to NHS funding for locally commissioned services, children’s hospices receive £11 million through the children’s hospice grant, which is awarded annually and administered by the NHS. Children’s hospices tend to receive smaller amounts of statutory funding because of how they have developed and the services that they provide. Unlike adult hospices, which tend to be more focused on end-of-life care services, children’s hospices can provide support for much of a child’s life, and that can involve not only more clinical care, but much more support for families.

It is worth highlighting the point made by the hon. Member for Liverpool, Walton that philanthropic support does not just mean money. I pay tribute to all those involved in volunteering in hospices. That is a fantastic example of how communities come together to bring out the best in people, so I thank everyone involved in that work.

Members may be reassured to hear that, to improve commissioning arrangements, NHS England is making a new palliative care pricing system available in April. That should help local areas to plan services, and it will also encourage more consistency and, perhaps, transparency in how much CCGs are supporting the sector.

While hospices are, of course, an important feature of end-of-life care provision in this country, it is important to see them within the wider context of our ambitions for such care. As the hon. Gentleman mentioned, the Government have published the end-of-life care choice commitment, which is designed to transform end-of-life care, and the hospice sector is an important partner in that process. We are determined to significantly improve patient choice by enabling more people to die in the place of their choice, be that at home, in a hospice, in a care home or in hospital. Our commitment is to set out the further action that we will take to deliver high-quality, personalised end-of-life care for everyone, including by delivering advance care planning and ensuring that we have the necessary conversations earlier. I draw Members’ attention to the reference to hospice care at home, which is a significant aspect of the programme. We need to make sure that more people are aware of what their options are, and we need to encourage innovation in end-of-life care. In collaboration with partners from the voluntary sector, including key hospice and end-of-life charities, the Government and NHS England have been working to make sure that the quality and availability of end-of-life care services continue to improve and that our end-of-life care commitment is delivered.

As I have already mentioned, the Government believe it is right that CCGs have the autonomy to shape local services according to local need, but it is important that we do more to provide commissioners with the tools, evidence, support and guidance to demonstrate the benefits of delivering our vision for end-of-life care. A crucial part of that is strengthening the provision of end-of-life care services outside hospital and in the community so that people can make the choice of where they wish to end their life.

To deliver this, we are working with sustainability and transformation partnerships so that there is tailored information to assess where we need further investment, commissioning and intervention. NHS England is also a member of the national palliative and end-of-life care partnership, which is made up of charities and organisations from across the health and care system that have together developed a framework for improving end-of-life care at a local level. More guidance will be published through that body soon.

NHS England has also commissioned Hospice UK to undertake an evaluation of the cost-effectiveness of hospice-led interventions in the community. I fully anticipate that could be a good news in support of the hon. Gentleman’s arguments. Although many such care models exist across England, there is poor data on what are the most effective approaches, which makes it rather more difficult for CCGs to confidently commission such services. The project will examine hospice-led initiatives that appear to be having a positive impact on where people are cared for, as well as on where they die. The Department and NHS England will pay close attention to the findings when they are made available, which should be next month.

We fully acknowledge that more needs to be done if we are to meet our ambition to reduce variations in end-of-life care and to ensure that the system works effectively to support more people to die in the place of their choice. However, I am confident that through NHS England’s programme board for end-of-life care, with all key system partners and stakeholders, including the hospice sector, we have the best opportunity to continue delivering the progress in end-of-life care that we all want, however and wherever it is provided. I cannot emphasise enough that hospices are central to our commitment. Local commissioners will wish to reflect on all the comments that were made in this evening’s debate when they come to make their allocations, and I wish Woodlands Hospice every success in the future.

Question put and agreed to.

Autism Diagnosis

Debate between George Howarth and Jackie Doyle-Price

Wednesday 13th September 2017 Westminster Hall

[Jackie Doyle-Price]

I hear the hon. Gentleman’s point, but the wraparound support and care will do more than any finite target time. I am happy to look at that.

We are running short of time and I really need to give the hon. Member for Enfield, Southgate time to respond. We have had a very constructive discussion today, and I look forward to engaging with all hon. Members on these issues.

[Mr George Howarth (in the Chair)]

Before the hon. Gentleman responds, may I thank all Members who contributed today, and particularly those on the Front Benches? It was very difficult to get everybody in, but we managed it in the end—certainly all those who had applied to speak. I call Bambos Charalambous to respond.

Backbench business

Debate between George Howarth and Jackie Doyle-Price

Thursday 14th February 2013 Westminster Hall

[Mr Howarth]

The hon. Lady is correct. I intend to address that issue when I bring my comments to a close, and I will make suggestions for what we need to do.

The consequence of people being treated either by a diabetologist who does not understand eating disorders, or by an eating disorder specialist who does not understand diabetes, is that they can be signposted to an unsuitable service altogether, or unforgivably, they will not be taken seriously when they have a serious problem.

An example I have been told about involved a young woman sufferer who was told that she was too heavy. That is not to say that she was heavy; she was very light, but she did not meet the criteria for being light enough to have an eating disorder, and was consequently told that she did not qualify for any support. The advice that she was given was that she needed to relax about food. Anybody who knows anything about diabetes knows that the relationship diabetics have with their carbohydrate intake is crucial to their well-being, so to say to a diabetic, “Go away and get more relaxed about eating”, could put them in a position where their life is threatened. Subsequently, the young woman concerned had to be admitted as an emergency case to hospital with ketoacidosis, which, had it not been treated quickly enough, would have been fatal. That was somebody who had presented themselves in the health system, looking for help, but was told to go away and get a better relationship with food.

DWED has some aims that I hope Ministers can address, and I shall go through those now. First, it wants to establish the principle, which I strongly support, that no diabetic with an eating disorder should be misdiagnosed or told, “There is nowhere to put you”, which is what is commonly said to them at the moment. That comes back to the point made by the hon. Member for Romsey and Southampton North.

Secondly, for type 1 diabetics with eating disorders—what I have termed as diabulimia—the condition needs to be properly recognised as a serious and complex mental health problem. I do not think that it is controversial for the hon. Lady to refer to it being a mental health problem, because although, in all the cases that she gave, there are serious physical consequences, the springboard often relates to mental health, relationship with body image, and so on.

Thirdly, those who seek treatment should receive the correct treatment with respect and compassion, on the basis of a multidisciplinary approach. In the example that I gave, there was not enough expertise in one specialism to be able to satisfactorily deal with the problem. Such an approach requires the Department actively to promote an understanding of the problem, so that health professionals catch on to what is happening. Protocols probably need to be in place, so that when somebody presents themselves with such a condition, health professionals know what to do.

The only people raising this problem, apart from me in today’s debate, are DWED, who work together with other bodies, such as Diabetes UK. DWED currently exists on an income, in the last financial year, of £9,000, which is not even enough to employ one full-time member of staff. DWED operates on the basis of having previous sufferers who are volunteers, under the co-ordination of Jacqueline Allan, who I mentioned earlier. I do not know whether it is more appropriate for support to come from foundations or the Government, or somebody else. I am not talking about needing hundreds of thousands of pounds, although I am sure that DWED would welcome that, but some way needs to be found to support the one organisation that is campaigning on, and raising and dealing with the problem. Given the importance of its unique role, I hope that the Government can find some support—not only for DWED, but for the issue as it exists across the health service.

Finally, just as it is vital that health professionals take a more multidisciplinary approach to this and other eating disorders, it is equally important that the Government take a more joined-up approach. I could have made the same criticism of the previous Government, and I realise how difficult it is to get a joined-up approach to eating disorders and many other things. However, on medical cases, there needs to be co-operation between different Departments, because a stronger push is required on the issue of body image and how that is dealt with. Perhaps it is not best dealt with by the Department of Health, but at the same time, some of the health issues involved need to be addressed.

[Jackie Doyle-Price]

Perhaps I can put an alternative view to the right hon. Gentleman. In my experience, people do not like being told what to do by the Government. If we acknowledge that the media are among the biggest perpetrators in pushing forward images that we should all aspire to, do we not need a good, populist campaign to educate the public that actually, curves are great?

[Mr Howarth]

The hon. Lady makes a good point. There is this idea of politicians wagging our fingers and saying, “This is what you should do”. For a couple of years in the previous Government, I had the responsibility in the Home Office for drugs policy, and one thing I know is that middle-aged men like me—perhaps I am flattering myself there—are probably the worst people to go into the media and say, “Actually, you should not be taking drugs.” A subtle, sophisticated approach is needed. A lesson from that, which applies equally here, is to provide information to young people so that they know the consequences of what they do. One problem we are dealing with is that people think there is an easy way to lose weight and to get to be the shape that they, or others, think they should be. Action has to be taken smartly, on the basis of real information about consequences, but it still has to be done.

The hon. Lady anticipated my next point, which is the responsibility of people in different industries. There is relentless media hype about what the perfect body shape should be, and the irresponsible attitudes often displayed by the fashion and entertainment industries need to be highlighted. Looking round the room, there might be one or two people who can remember what it was like to be a teenager—[Interruption.] I take that back. Several people around the room well remember what it is like to be a teenager, and one experience that we probably all share, and that every teenager in history has shared, is insecurity. They have not developed into who they are going to be, and they are insecure about everything, including their appearance—as is obvious, I have long since given up worrying about my appearance—the way they present themselves to the world, what it is to be cool, and all those things. A lot of that is dictated by what they read in magazines and see on cable channels—even on mainstream reality television shows.

It is wholly unrealistic for the industries that show those images to say, “Well, that’s a matter for the Government.” They have a responsibility to provide for young people role models that are realistic, that are just like the rest of the world, that show young people that they do not have to look like those images to be an acceptable, successful and attractive member of society. That responsibility is not just for Government or politicians, but for everyone who is in a position to influence how these things are presented to young people in particular, and to society in general. I hope that, as a result of this debate, we can at least move that agenda along a little further.

Coal-fired Power Stations

Debate between George Howarth and Jackie Doyle-Price

Wednesday 29th June 2011 Westminster Hall

[Jackie Doyle-Price (Thurrock) (Con)]

rose—

[Mr George Howarth (in the Chair)]

Order. Before I call the hon. Lady, I should point out that I intend to call the first of the Front-Bench spokespeople at 3.30 pm, and I ask the hon. Lady to bear that in mind.