NHS Hysteroscopy Treatment

Jackie Doyle-Price Excerpts

Tuesday 31st January 2023 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Mark. I wish I could say it was a pleasure to follow the hon. Member for West Ham (Ms Brown). I have genuinely enjoyed working with her on this subject for quite some years. But it is not a joy to follow her in this debate, because it is frustrating that we are still having the same discussion. It feels like groundhog day; it has been four years since I ceased to be the Minister responsible for this issue.

The hon. Member for West Ham reminds me that I started the moves towards the women’s health strategy, and established the women’s health taskforce, exactly because of the stories that she tells. It was very clear to me, when I started to look at this subject, that ultimately all the female Members of Parliament who are present have had terrible experiences at the hands of the NHS. We are very good at looking out for ourselves. If that has happened to us, then it is something that is being repeated for women up and down the land. It is something that we must address properly.

At the heart of what the hon. Member for West Ham is talking about is the principle of informed consent. Informed consent is the underpinning principle of our NHS. The stories that the hon. Member has outlined this afternoon show negligence around consent. They show women being referred for what is an investigatory procedure, not a treatment, without any proper consideration as to what they need to understand before consenting to such a procedure. The truth of the matter is that women find themselves undergoing a procedure in terrible pain before they even know what is happening to them. In 21st-century Britain, that is not acceptable.

We have made a lot of progress on centring women when we look at health, and ceasing to treat them as walking incubators for babies. We are human beings and we need to have our needs properly considered when we consent to treatment. We now have a women’s health strategy, which shows we have made some progress.

However, the hysteroscopy procedure has not received the attention that it deserves. Although two thirds of women who have the procedure go through it with less pain than in the cases we have heard today, a third of women experience terrible pain. That this is not properly explained to them is appalling. I have heard cases where women are just told to take some paracetamol before they go in and there will be no problem. For those women who do experience pain, as the hon. Member for West Ham has outlined, it is very severe. We must ensure that we have proper, well-understood protocols that govern how this procedure is managed, and how women are engaged in it.

The hon. Member for West Ham draws a parallel with mesh implants, and I think that is absolutely right. Again, the issue of informed consent was missing in many of those cases. We found that the mesh treatment was being routinely recommended to women after childbirth, women were not having any risks explained to them, and then, low and behold, they were suffering debilitating problems for the rest of their lives. As we roll forward with the women’s health strategy, we must stress-test exactly how much information we are giving to women, so that we can make informed consent an absolute reality.

The truth is, our wombs are not just here to incubate babies; they are part of us. The women here will have all had to go through invasive examinations internally. They are not very nice experiences. I do not know about anyone else, but when I have to do that I have an out-of-body experience where I zone out of what is happening to me. These women cannot do that, because they are suddenly visited with terrible pain. They cannot zone out of the fact that somebody is fishing around between their legs; they are living that, and that is an absolute trauma—a trauma that will stay with them for the rest of their life, notwithstanding the other side effects that they experience.

The women’s health strategy has alluded to some of those aspects, but I do not think it has taken up the issue with sufficient seriousness. It talks about the need for conversations about pain relief before a hysteroscopy procedure, but it needs to be a lot more than that: people need to be given sufficient information to enable them to decide whether or not they even want that examination. As many as 10% of women suffer with problem periods, fibroids and the kinds of conditions that would lend to them having such an investigation, but we need to be able to make that informed choice—“Is it really going to make a difference?” Frankly, if you are 71 years old, what difference is it going to make? All it is going to do is establish the cause of the bleeding. You might be better off managing that condition, because if there is going to be no end of treatment following the hysteroscopy, the whole thing is absolutely pointless, with a substantial degree of risk.

I am pleased to hear that the Royal College of Obstetricians and Gynaecologists is updating its best practice guidelines. I ask the Minister to consider inviting the women’s health ambassador, Lesley Regan, to carry out a proper stress test of everything around this issue. I had the pleasure of working with Lesley when I invited her to co-chair the National Women’s Health Task Force: she brings considerable expertise, including as a gynaecologist who is a woman. The truth is that far too many gynaecologists are male, and with the best will in the world, I do not think they are ever going to understand, let alone care about, the degree of pain that is being administered to their patients. I am really pleased with that appointment: Lesley is a fantastic advocate for women’s health, but I would like her to look at this issue properly so that we have a good set of ideas, advice and principles to help women make informed choices, and to make the medical profession understand exactly what difficulty this procedure involves for some women.

I invite the Minister to put that advice alongside some advice about healthy periods generally. Women need to be encouraged to take ownership of their gynaecological and menstrual health, but again, they can only do that with sufficient information. We will not avoid situations where women rock up to hospital for an appointment and, the next thing they know, find themselves on the trolley in stirrups without properly understanding what is happening to them unless everyone understands what good menstrual health looks like; what the alert factors are for some of the conditions that might invite a hysteroscopy examination; and what potential treatment might follow.

The hon. Member for West Ham has outlined the painful experiences that some people have had, but we all need to understand exactly what is involved in a hysteroscopy. It is an internal examination of the womb, which is undertaken by the insertion of a camera through the cervix. We know from the evidence that the hon. Lady and I have examined that women who have not had children are particularly affected by pain. If we think about what that procedure involves, it seems like a no-brainer that women who have not had children would suffer more pain, so again, I cannot get my head round the negligence with which women are referred for this procedure without proper consideration of the pain involved.

[Barbara Keeley]

I want to emphasise this aspect of the issue, based on what I was told by my constituent: the leaflet did not mention that the procedure can be stopped if the patient is unable to tolerate it. Can the hon. Lady think of another medical procedure that is run without anaesthetic on that basis—that it can be stopped if the patient cannot tolerate the pain? There are not many other examples.

[Jackie Doyle-Price]

No, and the interesting thing is that, in theory, a patient should be able to stop anything. That is what informed consent should be about. Again, it illustrates the relationship that we have with our health service. We naturally defer to medical professionals. We assume that they know better than us, and perhaps that is where we need to alter our relationship. These are human beings; they are not gods.

We need to be empowered to take more agency and ownership of how we approach these things. Listen to the description by the hon. Member for West Ham of Julie removing her hearing aids: there is no way that she was in control of that situation. How can a patient make informed consent and have the ability to stop something that is causing them significant distress and trauma in those circumstances? As I mentioned, it is extremely painful, especially for those women who have not had children.

We know that some women are just told to take paracetamol before they arrive, and there is a massive discrepancy from organisation to organisation when women try to exercise their ability to choose whether they have a general anaesthetic. In some cases, women are told that that is not really the best thing for them; in others, as we have heard, that elective choice was made quite easily. To me, that brings a real worry that too many in our medical establishment are not giving their patients the respect that they deserve. That is something that we really need to change in the culture of our NHS. It is all about behaviours, ultimately; we need to look at how we can encourage better behaviours towards patients throughout the system.

In the short time that I have left, I will make some specific asks of the Minister. I have mentioned that I would like her to invite Lesley Regan to properly stress-test this, but we need a proper risk assessment tool for each woman undertaking the procedure, so that both they and the medical professionals they are dealing with can make an informed choice on whether they are more or less likely to suffer the substantial pain that has been outlined in the debate. I also invite the Minister to consider the work of Baroness Cumberlege in “First Do No Harm”. One of the themes running through that work—and again, I mentioned mesh earlier—was the absence of informed consent. One of the conclusions we drew was that we need a proper patient’s voice to be able to stress-test those incidents where there is widespread poor practice in the NHS.

Ultimately, the NHS is a producer-driven system. We have care pathways that are very much process driven and not practitioner or patient driven, frankly. We must help practitioners to help themselves by empowering patients, because they need to have that mutual understanding on the same level. I invite the Minister to consider properly the establishment of a patient commissioner so that we have somewhere to refer these incidents of widespread poor practice.

We have outlined today the serious harm being done to women put through the procedure without appropriate care. That is doing real harm, and if we are going to have an NHS that works for all patients, we need to address incidents such as this extremely quickly.

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[Jackie Doyle-Price]

I thank the hon. Member for sharing a very personal story. She lands an important point. When women are desperate to fulfil the urge to give birth to a child—a deeply biological impulse—they will go through anything, as she rightly says. Does that not tell us that the degree of pain we are aware of could just be the surface?

[Feryal Clark]

I wholeheartedly agree with the hon. Member. It develops a level of acceptance, which is not right or acceptable. Hysteroscopies are paramount to women’s health, but we have heard horrific accounts from my hon. Friend the Member for West Ham of women’s experiences of having the procedure. That should never have happened to women, and those women affected are right in their fight for justice. There is a lack of information or no information about the choice of pain relief available before, during or after the procedure. Paracetamol is not enough. There is an assumption that the patient will experience only discomfort—in my case, it was slightly more than that—despite some women experiencing intolerable pain. If they do experience that so-called discomfort, the assumption is that it does not matter because it is only short lived.

It is astonishing that the NHS still does not collect data on the number of women who experience severe pain during hysteroscopy. However, the Campaign Against Painful Hysteroscopy, which does undertake surveys of women, has found that more than 90% of women surveyed were traumatised for a day or longer by the pain. Three quarters said they were not aware of pain management options before the procedure was carried out. In 2020, half of NHS hospital trusts in England failed to warn patients that they could suffer pain. Women are simply not given the information they need to make informed decisions, which must include information on potential pain, options for pain management and alternative procedures. Let us be clear: a woman should not have to experience excruciating levels of pain to access essential healthcare.

As we have heard, the national tariff creates an incentive for hysteroscopies to be carried out as an out-patient. We cannot deny the obvious advantages of out-patient care. For example, it allowed women to access hysteroscopies more easily during covid, and can reduce the time women have to wait for diagnosis and treatment, but it does not allow for patient choice and patient voice. Some 61 out of 131 NHS trusts admitted to the Campaign Against Painful Hysteroscopy that they did not warn patients about the risk of severe pain, and this could lead to unnecessary pain for women. Informed consent, choice and effective communication is not the norm when it comes to women’s health; it is barely there. That cannot and must not continue.

While some women are left in excruciating pain, some women hear those stories and decide not to have the procedure—I am not sure which is worse. No woman should feel discouraged from attended a hysteroscopy appointment for fear that they could experience pain, because, as mentioned earlier, hysteroscopies are an essential tool in diagnosis and treatment of women’s health.

The Royal College of Obstetricians and Gynaecologists’ guidance states that all pain relief options should be discussed with women. I welcome that those guidelines are being updated, but the clinical guidance currently in use is over 10 years old. Today is not the first time Ministers have been made aware of the seriousness of the issue for women, so why did the Government not ask for the guidance to be updated sooner? Will the Minister tell us what she is doing to ensure that the new clinical guidance will be in place as soon as possible, for all clinicians to use? We must ensure all women have access to the pain management they are entitled to. How is that being monitored, because it does not seem to be happening currently?

Improvements in hysteroscopy care are included in the women’s health strategy, which was published late last year, as the hon. Member for Thurrock mentioned. The Minister is responsible for the women’s health strategy, and it is her ambition that women and girls report better experiences of procedures, such as this one. However, the Minister’s letter, setting out her year 1 priorities, which she sent around last week, did not mention hysteroscopies. How many women will continue to have the procedure in pain, or not at all, as a result of it not being considered a priority? Will the Minister explain to us, and to all those women who face having the treatment, why it is not considered a priority?

Finally, painful hysteroscopies are just another iteration of no care being given to women and their health. Yet again, women have been given empty promises of improved care. How many more stories must we hear about women in unnecessary pain? How many more times must we hear that women are not listened to in healthcare settings? And how much longer must women wait for the healthcare they so desperately need?

Transgender Conversion Therapy

Jackie Doyle-Price Excerpts

Monday 13th June 2022 Westminster Hall

[Elliot Colburn]

I absolutely agree with the hon. Lady. I have had the privilege of listening to many survivors who have come forward to share their stories—I am sure many people in this place have—and those stories demonstrate just that fact.

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

The practices my hon. Friend has just described are basically exorcisms and witchcraft, frankly. Does he agree with me that we are dignifying such abhorrent practices by calling them therapies?

[Elliot Colburn]

I absolutely agree. That is why language is so important—that is going to be the theme of my speech. The tight wording of the ban is very important. Conversion practices is a much better description than conversion therapies. I only used conversion therapy for today’s debate because it is the go-to term.

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

Thank you, Sir Graham. It is a pleasure to contribute to the debate. As legislators, our starting point must be to eradicate harms, but in doing so we must not create new ones. It is in that spirit that I will address the proposals in—well, we do not have a Bill yet, so we are flying a bit blind.

My concern is the use of the term “therapy” in this space, which has been discussed. We are talking about coercive and harmful practices based on an ideological opposition to being trans, gay, lesbian or bisexual, and those are the practices that we need to eradicate. The term “therapy” implies something that is benign and designed to alleviate distress, which is clearly not something we want to outlaw in this space—for sexuality as well as gender. My plea to the Government is to re-examine that language.

In respect of transgender identity, when an individual wishes to undergo medical transition or surgical intervention, a therapeutic pathway is essential to establish informed consent. We must not allow any law to be passed that would get in the way of those conversations and clinical interventions, which are designed to alleviate distress.

[Alicia Kearns]

In the spirit of the point that I made in my speech that there are no two sides, I agree with my hon. Friend entirely. I suspect that she will find much unanimity in the Chamber that a ban should be about conversion practices. I am sure that the Minister, who campaigned for a ban for many years before he became a Minister, will be well aware of that and will be doing everything he can to ensure that the right Bill comes forward. I agree with my hon. Friend entirely, and I am sure others in the Chamber do as well.

[Jackie Doyle-Price]

I am grateful for that intervention. Indeed, although I have been outspoken on these issues, I have had this conversation with Jayne Ozanne, who shares this view. In terms of getting to a good law, I make this plea to everyone: we have heard lots of rhetoric today, but if we focus on creating a law that eradicates harm but gives support where it is needed, I think we can generate consensus. Notwithstanding the heat and noise on social media, there is much consensus in the Chamber.

I come to this matter having been the mental health Minister, with responsibility for gender medicine, when the General Synod of the Church of England passed the motion in favour of a conversion therapy ban. It is worth remembering that at that stage it was only about sexuality, and not about gender, which was added subsequently. At the time, however, I made it my business to look into exactly what the evidence was on the practices that we were trying outlaw.

Notwithstanding some of the experiences we have heard about, I could find no evidence of anything happening in a clinical setting after 1970. It became very clear that we were talking about practices that were often based in religious institutions, and very much based on an ideological belief against same-sex attraction and transgender. That is why we need to hammer down on outlawing exactly those things. That is the harm that we are trying to eradicate.

We have ended up with this vanilla term, “therapy”, for fear of alienating those people for whom these are issues of religious belief. Frankly, the risk of outlawing legitimate interventions should not get in the way of that. We need to be clear about what we are banning and that any therapeutic intervention designed to alleviate distress will not be eradicated by the legislation. I look forward to hearing words of comfort from my hon. Friend the Minister, with whom I have had many discussions about these things.

It is also worth noting that the term “trans” can mean any number of things, from declaring oneself non-binary to wanting to go the whole journey of medical and surgical transition. This is where the therapeutic care pathways are so important, because for some people gender dysphoria is a permanent condition that needs to be alleviated with treatment, but for others it can be a symptom of something else. This is not a straightforward condition that has the same pathology in all the people who experience it. We know that it is prevalent among people with autism and that it is very commonly experienced by girls going through puberty.

[Kirsten Oswald (East Renfrewshire) (SNP)]

May I ask the hon. Lady and any other Members in the Chamber thinking of making that connection between trans and autism to be more thoughtful about how they express it? A number of people watching and listening to the debate will find it particularly unhelpful. I think that we can probably be a bit more nuanced in our language.

[Jackie Doyle-Price]

It is important that we understand what we are talking about with gender dysphoria. It can also be a symptom of trauma. It is very important that we have the therapeutic care pathways—[Interruption.] Members may shake their heads, but I am talking about this from experience, having looked deeply into this area of medicine when I was responsible for it. We need to ensure that we are not putting people on to irreversible care pathways that will do them harm. For example, at the Tavistock, where the care pathway is based on therapy, as many as 40% desist. That is why it is important that people are given the space to explore what they believe to be their gender, because it can often be about something else.

[Nadia Whittome (Nottingham East) (Lab)]

Does the hon. Member acknowledge the fact that puberty blockers —I think that is what she is referring to when she speaks about “irreversible” treatment, because they are the only medical treatment that under-18s can have—are not irreversible? The point is to pause puberty, which can be done for many reasons, such as premature puberty. The whole point of the blockers is that they are not irreversible.

[Jackie Doyle-Price]

Puberty blockers are not irreversible—the hon. Member is right. The fact of blocking puberty may mean that the individual does not subsequently go through it, but she is right in the sense that puberty blockers were invented for a different purpose than the treatment of gender dysphoria. They absolutely should be dispensed where appropriate, but they should not be used as a way of treating gender dysphoria without someone’s having gone through the therapeutic care pathway.

The real issue here is the provision of hormone treatment, which is now routinely dispensed to people from the age of 16. Again, the impacts of those things are irreversible. We see a generation of trans men who have desisted and will now have a loss of sexual function, permanent facial hair and male pattern baldness. A more sophisticated way of allowing them to explore their gender would mean that they do not go through such things.

[Wera Hobhouse (Bath) (LD)]

Is the hon. Member not making a mistake by confusing what we are here to discuss banning? We are here to discuss banning pseudo-practices. We are not aiming to ban NHS therapies and practices that are conducted by professional medical experts; we are looking at banning conversion therapy, which is pseudo-scientific, often takes place in private settings and is not controlled.

[Jackie Doyle-Price]

I think the hon. Member is actually agreeing with my general thesis, which is that we should not use the term “therapy” in the Bill. Legitimate care pathways are exactly the things we should be ensuring that people can access, so that they get the right decision for them. As we know, if people cannot access those pathways through the national health service, there is a wild west out there on the internet, and people will start getting very harmful interventions that are not properly supervised.

[Dr Mullan]

Is not the key to all this the intention of whatever is going on? Conversion therapy sets out with a predetermined objective of stopping someone being something or forcing them to be something else. All the other therapies that my hon. Friend talks about are an exploratory process that may or may not, through the choice of the individual, lead to their taking puberty blockers or other things. The therapists themselves will not be entering into it with the intention to force them to do that, or to stop them being something else.

[Jackie Doyle-Price]

Again, I think my hon. Friend is agreeing with me. It is the term “therapy” that I am objecting to in the legislation because we are dignifying these practices with that description. Therapies are exactly the things that I have been describing. There is no doubt that we need better care pathways for people to explore their gender. My hon. Friend the Minister will probably have something to say about that as well.

That is really as much as I want to say. We must make sure that we call this practice out for what it is, we must make sure that the Bill only eradicates those harmful practices, and we must make sure that good, benign and positive therapeutic interventions will not be outlawed by the legislation.

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[The Parliamentary Under-Secretary of State for International Trade (Mike Freer)]

It is a pleasure to serve under your chairmanship, Mr Mundell. I thank the petitioner for securing the debate and the 145,000 people who signed the petition. On a personal note, I would like to recognise the 50th anniversary of Pride, and to thank those who went before me to secure the rights that I have today. We can get caught up in the heat of the debate around the issues we have to address, but it is sometimes important to look back and remember that we have made progress. Let us not lose sight of the progress we have made, while agreeing that we still have further work to do. I have to say that I welcome this debate, because I have spent considerable time and energy on the legislation, not least trying to myth-bust much of the nonsense going around regarding what is and is not conversion practice.

I thank my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) not only for securing the debate, but for what I thought was a powerful and thoughtful speech. It was a speech that he could have made from the Minister’s position—perhaps one day he will.

I have to say that the debate saddens me; I am genuinely sad that we are having this debate yet again. It saddens me that we have yet to achieve a consensus on many of the more thorny or heated topics that people disagree on or choose to misunderstand. It is a real regret that, having spent so much time trying to explain what is and is not a conversion practice, we continue to have this debate. From that point of view, since taking up the position of looking after LGBT issues in the equalities brief, I have genuinely tried to seek consensus, to pursue the debate with a degree of honesty and respect, and to remove the toxicity from the debate.

Many of us do not have direct experience of trans issues, although some of us do. I get deeply frustrated when colleagues make comments—from what I believe to be a position of ignorance—about the trans community, which also hurt colleagues in this House. The trans community is not some invisible, amorphous blob that people cannot recognise. Trans people are our friends and our colleagues. Members of this House have trans siblings and trans children. We have our first trans Member of Parliament. It deeply saddens me that hurtful comments are still being made, even if they are not designed to hurt.

I have taken time to speak to many of the survivors who have been through conversion practices, some of them decades ago. From speaking to them, it is clear that they still live with that trauma today. I have also spoken to people who have survived conversion therapy more recently. When people say that conversion therapy no longer exists, that is absolute, utter nonsense. They just need to go out and talk to people who have survived it, whose partners have committed suicide, or who have seen children taken abroad to conversion camps or to be married off.

It deeply saddens me that people continue to deny the existence of conversion practices. Yes, many of the more abhorrent physical acts are illegal. However, the pernicious, insidious, coercive so-called therapies are what we are trying to address, and they are still present today.

Colleagues have talked about rape being used as a tool to correct people’s behaviour. Part of the Bill that is being drafted will ensure that, while rape is obviously already an illegal act, using rape in the way Members have described would be an aggravating factor. That is the difference. People ask what the Bill will change in law that is not already illegal—that is one example. The use of corrective rape will be an aggravating factor. That is not currently the case.

I recognise people’s strength of feeling for ensuring that the Bill includes trans people. I want to make it abundantly clear that the Bill will protect everyone from coercive attempts to change their sexual orientation. We do not agree with attempts to change someone’s gender, but we wish to ensure that any action that we bring forward on transgender conversion practices does not have wider implications, such as affecting access to legitimate therapies.

At the start of my speech, I referenced the sadness I felt that we have not been able to reach a consensus. I am disappointed that we have not brought forward a fully inclusive Bill, as is fairly obvious from my previous statements, but in terms of where we go from here, I want to use the piece of work that is currently being scoped out, hopefully at pace, so that we can have an informed process as the Bill proceeds in its passage through Parliament. We must try to address the issue of how to ensure with cast-iron clarity, if one can have cast-iron clarity, that clinicians are protected in questioning someone’s gender discomfort—I will be corrected if I get this wrong, but dysphoria is the clinical end of the process. When someone is suffering from gender distress, a clinician needs to have absolute clarity that they are protected, and that their ability to explore why their client is feeling that way is not a conversion practice.

[Jackie Doyle-Price]

I think a lot of people will be very reassured by the tone of the Minister’s comments, because there is genuine fear that legitimate practices would be outlawed. However, one of the issues we have is that campaigners are looking at other laws elsewhere, which has perhaps led them to conclude that things will be included in the Bill that might not be. Could the Minister say what the timescale for a draft Bill will be? No one can predict what will be in the legislation, because we have not seen it yet.

[Mike Freer]

I thank my hon. Friend for asking for clarification. It is certainly my intention that the draft Bill, which is expected to be narrow in scope, clearly setting out what is and is not a conversion practice so that we have that clarity, will be brought forward in—I hope—September or October of this year.

Gender Recognition Act

Jackie Doyle-Price Excerpts

Monday 21st February 2022 Westminster Hall

[Elliot Colburn]

Absolutely. There is a strong case, simply if we look at the statistics around GRCs, to show that the process does not work. The fact that only 1% to 3% of trans people go through the process of obtaining a GRC demonstrates to me that the process is too bureaucratic, too expensive for many and simply not fit for purpose.

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

I hear the point that my hon. Friend makes, but should we not also consider whether GRCs fulfil any useful purpose? The GRA was introduced in 2004, at a time when we did not have same-sex marriage. We now do, so what is the point of a GRC?

[Elliot Colburn]

I think the point of a gender recognition certificate is the difficulty that trans people have in getting their legal gender recognised by very many bodies. That is why reform of the GRA to allow for an easier process to obtain a GRC is needed. We may need to come on to a discussion later about whether GRCs are fit for purpose in their entirety, and I would welcome that discussion, but given what we have been left with through these two bits of legislation, the first step is reform of the GRA to get us to that point—then we can look to the future.

The changes that were recommended in the Government’s 2018 consultation and in the two Women and Equalities Committee inquiries focused on three particular asks. The first was for the removal of the requirement to obtain a diagnosis of gender dysphoria before applying for a gender recognition certificate, as well as removing the need to provide medical reports detailing all treatment that people have undertaken. Both sides of the debate throughout the Select Committee inquiry agreed with that. The 2018 Government consultation showed that 64% agreed with removing the need for a diagnosis and 80% supported the need to remove detailed medical reporting.

The second ask was for the removal of the spousal veto, which requires a married transperson to obtain consent from their spouse before getting their legal gender recognised. Again, in the Select Committee inquiry there was agreement about this from both sides, and 85% of consultation respondents agreed that it should be scrapped.

Finally, there was a call to remove the need for transpeople to provide evidence that they have lived in their so-called “acquired gender” for two years prior to obtaining a GRC. That was condemned very strongly by both sides because it was felt that it reinforces gender stereotypes, and because there is no agreement on how to define or prove that someone has lived as a man or a woman for two years before obtaining legal recognition of their gender. Again, nearly 80% of people who took part in the Government consultation agreed that that should be removed.

Instead of having to collate all the information and submit it to the gender recognition panel, which from the anecdotal evidence we received is very confusing because there does not seem to be any accountability as to who sits on that panel or how it operates, the call was instead for a form of Registrar General to be introduced in England and Wales, before whom transpeople would have to make a legal declaration to an official in order to obtain a gender recognition certificate and legal recognition of their gender. That would, of course, come with consequences in law for any false declarations being made.

That change would not allow people to self-identify without an application to an official. The phrase “self-identify” has been confusing and, potentially, unhelpful. I admit that it conjures up images to those on the outside, who might think people can just wake up one day and decide to change their gender. That is not what the petition calls for, and I do not think anyone here would recommend that.

The model I have outlined has already been introduced in a number of countries, including Argentina, Brazil, Ireland, Denmark, Norway, France, Portugal, Greece, Iceland, Luxembourg and Malta, as well as four provinces of Canada and 10 states in the United States, and it is being introduced in New Zealand and Germany. The Irish model is probably the closest example to what some campaigners have been asking for, and is reported to have worked particularly well.

There is a lot of agreement, Sir George, about reform of the application process to obtain a GRC, so I hope the Government can take that away and look at it again, and that colleagues here, as well as those who have not taken part in the debate but would have liked to, can come together to realise that politics is a battle for hearts and minds, but we do not need to be at each other’s throats to talk about this subject.

There are strongly held views, and a temptation to steer the conversation into areas that are not directly relevant to the GRC, but we have to appreciate that transpeople face huge challenges in the country today, not least recognition of their gender, as well as the violent and sexual crimes to which they are subjected. They are twice as likely as other LGBT+ people to be subjected to conversion therapy, for example, and they face discrimination in their everyday lives.

However, there is reasonable and understandable concern, particularly from women, about the protection of sex-based rights. That comes from unacceptably high levels of physical and sexual violence towards women, which creates concerns about erosions of these rights. We must allow space and time for everyone to legitimately be heard, and to find a way forward.

Change is a slow process. I know that is frustrating to hear, particularly in the age of social media in which we live, where we demand instant gratification and action, but in my short time in this House I have found the real world, and the battle for hearts and minds, to be infinitely more complex. We have a duty to lead from the front, in order to remove the toxicity from the debate, because continuing in that way will not end well. It will just push people further in one of two directions, or leave them afraid to say anything or to act.

I urge colleagues to join me today in trying to take the toxicity out of this debate. Let this be the moment that we come together to do more and express the real and genuine concerns held on both sides, so we can work towards what everyone wants: a society where the rights of all are respected, and where what people get out of the country is what they are willing to put in.

Let us try to be the leaders on this issue that the country needs right now and calm this debate down, working together across the divide to find the answers and find the way forward.

--- Later in debate ---

[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.

--- Later in debate ---

[Mike Freer]

I think the hon. Lady jumped to the bottom of the page, because the Government recognise that the reference to “disorder” in the Act is outdated and dehumanising, and it will be removed.

I want to ensure that we remember the people involved. Many Members have talked about the people who are impacted by our debate, and again the conversation has become too toxic. Bizarrely, I have been described as a misogynistic self-hating gay because I support trans rights. The ability to have a rational conversation about some of these issues has passed too many people by. We have a responsibility to ensure that we make our decisions based on fact.

I am sorry that I am digressing, but I do feel quite passionately. I must correct this completely wrong view that a trans woman can be placed in a prison of her choice. That is simply not true. Three years ago, the Ministry of Justice changed the rules, and now a prisoner will be placed in the estate that is most suited to their position—what their status is on the transition journey, their treatment and what their physicality is like. It is not just simply: “Hello, I’m a woman and I’d like to be in a woman’s prison, please.” That simply is not true. It is important not to minimise the concerns that people have about what has happened in the past, but it is equally right that we make sure that we base our arguments on fact.

[Jackie Doyle-Price]

I welcome what my hon. Friend has just said, but is not the critical point that the Ministry of Justice has a framework in place for risk assessing each individual who identifies as the opposite gender? By using that risk assessment tool, people can be allocated to the correct prison that suits their needs and the needs of their fellow prisoners. Does that not get to the heart of what we really ought to be getting to here, which is for service providers to have sensible policies to manage any inherent tension in what they are delivering?

[Mike Freer]

My hon. Friend is absolutely right, and I will perhaps come on to some of the guidance in a few minutes. However, I wanted to put on the record that some of what is misinterpreted as going on in prisons simply does not occur. The rules have changed, I think three years ago. For reference, I refer colleagues to the answer given at the last Women and Equalities questions by the Under-Secretary of State for Justice, my hon. Friend the Member for South Suffolk (James Cartlidge).

To return the previous point, we are taking steps to amend a specific reference to “disorder” in the Act via a remedial order as soon as possible. In my view, trans people deserve the dignity of being known as their true selves, which for some will include a very personal decision of accessing a robust legal gender recognition certificate system.

It is important to remember that changing legal sex is only one part of the picture. Trans people can and do go about their daily lives as their true selves, including with documents that match their acquired gender, without needing to apply for a GRC. For some, a GRC will be a necessary next step—if they wish to get married in their acquired gender, for example—but that will not be the route for everyone. We often get caught up in focusing on the Gender Recognition Act.

On the subject of the GRA, the 2018 consultation was extensive and it received more than 100,000 responses. We looked carefully at all the issues raised in the consultation. It remains the Government’s view now, as in September 2020 when we responded formally to the consultation, that the balance struck in the legislation is correct: the system provides proper checks and balances, while supporting people who want to change their legal sex. The system is sound. The system is robust. It works in a balanced way for all parties. But that does not mean—as I said at the outset—that we cannot work on ensuring that the process, with all the issues that many Members have raised, is addressed and resolved. That does not mean that we are not working to make things better.

The system can be streamlined to make it more straightforward. People have poked fun about the cost being reduced, but that was an important step. It was something we were able to do quickly because it did not require primary legislation. Members commented on the digitisation process, and all our feedback from beta testing—that is where it is, at the beta testing phase—is that the process is much improved and that those who have used it found it more straightforward and helpful.

I accept, however, the views of Members about the intrusive nature of the information that might have to be required for a panel. I will take that away and look at exactly what has to be provided to see whether it is still relevant. As with many things in Government, we tend to bolt things on and rarely take them away. Perhaps it is time to look at what we are asking for and to see whether it is still relevant.

Numerous Members commented on spousal veto. We will address many of the issues raised today in the formal response to the Women and Equalities Committee report. That response will be published shortly. I understand, however, that the Divorce, Dissolution and Separation Act 2020, which is to come into effect imminently, will remove what is known as spousal veto. I am sure that, if I have got that wrong, officials will quickly give me a kicking.

I turn to single-sex spaces. I assure colleagues that we will not be changing the Equality Act. For many years, trans people have used single-sex spaces in their gender without issue. The Government have no interest in curtailing that. It is also important that we maintain existing provisions that allow organisations to provide single-sex spaces. The Equality Act already allows service providers to restrict access to services on the basis of sex and gender reassignment, where that is justified.

A lot of media attention has been given to the Equality and Human Rights Commission and its work to provide clarity to service providers on the provision of single-sex services, which has long been called for. My hon. Friend the Member for Carshalton and Wallington said that it might be time to ensure that there is more clarity about what the Equality Act allows. I have spoken to the chair of the EHRC. We had a fruitful, if frank, conversation about how we are not seeking to change the Act, while recognising that for some people—as many have said today—clarity about its provisions might be welcomed. The EHRC is of course independent of the Government, which the Equality Act 2006 provides for. However, I am happy to reiterate our commitment to maintaining the existing provisions under the Equality Act 2010.

I will now turn to some wider issues that impact on the LGBT community. Trans lives are impacted not just by legal recognition. I know from my conversations with trans people and organisations that more needs to be done to improve the health and safety of trans people. Since I took up this role, I have gone out of my way to engage with stakeholders in the trans community and I saw for myself, when I visited CliniQ and met service users and the dedicated staff and volunteers, exactly the level of support that is needed and provided by the amazing team of clinicians and volunteers.

As numerous Members have said and as far as I am aware, no one in this Chamber is a trans person and therefore we cannot speak from personal experience. It was important in my role to ensure that I heard from trans people themselves. However, I also want to put on the record my personal commitment that the proposals in the Conversion Therapy (Prohibition) Bill—I realise we may have some differences to overcome on particular provisions—will include protecting the trans community.

Gender Recognition Act Consultation

Jackie Doyle-Price Excerpts

Thursday 24th September 2020 Commons Chamber

[Elizabeth Truss]

In my statement, I outlined the work we are doing to improve transgender healthcare. In all the research work and engagement we have done, that comes out as the No. 1 issue for transgender people. Focusing on improving those healthcare services is the way to help people lead better lives.

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

My right hon. Friend’s statement will make it easier for people to be who they want to be, while maintaining the integrity of the Equality Act. Many women have felt anxious during this process, so will she reconfirm her support for single-sex spaces where reasonable?

[Elizabeth Truss]

My hon. Friend is right that we are striking a balance between the rights of transgender people and the rights of women. The position is clear in the Equality Act that service providers can restrict the use of spaces on the basis of biological sex, and it is important that women’s spaces, which have been hard fought for over generations, are protected.

International Women’s Day

Jackie Doyle-Price Excerpts

Thursday 5th March 2020 Commons Chamber

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

It is a great pleasure to follow the hon. Member for Canterbury (Rosie Duffield), who, like many speakers today, has given us much food for thought.

We have heard from only one man in this debate so far—other than yourself, Mr Deputy Speaker—the hon. Member for Cardiff South and Penarth (Stephen Doughty). I want to make the observation that we are here in the United Kingdom, we pride ourselves on being a modern, civilised country, a democracy, yet too often we turn a blind eye to the kind of discrimination that we should really not tolerate in a civil society. The hon. Member for Canterbury was just sharing her observations about the wild west that is social media—frankly, all we need to do is open a Twitter account to find ourselves the focus of abuse these days. That reminded me of an occasion three or four years ago.

We had a particular problem with car cruising in my constituency. Car cruising is something that, normally, young men do when they soup up their cars. They turned the local road network in my constituency into a motor track, causing immense distress for residents, who were disturbed by the noise. It was dangerous and on numerous occasions, people who turned up as spectators at these races were injured when collisions happened. I was working with the local police to try to tackle this menace. As a result, after issuing a press release with a picture of me and the police officers attending one of these events, the whole story went viral among the male community of car cruisers. There were literally hundreds of thousands of very unpleasant comments towards me.

As we all know, we develop our own ways of managing these situations. It is quite easy to ignore it—just do not look—but these quite unpleasant messages were being circulated. It was actually the local BBC that reported the traffic to the police, because it included death threats and some very unpleasant sexual imagery and messages. In the end, two people were arrested and action was taken. What was interesting to me, however, was that the action was taken against the death threats, whereas the more unpleasant and aggressive content was that which was very misogynist and sexual in nature. When we look at that against the backdrop of the hon. Member for Birmingham, Yardley (Jess Phillips) yet again reading out the names of people who have been killed over the last year, we see that we almost seem to have accepted this as normal, and that is why no one is getting upset about it. It really should not be normal and we should use occasions such as this to call it out. I just wish that some of our male colleagues were here to participate and show solidarity with us on this, instead of making smart-arsed comments like, “Ooh, when are we having an International Men’s Day debate?” If I had a pound for every time somebody had said that to me, I would be very rich—I just leave that message on the record.

I want to talk about some of the more practical things that we can do to tackle hidden discrimination against women, in the context of health. I will also make some observations about sexual violence and how it is still commonplace for a blind eye to be turned where sexual violence is used as a tool to oppress women. Notwithstanding the conviction of Harvey Weinstein, which is obviously very welcome, it is still too common and the state needs to do more to tackle it when it arises. I will end with some observations about the debate on gender dysphoria and trans issues, which I fear has become rather ugly in recent weeks.

I had a moment of revelation when I was a Minister for health. Over a period of time, a number of colleagues from across the House would come to share their experiences with me as women accessing healthcare for various reasons. I witnessed quite a lot of distress as colleagues recounted their experiences. I had been through similar experiences and I suddenly had a moment of clarity and thought, “Crikey, we are all assertive, pushy women. We all have voices that we are prepared to use, yet we have all been diminished at the hands of medical professionals when it comes to talking about often very intimate issues.” I took it upon myself to try to do something about that.

Underlying all this is that whenever women’s bodies are being seen as incubators for babies, everything is very straightforward, but too many morbidities come from our bodies being the way they are, which frankly, are seen as an inconvenience by the health establishment, and we often suffer in silence as a result. I am appalled that one in 10 women suffers from the incredibly chronic pain and heavy bleeding associated with endometriosis. They can go for years before that is diagnosed and live incredibly difficult lives as a consequence. There has been virtually no research into the causes and possible treatments for endometriosis. Frankly, if men were suffering from it, that simply would not be the case.

One in three women suffer from fibroids, which, again, lead to heavy bleeding and terrible pain. Yet again, too often women are told to run along, that that is their lot and that that is just the way it is. The result is that we all think that our experience of a period is normal when actually, if someone is spending more than £10 a month on pain relief and sanitary protection, their period is not normal. The more that we can do to make women think about their menstrual health, so that they can take early action and get support earlier, the better, and we will do them a great deal of good. No woman should have to tolerate, or think it is normal to be, bleeding for three weeks of every month, doubled up in chronic pain and having to sit with a hot water bottle every day.

When women do get treatment for these conditions, they are generally told, “Have a baby—it will go away,” “Go on the pill” or “Have a hysterectomy.” Again, there is not enough emotional intelligence or coaxing and there are not enough ways of helping women to help themselves and to live with a condition that can bring incredible stress. We all need to do much more collectively to empower women to have sensible and constructive conversations with medical professionals. Medical professionals need to be encouraged to see the human being in front of them. This is not a criticism—medical professionals are human beings, too, and have to have ways of dealing with people in distressing conditions, but they can do much more to be understanding and have conversations that allow women to take control of their treatment.

I also make the observation that it is not that long since Viagra was licensed to treat male erectile dysfunction. People do not need a prescription now to get Viagra—they can buy it over the counter. I would really like to see such things as the contraceptive pill and hormone-replacement therapy available over the counter, too, so that women can do much more to look after their health.

To turn to the issue of sexual violence, I add my voice to those who welcome the Domestic Abuse Bill, but we also need to take on board the fact that sexual violence is often—more than often—another tool of oppression in the domestic violence context. We must not let that be taboo. The hon. Member for Birmingham, Yardley said that, too often, the issue of children committing violence against parents is taboo, and sexual violence within the domestic abuse context is also taboo. We can pass as many laws as we like, but the root of all this is behaviour and the need to challenge those behaviours. Whenever we do not shine a light on them, we are acknowledging that they are normal.

I remember when the issue of the systemic abuse in Rotherham materialised. Sitting underneath the failure to act by the local authority, the police and everyone else was a prejudice—that for this particular class of girls, what more could they expect? That was totally unacceptable. I fear that we are witnessing exactly the same thing again when we talk about gang culture and knife crime, because we are talking about gangs that are not just made up of young black men stabbing each other. There are girls associated with these gangs who are being groomed for sexual purposes, yet none of us is talking about it. It is like the lessons of Rotherham have not been recognised at all, and it is incumbent on all of us in the House to make sure that we properly address these things.

We need to do much more collectively to empower young women to value and protect themselves and not feel that they have to be pressured into sexual relationships that they do not want. It is horrifying to see the increased sexual violence against our young women now and we all need to tackle it collectively. The tabloid culture that values everyone by their appearance, figure and who they are associated with does not help. The hon. Member for Canterbury (Rosie Duffield) mentioned Caroline Flack, and it is a really good example, but there are other successful women who are abused for their inability to have relationships with men. Jennifer Aniston is one of our best comedy actresses and a worldwide star, but every time we see an article about her, it is about the fact that she could not keep Brad Pitt, or that she has had another failed marriage, or who her boyfriend is this time. It is absolutely outrageous. No woman should be defined by their relationship with a man. The same goes for Kylie Minogue. Crikey, would we not all like to be Kylie Minogue and look like Kylie Minogue? But she also gets vilified with, “How many boyfriends has she had? She can’t keep a man.” So blooming well what? A message to all the men out there—“Do you know what, us women can do very well without you, thank you very much. Think yourself lucky that some of us let you into our lives.”

The issue of Caroline Flack is particularly instructive because her life and her relationships with men were tabloid fodder. Even in her death we had to read about the fact that she went out with Harry Styles, who was however many years younger than her. Caroline Flack’s life story should be a message as to how toxic our culture has become, and how, if we are going to do something more for young women going forwards, we should encourage them to value themselves in their own identity and not through their relationships with men.

I am particularly uncomfortable that the debate around trans rights and gender dysphoria has become pitted against the rights of women. It is surely not beyond the wit of policymakers to devise a set of rules and principles that protect the rights of transsexuals to find a way of living their lives and do not discriminate against women at the same time. Those of us who want to see women-only safe spaces are not guilty of hate crime against trans people—not at all. I think people who are trans want to quietly get on with their lives. It does not help any of them that they are pitted against women in this terrible, horrible toxic debate. The only people who are winning through this debate are those men who use their power to oppress women, and see the opportunity to claim the right to self-identify as a weapon. None of us in this room should collude with that. We have already seen the case of Karen White, who self-identified as a woman, went into prison and committed crimes against fellow inmates. We must be able to devise a law that stops that happening but also supports those who are most vulnerable and need to have their rights defended.

Parliament has failed to give proper oversight of the growing number of transgender interventions for younger people. We have allowed treatments to develop at the Tavistock really unsupervised. This is no criticism of the medical professionals there, who clearly are doing their work with the best of intentions, but we need to look at the ethics of some of this and the practicalities of it. We are seeing more and more girls being referred for gender reassignment treatment. We are talking about girls well below the age of majority. I personally am very uncomfortable—well, I think it is wrong—about putting forward people for treatment that is irreversible when they are not in a position legally to give consent. We really need to be more honest about the challenges of puberty.

Puberty is horrible. I was a tomboy when I was growing up—that probably does not surprise hon. Members. When I got to my teens and suddenly felt my body changing, it was horrible. I hated every minute of it. I cannot believe what might have happened to me now, going through that. I carried on climbing trees and so on, and playing at being “CHiPs” rather than “Charlie’s Angels”, but now I would be on my iPad and I would suddenly find lots of other people who thought like me and then—guess what?—all those people are going to the Tavistock. It scares the hell out of me. I fear we are doing harm to girls when actually this is something that they could just be going through. It is quite a normal thing not to be comfortable with what is happening to our bodies. The fact that so many of the girls who are going for such treatment also have issues with autism frightens me even more.

I was contacted by a parent just this week who thanked me for something that I had said about this issue. She wanted to talk about the experience she had had with her daughter, who is on the spectrum. As she said, one of the classic symptoms of autism is that, as a sort of self-defence tactic, you become a different personality. When we think about that in the context of puberty and unhappiness with the way your body is changing, of course it is a natural response to pretend to be a different gender. I really think we have failed in this House; we have not given sufficient scrutiny and debate to a treatment which, frankly, if it is given out wrong, will do real harm to those girls and boys who go through it. I hope that this is something that we can give more attention to in future.